ARTICLEThis article is an update to the overview in Advances by Douglas et al (2004). We summarise the most well-researched psychosocial approaches for dementia by focusing on those with goodquality evidence, and acknowledge some of the newer and less-researched interventions listed in Box 1.The recurrent theme throughout the literature regarding the efficacy of non-pharmacological interventions for dementia is the need for more robust evidence. Reasons for this include that research funding is largely targeted at biomedical approaches and that study designs are not always a good fit for the outcomes measured. Kitwood (1997) proposed that a person-centred approach should be the bedrock for supporting people with dementia. The essential tenet is that personhood remains throughout the experience of dementia and it is the caregiver's responsibility to ensure that it is maintained. Person-centred practice recognises the underlying needs of the individual, often expressed through behaviour. The paradigm shift from 'managing' behavioural and psychological symptoms of dementia (BPSD) towards improving well-being, engagement and quality of life represents a significant change. These goals are more hopeful, leaving therapeutic nihilism in the past. Reducing antipsychotic prescribing (Banerjee 2009) presents another opportunity to exploit these approaches. A review of 26 non-pharmacological intervention categories concluded that non-pharmacological therapies are useful, versatile and potentially cost-effective in improving outcomes and quality of life (Olazarán 2010); however, they necessitate staff time, raising issues regarding priorities and risk (Lawrence 2012).The essential component is the belief that distress and behaviour are expressions of unmet need -all behaviour having meaning -and are a response to the challenges dementia presents (Kitwood 1997). The key appears to be formulation or behavioural analysis (Moniz-Cook 2012) to understand the behaviour and its function for each person. is not yet robust enough to clearly suggest which interventions are most suited for which environment. However, from our literature review there appears to be reason to use music therapy, aromatherapy, life story work, animal-assisted therapy and post-diagnosis/carer support work. We focus on both the traditional outcome measures of behavioural and psychological symptoms of dementia (BPSD) and the more difficult to measure, but equally important, person-centred outcomes of non-pharmacological interventions, as their properties are distinctly different from those of pharmacological agents. LEARNING OBJECTIVES•• Be aware of the range of psychosocial interventions.•• Have a better understanding of the possible outcomes from given interventions.•• Be aware of the paradigm shift from managing BPSD to a person-centred approach that focuses on the patient's well-being and quality of life. DECLARATION OF INTERESTNone.BOX 1 Psychosocial approaches for dementia that are in use but research is ongoing
FACED with increasing responsibility over the past decade, and clearly with more to come, plus also certain radicalising influences in the social field, some interesting trends are becoming evident in the English probation service. Only a few of these can be indicated in this article.The casework pioneers accepted more readily their role in furthering social control than would today's workers. The traditional casework approach that dominated probation work in the 50's and 60's with a sometimes too precious notion of the one-to-one &dquo;worker/client&dquo; relationship was based on the &dquo;helper/helped&dquo; concept. A reaction is developing, but we should not go to the other extreme. The principles and techniques of casework based on the knowledge of psychology and child development remain valuable, provided these notions are re-defined and transposed into today's settings and the wider continuum of worker-clientcommunity relationships.&dquo;Through-care&dquo; has been a significant development. The recommendations made in the report on the Organisation of After-Care (1963)1 that compulsory and voluntary after-care be amalgamated into a common service were implemented and the Probation Service became the Probation and After-Care Service. Some of its officers were seconded to do casework in penal institutions as prison welfare officers.This new situation created some anxiety. It was feared that we had inadequate resources for this extra work; it was also queried whether a service traditionally established in the community was the right agency for the new task, whether a service hitherto used to working with easier probationers in more hopeful situations would cope with &dquo;a more damaged and hardened group of clients&dquo;.2 Happily, by now the service has begun to see the positives of the situation. It had been said often enough that after-care should start at the moment when the offender is sentenced, or even earlier. At long last this notion has been put into practice. Many departments have already developed a system of &dquo;through-care&dquo;. While the &dquo;outside&dquo; probation officer handles the family, the worker on the &dquo;inside&dquo; (the prison welfare officer) sees the husband who is in detention, with both workers collaborating. Such effective coat UNIVERSITE DE MONTREAL on June 16, 2015 ijo.sagepub.com Downloaded from
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