Biography
Discuss About The Dementia In Nursing And Living Facilities.
With an aging society, dementia has increasingly raised major concerns for policy makers and health care providers and in most cases, where there is need to determine the best possible care that that should be provided in order to realize better patient outcomes. Dementia further presents a number of social and psychological effects to the affected individuals among them including; decreased self-esteem, social isolation, withdrawal from family relationships, reduced ability to undertake daily activities, and an overall decline in the individual’s quality of life (Buettner et al, 2016, p. 5). To the family or rather caregivers, dementia may also create considerable psychological and emotional challenges especially with the experienced overwhelming difficulties associated with providing care to demented individuals. With severe stages of dementia, individuals may exhibit extreme behavioral changes comprising of agitation behaviors where the individual is restless and displays aggressive tendencies (Forbes & Neufeld, 2008, p. 11).
This paper seeks to understand the needs and experiences of Mr. A, a patient currently experiencing severe stages of dementia, and therefore analyze the implementation plan of the most suitable intervention method. In light of this purpose, the paper firstly details the biography of the patient and analyzes his needs based on the assessment model provided by Kitwood (1993). The second section details the available literature on various methods that are used in the treatment of dementia. The third section discusses the implementation plan and the evaluation approaches that were used to determine how Mr. A responded to the intervention. The final section concludes by providing the implication of the form of intervention to the current medical practice.
Mr. A was forced into early retirement in order to take care of his beloved wife who had then been diagnosed with a fatal disease. The two had enjoyed a happy married life through which they were blessed with three children, two daughters and a son, and four grandchildren. Their marriage had begun when Mr. A was 32 years old and before her wife passed away, the couple had enjoyed 52 years in marriage. The memories of this marriage were held dear by Mr. A and he would often reminisce the good times with his children and grandchildren. Most importantly, Mr. A has maintained his love for music throughout his life and as a novelist; Mr. A has consistently expressed his love for the poetry that is found in old classical music.
Dialectics of Dementia
Currently, Mr. A has been left under the care of his youngest daughter. At the age of 86, Mr. A has however presented a monumental task to her daughter in relation to taking care of the overwhelming needs of Mr. A. The exhaustion has arisen from the fact that Mr. A had previously been diagnosed with dementia and was left under the care of her daughter with occasional interventions being provided by home care workers. In the early stages of dementia, Mr. A exhibited mild symptoms which on his insistence, he was determined to overcome the condition single-handedly. However, the severity of the condition has considerably impacted on his quality of life especially since he has recently experienced a deterioration in his behavioral, physical and psychological health. These deteriorations have been evidenced by certain changes in his behaviors including; excessive aggression, hallucination of his wife and constant anxiety. Following the revelation of these signs coupled with the adverse effects that medication treatment has on Mr. A’s physical health, the family members have jointly agreed that Mr. A be admitted to a nursing home where he can receive appropriate care in accordance with his health needs.
In order to fully assess the needs of the patient, it is critical that his social and psychological well-being be taken into consideration. To fully realize this objective, Kitwood’s dialectic’s of dementia model will be used to assess the five main elements that contribute to the dementia process (Kitwood, 1993, p. 541).
As a novelist, Mr. A has maintained a conservative life in terms of his social relations and in most part of his life; he has been surrounded by his family. In such a case, it can be noted that Mr. A is an introvert who loves to spend his time with his family.
As aforementioned, his professed love for music has brought him even closer to his family as they attended music concerts at least once every month. This tradition has however been disrupted given Mr. A’s progressive agitation and anxiety making it difficult to control him especially in public settings. After being diagnosed with dementia, Mr. A spent most of his afternoons with his family especially grandchildren reading them stories. Also, he made it a habit to listen to music and sing along whenever he found time to do so. As he believed, these tendencies enabled him to remember the fond memories that he had of his family.
Literature Review
Mr. A’s agitation has exacerbated making him to wander alone in the neighborhood without the knowledge of his daughter. He has also been aggressive declining to undertake certain routine tasks even when instructed by a medical practitioner. In some instances, he experiences hallucinations involving his wife thereby depicting the severity of psychological deterioration that has been presented by the condition.
Similarly, Mr. A’s cognitive capacity has also been impaired by dementia given that he experiences cognitive functioning that declines his level of attachment to those closest to him. Furthermore, the loss of her wife has pushed Mr. A to a strange situation where Mr. A tends to feel unsafe and powerless for long periods of time (Jetten et al, 2010, p. 409). It can also be noted therefore that emotional depression further intensified Mr. A’s dementia.
