Summary Biography
What Is The Effect Of Intervention Treatment Behavioral?
Dementia is an illness that raises significant challenges to the diagnosed individual to the point that they experience difficulties in conducting their daily activities and therefore have to rely greatly on the care that is provided by caregivers or other companions. Aside from the physiological and behavioral changes that are exhibited by such individuals, their carers are also subjected to considerable stress especially when they do not receive sufficient training and support, or when the intervention methods are not conducted to fruition. Moreover, the much used pharmacological interventions seem to have limited benefits with many associated side effects (Johnson & Krahn, 2010, p. 2). Thus, non-pharmacological approaches have widely become prominent and as such, they are being used as a primary method of intervention for individuals with dementia.
In consideration of the movie Away from Her, this paper reviews and critically analyzes the condition that the main character of the movie faced. The demented individual in this case study is Fiona who exhibits various signs of dementia. For example, at one time while dining with another couple, Fiona offers to make a refill but she immediately forgets the word wine. The paper therefore entails a summary and biography of Fiona as an individual diagnosed with dementia, and also reviews the available literature regarding the best form of intervention that could be used to treat Fiona. A further illustration of the main effects from this intervention is reviewed with the best possible evaluation criteria being discussed. Ideally, music therapy, singing sessions and music listening are critical interventions for the well-being of Fiona.
Fiona was married to her husband Grant for more than forty years most of which were considered as being full of bliss. Despite such a lengthy period of courtship, their marriage was faced by plagued by Grant’s infidelities during his time as a professor. This indecent behavior went on for several years as Grant thought that Fiona had no knowledge of this yet she knew but decided not to confront Grant. Fiona decided to forgive him and they settled in rural county in Ontario.
As they settle in retirement, Fiona begins to exhibit a wide range of characteristics of Alzheimer’s disease including; memory loss, impaired reasoning and memory loss. These characteristics are depicted in various events. For instance, Fiona unknowingly puts a frying a pan in the freezer as his husband watches on. Also, she goes for cross-country skiing but she forgets her way back home even though she has lived there for many years (Stone, 2008).
Assessment of Fiona’s Needs
Fiona she discovers that she has dementia and she also realizes the impact that she would have on her spouse when her condition worsens. Therefore, she visits a nearby nursing where policy requires that the patient loses touch with their family for thirty days so that they can adjust to the life in the facility or rather transition to the new environment. As the thirty days elapses and Grant visits her wife in the nursing home, he realizes that the condition has made Fiona to completely forget about Grant and turn her affection to her coping partner, Aubrey. Although this unfolding saddens Grant, he decides to sacrifice his own happiness so that Fiona doesn’t wallow in depression when Aubrey leaves the facility.
The dementing process primarily consists of an outline comprising of a dialectical interplay between social-psychological factors and neurological factors. Also, social-psychological factors tend to deprive a neurologically impaired individual of their personhood (Kitwood, 1990, p. 177; Manthorpe & Iliffe, 2016). Hence, according to Kitwood (1993) the clinical manifestation of dementia may arise from the interaction of five main factors including; personality, biography, health status, neurological impairment and social psychology (Kitwood, 1993, p. 542).
Personality: Even after the realization of Grant’s unfaithfulness, Fiona still expresses love to Grant after retirement. Nonetheless, after being admitted in the nursing home, she forgets her husband and turns her affection towards another companion to whom she develops a close relationship with.
Biography: Fiona was outgoing and loved skiing but this was affected by her condition especially since she realized that she was losing touch with her fond memories. As she forgot her past life, Fiona held on to her new memories that were developed with Aubrey after the diagnosis of AD.
Health status: The major part of Fiona’s life was spent in distress given that she was worried of her husband’s infidelities. Also, following the withdrawal of Aubrey from the facility, Fiona stumbled back to emotional distress as she found it hard to cope without her new companion. This effect will therefore confound the basis of her treatment and hence, it will primarily focus on the emotional needs of Fiona as a patient with dementia.
Neurological impairment: Fiona has suffered from cognitive impairment which has impacted her ability to process and store information. This has been evident by Fiona’s forgetfulness and her inability to recognize her husband. Furthermore, Fiona has developed emotional need of love previously from Grant and presently for Aubrey.
Literature Review
Social psychology: It is commendable the action or approach taken by Grant in support of her wife. In this light, Grant decided to step aside and allow Fiona experience her happiness by allowing Aubrey back into her life. Had Grant refused to accept the outcome of Fiona’s condition and instead barred Aubrey from Fiona’s life, Fiona would then be subjected to excessive emotional trauma which would further exacerbate her condition.
The literature review entails a review of various studies involving the effectiveness of various intervention approaches for individuals diagnosed with dementia and experiencing emotional distress. The review further focused on music intervention as an approach to alleviate the physical and emotional well-being of demented individuals. This is in reference to Fiona’s condition that experienced both emotional and physical deterioration. In this light, search was conducted in several databases including CINAHL and PubMed. Key words in the search included; music intervention, dementia, depression, emotional needs, emotional distress and physical well-being.
