Psychology

Introduction
statement of the problem and definition of dementia
         
Dementia is a mental disease that manifests itself through loss of ability to make proper judgments related to life of a normal person. It is characterized by progressive loss of cognitive ability caused either by aging or consumption of alcohol in large quantities for a long period of time. However, despite the fact that many people think that dementia is associated with the old the discussion will show that it can occur at any stage of human development.
       
The following discussion will major mainly on the research problem of whether caring, observation and attentive listening can be a useful way in which the people suffering from dementia can be helped to adjust their behavior. There are many ways that have been tried to help these patients such as the administration of drugs but they have not been successful in catering for the emotional need of them. It is with this in mind that this research seeks to address other ways to assist in shaping the behavior of people with dementia.
                                                           
Discussion
b) The Review of Literature
Much of the work on dementia has also been done by other various persons and organizations as a way to understand it better and offer the way forward. One of such work was done by the Alzheimers Association (2005) from the End of Life care for people with dementia from residential care settings. According to them, their source of motivation to carry out that study was because over sixty-five percent of the people living in nursing homes died. They also discovered that most of the people with dementia, to be precise about seventy one percent died after the first six months. Therefore they were out to provide other better alternatives and recommendations to the problem as taking people to the nursing homes and taking them through medication was not really doing much to improve the condition of the people with dementia.
     
According to this researcher, he collected information from about 300 articles that were from 1994 to 2004. From these, he decided to settle about 158 articles since their information had been obtained mainly through experimental or quasi-experimental methods. From their findings, they observed that medical treatment was actually inappropriate as it mostly exhibits negative consequences that could lead to reduction in the functions of the patient leading to death and also the rate of its success is normally low.
         
The other thing that he called for was the staffing of qualified nurses and increasing the number of the physicians. The patients with dementia need to have someone who is there to interact with them in a conversation helping them to feed and any other thing that they may need done for them. Qualified staff will help to handle these patients in the best way possible with an aim to see positive improvement in their behavior, condition of their mind and the ability to do some things without much support from the family members of the nurses themselves. The increased ratio of the physicians to the patient is seen also as the way to ensure that every patient is attended to in the best way possible.
     
The research also found that the main infections of people with dementia are urinary track infections, coetaneous infections, upper and lower respiratory track infections and also the gastrointestinal and eye infections (Perls, TT, Herget M. 1995). This has been attributed to the decrease in the immunity of their body as dementia progresses in their lives. There are also other problems associated with this which includes pain while swallowing, (Janssens JP 2004). This makes many patients refuse to eat as they cannot bear the pain. They may also experience pain as they chew food. The two processes which are very important in the life of a patient could eventually be inhibited. The people really affected are the family members who have to take care of these patients and also the nurses. The two must ensure that the patents take food even if it means using alternative methods such as the use of tube feeding.
         
The other area that is affected is the health of these patients according to the research. Advanced dementia patients may not eat at all and even those that feed they have poor eating habits. This problem of deterioration in the health of the patients has also been attributed to either failure from the nurses themselves or the physicians (Katser J, Schell E. et.al 1999). The nurses could be unwilling to help the patients have food or failing to insist that they must eat. This could be because these patients are seen as though they are stubborn and deliberately refusing to eat but in the real sense it is because of the pain that they feel. The second thing is that a nurse might have quite many other patients to take care of therefore they might not concentrate on one patient for a very long time. That is the main reason why this research is calling for the increase of staff to handle the patients effectively.
       
Finally, the literature also after learning that the medical intervention has not been so successful in dealing with the challenges faced by people suffering from dementia, calls for palliative measures as an alternative to medical treatment. This will mainly involve being involved emotionally with the patient as a way to understand what they are going through and encourage them to remain active in a way to express their feelings rather than waiting until the situation has deteriorated and then taking them to hospital.

The Intervention Method
After going through the above literature review and looking at some intervention methods that have been used in the passed such as medical intervention, I decided to use communication as an intervention method aimed at bringing about the change in behavior of the dementia patients. Communication is the transfer of information or ideas from one person to the other and it is very important in keeping the patient active both in the mind or emotionally (Powell J.A. 2000).
   
