The Biomedical and Social Models of Dementia - Assignment Example

Dementia Introduction Several age-related physical alterations are noticeable likegaining weight, graying hair, wrinkles, and so on. But numerous changes, like weakened blood vessels and bone tissue, are usually ignored for so long. The process of ageing in human beings is accompanied by different cognitive, social, and physical changes, which can vary significantly both within and outside the individual. Cognitive changes are brought about by mechanisms in the central nervous system, but they can be caused by other factors as well like physical condition, intellect, lifestyle, and genetics (Manthorpe & Lliffe, 2005). Age-related memory deficiency and dementia can be different in several ways. Generally, a memory gap could become a problem if it starts to disrupt one’s everyday activities. Knowing the reason or causes of these physical changes with age will contribute to the slowing down or prevention of dysfunctional organs, tissues, and cells. Such information will help a person adopt the necessary measures to prevent or slow down the progression of illnesses like diabetes and hypertension that are more widespread or usual with ageing (Novak, 2006). This essay discusses the biomedical and social models of dementia, and analyzes an actual case of a woman who was diagnosed with vascular dementia. Biomedical Aspects Dementias have long been described or identified in terms of the biomedical perspective, influenced by the findings or contributions of scientific medicine. The biomedical perspective has offered a cultural framework for structuring and understanding visible aspects linked to dementia. As scientists move forward to discover remedies, this framework keeps on dominating our beliefs about dementia and the treatment and needed care of those who are suffering from it (Hooyman & Kiyak, 2005). Yet, biomedicine has continuously failed to provide a definite explanation of dementia. Furthermore, there have been uncertainties about how to identify a healthy individual from a diseased one, and vice versa. History shows that individuals with dementia were seen as at risk and helpless and think of them as abnormal. When this occurs stigma may arise. Studies on dementia and stigma are very few but were recognized in a Scottish research with the general population, showing that this belief is still alive (Scottish Dementia Working Group Research Sub-Group, 2014). The biomedical framework has three major principles (Kelly et al., 2012, 27): Dementia is a pathological, abnormal condition. Dementia is organic in aetiology and progresses through stages. Dementia is diagnosed using biomedical assessments. To believe that dementia is a disease it is important to identify what is healthy or normal, yet it could be very hard to differentiate between healthy aging and dementia. Even though those giving care for individuals suffering from dementia could have changed their beliefs and practices and it is currently broadly known that dementia implies a group of symptoms instead of an ailment, the theoretical bases of the biomedical model are still present (Borowski et al., 2007). There is a thin line dividing what is recognized as ‘normal’ and that associated with a psychological or biomedical state. It has also been discovered that the behavioral pattern that a person has shown his/her entire life could, after diagnosis, be linked to the consequences of dementia (Hughes, 2011). The word dementia also alters how people interrelate with a person with dementia. The allegedly progressive nature of dementia that is mentioned in biomedical models of dementia has been questioned. This is because the progress of symptoms is quite inconstant or changeable and individual phases are seldom observed. Nevertheless, caregivers usually believe in the presence of stages, for this provides several interpretations of the behavior of the person with dementia and some prediction of forthcoming occurrences (Mauk, 2013). Still, pressure and strain for the caregiver could arise when the progression of the disease is not matched with the specific stage. Medication of dementia results in a power relationship between caregivers and physicians and the individual with dementia. When a caregiver is under strain or already stressed they could exercise more power over the person with dementia, and this could be carried out, within the biomedical framework, employing chemical restrictions (Novak, 2006). Such power relationship could have an adverse impact on the behavior of the individual with dementia. It could also have an unfavorable effect in that the caregiver could begin to anticipate decline in the person’s behavior and condition. Dementia could hence turn into a phenomenon called ‘self-fulfilling prophecy’ (Lewis, 2014, 1226). Biomedical models of dementia provide helpful insights to the field of nursing or caregiving, as the notion of dementia as a clinical disorder offers a means of addressing the difficulties of caring for an individual with dementia. It also provides knowledge about the nature, cause, and effect of dementia. Furthermore, both doctors and nurses gain from a pathological classification for dementia (Morrison-Valfre, 2013). Biomedical models are also helpful in that they give individual diagnosis, and medication