Category: Dementia

Dementia is considered a general term for impairments in mostly remembering, moving, and thinking that serve as obstacles in a person’s everyday activity. However, the term is also strongly associated with the following problems: reasoning, problem-solving, attention, and communication. Furthermore, dementia is extended to numerous diseases with the most accurately identified symptoms. Overall, dementia outcomes stem from its negative influence on the body parts responsible for the damaged functions.

To begin with, the disease tends typically to affect older adults; however, it is not necessary identified in every more senior person. The rates of people with impairments are expected to soar in the following 40 years considerably, but today, “there is an estimated 5.0 million adults with dementia” (Centers for Disease Control and Prevention, 2019, para. 2). Furthermore, people are more likely to suffer from dementia due to their family history. An individual’s race is also crucial when estimating one’s chances of developing dementia, “Hispanics 1.5 times more likely to have dementia than whites” (Centers for Disease Control and Prevention, 2019, para. 12). In addition, negative habits like smoking might also play a pivotal role in provoking the disease as well as constant head injuries that affect the brain operations (Centers for Disease Control and Prevention, 2019). As a result, any type of this disease yields disadvantageous repercussions to the brain and, consequently, the human body on the whole.

As stated, every type of dementia is generally characterized by its impairment symptoms. For instance, Alzheimer’s disease is widely recognized by the problems with memory and walking that follow the development of this disease. In addition, it is considered one of the most common dementia types as it accounts “for 60 to 80 percent of cases” (Centers for Disease Control and Prevention, 2019, para. 24; Mahendra et al., 2018). Vascular dementia, on the contrary, is stronger associated with blood flow issues and is characterized by its “step-wise fashion, meaning symptoms will suddenly get worse as one gets more strokes” (Centers for Disease Control and Prevention, 2019, para. 25). However, dementia can also include problems with movement and balance, the same as the Lewy Body type of this disease (Centers for Disease Control and Prevention, 2019). To be more exact, this common type of dementia is also followed by “changes in alertness including daytime sleepiness, confusion, or staring spells” (Centers for Disease Control and Prevention, 2019, para. 25). Another critical point is that if an individual experiences numerous impairments in one’s brain functions, then it is possible for a person to experience mixed dementia, the combination of disease’ types.

Still, this condition might also negatively affect the behavioral aspect of a person’s brain and sometimes communication skills. Fronto-temporal dementia is also common among older adults as it is identified in more than 5% of the cases (Centers for Disease Control and Prevention, 2019). This type of disease is usually caused by the changes in the brain that provoke negative alternations in the behavior of an individual (Centers for Disease Control and Prevention, 2019). In other words, people who experience fronto-temporal dementia tend to behave ridiculously and sometimes embarrassing. Overall, the most common types of this disease are Alzheimer’s, vascular, and lewy body one.

Another critical point is that abnormal changes in the human brain cause any type of dementia. Consequently, the stated alternations trigger the decrease in a person’s skills and senses crucial for maintaining a comfortable everyday life (Alzheimer’s Association, 2021). Therefore, due to the person’s ethnicity or family history, one might experience the development of the disease and, consequently, its influence on one’s brain operation. Dementia yields numerous negative consequences to the human brain, such as decreasing numbers of neurons, destroying their networks (U.S. Department of Health and Human Services, 2021). Consequently, neuron’s weakening leads to the disruption of other processes related to the impairment of a specific disease type (U.S. Department of Health and Human Services, 2021). In addition, the negative influence on various areas of the brain develops into a decrease in social behavior. In other words, dementia usually is characterized by its ability to damage not one part of the human brain but others, not necessarily related to each other.

Furthermore, the person starts experiencing impairments in numerous functions due to the brain areas being damaged. As a result, because of such a harsh influence on an individual, one might lose “the ability to live and function independently” (U.S. Department of Health and Human Services, 2021, para. 14). Overall, dementia leads to the person’s death since one can no longer function along with problems in different functions necessary for everyday life.

To sum up, numerous types of dementia are widely identified by the kind of impaired functions. Furthermore, the influence of the disease is frequently fatal to an individual as one starts experiencing a decrease in numerous brain areas leading to the inability to live independently. In other words, dementia damages innumerable parts of the human brain, worsening a person’s skills, such as thinking, mowing, communicating, and remembering.

Introduction

Dementia was an illness which consisted of a group of symptoms characterized by reduction in memory, impairment in the reasoning skills and slow decline of skills required for daily living. Changes in the brain, both structural and biochemical, caused these illnesses. The condition was defined as “a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment” (WHO, 2007). Dementia was a disability which could occur at any age but affected mostly the elderly beyond 60 years.

The Aging, Demographics, and Memory Study (ADAMS) indicated that dementia in some form was found in 3.8 million of people in the US (Plassman, 2007). Older populations which were progressively becoming larger were bound to have more dementias (Shagam, 2009). Of the people older than 71years, the incidence was 14% of the population of 35 million. By 2030 the population was expected to double to 70 million. This would warrant the effective management of dementia for socioeconomic reasons (Anderson, 2007). Annual global costs of management of dementia reached to more than $315 billion (Shagam, 2009).

The US alone incurred costs of $100 billion (Worldwide cost, 2007). Despite all the efforts to provide care and the large amount of costs of treatment, the plight of the dementia patients was still not any better. The quality of life was something to be immediately put right. Dementia affected the family care-givers extending their stress in managing a job and caring for the dementia patient together. The intense pressures led to fatigue, depression and chronic illness.

The chances of care-givers dying earlier than people who were not care-givers were 63% greater (Schulz, 1999). A few varieties of dementia had been recognized. These included “Alzheimer’s disease, vascular dementia, fronto-temporal dementia and dementia with Lewy bodies” (Shagam, 2009). Primary care and community care were recommended (Congden, 2007). The hypothesis concerns how the quality of life of patients with dementia could be improved.

Statement of the problem

The memory loss, deficits in executive functioning and a lesser cognitive functioning caused the persons with dementia to lack competence and be unable to manage their affairs (Shagam, 2009). The quality of life they had in their aging days was miserable and demanded a drastic change. Dementia was neither preventable nor curable and could not be delayed. The sharp rise of the population with dementia had become a reality with shocking statistics.

The helplessness of these people had stimulated me to do something in favor of them. This study will be in search of methods to ensure that the aged with dementia were recognized sufficiently early, and provided ample opportunity to be cared for by the community, be it family members or professional carers or the community in the neighborhood so that the expected poor quality of life was reduced. The failure of diagnosis was never to be the reason that they went without assistance or care. Each patient had the right to live a good quality life just as others. Let us make them happy by caring for them as our own. This writer will be focusing on finding ways to improve the quality of life for the elderly with dementia through a search of relevant literature.

Prevalence

The prevalence of dementia in the US has been depicted in Chart 1 on the next page. It shows very obviously the prevalence in the older age groups (Plassman, 2007). The prevalence in the European countries was assessed from a population study in 1990, the EURODEM (Alzheimer’s disease International, 2008). According to Luengo Fernandez, UK has 820000 people with dementia (2010). The strategy for the US had been included in the Healthy People 2010 document and improved as the 2020 objectives. The goal of care for dementia was “to reduce the morbidity and costs associated with, and maintain or enhance the quality of life for, persons with dementia, including Alzheimer’s disease” (Dementias including Alzheimer’s disease, HealthyPeople.gov).

Background

The dementia patients had problems of memory loss and cognitive deficits. This section deals with the pathophysiology involved in dementias so that the reader understood the reasons for the illness. The different types of memory were affected in dementia. Memory was the ability to retrieve stored information. The amygdala and the hippocampus in the brain were directly involved with this function. Declarative and non-declarative types of long-term memory had been recognized (Shagam, 2009).

Storing the facts and retrieving them by conscious recall was termed declarative memory. The semantic memory and episodic memory were the divisions of declarative memory. The semantic memory helped a person to remember general facts and knowledge. Episodic memory assisted in remembering personally witnessed events or experiences. The implicit or non-declarative memory referred to the ability to do things from the experience of learning. These various memories were built into our system without us thinking about them (Shagam, 2009). Working memory was the ability to recall information recently learned like phone numbers and addresses. Remote memory brought back memories of the time long gone by.

The older people who had degenerating nervous systems soon lost these normal functions that facilitated the wonder of memory. What these patients were previously doing well was now forgotten due to the degenerating brain cells recognized as atrophy in imaging records. The fumbling and uncertainty, memory lapses, inability to remember their daily activities and asking the same questions repeatedly were all features of dementia (Memory loss with aging, AAFP).

Alzheimer’s dementia had slightly differing features. The Alzheimer’s was the world’s sixth leading cause of death (Alzheimer’s Association, 2011). This dementia showed decline in the language and defective decision-making abilities. The inability to retrace hidden objects was a typical feature. Soon incontinence of the GIT and Urinary systems made the life of the patient terrible. Their total dependence on carers was inevitable.

Vascular dementia came next in prevalence (Shagam, 2009). The fronto-temporal dementia occurred because the degeneration was focused in that region. Dementia with Lewy bodies had hallucinations, and delusions, sleep alterations and disturbances in the heart rate and digestion. The Lewy bodies were aggregates of alpha-synuclein, ubiquitin alpha B-crystallin and neurofilament proteins (Shagam, 2009).

Diagnosis

Evaluation in the primary care settings was necessary to reach out to and recognize many dementia patients. Treatment challenges were influenced by staff being unable to identify symptoms. The limited time for detailed examination was a problem. Patients did not complain due to the concept that management was not available for dementias including Alzheimer’s. Cognitive assessment could be enabled by the Mini Mental State Examination (Shagam, 2009).

The perceptions of staff at a primary care center to issues concerning dementia

Harris et al had a randomized controlled trial whereby the perceptions of primary care providers on different aspects of care for cardiovascular disease, diabetes mellitus and dementia were compared (2009). It was found that care providers believed that it was difficult to manage dementia when compared to the other two. Similarly they thought that it was hard to improve the quality of life of patients with dementia.

Routine screening was done for dementia almost as often as for the other two illnesses. Referral was common with diabetes and heart disease but rare for dementia. Effortless care coordination was also not possible for dementia as it was an illness which had a variety of symptoms requiring individualized care. Primary care management of dementia was to focus on referral resources, reduce the difficulty of provision of care and consider the perceptions of the providers for quality-of-life improvement (Harris et al, 2009). Primary care providers could be the earliest people who diagnosed the patients with dementia.

Thought the study results showed that dementia patients were almost neglected by these care providers. The reason could be their ignorance or their lack of time or their feeling that dementia did not merit a reference as it was not treatable. Sufficient training of primary care providers and precise policies for implementation could change the attitude towards dementia. The clustered chart in the next page has been drawn from the study results of Harris et al (2009).

