Dementia And Patient’S Quality Of Life

Dementia and patient’s quality of life

Dementia leads to disability and dependence between older people and has a great impact both affected by this disease and families, caregivers and society. Is the cause of 11.9% of years lived with disabilities. Cure with a progressive deterioration of memory, cognitive and behavioral capacities, which prevent the development of basic daily life activities (ABVD), being people lose their independence.

It produces great impact on the economy and increases the cost of socio-sanitary care. WHO adds that there is a great mismatch between the needs of prevention, treatment and care service services and the provision of services. Most people with dementia are infradiagnosed, so they do not carry out the convenient treatment in each phase of the disease. Occasionally, care programs with dementia are outdated or have not been carried out, there is also a difficulty in access to non -pharmacological stimulation therapies.

There is little awareness and understanding of this disease, which leads to its stigmatization, so, in many occasions the human rights of people with dementia are not respected, both in the community and in institutions, since they cannot always participateIn decision making and their wishes and priorities, they do not take into account. The need to expand interventions and services available is recognized, in order to prevent, diagnose, treat and address cases of dementia.

Treatment

Generally dementias are irreversible, but there are different pharmacological and non -pharmacological treatments that allow to influence the progress of the disease and improve the quality of life of both the patient and the main caregiver.

Pharmacological treatment began three decades ago, with the appearance of tacrine (first acetylcholinesterase inhibitor), it was a period of optimism, however, since then, revealing advances have not been achieved. Therefore, the pharmacological treatment is focused on the control of the symptomatology associated with the degenerative evolution of the pathology. It can be classified according to the symptoms to which it is directed:

•  Cognitive symptoms: acetylcholinesterase inhibitors (IACE) and Memantine.
•  Neuropsychiatric symptoms: antipsychotics (mainly atypical), antidepressants (ISRs) and antiepileptics.

This type of treatment in dementias is for controversial and complex use, since it has limited effectiveness and are normally emperated in elderly patients, who often have pluripatologies and polytratings which increases the risk of adverse effects. At the beginning of a pharmacological treatment in dementia, integral assessment must be carried out and the risk benefit risk.

For the above, the use of non -pharmacological therapies (TNF) has been extended, defined, as that non -chemical intervention capable of obtaining a significant benefit in the patient. These therapies rely on a certain therapeutic intervention, in a stimulating context considering the patient from a holistic panorama, personalizing the needs of the patient;These interventions transcend positively in the person and their surroundings.

The objectives of these therapies are:

• Stimulate and maintain the patient’s functional capacity.
• Favor relationships with your environment.
• Maintain user autonomy in ABVD.
• Encourage your own identity and self – esteem.
•  Slow the evolution of the disease, developing cognitive and functional performance.
•  Increase the quality of life of the person and their relatives.

To ensure good result, these therapies must be supervised by a healthcare professional. Here highlights the role of nurses since they are trained and qualified to carry out this type of interventions .

TNF can be classified according to:

•  The area of intervention: cognitive, functional, emotional and integral.
•  The Diana Group: Oriented to the patient or the caregiver.

There is a wide variety of TNF, among which is reminiscence therapy. This therapy began to be used in 1963 by DR. Robert Neil Butler, gerontologist and psychiatrist who investigated dementias and aging. Butler introduced the "life review" as a therapeutic intervention. Explained the review of life as a means in which the person evokes his life and meditates about past experiences. This concept was integrated into psychotherapy aimed at the elderly, with the aim of achieving successful aging, being able to enjoy its maturity in a beneficial way for society.

What does it consist of?

Reminiscence consists in recalling vital events through the stimulation of personal memories to promote positive feelings and resolve conflicts from the past. With this therapy, it is possible to activate the autobiographical episodic memory, thus working cognitive abilities such as focused attention, language, understanding or memory.

How is it done?

Reminiscence can be developed individually or in group workshops, since it enables cognitive, functional and social stimulation. Of the tools that can be used in each session, they highlight among others: visual stimuli, with old photographs, childhood objects;Auditory stimuli such as music and songs of the time, radio or sound recordings of a cuco clock;tactile stimulus by manipulation of objects;olfactory stimulus with the sample of aromas;taste stimuli through flavors of ancient plants or events related to events.

Benefits of therapy

Studies show that the application of a reminiscence program for older people with dementia helps in relation to psychological well -being since it relieves depressive symptoms and improves mood, cognition and behavior. Exercising memory plays an important role in the reconstruction of thought, maintenance of self and encourages personal growth.

During aging there is a reduction in support sources, so reminiscence therapy helps to recall and encourage social interaction by sharing different experiences lived with group members. Active interaction between participants occurs, since reminiscence is a sociable and inclusive activity.

The impact on the main caregivers involved in reminiscence therapy is also important. The results are an improvement in mood, stress, quality of life and communication and interaction to strengthen the relationship in caregivers.

Through reminiscence therapy, health professionals know the life history of the elderly and learn about their personality. All this information collected will help promote the development of individualized attention.

Justification

Current epidemiology demonstrates an increase in the prevalence of dementia (50 million cases), is a public health problem due to the increase in the cost of health and social care, causing disability and dependence between older people, with great impact bothIn people affected by this disease as in families, caregivers and society.

Currently dementia is irreversible, but the use of different TNF should be assessed, such as reminiscence, to stimulate the patient’s cognitive ability.

Memory alterations are the most frequent cognitive changes associated with aging. Of the different types of memory (episodic, semantics, procedure and work), the first two change more with aging. Episodic memory seems to decrease from median age, and is the loss of memory that predominates in Alzheimer’s disease (EA). These alterations, unlike dementia, are produced normally as the person ages and does not affect the functional capacity and the realization of daily tasks .

Find the appropriate word, name objects, understand language, plan and organize daily activities becomes increasingly difficult in people affected by dementia. Over time they are disoriented, they don’t know what time or even what year is or where are they. But what they seem to remember are the events of their childhood. By resorting to the reserve of remote memories, this strategy of reminiscence appears. This therapy favors the reduction in the thought of failure that older people can feel with cognitive impairment. Since these people tend to a depressed state, the work of remembering is useful to improve their mood. This stimulation of past resources is an acceptance activity and strengthens their identity, therefore, it helps them improve their quality of life .

In Spain, according to the data of the Know Alzheimer36% do not know that there are this type of therapies. Therefore, there is no awareness of the usefulness of TNF by socio-sanitary professionals, so they must prepare and expand dissemination, information and training programs aimed at professionals and patients.

Reminiscence therapy is a feasible intervention of planning, implementation and evaluation. In order for health professionals to include it in the therapeutic approach for older people, it is necessaryHealth…).

Nursing has a great function when recommending, establishing and carrying out non -pharmacological therapies, since it is the health professional that can have the most contact with the patient. As stated in article 31. Of the nursing deontological code, to correctly carry out our professional activity, we must: “Collaborate in the promotion of health by putting the scientific knowledge and ethical behavior in the development of the different programs that are plannedWith that goal ".

For all this, to improve the quality of life of these patients it is necessary to launch a health education project (EPS), because health and education are intimately united.