Communication has been sees as a way to improve the lives of people with dementia even though at certain stage of their life they cannot express what they feel as Goldsmith M. (1996) points out. Through communication, the family members taking care of this patient or the nurses are able to determine the state of the problem of whether the person can still talk and express their feelings in a coherent way or not.
       
However communication as an intervention method will become effective when it is done from the initial moments and not waiting until the advanced levels. It is good that all the people taking care of the patients show patient as the patient might be very slow in their communication as some of them might be looking for the words to express what they are feeling( Sabat S.R. Cagigas X.E. 1997). This has been the area where most of the people involved in providing care find so hard and therefore go for the other alternative methods which will not be very effective.
       
Despite the fact that it will be hard to make out what the patient is saying, it is encouraged that communication should continue as a way to know the cognitive status of this individual as Santo Pietro M.J. Boczko F. (1998) urge. Patient therefore need not run out and positive results will be realized.

methods
As we have already seen, communication deteriorates with the advance of dementia. This means that at times it is very difficult for the patient to externalize their feelings for the carers to know what they are going through. It is with this in mind that it formed a rationale for development of a way that will ensure that communication will be maintained regardless of the stage of dementia. Several attempts have been developed with an aim to improve communication and make it more effective.
     
The University of Sterling was very concerned about the problem and this motivated them to work hard and eventually came up with equipment that saw improvement in communication. They called it Talking Mat. This is a system of simple pictures and symbols and usual communication methods. The equipment has been said to have very profound positive effects as far as communication is concerned. It is said to improve the repetitive behavior from the patient and also help the patient remain focused in the conversation.
       
The methods to be used to find out whether communication and effective listening will assist in helping to improve the behavior of people with dementia are qualitative methods. These are methods that are used to come up with subjective information from the targeted population. Reason for these methods is because the researcher will be seeking to understand the subjective feelings of the person and therefore the use of quantitative methods such as the experiments will not be very appropriate. The other reason is that the researchers of social sciences are more concerned about the meanings and understanding of the experiences and as a result they will be dealing with the methods that will enable them collect data, analyze it and use it to make inferences and conclusions. Qualitative research therefore looks at the world in a more subjective way since the researcher has to understand the feelings of the subjects.

Some of the data collection methods that could be used in qualitative research include   the direct observation, participant observation and the unstructured or structured interviews (socialresearchmethods.net). Qualitative methods are said to have helped much in understanding the people with dementia (ageing.oxfordjournals.org)
     
Direct observation method will be used by the researcher who will be interested in making a comparison between the patients who used talking Mat in communication and those that did not use. The researcher can just visit any one nursing home and make that kind of observation and eventually he will get to tell whether there is a need for that equipment or not. One of the advantages of using this method is that it saves time and some better technology such as video recording can be used. The disadvantage is that there is no contact with the subject and therefore at times it is hard to tell their feelings.
   
One of the best methods used in qualitative research is the participant method of data collection. This is a method that involves the researcher going and becoming part of the subject of study and strives to understand them as they also participate in the activities of these subjects. This is what makes this method very effective. In this research, participant observation will be very useful since the researcher will be interacting with the patients to see how their behavior will be changing in the course of the time they will be together. This method however is slow since one has to adapt and understand the culture of these people better and on the other hand it is very expensive. However, the data collected here is very reliable.
   
Interview is another method that can be used to collect information. The interview could be either normal which is also called unstructured or involving written form or structured. In the structured interview, this will involve the administration of questionnaires that the respondents will be required to fill. In our case here, the respondents will be the family members who have been taking care of the dementia patients or the nurses. The questions will be structured in a way that will cover the time when communication did not involve the use of the equipment and the time when it was employed.
     
The unstructured interview involves the general interaction with the respondents. This is great since the researcher can move the conversation in any direction and be able to collect as much data as he or wishes. However, there is a disadvantage of taking a lot of time with one respondent unlike in the structured interview where several respondents can be reached within short period of time. The other disadvantage is that it may make the researcher lose the objective of his research as he may get carried away by other distractions and the emotional state of the subject.
     