Aggressiveness in dementia

Moniz-Cook and Clarke (2011) had addressed aggressiveness that was found to create chaos in nursing homes. They perceived that 6.9-30% of behavioral problems in nursing homes were accounted for by aggression, one challenging behavior in dementia. Challenging behaviors was a subjective term which explained the responses of the patient of being unreasonable or intense (Keady and Jones, 2010). They were formed from experiences and beliefs.

Aggression, a manifestation of psychosis, was to be treated with antipsychotic drugs for 2 weeks. The internal environmental factors like worry, fear, pain due to some health condition and discomfort were triggers for aggression. External factors included excessive anxiety, incessant conversation and busy episodes in life (Moniz-Cook and Clarke, 2011). Insufficient spaces, the reverberating noise, heat and cold were the accommodation factors which sparked off aggression. One-third of patients did not exhibit aggressiveness. The duration of treatment with antipsychotics was to be determined after weighing the pros and cons of the side effects, the cognitive reduction and death. In general the poor quality of life was evident when the drugs were used (Ballard et al, 2009b). The institution of enhanced psychosocial care could reduce the use of drugs (Fossey et al, 2006).

The causes could be due to distress stimulated by unmet needs which could be physiological, psychological or social. The deficit in the mechanisms for self-control found in frontal lesions could increase the risk of aggression. Hallucinations could trigger aggression (Leonard et al, 2006). Individualized care was recommended. The lack of interpersonal relationship lay behind the aggression which was mostly aimed at the staff. Coping mechanisms which reduced aggressive resistance needed to be chosen (Moniz-Cook and Clarke, 2011).

Classification

The stages of the dementia decided how much to intervene. A patient-centered approach could reveal the behavior behind the person. Subsequently interventions could be devised. Three stages were recognized in dementia (Keady and Jones, 2010). Impaired performance marked the first mild stage but the patient had not reached the stage of helplessness. Complicated tasks or leisure activities could not be performed. The moderate stage showed a further cognitive decline and the patient needed help to execute his daily activities like shopping and handling of money. Increasing restriction of activities was observed. The severe stage saw the patient without intelligible ideation (Keady and Jones, 2010).

Interventions

Several interventions which had worked with dementia included “reminiscence therapy, reality orientation, aromatherapy, music therapy and multi-sensory stimulation” (Keady and Jones, 2010). Problematic behavior was decreased through three interventions as described by James et al (2008). However these therapies had not considered the causes of dementia while being used (Keady and Jones, 2010). Unmet needs were the significant causes as they included all the factors mentioned under aggression (above). The disease could begin due to the patient attempting to satisfy his unmet needs. Interventions were modified to the requirements of the individual (Keady and Jones, 2010). The final “destination” was the improvement in the quality of life and elimination of suffering.

Care Plans

Keady and Jones indicated that an individualized care plan for their case study produced good results by one month (2010). Challenging behaviors of aggression and agitation had decreased. The patient was happier and contented. Then he was provided a patient-centered care with appropriate support. He also became more receptive of therapeutic interventions (Keady and Jones, 2010). The individualized care plan had succeeded in toning down the challenging behaviors and rendering the patient more amenable to suitable therapeutic interventions. Improvement of quality of life inevitably happened with the change in personality of the patient.

Management of daily living

Dementia patients who were living at home with their families or group homes or nursing homes preferred to be included in decision-making about their care. These people subsequently had improved well-being and positive demeanor (Oliver et al, 2010). Carers also believed in sharing the decisions on care with the patients. However communication problems and cognitive deficits hampered the involvement. A Talking Mats framework which was suggested by Murphy et al in 2007 indicated a bigger involvement of patients and families than when discussion through mere conversation was implemented (Oliver et al, 2010).

Picture symbols placed on textured mats were used for expression of views by people with communication difficulties. Some cards were picture-free to add the views of the patients. Oliver’s research using the Talking Mats reported some beneficial results. The participants including the patients and the families were perceived to be more involved with decision-making than through conversations (Oliver et al, 2010). Photographs of the experiment and specifically of the finished mats were taken to study them further. Notes were written in detail too. The dementia patients could manage personal care except for washing, dressing and taking of medicines in which functions they needed daily help (Oliver et al, 2010).

Dementia-friendly neighborhood

The only research exploring the interventions for dementia in the neighborhood was that of Mitchell and Burton (2010). The design for dementia-friendly neighborhoods required the surroundings to be familiar. Spatial disorientation, confusion and anxiety were not to subject the patient to difficulties. Legibility of the signs for different designated buildings was to be ensured. Accessibility was a must. The people in the community needed to enjoy the surroundings. Safety while moving around was significant; harm was not to occur. The primary services were to be incorporated within 500m. of the house and secondary services within 800 m. (Mitchell and Burton, 2010). The services of physicians and psychiatrists were to be arranged within this community.

The Biopsychosocial model

The biopsychosocial model was perceived to be an integrated method of consideration of health and illness (Cwikel, 2006). The components of the sociological, psychological and biomedical models had been incorporated. Four lines of thought were included in this. The formistic thinking divided people into ‘cases’ and ‘not cases’ categories. Mechanistic thinking dwelled on the causes for a particular result. The contextual thinking was also called relational thinking. It related an organism to the illness. However the patient was to be focused upon in dementia. Organic thinking spoke about the interaction between many causes which then progressed into many phenomena.

The Biopsychosocial model incorporated the contextual and organic forms of thinking (Cwikel, 2006). It was an interaction of complex proportions of the factors relating to the “environmental, psychological, sociological and cultural” entities (Cwikel, 2006). This model suited the present study of dementia. Dementia had many causes which were “biological, behavioral, psychological, cultural, social and genetic” (Cwikel, 2006). The same causes could produce different extents of dementia.

A mind-body unity was obvious in dementia. The mental problems involved emotional, physiological, biological and physical aspects. Treatment was not the intention of the study. Mere maintenance of health was aimed at. A multidisciplinary approach could be the best here (Cwikel, 2006). Psychosocial issues were significant in dementia studies: the patients would be finding ways to assume the role of a healthy person. For these reasons, the biopsychosocial model was found to be the best to study dementia. This model helped in understanding the external and internal influences of the individual (Sperry, 2008). Engels (1977) was the father of this model.

The biological issues, psychological issues and the sociological issues were to be considered equally to study a person or illness. The biological functioning referred to the subcortical systems of the neuroendocrine, autonomic and central nervous systems (Sperry, 2008). The psychological functioning pertained to the cortical and self-conscious internal system. This included the processing of information and communications. The personal feelings, goals and aspirations came under this system. The social functioning and relationship with family, friends, neighbors and community were regarded under the sociological functioning (Sperry, 2008).

The picture on the next page depicting the biopsychosocial model could be interpreted thus. A number of stressors could induce illness. These stressors along with coping efficacy and the neuroendocrine function status determined an episode of illness. If the coping mechanism was poor and the neuroendocrine system was of low function, the illness resulted. Brain pathways and effects like pleasure could be poorly buffered from influences of the external environment. When a huge stressor occurred, the interpretation of the patient could be that he could soon be experiencing a similar stressful episode of earlier times like a separation or bereavement. The patient escaped the after-effects of the huge stressor if his coping mechanism and social supports were adequate (Sperry, 2008).

Individual Psychology model

Individual Psychology was a new development of the biopsychosocial model (Sperry, 2008). In addition to the functions of the biopsychosocial model, this new addition had integrated the holistic functioning.

Biopsychosocial models would soon become a natural part of psychotherapeutic research and treatment protocols. The Individual Psychology model which was an improvement on the biopsychosocial model also would be adapted. The addition of the holistic care added to its value.

Quality of Life Assessment through the biopsychosocial model

Better health care revolves around what quality of life means to the patients (Debb and Blitz, 2010). Dementia patients would have many requirements when they become helpless as they progress from the mild to the severe stages. The biopsychosocial theory analyzed the three aspects of dementia: the biological, psychological and the sociological aspects. The information obtained would be sufficiently vast to identify the patient’s health status including the illnesses or drawbacks he suffered from. The factors analyzed could be the determinants of quality of life like personal attitudes and beliefs. The sociopolitical factors could be “community influence and education” (Faleiros and Machado, 2006).

This model was more “multimodal, symptom-focused, problem solving-oriented, and aids in the development of specific treatment goals based on the individual” (Sperry, 1988, 1999 in Debb and Blitz, 2010). Discovering organ deficiency was another strong advantage of the biopsychosocial model. The clinician understood the illnesses that his patient had apart from the dementia and this model ensured that he did not miss this diagnosis. Investigating the biological deficiencies could help to co-relate them to the environmental stressors.

The presence of several stressors caused psychopathology and the appearance of many new illnesses (Adler, 1927 in Debb and Blitz, 2010). The life tasks of the patient would be affected. The inferiority complex could act as a motivating factor for good and bad results. The behavior of the patient was found altered as a mechanism to face stress. The exploration of the quality of life from a holistic viewpoint could provide the clinician with plenty of information. The systems theory underlies the biopsychosocial model (Debb and Blitz, 2010).

The hypotheses generated were:

1. The quality of life of the dementia patient improved with the individualized plan of care.
2. The quality of life of the dementia patient improved through the competence of the primary care providers
3. The quality of life of the dementia patent improved with the change in perceptions of the primary care providers
4. The quality of life of the dementia patient improved through the use of the biopsychosocial model.
5. The quality of life of the dementia patient improved with the use of the Individual Psychology model.
6. The quality of life of the dementia patient improved with a dementia-friendly neighborhood.
7. The quality of life of the dementia patient with aggression improved through the major use of the psychosocial therapy and lesser drug therapy.

Conclusion

Dementia was an illness which consisted of a group of symptoms characterized by reduction in memory, impairment in the reasoning skills and slow decline of skills required for daily living. It was a disability which could occur at any age but affected mostly the elderly beyond 60 years. Statistics say that 3.8 million of people in the US had dementia (Plassman, 2007). Of the people older than 71years, the incidence was 14% of the population of 35 million. Annual global costs of management of dementia reached to more than $315 billion (Shagam, 2009). The memory loss, deficits in executive functioning and a lesser cognitive functioning reduced the quality of life in the aging days (Shagam, 2009).

Each patient had the right to live a good quality life just like others. Among the many perceptions of primary care providers one significant point was that they thought that it was hard to improve the quality of life of patients with dementia (Harris et al, 2009). They also believed that care coordination could not be provided for dementia like it was done for diabetes and heart disease. Primary care management of dementia was to focus on referral resources, reduce the difficulty of provision of care and consider the perceptions of the providers for quality-of-life improvement (Harris et al, 2009).

Sufficient training of primary care providers and precise policies for implementation could change the attitude towards dementia and make diagnoses after screening. Challenging behaviors referred to the responses of the patient of being unreasonable or intense that could be managed through coping mechanisms in the form of individualized care (Moniz-Cook and Clarke, 2011). The care plans had to be altered as required for each stage of dementia. Therapeutic intervention had to be adjusted according to the unmet needs of the patient which were the significant causes (Keady and Jones, 2010).

