Introduction
Dementia is a condition in which cognitive functions of brain decline due to disease or damage in brain. Dementia is a non specific illness syndrome in which affected areas may be memory, problem solving and language problems. Memory functions are first affected in this disease. There are different types of dementia includes: Huntington’s disease, Hypothyroidism, Parkinson’s disease, Vitamin B1 deficiency, Vitamin B12 ,deficiency, Folate deficiency, Syphilis, Subdural hematoma, Hypercalcaemia, Hypoglycemia, Aids dementia complex. Inappropriate behaviors in any disease are very common and in dementia different behaviors are common as in this disease memory function involves that’s why patient behaves abnormally. In this disease, patient gets mentally and physically disturb. Dementia patient needs more care and attention as patient’s behavior is more disturbing and needs more finance than any other disease. Behavior disturbances are very common in dementia; Lyketsos proved that each patient of dementia faces some behavioral disturbance at any point of time (Benjamin, 2004).
Dementia occurs in adulthood; studies conducted over past three decades proved that adults usually are not sexually active. These studies proved that 50% – 80% people are not sexually active, 60% people were sexually active once in a month. Inappropriate sexual behavior is one of the common symptoms with dementia patients. Common behaviors include sex talk, sexual acts, and implied sexual acts. These behaviors are really embracing for relatives and other as they occur in private or public places (Barouche, 2002). According to one estimate about 60-70% dementia patient shows inappropriate behaviors mainly sexual behavior. Dementia is often thought, this disease is generally defined as a decline in thinking and remembering due to which individual gets unable to function independently (Practice guideline, 1997). Non pharmacological interventions of dementia are listed below: music therapy, bright-light therapy, exercise and recreational activities, pet therapy, social contact intervention, environmental modifications, and modification of activities of daily living care to meet individuals’ needs (Sobin, 2002). Literature reviews shows that three major classes of dementia treatments are often used: antidepressants, anxiolytics, and antipsychotics (Robert, 2006).
Inappropriate behavior usually gives depressed effect but typically this term refers to observable behavior of dementia patients. Usually, Non pharmacological behaviors can be divided into four main categories: 1) physical behavior which includes kicking and biting 2) pressing and mishandling of objects 3) verbally non aggressive agitation 4) verbal agitation such as screaming and cursing. In past decades these disease and behaviors had been dealt with medicine, drugs and different treatments but OBRA 87 mandate have questioned to these treatments. In result of these treatments, inappropriate behavior increased as a result an over plus of non pharmacological intervention has been initiated. In order to understand this non pharmacological intervention three basic models are applied: Unmet model, behavioral/learning model, reduce stress threshold model. These models are widely used in order to treat dementia inappropriate behaviors. Unmet needs generally deal with the needs that cause inappropriate behavior. Lack of quality care also causes inappropriate behavior in dementia patients. Most pharmaceutical intervention in treating no cognitive behaviors is usually deal with medications. These medicines showed effective results with major symptoms like hallucinations, delusions, paranoia, verbal aggression/threatening, and physical aggression (Doody, 2001). Each dementia patient face these behaviors at any stage at least once in disease life, these symptoms in outpatient settings give burden to care taker and it’s a major reason of institutionalization (Schneider, Pollock et.al,1990).
Non Pharmacologic behaviors can be controlled by routine care, having a consistent living environment, keeping demands and tasks simple, Moreover, needs of dementia patient should be fulfilled on time to avoid complexity in behaviors (Cohen,2001). Hallucinations are generally less common than DELUSIONS (Cohen, 1998). Usually dementia patients’ shows different behaviors, some of them are: Caregivers are impostors (patient usually don’t recognize relatives even their own images in mirror because of memory dysfunction). Spouses are guilty of infidelity (when patient admits in nursing home he observe the feeling of betrayed or loss of trust by spouse). Patients feel abandoned, Hallucinations etc. Personals with dementia have delusions feel that people are stealing from them, because of their memory problems they usually misplace things and forget about their location, this happens because of orientation and memory difficulties. Dementia also causes vision loss, by which patient starts misidentifying objects.