Several studies have revealed multiple psychological functions that music helps to fulfill. For instance, study by Schafer et al (2013) revealed that there are three distinct reasons why individuals listen to music including; achieving self-awareness, regulating arousal and mood, and expressing social relatedness (Schafer et al, 2013, p. 511). Another study also revealed that although music has various psychological benefits, there exist considerable differences among individuals in relation to their love for music. Similarly, the study also acknowledges that music fulfills functions such as regulation of emotions, physiological arousal, and promotes self-awareness (Schaffer, 2016). In these studies therefore, it becomes apparent that music plays a key role in the emotional well-being of an individual basically because it regulates emotional arousal, mood and enhances the sociable aspect of an individual’s personality.
Studies have also specifically focused on the effect of music on people with dementia given the prior studies revealing the psychological benefits of listening to music. In a qualitative review of various articles to determine the emotional and behavioral responses in people with dementia, it was realized that music has a wide range of applications for individuals with dementia but most importantly, the study noted that music progressively lowers stress among these individuals (Sherratt, Thornton & Hatton, 2004, p. 3). A similar study by Garrido et al (2017) that reviewed more than 25 studies illustrated that pre-recorded music was pivotal in easing behavioral and psychological symptoms that are associated with dementia. In particular, this form of intervention was effective in reducing agitation and emotional distress among demented individuals even without the presence of a music therapist (Garrido et al, 2017, p. 1130).
Effectiveness of Music Therapy
Amore diverse study comprising a meta-analysis to investigate the effects of music interventions on people with dementia, it was evident that positive effects on behavioral, cognitive and physiological outcomes were prevalent among the demented individuals (Vasionyte & Madison, 2013). Hence, musical interventions become effective in enhancing the quality of life for demented individuals. Other studies also indicate that music therapy is essential since it enables patients to connect with their culture thereby enhancing better patient outcomes for physicians (Tanaka, Nogawa & Tanaka, 2012). Cognitive functioning has also been enhanced by music therapy as revealed by studies conducted by Vasionyte (2011) and Poli et al (2017).
Another study by Osman, Tischler & Schneider, (2016) found that individuals who were involved in group singing activities found it easy to accept and cope with dementia. Sole et al (2014) also indicate that group music therapy also produces beneficial psychological effects on people with dementia. In their study, it was revealed that group music therapy improves emotional well-being, enhances interpersonal relations, and generally enhances the quality of life for demented individuals. In regards to physical well-being, various studies have indicated that music therapy as a form intervention ideally reduces agitation among demented individuals (Pederson et al, 2017, p. 742).
Aside from being helpful and beneficial to individuals with dementia, music therapy as a form of intervention has also proven to be easy and less costly to implement. In this case, studies have revealed that music therapy is noninvasive, possess little risk to the patient, has a large potential for implementation in the patient care setting and also requires minimal training (Fakhoury et al, 2017, p. 623; Raglio et al, 2014, p. 1669). Thus, for health professionals, this form of intervention can be considered as a low-cost and effective therapeutic method for rehabilitation approach that enhances the quality of life for individuals diagnosed with dementia.
Prior to implementation, it was imperative to understand that although at one time she temporarily remembers Grant, her memories of her past life with Grant become completely forgotten as she forges new present memories with Aubrey. This condition has however enabled Fiona to forget the saddening memories in her life with Grant as she developed new fond memories of Aubrey. On the same note, it can be affirmed that Fiona developed an emotional need of love but this psychology need has also not been met. Fiona is precisely not capacitated to act on her feelings especially since she cannot keep Aubrey within the facility. Thus, Fiona’s needs are poorly met and also, the cognitive impairment hampers the demented person’s ability to act upon them.
Effects of Music Therapy for Individuals Living with a Dementia
Dementia produces an effect of decreased quality of life which mainly arises from social isolation, deteriorated self-esteem, changing relationships and decline in the ability to perform daily activities. These effects were all prevalent in the life of Fiona prior and after joining the nursing home. As revealed by studies, these changes in most cases result to depression and anxiety not only for demented individuals but also for their caregivers inclusive of their family members. Pharmacological treatments have often been used to treat these undesirable behavioral as well psychological changes (Snyder, 2012; Sole et al, 2014, p. 103). However, this form of treatment possesses significant effects on the patient thereby necessitating the need for non-pharmacological approaches.
The non-pharmacological approach that would prove to be beneficial for Fiona would therefore be music therapy. Specifically, it is anticipated that the devised music based intervention comprising of music therapy, community singing groups and music listening would be helpful for Fiona by enhancing her psychological well-being. One of the reasons for this is because music would provide a stimulating medium which would be enjoyed by Fiona and her companions including Grant and Aubrey. Ideally, Fiona viewed Grant as being persistent yet she had no recollection of him or her past life. On the same note, she had developed new affection for Aubrey. In this conundrum, music would prove to be a unifying factor for all the three individuals. In this case, by engaging these individuals in music singing and listening, Fiona would build new memories of Grant while at the same time reliving the present memories with Aubrey (Johnson & Krahn, 2010, p. 8). Consequently, her emotional well-being would be enhanced since she will be surrounded with people who love her. Additionally, the singing activity would provide some closure for Grant.