Keady and Jones indicated that an individualized care plan for their case study produced good results by one month (2010). The patient was happier and more willing to accept new therapies by one month. The individualized care plan had succeeded in toning down the challenging behaviors and rendering the patient more amenable to suitable therapeutic interventions. Improvement of quality of life inevitably happened with the change in personality of the patient. In Oliver’s study, the participants including the patients and the families were perceived to be more involved with decision making using the Talking Mats concept than through conversations (Oliver et al, 2010).

Dementia patients who were living at home with their families or group homes or nursing homes preferred to be included in decision-making about their care. Their outcomes turned out to be better. The designing of a dementia-friendly neighborhood enabled the involvement of the neighboring community in the dementia caring. This neighborhood also allowed the dementia patients to move out of their homes for their daily activities as long as they could (Oliver et al, 2010).

Accessibility to primary and secondary services within 800 m. of their home and the ensuring of safety enabled the patients with dementia to live a more satisfying life in the midst of all that was required for managing themselves. When they became helpless, community care was to be arranged for them. The availability of clinicians for their approach could be arranged. The biopsychosocial model was a good model for assessing the unmet needs of the dementia patients and then instituting appropriate therapeutic interventions as it unearthed evidences of the biological, psychological and sociological aspects of the dementia. Therapy would be more complete due to the several causes elicited.

Individual psychology was an improvement on the biopsychosocial model by adding the holistic concept. The factors analyzed included the determinants of quality of life like personal attitudes and beliefs (Debb and Blitz, 2010). Discovering organ deficiency was another strong advantage of the biopsychosocial model. The presence of several stressors and the co-relations could be studied and the reason for the patients converting to psychopathology could be better understood.

The exploration of the quality of life from a holistic viewpoint could provide the clinician with plenty of information (Debb and Blitz, 2010). This search through literature enabled me to confirm that the quality of life of dementia patients could be improved through individualized care plans, the use of the biopsychosocial model and its extension Individual psychology for investigation of dementia and the dementia-friendly neighborhood. Primary care providers were the people who would screen the patients and provide therapy or refer the patients as necessary. The search through the literature had unearthed plenty of ways that made my study worthwhile.

Definition of Dementia and Personal Experience

Dementia is not, despite widespread belief otherwise, a specific illness. Instead, Dementia is a term used to collectively describe a wide range of conditions that lead to cognitive decline, memory impairment, and other brain disorders [1]. The most prevalent form of Dementia is Alzheimer’s Disease, which is a debilitating illness characterized by progressive and catastrophic deterioration of certain parts of the brain and, resultantly, a decline in cognitive and physical function. Alzheimer’s is the fifth leading cause of death among elderly adults, as it is seldom seen before the age of 50, with 90 percent of all cases occurring after the age of 65 [2]. However, while the likelihood of Dementia is exacerbated by age, it is not a normal part of the aging process.

Having my father diagnosed with Dementia, and specifically, Alzheimer’s Disease was disheartening. It came as a shock, not only to me but also to the entire family and friends groups. He was quite healthy for his age, with a regular schedule of exercise and meticulous in every single detail. Some months before his diagnosis, he had been exhibiting mild forgetfulness, which everybody attributed to the normal aging process. However, it gradually worsened, and he started losing his spatial awareness, confusion, lacked the initiative to exercise, and also problems handling change and basic everyday arithmetic. These conditions were also exacerbated by mood swings and aggression, which we, as his family, attributed to frustration. In context, he was an army veteran and fiercely proud and independent. However, over time, it became increasingly apparent that these may have been symptoms of an underlying condition, and he was taken for review. The diagnosis came back as Alzheimer’s Disease. The deterioration of his cognitive and physical function was devastating to the family unit as a whole. My father became increasingly dependent, and it was frustrating for himself as much as us.

The Movement from Cure to Care: How the Psycho-Social Dimensions Impact Those Living with Dementia

The psychological and social dimensions of Dementia are as devastating as the physiological effects of the disease. The psychological impact would exhibit right before the diagnosis, during the onset of initial symptoms. A person losing his autonomy, memory, and other cognitive abilities will often feel frustrated, anxious, and apprehensive. Reactions to the diagnosis are also highly varied on an individual basis, but the psychological impact cannot be ignored. Some of the more aggressive forms of Dementia, such as Alzheimer’s Disease, are often interpreted by people as a death sentence. Therefore, reactions to the diagnosis may include grief, apathy, anger, frustration, loss, shock, irritability, disbelief, aggression, and fear in the short term. In the long-term, absent proper support may evolve into depression and anxiety.

However, the psychological and social impacts of Dementia are not solely confined to the afflicted individual but spill over to their support structure, including family members, friends, and caregivers. The reaction to diagnosis may be very similar between the patient and their support system. It is, therefore, paramount that those diagnosed with Dementia, along with the people around them, are given adequate avenues to express their emotions and relay their fears. It is estimated that adverse psychological reactions to Dementia, termed as the Behavioral and Psychological Symptoms of Dementia (BPSD), affect up to 90 percent of Dementia subjects and their caregivers [3]. Further, while it has not been adequately delineated, BPSD may contribute to poor outcomes in the treatment and care [3].

The social impact of Dementia is profound in the lives of the patient themselves, as well as spouses, caregivers, partners, families, and friends. The ailment impacts the lives of millions who, in some way or form, provide support for people living with Dementia, whether that be in helping with charities and shopping, to providing 24hour care. The progressive cognitive impairment of a person living with Dementia inevitably results in a reduced ability to communicate coherently or undertake mundane daily tasks. BPSD can also be challenging to respond to accordingly. Therefore, the social impacts of Dementia may include the reduction of loss of employment, impairment of relationships, loss of time with family, friends, and social activities, social isolation, and the need to relocate to provide care. Further, while Dementia is more openly discussed in contemporary media, there remains little evidence as to whether the anecdotal assumptions about dementia patients have been reduced, which may lead to discrimination of patients and caregivers.

Treatment Differences in Urban and Rural Areas

There are extensive studies conducted relating to rural health disparities, especially in regards to mental health and access to care. The consensus is that patients diagnosed with Dementia living in rural areas are more likely to receive suboptimal care [4]. This is underlined by the fact that mortality attributed to Dementia in rural areas exceeded that of metropolitan areas by 11 percent between 2005 and 2009, given that there is no effective disease-modifying or preventative strategies against Dementia [4]. However, these figures may be disproportionately inaccurate, as rural populations comprise higher proportions of older adults, and may consequently be more susceptible to diseases of old age.

However, it is essential to understand the rural-health disparities, if any exist, in the diagnosis and health care delivery of Dementia patients. Prevalent studies outline that there is lesser uptake of government health insurance initiatives, such as Medicare and Medicaid, in rural areas as compared to urban areas in the US [4]. Resultantly, there exists more underdiagnosis of Dementia in these regions, with the diagnostic prevalent being 11 percent lower in rural counties [4]. Rural dementia patients may also face barriers to efficient ambulatory care and further experience unnecessary hospitalizations [4]. Therefore, even with a correct dementia diagnosis, individuals in rural areas may receive comparatively suboptimal healthcare delivery. Early diagnosis of Dementia also allows the opportunity for symptomatic treatments, as there is no proven disease-modifying treatment, participation in clinical treatment trials, the creation of long-term care plans, and sufficient estate planning. Therefore, the underdiagnosis prevalent in rural areas is an inherent compromise to follow-up intervention.

Why multi-discipline rehabilitation is not typically offered

Ideally, the diagnosis, treatment, and support of patients with Dementia should be handled through a multidisciplinary structure that facilitates psychological support alongside the nurses, doctors, and caregivers. This psychological support should be availed not only for the patient but for the caregivers as well. Psychologists can also contribute to the training and of social care and health staff to support dementia patients, along with their family caregivers. Given the nature of Dementia and the lack of a disease-altering medication, many of the multi-discipline interventions are non-pharmacological. They may include primarily exercise and motor rehabilitation, occupational therapy, intervention for BPSD, complementary and alternative medicine, psychological therapy, and assistive technology and domotics.

However, these multidisciplinary interventions are rarely suggested and offered to dementia patients and family caregivers for various reasons. A significant reason is an economic and social impact of implementing these interventions, absent a reliable disease-altering medication. Therefore, this non-pharmacological therapy would be prescribed and tailored for each dementia patient, with a consistent review for progress and alterations over a relatively long period. This economic burden heavily deters the recommendation of multidisciplinary approaches to Dementia rehabilitation and treatment.

On the other hand, supporting evidence for most of the multidisciplinary, non-pharmacological interventions is still preliminary. Some studies do outline the statistical significance of some non-pharmacological therapy outcomes, but the clinical relevance of these interventions is still widely uncertain. As a result, well-designed, and closely monitored randomized control trials, implementing innovative and cutting-edge designs are necessary to ascertain the efficacy of the multi-discipline interventions on patients with Dementia. These tests may be unviable to many rural areas, significantly limiting their scope as well. Also, further review is required to provide robust neurobiological reasoning for the application of these interventions, and also ascertain a viable cost-efficacy profile to dementia patients. It is, consequently, perhaps too early in the adoption of the multidisciplinary approach to be widely advocated for and offered.

Conclusively, while Dementia remains a significant burden to patients and caregivers alike, the psychological and social effects of the disease will continue to be relatively profound until ideally such a time when a disease-altering medication regimen can be successfully invented and tested. In the meanwhile, further clinical testing to assess the efficacy, and cost profile of a multidisciplinary, non-pharmacological approach is highly warranted to preferably alleviate some of the burden of the disease in the future. Until then, the interdisciplinary approach remains unviable for a majority of the population, including disproportionately affected rural communities.

Background

Alzheimer disease is one of the major debilitating brain diseases whose effects are loss of memory and important mental functions among patients, a consideration which impacts on their social skills, ability to think and make judgment. Crooks et al. (2008) indicate that this form of dementia has varied ways of developing on different people. As such, it is imperative to develop a clear understanding of the dementia of Alzheimer in terms of its meaning, causative factors, treatment and management. These are some of the aspects explored in this paper.

Alzheimer’s disease

Moretti et al. (2008) in their article Different responses to rivastigmine in subcortical vascular dementia and multi-infarct dementia define Alzheimer disease as a progressive brain disorder that slowly and irreversibly destroy important mental functions leading to inability of patients to carry out their daily activities. It also leads to memory loss. It is a disease that derived its name from Doctor Alois Alzheimer (1960) who first noticed an unusual mental illness on a woman who showed massive progressive changes in her brain tissues (Jakobsson et al., 2008).Besides, the disease manifested its symptoms in varied unpredictable behaviors, language problems and memory. Research revealed that the examination of her brain following her death revealed many neurofibrillary tangles and amyloid plaques which then become the main features of the disease (Jakobsson et al., 2008).

