Today is the final day of Dementia Awareness Month 2020, and it has been a marathon of sorts posting daily blogs, although it has been helpful having hundreds in my draft folder. It now takes me a long time to read, think things through, and even longer after than to write coherently.
So, as I continue to review the impact of the Coronavirus pandemic, when related to BPSD, COVID-19 has made it even easier for me to understand why BPSD is so wrong… It could be seen as one of the major positives of the pandemic for me, which ironically is possibly a negative to the BPSD brigade. But enough rambling and onto my topic for day 30 of #DAM2020… if I stopped using my words, I can’t bear to think what might happen. 🙂
Dementia, touch, loneliness, and aggression
Touch is fundamental to the human experience, and the human need for it is an essential component of socio-emotional, physical, cognitive and neurological development in infancy and childhood (1) and an important form of non-verbal communication throughout life.
Of course, this is true for everyone, not just children, including people with dementia. Curiously, I have seen little, if any research on the impact of not having human contact through touch, on the way people with dementia respond (behave) when denied human touch.
People with dementia have not been provided with the same level of ‘care’ in the context of research; the quest for a cure is rightful, but the emerging research for better care does not appear to be very logical in its approach.
The Coronavirus pandemic has sent the acadamic world into a spin for new funding oportunities, for new research projects, even though many of the very same topics being researched were relevant to this cohort long before the pandemic.
It could be thought that many of these issues were not seen as important enough, until the rest of the world suddenly started experiencing enforced restrictions such as social and physical distancing and the subsequent isolation, resulting in what we all consider to be normal human responses.
The parallels are stark.
The importance of human touch can be seen in evidence that suggests the absence of affectionate touch or physical neglect can contribute to higher levels of aggression in adolescents (2).Field, (2002)
Touch is also a powerful method used to relieve and reduce the suffering of others (3), and although I reject that label, many people with dementia do suffer. Their suffering is more often due to neglect and abuse, to restraint and segregation, and to various forms of chemical and physical restraint, and not dementia.
I’ve been reading lots of articles about the impact of the coronavirus on people’s health, and an Editorial piece in the Journal of Clinical Nursing titled Life in the pandemic: Social isolation and mental health (4) says:
Imposed quarantine or isolation is an unfamiliar and unpleasant experience that involves separation from friends and family, and a departure from usual everyday routines… Isolation is known to cause psychosocial problems, especially for those recognised as vulnerable. While all humans are at risk of psychological harm when kept in isolation, the most vulnerable in these situations are children and adolescents, older adults, minority groups, those from lower socio-economic groups, females and people with pre-existing mental health conditions.Usher, K., Bhullar, N. and Jackson, D. (2020)
The psychosocial problems caused by isolation, is one of the extremely common experiences that many people with dementia face, soon after diagnosis.
If isolation causes aggression in people without dementia, then of course, it has the same affect on people with dementia.
Health care professionals have been taught they are neuropsychiatric symptoms of dementia, or the Behavioural and Psychosocial Symptoms of Dementia (BPSD) due to dementia, although, it would seem as we read more artcles about the impact of the coronavirus, they are from the impact of loneliness, and have very little to the pathology of dementia.
Research and editorial pieces like the one above by Usher, Bhullar and Jackson about the impact of the coronavirus, continue to help seal the fate of BPSD, and the absolute need to stop using it.
(1) Hertenstein, M. J., Keltner, D., App, B., Bulleit, B. A., & Jaskolka, A. R.(2006). Touch communicates distinct emotions. Emotion, 6(3), 528–533.
(2) Field, T. (2002). Violence and touch deprivation in adolescents. Adolescence, 37(148), 735.
(3) Goetz, J. L., Keltner, D., & Simon-Thomas, E. (2010). Compassion: An evolutionary analysis and empirical review. Psychological Bulletin, 136 (3), 351–374.
(4) Bunt, D. & Berry, P. (2020) Slow Puncture: Living Well With Dementia (p. 7). The Book Guild. Kindle Edition.
(5) Usher, K., Bhullar, N. and Jackson, D. (2020) ‘Life in the pandemic: Social isolation and mental health’, Journal of Clinical Nursing (John Wiley & Sons, Inc.).