The presence of his wife made it easy for Mr. A to cope with the condition but after she passed away, Mr. A drifted into a state of grief which further worsened his condition. This sense of loss made him to become socially isolated thereby interfering with his hopes for the future. In the same way, it can be affirmed that Mr. A has lost a sense of living a condition which further deteriorates his emotional well-being.
Research reveals a number of approaches that can be taken in order to mitigate the behavioral and psychological effects associated with dementia. Furthermore, given the adverse events that emanate from antipsychotic medications that are associated with pharmacological treatments, non-pharmacological and behavioral treatments have been used as first line therapy to control effects of dementia. These forms of therapy primarily include; music therapy, light therapy, animal assisted therapy and massage amongst others (Smith, 2014, p. 1). However, there exists limited literature regarding the effectiveness of these approaches aside from music therapy in which most studies have focused on. As such, various researches have provided credible data that substantiate the effectiveness of music therapy in controlling the behavioral and psychological impacts associated with dementia (Gerdner & McBride, 2015, p. 2).
For instance, study by Poli et al (2017) revealed that music therapy has positive cognitive effects on individuals who have been diagnosed with dementia. In the study involving a systematic review of more than 100 studies, it was evident that there are beneficial effects on active music therapy on global cognition (Poli et al, 2017). Study by McDermott et al (2014) also reveals that music therapy provides significant importance top both the patient as well as their caregivers inclusive of the medical personnel and the patient’s family. In this light, this study illustrates that music supports personal psychology of people suffering from dementia and also support the social psychology of the care home environment (McDermott et al, 2014, p. 708).
The benefits associated with music therapy as a form of intervention for individuals suffering from dementia has been generalized into diverse functions. For example, study reveals that in comparison to other forms of treatment especially those comprising of pharmacological medication, music therapy has been found to be less costly thereby easing the financial burden incurred in health care cost to the patient and their families (Osman, Tischler & Schneider, 2016, p. 1327). As aforementioned, studies have also well documented the effectiveness of music therapy intervention as a therapeutic rehabilitation approach that reduces behavioral disturbances that are common among persons with dementia. Alternatively, music therapy has also been positively associated with stimulation of cognitive functions among demented individuals and also enhancing their quality of life throughout the process of dementia (Jetten et al, 2010, p. 408).
Other studies also reveal that music therapy produces substantial effects in relation to reducing agitation among demented individuals. Agitation is common among individuals diagnosed with dementia and it primarily comprises a number of behaviors such as aggressive behaviors, restlessness and wandering. Agitation worsens dementia since it reduces positive social interaction and enhances organizational and psychological burden. In most cases, this type of behavior has been treated medically with drugs but as evidence reveals, there is need to implement complementary methods of intervention (Ridder et al, 2013, p. 667). In this light, music therapy has often been touted as one of the most efficient ways of reducing agitation among individuals suffering from dementia. As indicated by Pederson et al (2017) in their study, basing on the sub-types of music intervention as well as the target groups involved in this approach, music intervention provides substantial positive benefits to demented individuals since it mitigates agitation (Pederson et al, 2017, p. 743).
Perhaps the most overlooked importance of music is the value that it creates to persons with dementia. As studies reveal, people suffering from dementia are often forgotten in the environments in which they are situated or alternatively in their communities. This precisely occurs when caregivers are neglectful of the person’s with dementia role in the society as well as individualistic likeness of various aspects. In the same regard, music therapy helps in bridging this gap since it helps to preserve the individual preferences of music. In this case, throughout the stages of dementia with an intervention of music therapy being implemented, studies have revealed that this approach helps to sustain musical and interpersonal connectedness thereby helping in creating value to the person with dementia in their own individualistic manner (Sakamoto, Ando & Tsutou, 2013, p. 776). This effect further contributes to the maintenance of quality of life for individuals suffering from dementia.
Another similar study conducted by Wing (2010), also reveal that music therapy interventions are critical in reducing agitation in dementia. The authors in the study noted that by involving people with dementia in group singing activities, these individuals increased their willingness to socially interact with individuals while their levels of agitation were also reduced (Wing, 2010, p. 18). Garrido, Dunne & Chang (2017) also reveal that pre-recorded music is essential in easing agitation among demented individuals. In this study, the authors reveal that agitation behavior is significantly reduced when individuals with dementia are allowed to listen to music during times when they exhibit agitation or rather aggressive tendencies (Garrido, Dunne & Chang, 2017, p. 1131).