Age of onset and causes

Studies indicate that Alzheimer disease (AD) begins when an individual is past the age of 60 years (Moretti et al., 2008). According to Moretti et al. (2008), this may begin earlier or can be from 60 years with a majority of case being at 65 years and above. It is worth mentioning that referring to the age of 60 years and above does not quite indicate that the disease is for the old aged people. Relevant research shows that there is a younger on-set of the disease that when an individual is at the age of 40 or even 50 years (Moretti et al., 2008). In fact, the latter authors cite that early-onset of Alzheimer among individuals of ages between 30 and 50 years accounts for about 5% of the total AD burden.

The cause of the disease still remains unclear. However, studies show that the disease starts earlier in life as the brain is believed to begin to impair a decade before the exact symptoms show. Crooks et al (2008) indicate that toxic changes in the brain start earlier on in what is referred to as the preclinical stage due to the tau tangles and the amyloid plagues being deposited in the brain. The effect of the deposits is that it causes inefficiency of the healthy neurons. Loss of communication occurs and eventual damage of the hippocampus responsible for the formation of memories.

Besides, another believed cause of Alzheimer is genetics. Johnson and Stahl-Moncada (2008) indicate that changes in parental inherited genes (the autosomal dominant) may cause familial AD among individuals of the ages between 30 and 60 years. Johnson and Stahl-Moncada further note that senile plaques 42 protein is formed when mutational changes occur in the genes. This also has been determined among individuals with a late onset of the disease in relation to the apolipoprotein E (APOE) gene which occurs in the form of APOE ε4 allele. These may cause the disease.

The reduction of the neurotransmitter acetylchloline has been thought to be another cause of Alzheimer disease (Jakobsson et al., 2008). The cholinergic hypothesis though under investigation is based on medical therapies. Besides, it also indicates that the aggregation of amyloid in large scale may be a major cause of neuro-inflammations. Johnson and Stahl-Moncada (2008) are quite categorical that quite a n umber of hypotheses can be drawn from the aforementioned piece of literature

Crooks et al (2008) indicate that environmental and lifestyle patterns contribute to the development of AD. There are several factors that have been elaborated in the latter piece of literature that have been elaborated in the latter piece of literature. Examples include hypertension and overweight. Crooks et al. also cite that lack of activities like mental stimulation, social engagement, physical exercise as well as a nutritious diet may lead to the disease.

Signs and symptoms of Alzheimer

There are numerous warning signs that research has attributed to the development of AD. One of the signs is memory problems (Jakobsson et al., 2008). This, as indicated earlier, reflects a state of cognitive loss. A mild cognitive impairment may lead another sign which is the inability to perform normal daily activities. Other signs to watch out for include impaired judgment, diminished reasoning, spatial and vision problems and a decline in the ability to find words. The aforementioned signs may appear earlier stages of AD development. In some cases, Laforest et al. (2008) indicate that certain warning signs may reveal the development and progress of the AD. Such include inability to read or write, an individual not being able to recognize member of family, wandering off and getting lost and the tendency of being aggressive and anxious.

Stages

The AD occurs in three main stages namely the mild, moderate and severe Alzheimer stages (Laforest et al., 2008).Usually; symptoms are often visible when the process enters the middle level stage. As the AD progresses, an individual may begin to show poor judgment, inability to handle money, pay bills, and perform daily tasks. It is in this stage individuals get diagnosed (Jakobsson et al., 2008).

The second stage is the moderate stage. This stage is usually associated with myriads of activities in the brain (Jakobsson et al., 2008). Individuals in this stage may be unable to handle situations, dress on their own, and even recognize family and friends.

The final stage of severe AD as the name suggests puts an individual to the near end of life as most functions of his/her brain shuts down (Jakobsson et al., 2008). In this stage, the brain of an individual is fully plagued by tangles and plaques. Such a person may not be able to communicate and is left under the care of family or caregivers. This has posed an additional healthcare burden to both the care givers and close members of the family.

Risk factors

Johnson and Stahl-Moncada (2008) indicate that the main risk factor of the AD is advancing age. After the age of 60 years, reports indicate that with in every 5 years that follow, the chances of developing AD doubles with women being at risk than men. Besides, another risk factor is lifestyle practice and health factors like smoking, diabetes and hypertensions. These are believed to be the cause of the late onset of AD. Other risk factors include genetic factors of theAPOE4 and APOEε4 allele inheritance (Johnson & Stahl-Moncada, 2008).

Diagnostic criteria assessments and interventions

As indicated earlier, AD has no particular cure. Therefore, its diagnosis has largely been pegged to DSM-IV that calls for subjection of a patient to one month assessment and depiction of at least two symptoms, checking family history and running clinical trials. While this is not very effective, Laforest et al. (2008) note that diagnosis of AD can only be done after the death of an individual to examine brain tissue. When done earlier, it may aid in determining the causes and possible treatments. Even so, while there is no cure to the irreversible brain damage of AD, an early determination may help in making arrangement regarding finances, living arrangement, hiring caregivers and legal matters.

Based on crisis theory, the need to address the major problem of AD requires setting up key measures. The theory holds that for crises to occur, an individual will have tried to address the situation he is undergoing through without success that culminates to emotional blockage (Jakobsson et al., 2008). Therefore, this method entails bringing the victim to comprehending the problem and facilitating the correct coping skills. Besides, the process further involves enhancing the ability to employ alternative mechanisms in addressing various problems that encounters them at different times. From the above discussion, it can also be deduced that appropriate measures ought to be put in place in order to effectively deal with the devastating effects of AD. Moreover, additional research study can be undertaken so as to establish other variants of AD that are yet to be discovered.

More and more people have been diagnosed to have dementia. These people need special care that may be provided by their relatives or specially trained caregivers. It has been observed that women with dementia who have daughters are usually cared for by them. Catherine Ward-Griffin, Nancy Bol, and Abram Oudshoorn’s research is devoted to the mother-daughter relationships and the perspectives of women who receive care from their adult daughters.

Sometimes, it is better for women when they are cared for by their daughters. This care is more effective than the formal one (Ward-Griffin, Hall, DeForge, St-Amant, McWilliam, Oudshoorn, Forbes, & Klosek, 2011). Nevertheless, there are some difficulties in such relationships. Mothers sometimes feel that they make the life of their daughters more difficult. They do not want their daughters to devote so much time to them and they start feeling guilty before them. Mothers with dementia may consider themselves to be unnecessary or even a burden for their daughters’ lives.

The types of care, as well as the types of caregiver-patient relationships, may be different. The care provided by the daughters may be determining, undemanding or accepting. As for the types of daughter-mother relationships, they also may be different. Custodial, combative, cooperative, and cohesive relationships are differentiated in the research (Ward-Griffin, Oudshoorn, Clark, & Bol, 2007). Cohesive and combative relationships are based on emotions while cooperative and custodial are task-oriented. More than that, there are a lot of other factors predetermining these relationships such as the level of support provided by the daughters and mothers’ expectations from their daughters. Sometimes mothers demand more than their daughters may offer or the daughters provide more support than their mothers expect from them (Forbat, 2003). Both these situations may have negative consequences. In the first case, mothers with dementia may feel unnecessary and neglected by their daughters and they judge their daughters for paying less attention than they could pay. In this case, daughters understand that their mothers except more than they can provide and they feel upset. These conditions make their relationships worse and as a result daughters seek at finding a professional caregiver to improve the level of support but the reaction of their mothers may also be different to such a new ball game. The mothers with dementia may think that their daughters want to get rid of them. In the second situation when the level of support is higher than mothers expect it to be they feel guilt in this case. They persuade their daughters to devote much time to their own lives and refer to the services of formal caregivers to make their life easier. Sometimes it is quite difficult to find the decision of these problems as far as the women with dementia are unpredictable in their behavior and emotions. It should be noted that in some cases professional help is necessary. Nevertheless, not every family with women with dementia may afford to pay for these professional services (Brindley, 2011). It is one more problem of modern society. Women with dementia need social help from the government. These services should be free of charge.

From the above said, we may conclude that it is a widespread phenomenon when daughters take care of their mothers with dementia. Factually this care has a positive effect in most cases but there are some difficulties posed before daughters. One of the main drawbacks of such relationships may be the unprofessional care provided by daughters. Women with dementia should be provided special care by people who have been specially trained and skilled.

Alzheimer’s Disease (AD) and Vascular Cognitive Impairment and Dementia (VCID) are the two most common types of dementia (Cunningham et al., 2015). Dementia also termed Major Neurocognitive Disorder in DSM-5 is an abnormal aging phenomenon and mostly develops later in life. The progressive deterioration of brain functioning is irreversible medical treatments could only slow down the problem. During initial and moderate stages, cognitive symptoms include prospective memory and visuospatial skills impairments, agnosia, as well as difficulties with planning, organization, reasoning, language, sequencing, and abstract information. On the other hand, behavioral symptoms are usually impulsive, including aggression, apathy, agitation, and sundowner syndrome. Patients also experience delusions, changes in mood such as depression and anxiety, different personality, and negative impact on social and occupational functioning. During the late stage, patients’ quality of life is poor. They are unable to move around, communicate, eat, or take care of themselves. Day-to-day activities needed to be entirely supported by family or others. There is also an increased risk of early death due to inactivity and the onset of other illnesses.

Nonetheless, in recent years, the rapid growth of literature suggests that physical exercise, especially aerobic type, is effective in coping with dementia patients’ conditions. The following would discuss and analyze the beneficial effects of physical exercise on dementia patients.

Brain Function

The health of the gray matter and white matter is essential for coping with dementia. The gray matter contains most brain neuron cell bodies, and it is a region responsible for muscle control and sensory perception including vision, hearing, memory, emotions, self-control, speech, and decision making. Studies have found that a group of senior participants recorded larger hippocampal volumes after one year of aerobic exercise, compared with the control group that does only stretching and toning (Ahlskog et al., 2011). In other words, seniors’ brain gray matter volumes could be decreased slower or maintained in size with regular physical exercises.

Except for gray matter, white matter is also damaged in VCID patients which negatively affects information processing (Trigiani & Hamel, 2017). White matter fibers in AD patients also have increased microstructural damage with a strong correlation with low cerebral blood flow. Blood flow in white matter is naturally low and contains less metabolic reserve. Based on research findings, physical exercise enhances the connectivity of white matter (Hayes, Salat, Forman, Sperling, & Verfaellie, 2015). It improves global cerebral blood flow, increases proteins that are responsible for neuronal differentiation and axonal growth, and it also escalates the number of endothelial glucose transporter 1 receptors which deliver glucose to oligodendrocytes where the myelin sheath is produced. Besides, moderate physical exercise increases brain perfusion as research showed there was an improved executive function by using the Stroop test (Lucas et al., 2012). Therefore, physical exercise counteracts the loss of white matter integrity and potentially influences cognition.

Moreover, physical exercise improves the spatial memory of dementia patients by stimulating neuroplasticity mechanisms. Aging rats were used in a study (Vilela et al., 2016). The Aging Wistar rats performed aerobic or strength training for 50 min 3 to 4 days per week and lasts for 8 weeks. After the physical exercise, there was improved cognition in a spatial memory task due to a higher level of synaptic plasticity proteins within the hippocampus. The hippocampus is responsible for memory and progressively degenerates in AD patients. Therefore, physical exercise is crucial for memory improvement in dementia patients.