To address the emotional needs of Fiona, there is need to review the strategies taken by the nursing home as Fiona transitions within the institution. Ideally, Fiona needs to maintain her emotional attachments to her family or rather partner. Even though the music therapy would be pivotal in reconnecting the couple additional approaches need to be taken in order to ensure that Fiona remains emotionally attached to Grant. In this light, the nursing home environment should be designed in such a way that it establishes and maintains familiar thoughts of attachment that are held by Fiona (Johnson & Krahn, 2010, p. 4).Furthermore, Fiona suffers from depression especially when Aubrey is withdrawn from the facility and this jeopardizes her emotional as well as physical well-being. For this reason, it is critical that Fiona maintains a close emotional attachment to Aubrey. Hence, the intervention methods included should therefore aim to make an inclusion of Aubrey to enable Fiona cope with the distress that she is facing. For example, the singing sessions should include Aubrey where both Fiona and Aubrey are involved in similar sessions.
The major effect of implementing the aforementioned interventions will be realized in the recognition of emotional importance of Fiona’s attachments to both Grant and Aubrey. This recognition is also inclusive of the psychological complexity that Fiona faces as an individual with dementia. In this light, although Grant finds it difficult to observe Fiona in the company of another companion, the therapy sessions will allow Grant some time to rekindle the fond memories that he has for Fiona. Fiona on the other hand can benefit emotionally from the company of Aubrey thereby reducing emotional distress that she could have faced in the absence of Aubrey.
In addition, this form of intervention also allows Grant to view Fiona as a different individual with new sets of needs that cannot be fulfilled by him. Thus, even though the dementia made Fiona to forget the relationship that she had with Grant and consequently disrupt their close relationship, the intervention taken enabled the partners to take different paths for the remainder of their lives, one which was beneficial for both parties.
To evaluate the music experiences of Fiona, there will be need to conduct separate focus groups and interviews among all the involved parties with much attention being accorded to Fiona. For instance, a focus group and interview should be conducted with the care home resident which in this case is Fiona, with Grant also being present. Another interview should be conducted with the nursing home staff in order to receive their views on the progress that Fiona is making (McDermott, Orrell, & Ridder, 2014, p. 706). Also, there is need to conduct an interview with associated music therapists in order to understand whether Fiona is responsive to the music intervention that is being implemented.
Notably, musical therapy is considered to be inexpensive and lack adverse side effects and as suggested by various studies, this form of intervention should be recommended for patients in any stage of dementia. Given the prevalence of dementia among older adults above the age of 65, this condition has raised major public health concern and as such, there is need for health professionals to establish rehabilitation methods that relieve the patient’s dementia symptoms (Tanaka, Nogawa & Tanaka, 2012). Even so, there are diverse psychological, behavioral and cognitive functioning impacts that are presented by dementia to the diagnosed individuals. Caregivers are therefore faced with a critical task of developing psychosocial interventions that will help manage the condition as well as enhance the well-being of the demented individuals (Osman, Tischler & Schneider, 2016). Music therapy therefore presents a valid treatment option for the caregivers and the individuals diagnosed with dementia.
As evidence reveal, music as a form of therapy can be used to improve mood, relieve stress and regulate emotion for individuals diagnosed with dementia. To the carers, music activities have been found to be beneficial in improving the relationship between the carer and the demented person thereby easing caregiver burden (Poli et al, 2017). Hence, the current practice should focus on music intervention in order to improve social interaction between the health professionals and people with dementia. Such focus will also promote relaxation and reduce stress levels for people with dementia. Additionally, understanding the dialectics of dementia can enable health professionals to formulate and implement the best possible interventions.
Conclusion
Many individuals diagnosed with dementia are subjected to pharmacological treatments which may prove to be effective but at a high cost both to the health of the individual as well as from a financial point of view. The health risk associated with this form of treatment usually emanates from the adverse side effects that arise from pharmacological treatment. It has therefore become imperative that non-pharmacological forms of treatment be administered to patients diagnosed with dementia. In this regard, approaches such as musical interventions therefore present alternative modes of treatment.
In regards to the condition faced by Fiona, musical therapy, singing groups and music listening could prove to be beneficial to the psychological and physical well-being of Fiona as an individual diagnosed with dementia. This form of intervention would enable Fiona to regulate her emotions, moods and control her psychological arousal. Eventually, the experienced emotional distress would be reduced thereby improving Fiona’s quality of life. To achieve such objectives, it will be worthwhile to involve Fiona, Aubrey and Grant in these music sessions since it will enable Fiona to maintain a close emotional attachment to the two companions. Additionally, this form of intervention would prove to be less costly and less risky to the patient.
Finally, the findings in this paper provide important solutions for health professionals in their practice and specifically for cargivers involved in providing care to individuals diagnosed with dementia. The future practice in this case is therefore inclined to look into new psychosocial forms of intervention such as music therapy in the provision of care for individuals diagnosed with dementia.
References
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