Intervention Implementations
Based on the needs of the patient, it was essential that the intervention be person centered in such a way that it promotes the independence of the patient. Mr. A had experienced difficulties in socializing with other people with adverse effects associated with his agitation. These conditions subsequently impacted Mr. A’s ability to undertake individual tasks on his own and was constantly being assisted and supported to carry out daily activities. The intervention plan therefore had to focus on the need to enhance social integration and reduce agitation exhibited by Mr. A (Tilly & Reed, 2008, p. 4). In consideration of these factors, music intervention and specifically personal intervention was deemed as the best form of intervention to address the challenges faced by Mr. A.
Personal intervention was based on the interaction between Mr. A and his therapist. In this case, Mr. A was allowed to listen to his own music at his own pleasure. Moreover, it was planned that Mr. A listen to some of his favorite music when he exhibited signs of being agitated. More specifically, the therapist was to subject Mr. A to listening to soul music and these sessions would be conducted preferably in the afternoon since Mr. A was most agitated during these periods (Vasse et al, 2010, p. 191). However, in the event that Mr. A expressed his view of not requiring any music sessions, the therapist was to acknowledge his wishes and hence use an alternative mode of intervention. In such cases, it was suggested that Mr. A be allowed to explore other activities of his interest such as reading.
Alternatively, Mr. A would be allowed to take an afternoon walk where he would meet with his peers going through the same condition. This initiative would also enhance Mr. A’s social interaction and in the process reduce his social isolation. Finally, there were regular visits which were scheduled for Mr. A’s family members. During these visits, it was essential that all the family members be involved in a music listening activity in order to foster emotional touch between Mr. A and his family.
As anticipated, the use of music therapy reduced agitation disruptiveness and prevented medication increases for Mr. A. With an ongoing intervention involving music therapy, there were positive trends that were established positive trends in regards to agitation frequency. Furthermore, it was observed that this form of intervention eased the care burden and also contributed to the increase in quality of life for Mr. A (Ridder et al, 2012, p. 667). These findings were confounded on the fact that Mr. A exhibited reduced number of agitation episodes and reduced anxiety as well.
In order to determine these findings, the therapist was instructed to formulate a diary which would document Mr. A’s reception to the intervention plan. For instance, prior to implementing the plan, the therapist recorded the times during which Mr. A exhibited agitation the most. During these times, it was decided that the music sessions be conducted immediately before Mr. A’s agitation tendencies. His response to music was then recorded and the therapist also noted whether the music reduced the Mr. A’s agitation.
An interview between the therapist and the family members was also conducted to relay to the family members the progress that was made by Mr. A. On individual basis, Mr. A was interviewed in order to understand whether the new environment was conducive and secure for the patient (Quinn, Clare & Woods, 2009, p. 145). For example, Mr. A was asked whether he was feeling comfortable in this environment and whether the music that he listened to drew some familiar thoughts. In response, Mr. A lamented about the number of people that were crowding his space and he would prefer to be left alone in his room. In this room, Mr. A attested that he felt comfortable and with the chance to listen to music in the afternoon, Mr. A noted that this gave him hope.
A mini mental state examination (MMSE) was also used to determine the level of happiness experienced by Mr. A. The test was conducted prior to implementing the intervention and based on the test scores it was affirmed that Mr. A was experiencing a severe case of dementia. This evidence was realized after Mr. A scored 8 and 7 scores in the two weeks prior to implementing the intervention (Plokhotnikov, 2015). However, the music intervention was carried out to fruition since his test scores began to rise immediately after the implementation of the intervention. In this case, after the first week of implementation, Mr. A’s test scores was recorded at 10 a figure which rose to 13 during the second week of implementation (See appendix A). These test scores illustrated therefore that the intervention was a success and that better patient outcomes characterized by increase in quality of life was being realized.
The findings from this study ideally shape the way medical practitioners structure their treatment plans for people diagnosed with dementia. As such, these professionals are inclined to take into consideration alternative modes of treatment including non-pharmacological treatment plans. As aforementioned and basing on the available literature, music therapy provides a unique yet effective ways of providing care to individuals with dementia. Furthermore, this form of intervention produces no adverse effects on the patient unlike pharmacologic instituted medication (Naue & Kroll, 2009). Hence, to protect the well-being of the patient and reduce the risks involved in the provision of care for people suffering from dementia, it is essential that medical professionals look to implement music therapy as a form of provision of care for such patient populations.
Conclusion
From the above discussion, it is evident that individuals at an old age are at great risk of developing dementia, a condition which significantly impairs the well-being of an individual both emotionally and physically as they increasingly become dependent on the support provided by caregivers. To alleviate their living conditions and as such enable them to carry out their daily activities with relative ease, it is essential that the caregivers be efficiently equipped with the resources as well as the expertise to accord care. These factors are ideally inclusive of the best form of intervention that can assist the individual to function normally. In such cases, music therapy, light therapy, massage and animal assisted therapy have been proposed as some of the best non-pharmacological forms of interventions.
