. The role of behavior analysis in the rehabilitation of persons with dementia. Behav Ther. 2011 Mar;42(1):9-21. PubMed.

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  1. I think it is extremely useful and important to have papers like this one by Buchanan et al. (2011), who proposed that non-pharmacological rehabilitation efforts need to target five broad areas: memory enhancement; altering social contingencies and communication styles; improving self-care skills; arranging the physical environment to maintain and improve functioning; and increasing physical fitness or activity. A variety of specific behaviorally oriented interventions that targeted these five areas and showed promise for inclusion in comprehensive rehabilitation efforts for individuals with dementia had been included and discussed.

    However, I think the goals of dementia care are not only for rehabilitation or maintenance of cognitive functioning of the older people, but also for palliative care to the aged and their family members. Palliative care in later-stage or advanced dementia, similar to that in cancer care, refers to the maintenance of quality of life, dignity, and comfort of the people with dementia. Enhancement of quality of life in dementia requires attention to three main domains: provision of meaningful activities, appropriate medical care, and treatment of behavioral symptoms (Gove et al., 2008). Individuals with advanced dementia may not be able to participate in many activity programs, but they still may maintain reasonable levels of quality of life if they are provided care in pleasant physical and psychosocial environments, with the consistent and warm presence of caregivers (i.e., professional and/or family members). Simard (2007) describes a program called Namaste Care, which is specifically tailored for individuals with advanced dementia. This program requires neither major expenditure nor increased staff, and thus could be used in different institutions providing care for people with advanced dementia. Maintaining functional status of individuals with advanced dementia is also important because it improves their self-esteem and facilitates higher quality of care. Namaste Care is an example of a care setting that respects individuals’ dignity and human life until death.

    Volicer (2007) also highlights that it is significant that the older people are never hospitalized and always treated in a nursing home. It is because hospitalization can lead to functional deterioration easily, even in cognitively intact elderly individuals. This study echoes two important considerations of appropriate models of behavioral interventions for the older people with dementia by Buchanan et al. (2011), that is, arranging the physical environment to maintain and improve functioning, and increasing physical fitness or physical activity.

    Furthermore, models of palliative care, which is well accepted by many family members of people with advanced dementia but not promoted by many health care professionals, should also be encouraged and emphasized. As healthcare professionals, we need to create more innovative programs by applying different potentially effective models and provide clear and consistent research evidence to increase the use of palliative care in advanced dementia.

    See also: Simard J. The end-of-life Namaste Care program for people with dementia. Baltimore, MD, Health Professionals Press, Inc., 2007.

    References:

    . The role of behavior analysis in the rehabilitation of persons with dementia. Behav Ther. 2011 Mar;42(1):9-21. PubMed.

    . Recommendations on end-of-life care for people with dementia. J Nutr Health Aging. 2010 Feb;14(2):136-9. PubMed.

    . Goals of care in advanced dementia: quality of life, dignity and comfort. J Nutr Health Aging. 2007 Nov-Dec;11(6):481. PubMed.