Furthermore, physical exercise reduces oxidative stress as it is one of the causes of dementia. Studies revealed that there is an inverted U-shape relationship between physical exercise and oxidative stress, which means a moderate amount of physical exercise has an optimized effect (Miyamoto et al., 2013). Physical exercise thus improves mitochondrial function and decreases reactive oxygen species (ROS) production as a neuroprotective mechanism, showing that physical exercise acts as an antioxidant therapy on the brain’s vascular culture.

Lastly, there is toxic protein aggregation accumulation before dementia onset, and it is considered a cause of neuron deterioration process. Physical exercise is proven to significantly reduce levels of amyloid-beta (Aβ) plaque and hyperphosphorylated tau (Trigiani & Hamel, 2017). It is suggested that because of less amyloid, there is less vascular damage induced by the proinflammatory mediators. Besides, the clearance of toxic proteins is also due to improved quality and longer duration of sleep induced by PE. Plus, neuroinflammation is also manifested in dementia. The more toxic protein, the more neuroinflammation. In the early stage of AD, microglia are supposed to slow disease progression since it is responsible for phagocytosing Aβ. However, constant microglial production leads to neuroinflammation which is found in AD patients (Solito, E., & Sastre, M., 2012). Research has shown that physical exercise reduces or even inhibits peripheral inflammation and neuroinflammation. Through the investigation of two groups of Tg2576 AD mouse models, with exercise and no exercise, sedentary mice indicated an increased hippocampal expression of proinflammatory interleukins IL-1β and TNF-α, and reduced levels of interferon-gamma (IFN-γ) and chemokine ligand 3 (Trigiani & Hamel, 2017).

Consequently, physical exercise improves gray and white matter, and spatial memory, and also reduces oxidative stress, toxic protein, and neuroinflammation in dementia patients.

Physical Function

Studies have proven that physical exercise enhances muscle strength, coordination, and endurance, in dementia patients.

Exercise intervention for mild cognitive impairment, and mild to moderate dementia patients are tested and showed significant improvement in balance, mobility, step length, and walking endurance (Lam et al., 2018). For balance, 722 dementia patients were recruited to have exercise intervention and tested with the Berg Balance Scale for six trials. Results showed that patients improved by 3.6 points. Another 242 patients are examined on the functional reach test for six trials, which showed significant improvement by reaching 3.9 centimeters. Participants also performed better in the Tinetti balance assessments after multimodal exercise, Tai Chi, and walking for 20 to 120 minutes at least twice a week. For mobility, 249 moderate-stage dementia patients with multimodal exercises manifested significantly reduced time required to complete the Times Up and Go (TUG) by two sec. Walking speed was also improved by 0.13 m/s in 568 participants with seven trials. For step length, 296 dementia patients showed improved step length by 5 centimeters after adopting multimodal exercise with walking and aerobic workout for 1-2 hours 2 to 3 sessions per week for 15 weeks. For walking endurance, after dementia participants performed multimodal exercises 0.5-1.5 hours 2 to 4 times per week for 9 to 12 months, participants could perform a 6-minute-walk distance of 75 meters.

To sum up, the above studies have proven that physical exercise, especially aerobic and multimodal types, improve physical function in dementia patients including balance, mobility, step length, and walking endurance which are important for day-to-day activities.

Psychological health

As mentioned, dementia patients easily to have changes in mood such as depression and anxiety, especially patients who have good insight and awareness of their condition. On the other hand, physical exercise is beneficial to psychological health.

Physical exercise induces a positive mood in dementia patients. Neurogenesis is stimulated by physical exercise and it helps to reduce anxiety and depression. Physical exercise promotes hippocampal neurogenesis with molecular mechanisms including B-endorphins, angiogenesis, brain-derived neurotrophic factor (BDNF), and serotonin (Ernst, et al., 2006). Firstly, B-endorphins are responsible for coping with stress, pain management, reward feeling, behavioral stability, and maintaining homeostasis. Secondly, angiogenesis refers to the formation of new blood vessels from existing ones. Researchers found that elderly individuals with 3 hours per week of physical exercise for 10 years have more small vessels in the anterior cerebral circulation than the ones who did not have regular exercise. The induced angiogenesis improves peripheral organ blood flow, cerebral blood volume in the motor cortex, and cerebral blood flow (CBF). Improved CBF means improved neurovascular coupling, and it ensures a sufficient supply of oxygen to active neurons, which is dysregulated in AD and VCID. Thirdly, BNDF’s function is to maintain the survival of neurons and synaptic plasticity. However, patients with depression and suicidal thoughts have lower expression of BDNF (Dwivedi Y., 2009). Thereby, an adequate expression of BDNF is needed. Lastly, serotonin regulates mood, sleep, and appetite which is also paramount for patients with depression.

In addition to neurogenesis, physical exercise improves one’s mood by increasing the levels of endocannabinoids which are associated with a sense of well-being, anxiolysis, and analgesia (De Moor, et al. 2006). Physical exercise also promotes the change of the hypothalamic-pituitary-adrenal axis (HPA axis) including more adrenocorticotropic hormone (ACTH) and decreased cortisol production, which induces a positive mood (Wittert, et al, 1996). Finally, self-concept, self-esteem, sense of accomplishment, and social support can be gained through team sports.

As a result, physical exercise not only improves dementia patients’ cognitive and physical function but also generates a positive mood in order to cope with or prevent anxiety and depression caused by the stressful dementia condition.

To recapitulate, dementia is a disease related to brain damage. There are medical treatments for dementia to slow down the progression of deterioration. Some of the drugs target cognitive deficits such as Cholinesterase-inhibitors: Aricept, Exelon, and Reminyl. Some of the drugs target associated symptoms such as SSRIs for depression and anxiety, Antipsychotics for agitation. However, the application of medicine is merely effective for a short-term duration. Instead, physical exercise is a more natural and holistic treatment for dementia patients as it acts as a neuroprotective therapy, physiotherapy, and psychosocial therapy. Dementia cannot be cured, but physical exercise is a successful method to alleviate the condition or even act as dementia prevention for middle-aged people.

Reference

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Introduction

Background Information

Aging of the world’s population, along with the fast-growing life expectancy, results in increased expenditures spent on health care services.

Older age is closely associated with high rates of chronic diseases. In this respect, dementia is considered to have had a serious impact on the quality of life, as well as on the economic burden that family should take. At the current moment, dementia treatment refers to advanced medicine and novel approaches to cope with the increasing number of cases. However, the ineffectiveness of treating dementia has a negative impact on life expectancy in aging societies.

The global trends in aging undergo significant changes due to the influence of external factors, including economic, political and social challenges. This is of particular concern to the evident difference in the distribution of adults with dementia in developing and developed economies.

The recent explorations of the problem have indicated the tangible impact of environmental factors on dementia development (Prince, 2000). In particular, because the mental disorder is considered a significant problem in the developed world with increased rates of aging population, it has considerably higher rates in the developing economies. The evident distinctions, as well as demographic transitions, have negative consequence for the dementia spread among the developing world’s population.

The research studies by Wang et al. (2008) have recently discovered that dementia is the core reason for economic burden among the aging population in developing countries. Such a situation is explained by insufficient education, as well as poor health care services tailored to the patients’ demands. Attention should also be given to the cross-cultural survey of people with dementia in the third world.

Research studies in such developing regions as Latin American, Africa, China, and Southeast Asia are indispensible to define how lack of education, poor health care network, and community perception affect dementia diagnosing (Prince et al., 2003). Considering culturally and economically sensitive environments of the developing countries is vital for evaluating the differences in incidence and prevalence of the disease among the identified populations.

Purpose of the Research

Although the developed world recognizes dementia as a serious threat to the aging population and overall demographics, little comparative analysis has been done on the assessment of the situation in both developing and developed worlds to define what external and internal processes influenced the lifespan of adults with dementia.

This is of particular concern to such issues as cultural diversity, economic impact, political situation and education serving as the comparative tools of the analysis. Therefore, the purpose of the research lies in defining what underpinnings influence greater lifespan of people with dementia in developed region, as compared to the developing world.

Main Discussion

Influence of Dementia on Life Expectancy

Numerous researches have been dedicated to the analysis of the connection between dementia and life expectancy. In this respect, Xie (2008) states,

People with dementia have markedly decreased survival rates compared with those without dementia and are two to four times more likely to die at a given age than those of the same age without dementia (p. 259).

Even minor cognitive disorders can have a negative impact on the survival mechanisms of individuals and, therefore, it has direct relation to the risk of mortality. The degrees of mortality of people suffering from dementia are largely predetermined by such characteristics as sex, age, demographic characteristics, type of dementia, and genetic information. Higher risks of mortality are observed among older people (Xie, 2008).

Gender characteristics are considered less important in defining the impact of dementia on life expectancy. The studies produced by Routree et al. (2012) have also provided evidence concerning the strong dependence between greater probability of dementia disorder among males of older age and slower pre-progression rate.

The evident connection between the age of the patients and survival rates explains the survival mechanisms and the necessary health care assistance. Within this context, the lifespan rates among the patients will largely depend on economic and political realms within which these patients are placed (Waring et al., 2005). In this respect, the overall impact of dementia is closely associated with the quality of health insurance, economic and social conditions under which the individuals are treated.

Analysis of Economic Aspects Influencing the Lifespan of People with Dementia in Developing and Developed Countries

On the one hand, the previously discussed studies point to the direct influence of age on life of people with the disease. On the other hand, the survival probability can significantly be increased with the introduction of advanced technologies, medication, and quality of health care delivery. In this respect, Kalaria et al. (2008) have defined that, although mortality rates predetermined by poverty, communicable diseases, and human conflicts, number of individuals with dementia have augmented in the developing world.

The current evidence suggests that age-predetermined dementia observed in individuals under the age of 65 is higher in such developing regions as Latin America and Asia than in India and sub-Saharan Africa (Kalaria et al, 2008). Moreover, education is considered the decisive factor in development of the disease because illiteracy increases the potential risk for dementia emergence.

Rapid expansion of patients with dementia in the developing countries is strongly associated with the financial resources invested in treatment and prevention schemes. In particular, the costs spent on treating dementia in the developing countries reach about $ 73 billion annually (Kalaria et al, 2008).

However, the actual care demands for social protection are much higher than the actual budgeting. Therefore, lack of sufficient financing in developing economies constitutes the core reason for the increased rates of dementia among patients, as well as their shorter level of life expectancy (Rooij et al., 2011). As a result, greater demand for residential care should be introduced in the future to prevent the expansion.

In contrast to the economic environment in developing countries influencing dementia treatment, the developed world manages to spend significant part of financial resources to cope with the problem (Rooij et al., 2011; Xie, 2008).