Nonpharmacologic Treatment of Psychotic Symptoms
With the aid of Non pharmacologic interventions dementia patient feel better and secure. Some non pharmacologic treatments are as follows:
- Identify problem through assessments of symptoms, try to match symptoms with environment, check their negativity, judge that a patient is suffering from social isolation or memory dysfunction, does the person misinterpreted situation?, conduct a detailed examination of patient and symptoms, co-relate symptoms with environment. The intervention must address to the resident, environment, staff member, system of care. Judge the symptoms and try to improve dementia’s patient lifestyle. Research on non pharmacological intervention is lagging behind that of other non pharmacological care. The most important thing need proper judgment and proper examination of diseases with the help of symptoms, secondly, impact of dementia needs to be ascertained (Keddy, 2003).
- The possible causes of delusion sensory disorder or medical causes should be investigated. Mis understanding and diagnosis makes diseases complex and critical in order to avoid this relationship between patient and caregivers should be improved, this action will help a lot in proper diagnosis and non pharmacological treatment of inappropriate behaviors in dementia. Methods for patient to help them in finding their things or belonging are needed. This can be done by purchasing copies of items. Space retrieval methods help a patient in keeping items always at place (McKitrick, Camp and Black, 1992).
Barriers
There are number of barriers include in non pharmacological treatments, some of them are listed below:
Current system does not support non –pharmacological intervention, assessments and implementations. Usually doctor suggests medication on the basis of reports without direct examining a person. Patient’s interaction with environment is also very less in this current environment. Lack of knowledge about environmental etiologies and non pharmacological treatments is major barrier. There are several prerequisites in order to implement non pharmacological interventions are the system of care needs to promote an atmosphere and caring practice that must be an improved version of what’s available in current environment. Strong listening and careful examination of patient is needed in order to treat dementia’s patient non pharmacologically (Camp, 2002).
Significance
Genealogical nursing has its own importance and has great significance as when elderly admits in nursing home with dementia, patient needs special care and attention, there are several problems in it but quality of life can be increased by helping them like residents of dementia helps other dementia patient (Marjorie, 2001). Three types of models are generally applied: unmet needs, behavior model, stress threshold model. Non pharmacological intervention helps in addressing proper diagnosis by asking questions and examines a dementia individual. It prevents adverse effects of pharmacological intervention with dementia. It gives proper path to establish a good relationship between patient and caregivers. Dementia affects up to 8% of the population of 65 or later.
Dementia of Alzheimer‘s type is the most common dementia among all types of dementia (McDowell, 1994). Sittings with patient support a lot in understanding and recognizing the impacts, causes and other factors of dementia patients. This study helps in treating a person effectively by using non pharmacological methods. On the other hand, physicians usually prescribe medicines on the basis of reports which some time causes adverse side effects and this act also increments the patient’s suffering. Proper diagnosis and examining patient physically can only illustrate the exact and accurate condition of disease and memory condition. In current system, there is a lack of physically and mentally examining practice the patient for proper treatment. Non pharmacological methods and treatments help in recognizing the exact problem and cause of dementia and treat it according to that condition rather than report’s statements. There are different problems involve in nursing to dementia, few of them are lack of nursing education, family difficulties, search difficulties, family conflict, time lacking for care etc. Thee problems lead a person towards downfall and it gives patient feeling of loss, trust and uselessness.
Dementia is neither a severe disease nor its incurable but little care and on time treatment and attention is required. Sometimes dementia patients forget about their own identity due to dysfunction of memory. In this situation they need proper examination, analysis and proper treatments, medications. Non pharmacological interventions help a patient to recover fastly with no burden of passing through number of medical test and have lots of medicine prescribed by physician on the basis of reports. Non pharmacological treatments are best in many ways problems are there as current environment is not very supportive but still it has a great impact and effective results if properly applied. Medical and physical interventions include bright light therapy and sleep intervention, this act is being used to improve sleep and help in reducing agitation. Results of this technique may vary from patient to patient depending upon individual’s base line conditions and treatment objective.
Different treatments also helps in improving dementia’s patient baseline condition such as hearing aids, music therapy is one of the most common and widely used therapy for the treatment of dementia. This therapy is not always recommended but it helps a lot in dealing with dementia patients. Nursing care of dementia at home can be easily done in daily routine by just making lifestyle little restrictive and planned. In nursing dementia patient nurses usually face number of ethical problems like patient like to do alternate acts and sometimes, its quiet difficult to satisfy all parties in ideal way ( Here mere, 1999).As, in dementia cognitive abilities decrease then it become so difficult to satisfy their needs as their wishes become uncountable (Thompson,1992). Nurses are still at risk of making decisions at this time. For nursing its quiet difficult to provide desirable life for a person on instruction of any other person, it’s quiet morally distressful (Frankena, 1973). The goal of nursing dementia should be to provide best life to patient and their significant others (Schemer, 2002).An overall goal of care should be providing best care and best life to dementia patient in easy way (Brulde, 1998).