for other health problems which can worsen signs of dementia, such as hypothyroidism (Tanner & Harris, 2008). Hence there are vital features of biomedical perspectives of dementia that can guide caregivers in negotiating their tasks with other healthcare providers. Classifying dementia as an illness can also contribute to the reduction of the stigma usually linked to conditions viewed as mental health disorders, and it has been reported that the medicalization of dementia resulted in greater research subsidy for Alzheimer’s disorder and other forms of dementia (Innes, 2009). Biomedical models have contributed greatly in terms of informing us about the significance of early and prompt diagnosis and potential means to avoid having dementia later on. The main component that is lacking from biomedical explanations of dementia is the experiences and opinions of the individual with dementia. Biomedical perspectives have been claimed to have weaknesses in their helpfulness, as explained by Harding and Palfrey in 1997 when they summed up all the evidence regarding dementia from empirical studies: “cause: unknown; diagnosis: very difficult until after death” (as cited in Morrison-Valfre, 2013, 194). Nevertheless, this assumption is declining, due to the developments in diagnostic measures like greater knowledge about aspects that could create or prevent a possibility of having dementia at old age, the increase in the anti-dementia drug prescriptions, and arrival of magnetic resonance imaging (Walmsley & McCormack, 2014). The main existing problem in biomedical models of dementia is the exclusion of the experiences and views of the person with dementia. Social Aspects Criticisms against the biomedical model have encouraged the development of other models of dementia, like the social model. Quite simultaneously, during the latter part of the 1980s and 1990s, Steven Sabat of the United States and Tom Kitwood of the UK both separately started introducing other explanations of the ‘decline, decay and deficiency’ perspectives of dementia generally endorsed by those engaged in a framework explained by biomedical models (Brooker, 2006, 15). The writings of Kitwood can be regarded as a reinterpretation of the medical approach to dementia, yet he did not reject the biomedical foundation of dementia. Kitwood’s most important input to the knowledge about dementia, and in turn questioning the medical approach to care, was his assertion that what he called ‘personhood’— explained as “a status or standing bestowed upon one human being, by others, in the context of social relationship and social being. It implies recognition, respect and trust” (Mauk, 2013, 170)—must be sustained, even though an individual is diagnosed with dementia. In consequence, preserving personhood implies that we work together with that individual and help them preserve an identity and esteem by means of communication and interaction techniques, and such topic has persistent importance to caring (Mauk, 2013). Another input to the social model of dementia started with Sabat and Harre in 1992, who asserted the significance of considering the self of individuals with dementia. Sabat has further attempted to expand this assumption and has explained that the self has three kinds (Innes, 2009, 14): Self 1: this is the singular self and uses the indexicals of ‘I, me, mine’ to describe personal attributes. Self 2: this aspect of self consists of the characteristics held by an individual (mental, physical and emotional), and the beliefs the individual holds about these characteristics or attributes. Self 3: this is the publicly presented persona that requires the cooperation of others. Sabat explained the significance of recognizing the various forms of self by using case studies. Nevertheless, he claims that the weakest or most at risk self is the third one, for this necessitates skillful caring and communication techniques to maintain existing roles and relationships. An additional, more current and important input of social psychology to the explanation of dementia is through efforts concentrating on the notion of awareness, where it was demonstrated that individuals with dementia do hold ideas about their situation and that there are various means to produce such knowledge (Innes, 2009). A ‘human-person perspective’ was proposed by Julian Hughes in 2011, which considers the status an individual holds in the world, in connection with other people (Hughes, 2011). In numerous ways such perspective reflects Kitwood’s person-centered model, yet it enhances thought about what this implies about how to behave instead of merely to think. Nevertheless, person-centered care is possibly the most continuing input to understanding dementia that started with Kitwood’s use of psychological models of dementia. This is partly due to the fact that the person-centered approach offers healthcare providers with a system of values that are caring, ethical, and courteous to the individual with dementia (Tanner & Harris, 2008). However, there is still an indefinable absence of evidence about the features of person-centered caring that are effective, and what is needed to attain person-centered care. In spite of the principles of person-centered care and subjective descriptions of person-centered care in actual fact, outcome evaluations for