However, provided aging has become the major challenge for dementia development, the prosperous economies can face serious problems in dealing with the patients suffering from the disorder. Greater ratios of older people in the developed world, therefore, can prevail in number over the ratio of older people in the developing countries.

To enlarge on the issue, Wehling and Groth (2011) have introduced the statistics counting, “…number of people aged 65 years and above will grow from 600 million to 2 billion (increase of 330 %) and the 80+ generation will increase by more than 400 % from 105 million to 400 million” (pp. 275-276). Therefore, the increase in life expectancy levels presupposed by the socioeconomic progress explains the ratio of older people in the developed world. However, these improvements contrast with the rapid decrease in birth rates.

In case the established pace of life expectancy continues growing in the course of the 21^st century, most children born in 2000 are likely to reach the age of 100 (Wehling & Groth, 2011). Such statistics is worsened by the decline of the youth ratio. For instance, Japan has one of the highest rates of life longevity in the world.

Education as the Threshold Identifying Lifespan of Individuals with Dementia in Developing and Developed Countries

According to Prince et al. (2003), “low levels of education, literacy, and numeracy can result in cognitively unimpaired people screening positive for dementia” (p. 909). In educational terms, sensitive screening techniques do not allow to define arithmetical ability, as well as the level of writing and reading skills.

However, the screening instruments can be applied to various cultural circumstances. For example, it is possible to introduce interview formats that do not relate to educational realm. It should also be stressed that lack of education in developing region does not indicate the higher risk of dementia.

Rather, the low indices of educational activities do not contribute to appropriate diagnosing of the disease. Therefore, the developing region should be more concerned with the development of new technological devices that can improve the situation.

With regard to the above-presented research studies, developing economies should give specific attention to education as a decisive factor in determining the quality of diagnosing, which later complicates to define advanced from of the disorder. Such a situation can also be a reason for shorter lifespan of people with dementia.

In particular, the research evidence shows that Shanghai citizens defined that the mortality levels for dementia, particularly for people over the age of 75, had similar mortality indices as people suffering from cancer (Kalaria et al., 2008).

In India, the average rate for survival among the patients equals to 3.3 years in developing countries, which is much lower than in developed regions where the lifespan of adult individuals with dementia reaches 9 years (Kalaria et al., 2008). In addition, high mortality rates have been identified in African region; in particular, the relative risk ratio amounts to less than 3 years.

The studies by Kalaria et al. (2008) have been defined that Asian ad Latin American regions are the leading ones in terms of the dementia prevalence.

However, aging groups of population reveal lower ratio of adults with dementia in Sub-Saharan Africa and India. In this respect, it can be concluded that this region demonstrates the lowest life expectancy, which is partially predetermined by depressive illnesses and illiteracy that contribute to the development of disease.

In addition, Kalaria et al. (2008) have discovered, “…increasing frequency of vascular disease and global tends in modernization will add to the burden of AD within the developing countries” (p. 826). Indeed, the globalization process and mobilization provide a new outlook on the treatment techniques of patients. Therefore, much concern relates to the problem of the aging population among which the ratio of adults with dementia is lower in the developing countries than in the developed ones.

Introducing Costs Spent on People with Dementia in Developing and Developed Countries

Understanding the importance of expenditures spent on treating dementia is vital to promote future health case, as well as improve the overall socio-economic policy. The government needs to gain evidence for establishing firm policies for the fast-growing numbers of adults with dementia.

Low social awareness, underestimated attitude to the problem, and maltreatment does not contribute to the efficiency of the introduced strategies. In this respect, social protection and security are among the major challenges in the developing countries because of such factors as urban migration, conflict situations, and deployment of HIV/AIDs (Kalaria et al., 2008). The circumstances also point to the older people as the most vulnerable segment of the population living in the third world.

Apart from weak social environment, the developing countries face race discrimination, which is also another reason for the decline in lifespan of people with dementia. Moreover, the aging process of people with dementia provides greater costs and, as a result, this category is considered the economic burden, particularly for the developing world.

In this respect, Wang et al. (2008) have discovered that China is among the leading countries that enters the aging era due to the high level of health care delivery. At the same time, the patients with dementia need constant care with regard to the level of disease severity (Wang et al., 2008).

Therefore, despite the fact that the longevity of the patients increased, the economic burden imposed on hospitals and caregivers has been increased as well. Dias et al. (2008) support the idea of enhancing the home care support that can ensure longer life expectancy in India. In fact, the Indian region lack sufficient budgeting of the health care services, particularly people suffering from dementia and, therefore, longevity of their lives is much shorter than in other regions.

Rapid demographic aging can result in the rise of adults suffering in dementia in the developing countries and, therefore, specific attention should be given to health care arrangement in this particular region. According to the studies by Prince (2004), older individual living in developing countries are not isolated from their younger relatives. However, significant levels of family stress create certain disadvantages in terms of lifespan of people with dementia.

Moreover, in contrast to the developed countries, adults with dementia in the developing world usually live in extended families composed of three-generation households. Older people suffering from the disease cannot be regarded as a separate category in the developing societies. As a result, this group experiences significant psychological strain and increase costs influencing all family members as well. Further complications can affect education, impoverishment levels, and gender discrimination.

Therefore, Prince (2004) argues, “dementia is a development issues, and as such a proper concern for proper concern for policymakers in developing countries” (p. 176). Because people in the developing countries are under the stress of family bonds, their lifespan is unlikely to be higher as compared to the lifespan of adult living in the developed world.

Despite the fact that developing world has higher ratio of people with dementia among elder population, the aging phenomenon is still more typical of the developed countries. In fact, greater life expectancy in the developed economies is explained by the greater attention given to the quality of health care services.

At the same time, Asian, African, and Latin American regions also witness significant rise of the aging population rates, although their services are less advanced (Shaji, 2009). As a result, because their rates of dementia disease are higher, the aging process poses a significant challenge to this region.

Despite the fact that the biological phenomenon of aging is a global problem, the life of senior members of society varies greatly due to the difference in cultural and economic contexts (Shaji, 2009). Health care and aging, therefore, are predetermined by social and cultural factors, including social status and attitude to elder people as accepted in various countries (Prince, 2004). Traditional support systems are unlikely to have a potent impact on economic changes and social restructuring.

Conclusion

In conclusion, the research studies have discovered that the life expectancy of people with dementia in developed countries is much higher as compared to that of people with dementia in the developing countries due to a number of economic, cultural, and political factors.

To begin with, the globalization can be considered as the underpinning for the highlighting the aging process in the world due to the technological and scientific progress. Due to the fact that innovation is more associated with the developed world, this region has higher level of aging population.

Although the developing region, including Asia, Africa, and Latin America, has lower quality of health care services, the social support of elder generation is ensured by cultural aspects and traditions. As a result, because both face the aging process, the developing economies are under the threat of having lower rates of longevity among people with dementia. Education and economic costs also relate to the risk factors influencing the rapid growth of the patients.

References

Dias, A., Dewey, M. E., D’Souza, J., Dhume, R., Motghare, D. D., Shaji, K. S., & … Patel, V. (2008). The Effectiveness of a Home Care Program for Supporting Caregivers of Persons with Dementia in Developing Countries: A Randomised Controlled Trial from Goa, India. Plos Clinical Trials, 5(6), 1-7.

Kalaria, R. N., Maestre, G. E., Arizaga, R., Friedland, R. P., Galasko, D., …& Antuono, P. (2008). Alzheimer’s Disease and Vascular Dementia in Developing Countries: Prevalence, Management, and Risk Factors. Lancet Neurology, 7(9), 812-826.

Prince, M. (2000). Dementia in developing countries. A consensus statement from the 10/66 Dementia Research Group. International Journal Of Geriatric Psychiatry, 15(1), 14-20.

Prince, M. (2004). Care arrangements for people with dementia in developing countries. International Journal Of Geriatric Psychiatry, 19(2), 170-177.

Prince, M., Acosta, D., Chiu, H., Scazufca, M., & Varghese, M. (2003). Dementia Diagnosis in Developing Countries: A Cross Cultural Validation Study. The Lancet, 361, 909-917.

Rooij, A., Luijkx, K. G., Declercq, A. G., & Schols, J. (2011). Quality of Life of Residents with Dementia in Long-Term Care Settings in the Netherlands and Belgium: Design of a Longitudinal Comparative Study in Transitional Nursing Homes and Small-Scale Living Facilities. BMC Geriatrics. 11(20), 20.

Routree, S. D., Chan, W., Pavlik, V. N. Darby, E. J., & Doody, R. S. (2012). Factors that Influence Survival in a Probable Alzheimer Disease Cohort. Alzheimer’s Research & Therapy, 4(16), 1-6.

Shaji, K. (2009). Dementia care in developing countries: the road ahead. Indian Journal of Psychiatry, 51, 5-7.

Wang, G., Cheng, Q., Zhang, S., Bai, L., Zeng, J., Cui, P., & … Chen, S. (2008). Economic impact of dementia in developing countries: an evaluation of Alzheimer-type dementia in Shanghai, China. Journal of Alzheimer’s Disease: JAD, 15(1), 109-115.

Waring, S. C., Doody, R. S., Pavlik, V. N., Massman, P. J., and Chan, W. (2005). Survival among Patients with Dementia from a Large Multi-ethnic Population. Alzheimer Disease and Associated Disorders, 19(4), 178-183.

Wehling, M., & Groth, H. (2011). Challenges of longevity in developed countries: vascular prevention of dementia as an immediate clue to tackle an upcoming medical, social and economic stretch. Neuro-Degenerative Diseases, 8(5), 275-282.

Xie, J. (2008). Survival Times in People with Dementia: Analysis from Population Based Cohort Study with 14 Year Follow-Up. British Medical Journal. 336, 258-262.

Down syndrome

Down syndrome is one of the neurodevelopmental disorders, and it emerges after a genetic disorder occurs during the division of chromosomes. The genetic material in the chromosome 21 is responsible for the development of the disorder, and its symptoms appear at the infantry stage of development.

Children with Down syndrome experience slower physical development. The children also struggle with learning, and the disorder may also lead to their development of complicated health issues. Some of the common symptoms of the disorder include having abnormal facial features like smaller ears with unique shapes. The victims may portray various health problems depending on the affected parts of their bodies (Chapman & Hesketh, 2000).

For instance, some children with the disorder develop heart-related complications when their hearts fail to develop properly. Other children may portray hormone-related illnesses, especially when the thyroid gland fails to develop normally. Down syndrome tops the list of the most common genetic chromosomal illnesses, and it causes learning problems for many children (Silverman, 2007).

Behavioral criteria

The behavioral criteria of the victims of Down syndrome depend on the severity of the disorder. The disorder ranges from mild severity to moderate severity. Down syndrome causes serious health problems, especially when the vital organs in the body do not develop as required. Victims with mild cases of Down syndrome portray close-to-normal development in their physical nature, but they have limited ability to learn.