In the case of Mr. A, music therapy was efficient in reducing the patient’s agitation thereby enhancing his quality of life. Although the intervention had minimal effect on the patient’s social isolation, it provided more room for the patient to interact with his family. Additionally, this intervention was also crucial in relieving the patient of depression which was primarily associated with the condition.
References
Buettner, L., Lundedren, H., Lago, D., Farrell, P., & Smith, R. (2016) Therapeutic Recreation as an Intervention for Nursing Home Residents with Dementia and Agitation: An Efficacy Study. American Journal of Alzheimer’s Disease. 11(5), pp. 4-12.
Forbes, D. A., & Neufeld, A. (2008) Looming Dementia Care Crisis: Canada Needs an Integrated Model of Continuing Care Now. Canadian Journal of Nursing Research. 40, pp. 9-16.
Garrido, S., Dunne, L., & Chang, E. (2017) The Use of Music Playlists for People with Dementia: A Critical Synthesis. Journal of Alzheimer’s Disease, 60(3), pp. 1129-1142.
Gerdner, L. A., & McBride, M. R. (2015) Individualized Music Intervention for Agitation in Dementia Care and Disaster Preparedness. HSOA Journal of Gerontology & Geriatric Medicine. 1(5), pp. 1-4.
Jetten, J., Haslam, C., Pugliese, C., & Haslam, S. A. (2010). Declining Autobiographical Memory and the Loss of Identity: Effects on Well-being. Journal of Clinical and Experimental Neuropsychology. 32, 408-416.
Kitwood, T. 1993. Person and Process in Dementia. International Journal of Geriatric Psychiatry. 8(7), pp. 541-545.
McDermott, O., Orrell, M., & Ridder, H. M. (2014) The Importance of Music for People with Dementia: The Perspectives of People with Dementia, Family Carers, Staff and Music Therapists. Aging and Mental Health. 18(6), 706-716.
Naue, U., & Kroll, T. (2009) The Demented Other: Identity and Difference in Dementia. Nursing Philosophy. 10, 26-33.
Osman, S. E., Tischler, V., & Schneider, J. 2016. Singing for the Brain: A Qualitative Study Exploring the Health and Well-being Benefits of Singing for People with Dementia and their Carers. Dementia. 15(6), pp. 1326-1339.
Pederson, S. K., Andersen, P. N., Lugo, R. G., Andreassen, M., & Sutterlin, S. (2017) Effects of Music on Agitation in Dementia: A Meta-Analysis. Frontiers in Psychology. 8, p. 742.
Plokhotnikov, J. L. (2015) The Use of Music in Dementia Care: A Literature Study, Aging and Mental Health, 17(6).
Poli, L. F., Bieleninick, L., Brondino, N., & Gold, C. (2017) The Effect of Music Therapy on Cognitive Functions in Patients with Dementia: A Systematic Review and Meta-Analysis. Aging and Mental Health, 10(1).
Quinn, C., Clare, L., & Woods, B. (2009) The Impact of the Quality of Relationship on the Experiences and Wellbeing of Caregivers of People with Dementia: A Systematic Review. Aging and Mental Health. 13, 143-154.
Ridder, H. M., Stige, B., Qvale, L. G., & Gold, C. (2013). Individual Music Therapy for Agitation in Dementia: An Exploratory Randomized Controlled Trial. Aging and Mental Health, 17(6), pp. 667-678.
Sakamoto, M., Ando, H., & Tsutou, A. (2013) Comparing the Effects Different Individualized Music Interventions for Elderly Individuals with Severe Dementia. International Psychogeriatric. 25(5), pp. 775-784.
Smith, G. (2014) Light as an Intervention to Manage Distressing Symptoms in Dementia: A Literature Review. Mental Health Nursing. 34(5), pp.1-4.
Tilly, J., & Reed, P. (2008). Evidence on Interventions to Improve Quality of Care for Residents with Dementia in Nursing and Assisted Living Facilities. Available from: https://www.alz.org/national/documents/dementiacarelitreview.pdf [Accessed 23 May 2018]
Vasse, E., Dassen. M. V., Spijker, A., Rikkert, M. O., & Koopmans, R. (2010). A Systematic Review of Communication Strategies for People with Dementia in Residential and Nursing Homes. International Psychogeriatric. 22(2), pp. 189-200.
Wing, J. D. (2010) Responding Agitation in People with Dementia. Nursing Older People. 22(6), 18-27.
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