To prove that the validity and reliability of using the Talking Mat, the patients could be divided in three categories. One of the categories will use the normal conversation, the other will use the structured conversation and the final group will be required to apply the Talking Mat in their conversation. Proper observation then needs to be taken in the three groups to determine if there will be a difference in the way the patients articulate words, whether they have any difficulties in talking and finally if they can concentrate on the conversation and keep to the objective. At certain times though the carers will be needed to respond to how they have seen the progress.
       
Such is a study that was carried after the introduction of the Talking Mat as was pointed out by Joan Murphy, Cindy M. and Sylvia Cox (1999). The three groups were studied for a certain period of time and when the results were out, there was a lot of improvement noted in the people using the communication equipment.
       
The study found an increase in the time for the conversation. Under normal circumstances the patient will either look for words or will not speak at all especially in the advanced stage of dementia. Even those that communicate, they can not last for a very long time since some of them will get carried away by what is happening in the surrounding or they will even forget that there was a conversation going on. However, with the use of a Talking Mat, time for conversation is observed to increase significantly giving them time to express their emotions.
         
Another observation made is that it is able to make them more coherent and pass the message that makes sense. In the groups that used normal conversation, it was found that they either went off-tasks or they lost sense of the conversation. This being the case, communication becomes so difficult requiring intervention from the carers as a way to understand what the patient feels. However, as we saw earlier, most of the carers do not have the patient and they will dismiss them as soon as they realize that successful communication is not taking place and that they cannot figure out what the patient is saying. They therefore seek for other alternative intervention methods such as medication which as we saw, are not very effective in changing the behavior of the patient. However, the use of the talking mat has provided a solution here as the patient is able to focus on the topic of discussion and make sense.
   
Another observation made was that the level of concentration increased drastically when the talking mat was used as compared to normal conversation. The eye contact was also observed between the researcher and the patient. Concentration is very important in every communication. This basically involves listening to what one is saying before you begin talking. It has been observed that these patients are able to externalize their feelings in a more mature way and at the same time they become sensitive to the feelings of the researcher. This is actually a great move since under normal conditions this people will not communicate their feelings.
   
It has finally been found to be even much effective to those showing early stages of dementia. Apart from improving their time of conversation, concentration and coherent in their communication, they have been observed to have a greater improvement in their reasoning and the power of decision making (Joan Murphy, Cindy M. and Sylvia Cox 1999). They improved to the point that some made a decision of what to do at certain times in their lives rather than staying passively and having everything done for them. It has also helped them to remember what they said and this makes it even more useful in making the follow up to the patient.
       
Going by the above discussion and observations, our hypothesis and the question are well substantiated by the facts observed. Therefore, we can say boldly that the social workers need to be well trained and willing to apply the communication as the best intervention method which demonstrates care, love and concern with an aim of improving the behavior of the people with dementia. With the above observation also, our question of whether the approach of caring, direct observation and use of attentive listening can be used to improve the behavior of people with dementia, has been answered with a positive answer.
                                                             
Conclusion
Many intervention methods have been used as a way of treating the people with dementia but to no greater results. There has been a need to improve the condition of this people because the research has shown that keeping them in homes does not really help much as some of them die immediately while others in the first six months.
     
It is with this in mind that the use of communication as an alternative method was developed since apart from it being a way of passing information about oneself, it is a form of therapy and most of them will have their traumatic experiences healed. It also keeps the interaction between the family members and the patient and this shows a sense of love and care. Relieving the stressful emotions keeps the person energized and hopeful of facing life positively.
       
Finally, a lot remains to be done as far as research is concerned in getting the real cure for dementia. Therefore as a researcher it is important to know the main causes of dementia and going beyond that point to sensitize people on how they can prevent themselves against such ailments. It will be also good to let the people know that it does not only occur in the old age as most of us perceive it.     Therefore until the right cure of dementia is obtained, the research will be still on in order to help very many patients out there in nursing homes.