Future Developments
In order to deal with dementia patients there is a strong need to differentiate between physociatic symptoms in AD and symptoms associated with other diseases. Current examination of dementia is not corrigible so there must be some enhancement in this vein. Future research needs a clear and strong difference between above mentioned diseases for non pharmacological treatment. Moreover, research need to clarify the results and effects of non pharmacological treatments in dementia’s patients. The cost benefit ratio needs to be demonstrated between both interventions’ methods (Cohen, 1995). Research needs proper ratio and efficiency of non pharmacological interventions of dementia and it needs clear and strong differences between pharmacological and non pharmacological interventions for dementia. Research also needs to investigate and search such system structures which could provide good non pharmacologic treatments and the financial contingency configurations that promote such care (Bassiony, 2002).
Conclusion
Dementia patient needs little care and it can be provided by implementing healthy lifestyle and by fulfilling their needs. Different theories and models are present if properly implemented can be helpful for the betterment of dementia patients. According to research every person shows inappropriate behavior at any stage of dementia. Conditions and symptoms vary person to person and need proper assessment with proper diagnosis. Non pharmacological intervention deals dementia in effective manner with the aid of proper examination and questioning to patient. As, current environment is not very supportive so there is a need of promoting such environment in order to achieve best results from non pharmacological intervention of dementia. Non Pharmacological intervention has no adverse effects and is very effective if properly implemented.
References
American Psychiatric Association Workgroup on Alzheimer’s disease and Related Disorders., (1997), Practice guideline for the treatment of patients with Alzheimer’s disease and other dementias of late life. Am J Psychiatry; 154(suppl.):1-39.
Barouche AJ, (2002), Assessment of behavioral and psychological symptoms of dementia. CNS Spectr.7:797-802.
Benjamin Black, (2004), Inappropriate Sexual Behaviors in Dementia, 2008. Web.
Brulde B, (1998) The human good [Dissertation]. Acta Universities Gothoburgensis.
Bassiony MM, Warren A, Rosenblatt A, (2002), The relationship between delusions and depression in Alzheimer’s disease. Int J.
Cohen-Mansfield J. (2001), Non pharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. Am J Geriatr Psychiatry;9:361-381
Cohen-Mansfield J, (1998), Delusions and hallucinations in an adult day care population: a longitudinal study. Am J Geriatr Psychiatry; 6(2):104-121.
Cohen-Mansfield J, Werner P. (1995), Depression in senior day care participants: ratings by different informants. Depression; 2:272-277.
Doody RS, (2001), Practice parameter: management of dementia (an evidenced-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology; 56:1154-1166.
Frankena W. (1973), Ethics. Prentice Hall.
Hermere´n G, (1999), Neonatal screening: ethical aspects, 88 (Suppl 432), 99_/103.
Kidder SW, (2003), Psychosis in the elderly—whose delusion is it? Geriatric Times; 4(2):25-26.
McKitrick L, Camp C, Black F, (1992), Prospective memory intervention in Alzheimer’s disease. J Gerontol; 47(5):P337-P343.
Marjorie Oleson, (2001), Improving nursing home quality of life: Residents helping residents, 2008. Web.
McDowell, I. (1994), Canadian study of health and aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899-913.
Robin PB, (1992), Non-neuroleptic treatment of behavioral symptoms and agitation in Alzheimer’s disease and other dementia. Psychopharmacology Bull; 28:71-79.
Robert L, (2006), The Pharmacological Approach of Behavioral Disturbances in Dementia, 2008. Web.
Schneider LS, Pollock VE, Lyness SA, (1990), A met analysis of controlled trials of neuroleptic treatment in dementia. J AmGeriatr Soc. 38:553-563.
Schemer M, (2002), In search of ‘the good life’ for demented elderly. Med Health R I, 85: 216/18.
Thompson JE, (1992), Bioethical decision-making for nurses. University Press of America.