Fiona Tyrrell examines care provisions for a condition which affects 31,000 people in Ireland
The distressing and, at times, aggressive symptoms associated with senile dementia can be a major burden to care-givers and has the greatest negative impact on the care given to the estimated 31,000 people in Ireland suffering from some form of dementia.
Dementia is an umbrella term used to describe a collection of symptoms characterised by the loss of cognitive and social functioning and behavioural changes. It is caused by many different diseases of which by far the most common is Alzheimer's disease.
While to date medical research and treatments have focused on the cognitive problems associated with dementia, it is the associated behavioural symptoms, such as wandering, repetitive behaviours and aggression, that are known to have the greatest impact on the care of those diagnosed.
These and other behaviours continue to be a major source of burden to care-givers and are often identified as the main reason why family members place their relatives with dementia in nursing homes.
In the hospital setting, where all too often people with dementia are cared for in ordinary geriatric wards, these behaviours are also a source of stress for other patients.
Behavioural symptoms differ depending on the type of dementia. Some can be transitory and others can endure, some behaviours increase with the severity of the dementia and one behaviour may trigger another.
Behaviours such as hoarding or searching for lost items are more likely to occur early on in the illness. Others such as following people around and aggression are more likely to occur as dementia advances.
A comprehensive understanding of the person's personality before the dementia is fundamental to understanding the behavioural symptoms and to best practice in dementia care, according to Dr Suzanne Cahill, director of Dementia Services Information and Development Centre, St James's Hospital, Dublin.
Different conceptual models have been used to help understand and develop interventions to combat challenging behaviours associated with dementia.
The ABC model, which originally derived from rational emotive therapy and is now used by many professional care-givers, suggests that to better understand these behaviours we need to look at what went before the behaviour and consequences of the behaviour.
The key to success, according to this model, is to anticipate situations which might trigger the behaviour and avoid them by changing the situation or the environment.
A newer model aims to help professional and family care-givers understand and interpret these behaviours. This model, called the needs-driven behaviour model, is set within the nursing perspective and suggests that behavioural symptoms in dementia need to be understood against the backdrop of an individual's basic human needs.
In this model, the interaction of two sets of factors - background and current - drive behaviours.
Background factors include neurological, cognitive abilities, health and psycho-social history and are not that easily changed.
Current factors are less enduring and refer both to the person's social and physical environment and how the person feels - their physiological and psychological needs.
This model is useful because it shifts focus away from the more conventional view of behavioural symptoms of behaviour as being disruptive to a perspective and considers people's behaviours and possible indicators of need which, if responded to appropriately, will enhance quality of life, according to Cahill.
This model is also helpful as it builds on the definition of dementia as a disability and encourages us to look beyond the neurological condition of dementia to the environment and the psychosocial forces that impact daily on the lives of people diagnosed, she says.
There is no doubt that in Ireland we are behind much of Europe in terms of dementia services, according to Cahill. However, there has been a "huge movement" to do things right and progress is being made.
There are pockets of good practice and pockets of neglect and malpractice, she says. Increased financial input is badly needed for dementia services, she says.
There is also an increasing interest among healthcare practitioners to gain further knowledge about dementia. A recent survey of GPs' approaches to dementia, carried out by the Dementia Services Information and Development Centre, revealed that GPs experience difficulty diagnosing and disclosing a diagnosis of dementia to patients.
Only 19 per cent of those surveyed said they often or always disclosed a diagnosis to a patient. Some 90 per cent of GPs had never undergone any dementia-specific training and 83 per cent expressed a desire for training.
Once the Cinderella of the health service, geriatrics and particularly dementia care is benefiting from new thinking and changing attitudes, according to Cahill.
The Dementia Services Information and Development Centre will host its second national conference, What Needs to be Learned: Education in Dementia, in Dublin on December 2nd. The conference is open to all. Register by calling 01 4162035.