The victims of the disorder have difficulties in using one or more of their senses. Some may fail to see properly, whereas others have difficulties in hearing. Those with hearing problems may fail to learn their language unless they get hearing aids. Learning for most of the victims of Down syndrome is a big challenge because their IQ is significantly lower than the normal human.

Children with Down syndrome also have a limited ability to engage in socializing activities. Most of the children like their solitude because they do not know how to create relationships with other children around them. The children also portray dependency in accomplishing simple tasks like eating as they grow up. The children may also portray unique behaviors like temperament and the inability to control their emotions. The children also have a difficult time learning languages and simple arithmetic (Chapman & Hesketh, 2000).

Causes

Down syndrome is a genetic disorder that results from the abnormal division of chromosome 21. Chromosome 21 is responsible for the physical and cognitive development problems portrayed by victims of the syndrome. There are different abnormalities in chromosome 21 division that may lead to the disorder. Trisomy 21 is the most common abnormalities, which involves the victims developing three copies of chromosome 21. A normal human being has a pair of chromosome 21.

This problem begins at the stage of development of the sperm or the egg. Mosaic Down syndrome is not common, but its victims have three chromosomes 21 copies in specific cells. The abnormal division occurs after fertilization. Translocation Down syndrome occurs when some part of chromosome 21 is translocated to another chromosome. This process leads to the development of children with additional genetic material to their chromosomes. The three causal factors may lead to the development of mild or moderate Down syndrome, but trisomy 21 is the most common cause of the disorder; hence, the severity can be detected before birth (Patterson & Costa, 2005).

Treatment

It is quite difficult to deal with Down syndrome in children, especially when it is detected late into its development. Physicians recommend the early intervention to help children attain positive development. When detected early enough, there are many options for managing the disorder. Detecting the disorder in time also eliminates the chances of developing health complications.

Early intervention programs for the disorder include the development of specialized training to develop motor skills in children. The programs may also help children in the development of sensory abilities as well as cognitive development. Different cases of Down syndrome should undergo patient-focused interventions to ensure each victim receives the appropriate care for their respective cases. As revealed by Piaget’s theory of cognitive development, children should receive parental assistance in their early learning process to enhance their learning abilities (Lanfranchi, Jerman & Vianello, 2009).

In the same capacity, children with Down syndrome should receive learning instructions from their parents and guardians to influence normal learning. Their speed of learning may be slower than normal children, but the repetition of ideas influences their comprehension (Chapman & Hesketh, 2000).

Researchers in the health care field have developed viable programs to help children with Down syndrome by focusing on their motor, social, cognitive, and independence skills. As Vygotsky’s social theory indicates, parents should be instrumental in helping their children develop social skills by teaching them how to use their first language, and how to control their emotions (Alony & Kozulin, 2007).

There are professionals in the field who have mastered how to diagnose the disorder and indicate the specific needs of children with the disorder. The experts offer therapy programs to help the children in their early childhood learning. Experts in different areas of early childhood development should integrate their efforts to help children with Down syndrome to attain normal childhood development. Medications may be administered to control the symptoms, but the genetic disorder cannot be reversed by taking drugs.

Dementia

Dementia is a general term for a neurocognitive disorder characterized by the loss of the ability of a person to think, memorize ideas, and reason logically. The disorder is normally a result of the development of illnesses that affect the normal functioning of the brain or the development of the condition because of drug abuse, among many other factors.

The common symptoms of dementia range from changes in character, inability to control emotions to changes in the behavior of the victim. The severity of dementia in victims depends on the cause of the disorder. While some of the causal factors of dementia are easily treatable, others are untreatable. Some of the treatable causes of dementia include drug abuse, hormonal imbalance, and side effects of medications. Treatable dementia is referred to as pseudo-dementia. Some of the causes of the untreatable form of dementia include diseases like Alzheimer’s, drug abuse, and brain infections (O’Connor et al., 2007).

Behavioral criteria

The behavior of dementia victims varies depending on the part of the brain that is affected by causal factors. Dementia caused by Alzheimer’s syndrome involves the loss of memory, inability to comprehend ideas with ease, and impairment of thoughts. Victims of Alzheimer’s-related dementia portray impairments in their use of language, motor skills, and visual abilities (Goedert & Spillantini, 2006).

Pseudo-dementia involves impaired speech, behavioral changes, and alterations of personalities. The severity of dementia varies for the different types of the disorder based on the severity of the degeneration of the brain. For instance, a beginner in drug abuse activities may have milder dementia than a person with a long-term record of using the same drugs.

Causes

Various factors can cause dementia in people from different age groups. The most common causes of the disorder are degenerative neurological illnesses like Alzheimer’s and Huntington’s. Degenerative illnesses lead to brain damage and the destruction of the nervous system. These damages result in the inability of the victims to perform their normal mental functions.

Dementia may also result from the excessive consumption of alcohol or drug abuse. The toxic effects of drugs on the brain and the nervous system lead to the impairment of behavior and normal motor skills. Pathogens infect the brain and the spinal cord when diseases like AIDS affect the immunity of individuals. Physical injuries to the brain and the development of tumors may also lead to the development of dementia. Dementia is common among long-term boxing players because the constant physical shock on their heads gradually leads to the destruction of some parts of the brain (White et al., 2005).

Treatment

Treating dementia depends on the causes and the parts of the brain that are affected. For all types of dementia, there are two possible treatment approaches, which include medication therapy and care therapy. Alzheimer’s-related dementia is not curable, but the administration of drugs aimed at alleviating the symptoms can help in managing the disorder.

For instance, there are drugs used to stabilize the emotions of the victims to help them maintain their normal behavior. Physicians use Beck’s cognitive therapy model to enhance the wellness of their patients. The theory advocates for therapists to use a patient-oriented approach to promote wellness in patients suffering from various mental impairment disorders (Gallagher-Thompson, Steffen & Thompson, 2008).

The caring approach to treating dementia involves the development of programs aimed at managing the symptoms portrayed by patients with dementia. The cognitive-behavioral therapy model is instrumental in the development of the appropriate therapy program to control the behavior of the patients while promoting their cognitive ability. This approach is quite effective for treatable dementia, and it slows down the degenerative effects of untreatable dementia (Gallagher-Thompson, Steffen & Thompson, 2008).

References

Alony, S., & Kozulin, A. (2007). Dynamic assessment of receptive language in children with Down syndrome. International Journal of Speech-language Pathology, 9(4), 323-331. Web.

Chapman, R. S., & Hesketh, L. J. (2000). Behavioral phenotype of individuals with Down syndrome. Mental retardation and developmental disabilities research reviews, 6(2), 84-95. Web.

Gallagher-Thompson, D., Steffen, A., & Thompson, L. W. (Eds.). (2008). Handbook of behavioral and cognitive therapies with older adults. New York NY: Springer. Web.

Goedert, M., & Spillantini, M. G. (2006). A century of Alzheimer’s disease. science, 314(5800), 777-781. Web.

Lanfranchi, S., Jerman, O., & Vianello, R. (2009). Working memory and cognitive skills in individuals with Down syndrome. Child Neuropsychology, 15(4), 397-416. Web.

O’Connor, D., Phinney, A., Smith, A., Small, J., Purves, B., Perry, J., & Beattie, L. (2007). Personhood in dementia care Developing a research agenda for broadening the vision. Dementia, 6(1), 121-142. Web.

Patterson, D., & Costa, A. C. (2005). Down syndrome and genetics—A case of linked histories. Nature Reviews Genetics, 6(2), 137-147. Web.

Silverman, W. (2007). Down syndrome: cognitive phenotype. Mental retardation and developmental disabilities research reviews, 13(3), 228-236. Web.

White, L., Small, B. J., Petrovitch, H., Ross, G. W., Masaki, K., Abbott, R. D., & Markesbery, W. (2005). Recent clinical-pathologic research on the causes of dementia in late life: update from the Honolulu-Asia Aging Study. Journal of geriatric psychiatry and neurology, 18(4), 224-227. Web.

Three of the Most Important Major Theories used to explain Dementia, Aging, or Gerontology

Aging is one of the most challenging phases of human development due to several reasons. The period comes with various physical, psychological (emotional), and social problems that if not handled well may adversely affect an individual. Among the most compelling complications that are witnessed during this critical stage of life include dementia, a problem that affects a large fraction of the aging population. In a bid to determine, explore, and explain aging or gerontology, researchers have developed various theories that take diverse viewpoints. As this section reveals, three of the most comprehensive and insightful theories that have attempted to account for dementia among other problems experienced during old age include the disengagement theory, activity theory, and continuity/dialogical theory.

The Disengagement Theory

The disengagement theory posits that aging is a process that extricates people from the social world. Proponents of the theory, Elaine Cumming and William Henry take the psychosocial perspective in explaining the unhealthy collective relationships the aging person’s experience in the latest phases of their lives (Comer, 2015). In this theory, it is believed that aging is an inevitable mutual withdrawal from the social system by a person.

It is imperative to note that the data that was used to formulate this theory was generated from a study in Kansas City (First, Frances, & Pincus, 2015). This longitudinal study traced the life changes observed among hundreds of people, as they moved from middle age to old age. The findings from the group of researchers were used to create nine assumptions about aging. One of the assumptions is that as people approach old age, they tend to lose social ties apparently due to their anticipation of death. They begin to live a life of isolation, which implies that they disengage with intimate or non-intimate relations (Silverstein, Bengtson, Putnam, Putney, & Gans, 2008). As this happens, they begin to lose touch with social norms, a situation that deteriorates their life in isolation.

As the theory reveals, throughout the process, gender roles assume the center stage of the isolation and disintegration with social norms. The process is spurred by the aging people’s unwillingness to maintain their social reputation amid these changes. Simultaneously, the theory believes that younger adults are socially prepared to take on the roles of those who hit the detachment stage. From a sociological point of view, total disentanglement takes place when the person going through the change and the community are prepared to face it. However, the disengaged person must be able to adopt the new social roles for the process to be successful. Failure by either the society or the people changing to alter their lifestyle by assuming new roles may lead to several physical, psychological, and social problems, including dementia. The disjunction may also bring other problems such as identity crisis among others.

Activity Theory

Given that disengagement theory was the first sociological perspective to explain aging, other theorists came up to respond to the argument is expressed. One of the significant theories to have responded to the disengagement perspective is the activity theory. While contrasting disengagement theory, this viewpoint posits that aging people tend to form healthy relationships, which keep them vigorous and functional. The theory postulates that strong and healthy relationships among elderly persons are beneficial in the establishment of stability in society. For one to be satisfied with his or her late life, he or she needs to create a working and healthy social system.

Besides, the theory takes a rather psychological perspective in addressing some of the issues that face the elderly people. For instance, it recognizes that old age comes with numerous socio-emotional and physical challenges that one can only address if he or she takes a positive view (Arkowitz, 2008). To the proponents of this theory, people in their old age must be encouraged to stay active, repeat their life-long habits such as dancing, and/or create positive relationships with the society and people around them. Happiness is considered the ultimate goal of every person living in his or her latest age. The society is more stable, secure, and satisfying when the elderly persons are given a chance to enjoy their lives just like other members of society.

