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Cognitive and psychosocial interventions to vascular dementia

Cognitive and psychosocial interventions to vascular dementia

Any assessment or intervention should meet the needs of the individual and therefore take into consideration their cultural and spiritual needs and beliefs. Assumptions should not be made based on gender, colour, ethnicity, culture or disability, but should be tailored to the individual’s needs and lifestyle. The client should be at the centre of the process and considered within the context of their social network.

Cognitive behavioural therapy is a recognised intervention when working with people with mental health problems but is not usually considered as an option for people with dementia. However, in the early stages of dementia, it can be beneficial in helping the client to develop more insight into the relationship between their thoughts, feelings and behaviour; it can also empower the client in having some control over their experience and to make sense of it all. Including people in the process of assessment, diagnosis and interventions can make the whole experience less frightening; however, people react differently and staff should respond to the individual and explore their expectations and beliefs about dementia. Person-centred counselling can be beneficial to the client and carers, and recognizing the impact of dementia on the whole family is a step towards working with them. Recognising each person’s role and perspective within the family may give some indication as to what may be needed to support each member. Sometimes, friction will develop between family members as to what should be done, and because one person may feel they are doing most of the caring. The way in which the family members related to each other before the client developed dementia may impact on the experience of living with dementia. Although there are no cures for people with dementia, much can be done to support, empower and ease the symptoms and experience of living with the condition. Knowing more about the disease and understanding why the individual is behaving in certain ways may help him or her to cope with it. Speech and language therapists may be able to help with language problems – both understanding and expressing – and a multidisciplinary approach is advocated.

Carers and staff may be able to develop coping strategies, such as avoiding confrontation and working round obsessions rather than trying to change the behaviour of those affected. This can be done by responding to and exploring the feelings associated with the behaviour or what is being said. For instance, if someone is repeatedly asking to go home, talk about their home with them, find out what they like about their home, who lives there, what it feels like to be away from

them and perhaps engage in some happy memories. This process is described by  Seman  as ‘meaningful communication’ that validates the person’s feelings relating to what is being expressed through their behaviour or language. Social interventions are important; opportunities for people to come together to share their experiences and to socialise in an environment where they are supported and not under stress to hide their difficulties can increase their self-esteem and confidence. Occupation is essential and can take a variety of forms. It is important that those involved in caring for and supporting the individual are creative and consider all sorts of things to engage and interest someone with dementia. Exploring their life story may give clues as to what may be of interest to them or spark some recognition and pleasure.

When asked, people with dementia and their carers express a need for information. This should be available freely and in a language that can be easily understood.

Understanding why the person may be behaving as they are can help carers to cope with the situation. It takes away a sense of blame or responsibility: it is the disease that is responsible not the person. Using different forms of communication is essential. Make use of touch, smell, music, images (especially photographs) and language, which are meaningful to the person with dementia. This can be done through finding out about their past and interests. Information about their childhood, work, favourite holidays, their own children and interests will provide a link and

common focus for you and the client. Below are two scenarios that provide examples of how knowing something about a client’s past can lead to a greater understanding of their current behaviour.

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