Dementia as a biopsychosocial condition Edelman 2000 describes

Dementia as a biopsychosocial condition

� Edelman (2000) describes biopsychosocial approach to health as an interplay between the following aspects of our life.

◦ Biological – which includes all aspects of the body such as the brain and nervous system; ◦ Psychological – which includes all aspects of individual experience and behaviour such as cognition and emotions; ◦ Social – which includes all aspects of society, such as family, the local community, public services and physical environment.

Other biopsychosocial approaches ◦ Integrity promoting care (Brane et al, 1989) ◦ Individualised care (Rader, 1995) ◦ The ‘best friends’ approach (Bell and Troxel, 1997) ◦ The relationship approach (Zgola, 1999) ◦ Person-focused care (Cheston and Bender, 2000) ◦ Emotion-orientated care (Finnema, 2000)

Brooker (2007) � Brooker presented an updated model of personcentred care. ◦ V - A value base that asserts the absolute value of all human lives regardless of age or cognitive ability. ◦ I - An individualised approach, recognising uniqueness ◦ P - Understanding the world from the perspective of the service user. ◦ S – Providing a social environment that supports psychological needs

V – valuing the person with dementia � Valuing people is not just for special occasions. � It means giving people with dementia equal access to specialist care an equal consideration for their social, emotional and physical needs. � It means avoiding all the ways in which people who are cognitively disabled and devalued in society. � It also means acting in ways that compensate for the difficulties of living with dementia.

Do your clients know that they are valued? � How do you show your clients that they are valued? � Is it easier to value some people than others? � Are there some features of your service that might give clients with dementia the feeling that they are not valued? � How not? do you find out whether clients feel valued or

I – treating people as individuals � What does it mean to treat each person as an individual? And what prevents us from doing this? � If you think about your own experiences of not being treated as an individual but as one of a crowd, sometimes we find this tolerable, and other times if makes us angry, hurt, irritated or despondent. � Most of us can endure being treated as one of the mass on a temporary basis but how would we feel if not being treated as an individual pervaded every aspect of our daily life?

P – understand the world from the perspective of the service user � Think about a time when you have been faced with a totally new situation, how did this feel? � Think of the experience of a person with dementia who might be faced with a new and challenging situation such as a new care setting or service. � This principle recognises that whilst we all have shared experiences of what it is like to live in a social world, each of us also has his or her own ‘version of reality’, or ‘frame of reference’.

P – understand the world from the perspective of the service user � Drawing on our own experiences, using our imagination and thinking creatively are important aspects of working with people who have dementia. � Trying to interpret what each person with dementia might be communication through his or her words and actions is vital if we are to propose responses that are genuinely person-centred.

Try to imagine how care practice looks through the eyes of your clients. � When a client says of does something that you don’t understand , do you consider explanations based on his or her life history, physical health, or psychological well-being? � Are there attempts in your workplace to respond to behavioural signs that a person is unhappy. In p ain, or angry about the way they are being treated? � Is the care regime changed to suit the individual?

Treating people as individuals � Think about the extent to which the clients of your service are treated as individuals � What prevents you from treating clients as individual?

S – maintaining a positive social environment � It is important we create a supportive social environment if needs are to be met and well-being maintained. � An understanding of life history is crucial when planning improvements to a person's social environment. This can help us see how to make alterations to better meet their needs for security and attachment, stimulation and occupation, social inclusion, comfort and identity. (Kitwood, 1997)

S – maintaining a positive social environment � This principle is about creating a social environment for each person that will enable them to maintain well being. � People with dementia are no different from the rest of us – relationships play a vital role in meeting their needs. � The losses of late life and life circumstances (which may have altered due to dementia) in combination with each person’s specific difficulties often disrupt vital relationships.

How well does the social environment meet needs? � Consider how well your clients needs are met by her (or his) social environment. For example, does the environment meet needs for ◦ ◦ ◦ friendships/relationships of trust conversation, intimacy and companionship a sense of belonging and having recognised social roles help with practical matters pleasant living circumstances a sense of hope and agency – of being able to ‘make things happen’?

References � Bell V and Troxel D (1997) The best friends approach to Alzheimer’s care. Baltimore: Health Professions Press. � Brane G, Karlsson I, Kihlgren M and Norberg A (1989) Integrity-promoting care of demented nursing home patients: Psychological and biochemical changes. International Journal of Geriatric Psychiatry, 4 (3) pp. 165 -172. � Brooker D (2007) Person-centred dementia care: making services better. London: Jessica Kingsley Publishers.

References � Cheston R and Bender M (2000) Understanding dementia: The man with the worried eyes. London: Jessica Kingsley � Edelman RJ (2000) Psychosocial aspects of the health care process. Essex: Prentice Hall. � Finnema E (2000) Emotion-orientated care in dementia: A psychosocial approach. Amsterdam: Vrife Universiteit. � Kitwood T (1997) Dementia reconsidered : The person comes first. Buckingham: Open University Press.

References � Radar J (1995) Individualised dementia care: Creative compassionate approaches. New York: Springer Publications � Zgola JM (1999) Care that works: A relationship approach to persons with dementia. Baltimore, MD: Johns Hopkins University Press.