It is worth noting that various perspectives of productive and successful aging that were generated from this theory have been criticized for various reasons (Arkowitz, 2008). However, while the theory is deemed successful in challenging the disengagement perspective, it also faces criticisms. One of the shortfalls that skeptics cite in their attempt to disregard the theory is that it overlooks certain problems that emerge during the old age stage of life. For example, some old people encounter various traumatic events that significantly challenge their ability to stay active in the social arena. The activity theory ignores the stated fact, a case that also fuels criticisms. Moreover, skeptics of the theory also cite that it ignores the health and economic disparities that may curtail or diminish the desire and opportunities for some elderly persons. To this perspective, professionals such as recreational therapists must endeavor to encourage the senior generations to get out of their comfort zones and engage in meaningful activities to achieve healthy lives.

Continuity/Dialogical Theory

Central to the arguments presented by the continuity theory is that aging involves maintaining or preserving the same activities a person enjoyed in his or her early years (Comer, 2015). In other words, healthy aging is witnessed when people display the same behaviors they exhibited during their youthful age. Additionally, people need to respond to old age challenges just as they did during their early lives. The continuity is created by establishing new experiences that interconnect with the past. Based on the theory, aging is all about reliving the life one had in the past. For instance, aged persons may decide to listen to the same music they used to listen to while they were young. They may also visit the same social places such as museums just as they did in their past life.

It is important to note that this theory uses life course perspectives to create a substantial argument about aging (Silverstein et al., 2008). Just as the other two theories mentioned above, the continuity theory is derived from the psychosocial school of thought in which issues that relate to social relationships and their influence on people’s behavior are taken into account. For instance, goal setting and adaptation form one of the issues that this theory focuses on in its explanation of old age. It is postulated that the majority of aged people recreate their experiences and feelings as a way of adapting to their new roles and responsibilities. In line with Silverstein et al.’s (2008) sentiments, the interconnection between the internal and external structures helps in harnessing these elements. The internal foundations help them in making plans that in turn assist aged people in attaining social and psychological satisfaction (Comer, 2015).

Why the Three Theories Are the Most Compelling

As evidenced by the arguments presented in this paper, the three theories strikingly stand out as the most appropriate among the long list of aging theories because they all capture the psychosocial aspects of people’s well-being as they struggle to live in the challenging environment. According to Silverstein et al. (2008), the behaviors of the old are heavily influenced not only by biological or internal states but also by the social environment. Although the theories differ in several aspects, the central theme that they all discuss regards the social and psychological interplay that creates individuals’ behavior during old age. The decisions, perceptions, and reactions of the seniors are highly influenced by most issues discussed in the three selected theories. It is important to conclude that people working with elderly persons must take into consideration most of the elements highlighted above.

Additionally, the three models were developed by scholars who were open-minded in their approach to both social and psychological issues that are associated with development. Although it was inflexible in its reason, the disengagement theory formed the antecedent that benchmarked every single offspring’s psychosocial perspectives. It also initiated the debate about the challenges that affect old people, including ways in which they can best be addressed (Silverstein et al., 2008). Similarly, continuity and activity theories address social and psychological issues that directly affect human reaction and behavior.

How Various Areas of Social Work, Sociology, Long Term Care, and/or Communication Disorders Help in Understanding Aging, Dementia, and/or Gerontology

Sociology and Dementia

Sociology refers to the study of human behaviors and their social relations at the individual and the societal level. To understand dementia, one needs to approach it from a sociological point of view. The view is informed by the fact that the environment in which dementia patients reside largely influences their wellbeing. If the patients are well connected to the society in which they reside, the severity of the dementia symptoms may be reduced. Additionally, the available research indicates that the disease is less severe if the victims are actively involved in communal activities (Silverstein et al., 2008).

The understanding of dementia from a sociological perspective requires a good understanding of the symptoms. One of the symptoms of dementia is poor self-esteem and a feeling of worthlessness. This feeling results in poor involvement in communal activities. The problem of low self-esteem often escalates if the concerned person faces stigmatization from society. In severe cases of dementia, the victim may avoid intimate and non-intimate relations, a situation that may lead to a feeling of alienation. According to Saxena (2006), alienation is one of the factors that lead to the escalation of dementia. The connection between alienation and the worsening of dementia is supported by the functionalist theory. The mentioned theory states that any kind of isolation leads to a chain of reactions, which manifest in the form of various dysfunctions. In contemporary society, old people seem to be alienated from society since the young often perceive them as less important. Additionally, seniors often suffer discrimination because of the negative stereotypes about them. This situation leads to poor participation in communal activities, thus further worsening the dementia symptoms.

The association between sociology and dementia may also be used to explain the reason for the increased cases of the disease in developed countries. Based on the recent World Health Organization’s statistics, developed countries have the highest number of patients suffering from dementia (First et al., 2015). The high number of dementia patients in such countries is largely associated with familial and social alienation. In most developed countries, traditional family structures have been eroded due to various reasons. Saxena (2006) claims that one of the reasons why traditional family structures have been eroded is the increased embracement of family planning, which results in fewer children. This situation, which leads to a reduction of the number of family members, exposes the aging parents to the risk of poor care during old age. Based on the arrangements of traditional families, children are expected to take care of their old parents. Therefore, without children, old parents are exposed to the danger of lack of care. Given that dementia is more common in old age, the lack of care from children during such times may lead to the escalation of the disease. The rate of divorce in developed countries has also increased tremendously. The case has attracted the risk of loneliness among old people. Loneliness is closely related to the escalation of the dementia symptoms. Hence, familiar dissociation may contribute to the worsening of the problem.

Long Term Care and Dementia

Another approach to understanding aging, dementia, and/or gerontology involves examining the patient’s need for long-term care. Since dementia mostly manifests among the seniors, it is appropriate for them to receive the necessary care to reduce the effects of the symptoms on their health. Two types of long-term care, namely, assisted living facility and skilled nursing facility (nursing home) are available for seniors who suffer from dementia (Macdonald & Cooper, 2007).

The assisted living facility refers to intervention for people suffering from dementia. This form of care is suitable for seniors whose illness is at the initial stages. Such seniors can perform Instrumental Activities of Daily Living (IADLs) independently or with minimal help from a caregiver (Macdonald & Cooper, 2007). Therefore, despite being somehow independent, a senior placed in this intervention requires little assistance. On the other hand, the skilled nursing facility enrolls seniors whose illnesses have already deprived them of their ability to perform IADLs. Such facilities ensure that the concerned patient is under continuous monitoring from skilled caregivers.

The two types of care described above are critical to the understanding of dementia. One of the lessons that one can gain from the interaction with the long-term care options is that dementia in old age deprives victims of the power to take care of themselves (Silverstein et al., 2008). For the care-giving systems described above, victims are assisted in performing basic daily activities. Although other seniors without dementia also require assistance, those with the illness require more care.

The other lesson that can be learned from this analysis is that dementia intensifies with time. At the earlier stage, the affected seniors are not fully deprived of their ability to take care of themselves. However, they must be assisted by a person to make certain decisions, especially those revolving around savings. However, as the disease advances to the next stage, the affected senior is deprived of the ability to perform even the smallest tasks. Patients in this stage must rely on a caregiver for support in every task they intend to accomplish. The establishment of such care facilities also confirms the view that young people have neglected the old. If the traditional family structures still existed, probably there would be no need for such facilities. Lastly, the long-term care concept helps one to understand the relationship between dementia and old age. The two types of care target the old people, as opposed to the young. Hence, dementia mostly affects old people. Dementia among the old is attributed to various factors among them a stroke or other types of illnesses that affect the brain (Macdonald & Cooper, 2007). Given that the old are less active compared to the young people, the impact of the illness on them is severe.

Communication Disorders

The other factor that may help people to increase their knowledge regarding dementia is communication disorders, which are associated with the illness. The most common language disorders associated with dementia include the inability to construct sentences (Lin et al., 2011). Poor sentence construction skills lead to miscommunication, which reduces their ability to communicate their problems. Other than poor sentence structure, seniors who suffer from dementia tend to have reduced grammar skills.

Communication disorders presented by dementia help one to understand the reason why many old people usually exhibit low levels of self-esteem. The stated observation is based on the view that people with poor verbal communication skills tend to face stigmatization from eloquent individuals. In this regard, they tend to exhibit a sense of worthlessness, which causes them to experience poor self-esteem levels. The problem is compounded by the fact that seniors who suffer from dementia cannot understand euphemisms, sarcasm, double meanings, puns, or another wordplay (Silverstein et al., 2008). If a person uses such language, seniors may misinterpret the message to think they are being negatively targeted. This situation increases their hatred for the youths and hence their (seniors) lower self-esteem.

In addition to low self-esteem, the analysis of the communication disorders sheds light on the reasons why most old people in the society are reluctant to participate in communal activities. Such relations might require the concerned seniors to communicate their views verbally, a scenario that may be challenging. Their inability to communicate denies them the opportunity to contribute their views during such activities for fear of being laughed off (Lin et al., 2011). Old people who suffer from dementia are unable to speak out their problems with ease (Lin et al., 2011). Without communicating their problems, it is hard for them to secure the necessary support from prospective caregivers. Therefore, the inability to speak may be the reason why youths and relatives fail to offer the necessary care. This claim discredits the assertions that youthful individuals have deliberately neglected the old.

Conclusion

Not many theories of aging have been comprehensive and insightful in their analysis and postulations about dementia, aging, or gerontology compared to the three that have been highlighted in this paper. Concisely, the three theories are undeniably a revelation in the issue of aging. In as much as the young are said to have neglected their parents, the analysis of the speech disorder gives another dimension to the assertions. As stated previously in this paper, the old tend to face stigmatization from the young people due to their incapacitation. The inability to speak may cause young people to stigmatize them and hence the need to understand the best approach that can be adopted to take care of the aged class of people.

References

Arkowitz, H. (2008). Motivational interviewing in the treatment of psychological problems. New York, NY: Guilford Press.

Comer, R. (2015). Abnormal psychology student workbook. New York, NY: Worth Publishers.

First, M., Frances, A., & Pincus, H. (2015). DSM-V-TR handbook of differential diagnosis. New York, NY: American Psychiatric Publishers.

Lin, F., Metter, E., O’Brien, R., Resnick, S., Zonderman, A., & Ferrucci, L. (2011). Hearing loss and incident dementia. Archives of Neurology, 68(2), 214-220.

Macdonald, A., & Cooper, B. (2007). Long-term care and dementia services: An impending crisis. Age and Ageing, 36(1), 16-22.

Saxena, D. (2006). Sociology of aging. Delhi, India: Concept Publishing Company.

Silverstein, M., Bengtson, V., Putnam, M., Putney, N., & Gans, D. (2008). Handbook of theories of aging. New York, NY: Springer Publishing Company.

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.

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