Bio-medical model for dementia

Importance of an early diagnosis

Someone that recognizes changes in their thinking and memory skills (experiencing memory lapses) often are relieved when they learn there is a medical cause. The treatment for treating neurocognitive disorders such as a dementia or Alzheimer's disease is the "bio-medical model" which focusses on what is "wrong" with the person, and not necessarily what the person, or the family really needs.

Sadly, many healthcare professionals have low expectations of the overall outcomes, and do not encourage individuals, families, or friends to explore additional treatment options. Frequently, after a diagnosis of dementia, which is often delayed because of the stigma the person and the family members feel, physicians and specialist only suggest medications for the individual, and maybe support groups for the family.

A follow up appointment is gladly schedule 6 or 12 months out to retest and report the changes in the brain and to make medication changes. To me, that does not give much hope to these families.

Medication are prescribed to treat symptoms that dementia can cause such as depression, anxiety, sleep difficulties, or confusion. Unfortunately the drugs that are prescribed to address the symptom often have unpleasant side effects such as nausea, vomiting, a rash, muscle pain or loss of appetite.
So is it fair to have a loved one experience these possible side effects so we can "manage their behaviors" to suite our needs?

I am not anti-drug therapy and believe by bridging models of care and more holistic approaches to address symptoms of dementia can result in a more comprehensive approach to supporting your friend or loved one living with dementia.

Memory Loss is not part of "normal" aging

Forgetfulness and memory loss are not the same. We all can be forgetful. How often do you walk into a room and forget why you are there? Giving yourself a few seconds to concentrate or even by walking out of the room and returning can help "jog" your memory. As we age, the speed we process information can slow down, but if we misplace our keys, or forget someones name, we will eventually recall the persons name and where we left the keys. That forgetfulness can be part of normal aging.

However, if a person does not recognize a familiar person, or can not recall recent events, they may be experiencing memory loss and an evaluation may be necessary to determine if something more serious is developing.

Paying attention to lapses in memory of your loved one, will be helpful to tell the doctor at the appointment. Your loved one will likely deny there are any issues with thinking, problem solving or memory, so observations you can share with the doctor will assist in receiving early support and the need to do formal testing.

Eco-psychosocial model for dementia

Bridging the gap

By embracing a new approach in the treatment of a person living with Alzheimer's disease or another type of dementia, the ecopsychosocial approach focuses on the social environment and the psychosocial needs of the person and their relationships. The interactions, how needs are expressed, social engagement with family and friends and maintaining relationships, can create engaging and shared joyful moments, and support individuals and their family and friends.

So much money is being raised to find a "cure" for Alzheimer's disease and other causes of dementia. Walks are organized, benefit golf tournaments are popular, tribute donations are available and even funding from the US government in billions of dollars are all reputable efforts to finding a treatment for cognitive decline. Unfortunately, after over three decades of research, and billions of dollars, there is still no cure. Medications have been introduced to "manage the symptoms," but often the side effects, exuberant costs, and the minimal benefits, families continue to wait, hanging their hat and hope that the "cure" is just around the corner.

Focusing on the deficits of a person with cognitive decline, or any disability, the person will experience prejudices, discrimination, and isolation. We believe a strengths base approach, and focusing on what the person can do and helps slow down the progression and creates a more joyful life. The "social model" for supporting people living with cognitive decline suggests that by providing more education and awareness to society and addressing the stigma of dementia. By eliminating barriers for the person to be able to truly live their full potential and a life of quality a more inclusive community is possible.

Negative attitudes and misperceptions of a person diagnosed with a type of dementia, also creates barriers for people living with a neurocogntive disorder to maintain a job, live independently, and maintain autonomy.

The psychosocial approach to wellness includes activities to promote physical, cognitive, and social health. The"eco"-psychosocial approach for supporting someone living with dementia" includes assessing the environment and focus on the person and their lived experiences.

The L.O.V.E. Approach supports this model and a "person-centered" and friend-centered approach. Staying active in the community with familiar people and familiar places and living a meaningful and engaged life encourages the person to maintain independence as long as possible.

Perhaps you have heard this story....

A little girl was helping her mother prepare dinner. Like so many times before, when her mother was preparing a roast beef dinner, she always cut the ends off the roast before placing it in the pot. The little girl had been curious about this for some time and finally asked her mother why she cut the ends off the roast? With no hesitation her mother answered, "because my mother did it this way." This piqued the child's curiosity who immediately ran to her grandmother and asked her why she cut the ends off roast before putting it in the pot, and quickly answered "because my mother did it this way."

The little girl continued on her quest to discover the real answer and asked her great grandmother why she cut the ends off the roast before putting it in the pot. Her great grandmother matter-of-factly replied, "well honey, my pot just wasn't big enough so I had to cut the ends off so it would fit."

I don't recall when I first heard this parable, but it has stuck with me and I use it often to encourage people and organizations to examine long held beliefs. I am sure there are several versions to tell, but the lesson is clear. Not questioning the reason or rational for continuing to use the same approach because its has "always done that way," stifles creativity and opportunities to find new innovative strategies to improve upon an idea or technique.

So when it comes to treating persons living with Alzheimer's disease and other dementia's, should we continue to cut off the ends of roast (continue to interact the same way with our loved one with dementia) or should we buy a bigger pot (try new strategies and communication skills)? I believe we need to buy a bigger pot and move beyond the "bio-medical model" that focuses on the neurological changes in the brain rather treating the whole person..

Millions of dollars are poured annually into finding the cause and a cure when the answer is unknown and may not be available for many more years. So should we shift our paradigm on how we treat people with dementia and begin to use a more eco-psychosocial approach and learn how to reduce our loved ones anxiety, depression, stress, and even apathy through engagement?

We believe there needs to be significant changes in the approach to support (or not support) people living with Alzheimer's disease and other dementias. In the United States, 80% of people with a type of dementia are still living in their homes and in their communities. There needs to be more support for these families.

Please don't misunderstand me. We need research, but alternative treatment approaches need to be included in those research dollars and assist the individuals and families who are already impacted today had have more emphasis on "living well with dementia."

Consider to stop identifying as a "caregiver"....

Identifying as a "caregiver" can create an imbalance of power and the person with dementia can loose their personhood and autonomy and feel powerless and give up. Spouses, sons, and daughters report "loosing their identity" as one of the worse things that happen. Maintaining your identity and relationship with your loved one is important.

Continuing with the relationship roles you have with the individual can show respect to the person and by offering choices, showing respect, and using a strengths based approach by modifying tasks, persons with dementia can maintain independence longer and help the person continue to feel a sense of purpose in life.

Imagine if you were in their position. Imagine that your spouse, son or daughter suddenly takes control of your life and tells you the things you can and can not do. Imagine you were never given choices again? Imagine not feeling respected, or valued?

Breaking the stigma from "suffering from dementia" and start seeing a person “living with dementia," family members and friends can continue to maintain relationships as a spouse, daughter, son, grandchild or friend.

So consider getting the bigger pot and join me in this approach! It is time we shift the paradigm from depending on drugs to "manage" loved ones confusion and anxiety, and begin engaging with them with meaningful activities and continue to create joyful memories as a family.