person-centered approach are still indefinable, as does general reforms or transformations in care techniques. This is due to the fact that person-centered care does not place emphasis on the broader political and social setting that encloses care delivery and knowledge of dementia; it does not also present a change technique to provide premium care; the notions of awareness and self focuses more on how the individual with dementia keeps on expressing their self-identity and showing awareness of their situation and their surroundings (Kelly et al., 2012). Social psychology has contributed greatly to the process of reminding healthcare providers about the significance of concentrating on the individual with dementia. It reveals potential treatments and regimens that could be helpful for a person, or for the members of their family to assist them in caring for and supporting the individual with dementia (Adams, 2008). The significance of discovering treatments that are appropriate to a person has been emphasized, as has giving prompt medications to assist the person in reducing impairments related to experiencing dementia symptoms later in life. However, the emphasis on the person with dementia, although marking a major progress in understanding dementia, does not explore the broader aspects that put individuals with dementia in a status that is usually inferior and marginal (Hooyman & Kiyak, 2005). Per se, psychology does not give recommendations or answers to the problem of enhancing the general status of individuals with dementia in society. The total weakness of psychological models is the inability to situate assessments of experiences of people within broader economic, cultural, political, and social issues which work together to influence people’s experiences and the care provided to them (Peel & Harding, 2014). Theoretical models of dementia coming from social gerontology and sociology do provide these prospects. Discussion of an Older Person’s Experience Mrs. Susan, a 73-year-old widow and a close friend of my mother, was interviewed for this paper. She has two children, a son and a daughter. Both are already working and have their own families. She has been living alone for 5 years now, since her husband passed away. Her son told me that he has recently observed a change in her mother. Her memory is beginning to weaken and has slowly deteriorated. Even though she keeps herself clean, her clothes at times are quite confused. The house, which she kept organized and tidy in the past, has begun to become disorderly. The son has seen plenty of unopened letters on the living room. A particularly worrying behavior that the son told me is her mother’s persistent calling at night just to ask the same questions repeatedly. The son informed me that her mother has been somewhat depressed and restless since her husband passed away. She maintains her weight, eats well, and exercises regularly (e.g. brisk walking). She has medications for urinary tract infection and hypertension. She has no previous record of severe depression, stroke, or diabetes. She does not admit drinking or smoking. Three months ago, her son consulted a neurologist to ask about her memory issues. The checkup involved neuroimaging and blood tests. She was diagnosed with ‘vascular dementia’. Physically, Mrs. Susan seems healthy and tidily dressed. When I talked with her she did not show any signs of depression. She is also sociable and easy to get along with. She told me that her neurologic test shows normal posture and muscle stability. Her speech is smooth, but she has problems finding words and remembering current events. Mrs. Susan’s memory loss and disorder in vital functioning (e.g. inability to match clothes and to keep the house clean) suggest that she is suffering from dementia. Even though the identification of vascular dementia was given beforehand, the history of steadily deteriorating memory and physical examination results are in line with possible Alzheimer’s disease (Chan et al., 2014). It is probable that Mrs. Susan was diagnosed of vascular dementia because of her past records of hypertension, alongside anomalous neuroimaging. Some of the major causes of progressive dementia are Parkinson’s disease and dementia with Lewy bodies (DLB) (Mauk, 2013). Depression is a major cause of memory deterioration among old people, and often coincides with dementia (Novak, 2006). Mrs. Susan does not seem to have clinical depression, yet more thorough examination or interview must be carried out. Normally, vascular dementia is a progressive disease where declines could be unexpected or abrupt or steady but have a tendency to worsen in a stepwise way. It can be exacerbated by cardiac failure, diabetes mellitus, and hypertension (Tanner & Harris, 2008). The difference between Alzheimer’s dementia and vascular dementia is becoming more and more unclear because risk factors for vascular dementia are present in both illnesses and both forms of dementia could coincide in the same person, which is called ‘mixed dementia’ (Chan et al., 2014). Similar to other dementias the medication or clinical intervention is symptomatic, dealing with the person’s primary difficulties and helping the caregivers. Moreover, dealing with cardiovascular risk factors is highly vital in order to reduce the speed of progression (Adams, 2008). I personally interviewed Mrs. Susan about her everyday routine. She revealed to me some interesting information about her daily experiences, which are as follows: (1) Problems carrying out or accomplishing everyday activities independently, since she is living alone; (2) Problems in managing and holding money; she said that she sometimes forget to pay her bills. (3) Problems in handling appliances safely (e.g. boiling kettles, ironing, etc.); she admitted that she suffered a number of burns because of mishandling of hot appliances. (4) Problems in accomplishing tasks in orderly and sequenced manner; and (5) Problems locating words. Unfortunately, dementia is also a social situation. Dementia has a severe effect, not just on the life of the individual with dementia, like Mrs. Susan, but on the lives of people surrounding them. Taking care of an individual with dementia is especially problematic and difficult. The progressive decline of the cognitive ability of the individual unavoidable leads to a weakened capacity to interact, socialize, or communicate and to perform everyday tasks. Consequently, there are usually severe health and social effects for family caregivers. If Mrs. Susan’s condition worsens, one of her children will be forced to assume the responsibility of a caregiver. This new role could entail decrease in the number of work hours or joblessness, negative effect on relationships, and other adjustments in living arrangements in order to deliver care. Health outcomes involve sleep disorder, physical impairments, stress, anxiety, and depression (Chan et al., 2014). For the individual with dementia, like Mrs. Susan, being labeled with dementia is stigmatizing, and may lead to discrimination and social isolation. As stated by Lewis (2014), in spite of the fact that the condition is currently widely recognized and documented in the media, there is not much proof in the stories of individuals with dementia and their family caregivers that such stigma or social tensions have reduced. Opportunities for managing/improving condition/reducing negative symptoms, outcomes Individuals with vascular dementia, like Mrs. Susan, have physical disorders, like diabetes, kidney problems, and hypertension. The dementia is simply a symptom of the disorder. Numerous individuals with vascular dementia will be prescribed with medications for cardiovascular illnesses or high blood pressure (Mauk, 2013). In caring for the person with dementia, the nurse or carer will have to be informed of treatments and other special regimens the patient should follow. The carer may be required to monitor the patient’s pulse and blood pressure more often than for other patients so as to track the effects of the treatment and the progression of the illness. People with dementia could be incompetent in handling objects. They are also likely to fall because of their wobbly gait (Hooyman & Kiyak, 2005). Caregivers have to be cautious of hazards in the surrounding that could bring about problems. Furthermore, the carer should be watchful of any problems like a heart problem, seizure, or stroke. In caring for an individual with dementia there are a number of aspects that are useful to keep in mind. These people are likely to suffer from physical impairments because of deficiency to particular portions of the brain. They could be ungainly and prone to accidents. They could be quite sluggish. They may have difficulties using one of their hands. Or they could have difficulties speaking, either in saying what they need or comprehending what is uttered (Novak, 2006). It is useful for caregivers of individuals with dementia to remember that a great deal of their rash or thoughtless behavior, irritable depression, indifference, and excessive emotions are the outcome of impairment to the brain. What these individuals with dementia have lost because of damage to their brains is the capacity to control their urges, regulate their emotions and impulses (Borowski et al., 2007). It would be advisable for the carer to deal with these kinds of flare-ups or slurs in an objective manner, remembering that it is not actually directed at the carer and that s/he should not take it seriously or personally. Caregivers should in fact keep their sympathy for the patient in order to strengthen their relationship with the patient so that caring will be more effective and fruitful. Conclusion Dementia is a very difficult condition that occurs later in life. When an individual is diagnosed with the condition, a complete evaluation could be recommended to examine their practical competencies, their capacity to do important tasks independently, the safety of their environment, and so on. An individualized care plan should be made that specifies the individual’s particular needs. The goal is to sustain the competence of a person with dementia as much as possible. It is very crucial that caregivers, especially family members, obtain the total support and guidance of healthcare professionals and the community. The effects of dementia could be tolerable if proper assistance and support is given to the individual, their families, and their caregivers. It is very important to keep in mind that dementia is not a disease, but a part of the normal ageing process. 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