I have written often about the value of positive psychosocial and non pharmacological interventions for dementia, including listing the numerous ones I personally use almost every day. And although I find the article below quite useful, I still feel it may be missing the point in some ways. By the way, ADL’s stands for Activities of Daily Living, of which, of course, walking is one as well, so perhaps walking is not wandering after all…
The interventions listed in the article below may work well in residential care, but I do wonder how, or even if they apply at all, to people with dementia living in the community. I personally feel some of the interventions are, regardless of research papers supporting them, inappropriate for many people with dementia, and that they are infantilising and patronising.
I do realise though, they definitely do work for some, and when used appropriately can and do alleviate distress for many.
Somehow, and I’m not really able to articulate why, it is more of an intuitive feeling, but I feel that calling everyday activities such as listening to music, singing or gardening therapy may well undermine their value, especially as they a normal life activity that most people engage in. Why not just call them by what they are, e.g. gardening, listening to or playing music, etc., I wonder?
Personally, I also dislike reminiscence therapy, as many of my long term memories have disappeared, so this style of activity is, for me, far more distressing than helpful. Of course, for people with predominantly short term memory loss, who have long term memories in tact, it is probably great fun and a valuable intervention or activity. But, isn’t it just living. We all look back at photographs and times gone by.
And, I have had many debates and discussions with Leah Bisani regarding Doll Therapy, which I am not overly supportive of, but I do know she uses it in her practice, and says it really supports some of her clients, and I believe her. For late stage dementia, for those people who want to hold dolls, of course, why not let them. That is rational, and sensible, of course.
With regard to the article blow, ‘ve come to know Gary Mitchell in the online space, even writing a blog for a blog series he ran as part of DAW2015 in the UK, and really respect the work he and Joanna Agnelli are doing, and I was lucky enough to have the pleasure of actually meeting Joanna in person at ADI2015 in Perth.
The important thing, I think, is we are all communicating and collaborating, trying to work together and inform each others work and professional ideas. That is the part of this global community of dementia – people diagnosed, our supporters, and people researching or working in the field – that is really exciting, as we are starting to all work together, and talk to each other.
So, please read the article, and please feel free to leave your thoughts as we are all interested. Thanks.
19 Jan, 15 | by josmith
Gary Mitchell, Dementia Care Advisor and Joanne Agnelli, Dementia Services Quality Manager for Four Seasons Health Care, led an ENB TWITTER chat on Wednesday 21st January 8-9pm UK time, focused on non-pharmacological approaches for alleviating distress in dementia care. I did not participate in the online chat due to time zone challenges.
Estimates suggest that feelings of distress occurs in almost 80% of people living with dementia (James et al, 2008). Traditionally the management of distress was through the use pharmacological intervention, like Risperidone, Olanzapine, Quetiapine (Sink et al, 2005). While the use of these medications may be appropriate for some people living with dementia, the use of non-pharmacological approaches as a means to reduce distress is recommended because they can be more dignified and are in keeping with the ethos of person-centred care, and are more cost-effective when compared to the prescription and administration of medications (NICE, 2011). The approaches of reminiscence, reality orientation, validation, music therapy, horticultural therapy, doll therapy and pet therapy have proved popular techniques when considering non-pharmacological approaches for alleviation of distress in dementia care.
Reminiscence Therapy – focuses on assisting the person living with dementia to relive positive past experiences of their life and may be related to their family life, their wedding, the places they used to visit or the activities they used to carry out at work.
Reality Orientation – is about re-orientating the person living with dementia to their current environment. Orientation can be achieved directly through open communication between healthcare professionals and people living with dementia. In addition aids such as clocks, calendars, specialist dementia signage and personalisation of living spaces can also aid in assisting people living with dementia to recognise their surroundings.
Validation Therapy – centres on the idea of acceptance of another person’s reality. The clinical manifestations of dementia mean that sometimes people living with the condition may feel they are in another time or place. When healthcare professionals fail to validate a person’s feelings or reality this can intensify the level of distress a person is experiencing.
Music Therapy – is categorised as a sensory therapy which has generated positive results in relation to enhancement of wellbeing and alleviation of distress in dementia care. The personalisation of music therapy is an important element to consider so as to ensure that the person living with dementia actually finds the music, either being played or being listened to, as therapeutic.
Horticultural Therapy – or garden therapy has been emerging as a popular therapy in recent years. Horticultural therapy can be directed by healthcare professionals in a garden area and activities may be guided, for example the potting of plants, the sewing of seeds or the feeding of birds.
Doll Therapy – arguably the most contentious non-pharmacological approach on offer, doll therapy is often unstructured and engagement with the doll could be any number of things to include: talking to the doll, cuddling the doll, dressing the doll, playing with the doll or feeding the doll Benefits to doll therapy include: greater levels of wellbeing through improvement in communication, maintaining a safe environment and personal care. It should be noted that while there are a plethora of benefits associated with doll therapy, there are number of things that healthcare professionals need to consider in relation to doll therapy, the most of important of these is arguably ethical conduct as some critics of doll therapy believe it to be infantile, in that people living with dementia are encouraged to play with dolls like children.
Pet Therapy – is a popular but sometimes difficult intervention to source given the practicalities. Pet therapy or animal assisted therapy has shown positive results in people living with dementia who are fond of animals. The most popular animal used in this intervention is a dog.
Personalisation – Arguably the most important factor in all of these approaches is personalisation. These approaches to care are enhanced through life-history work (i.e. when a healthcare professional has taken the time to get to know the person living with dementia and understands their personality). The final point to note is that note that these approaches are important, not only in reducing episodes of distress, but actually enhancing the wellbeing of people living with dementia.
James I, Mackenzie L, Pakrasi S et al (2008a) ‘Non-pharmacological treatments of challenging behaviour’. Nursing Residential Care 10, (5), pp. 228-32
National Institute for Clinical Excellence (2011) A NICE–SCIE Guideline on supporting people with dementia and their carers in health and social care. National Clinical Practice Guideline Number 42. HMSO: London
Sink, K., Holden, F. and Yaffe, K. (2005) ‘Pharmacological treatment of neuropsyciatirc symptoms of dementia: A review of the evidence’, Journal of American Medical Association, 293, (5), pp. 596-608.