Free Nursing Dissertations - In The National Service Framework For Older People, It Is Recommended To Use
In the National Service Framework for Older People, it is recommended to use non-pharmacological management strategies such as mental exercise, physical therapy, dietary treatment alongside drug therapy. These may be beneficial in reducing the impact or slowing down the progression of the disease (Department of Health, 2001, section 7.39). However, it is necessary to carefully evaluate the respective therapies that are proposed to be beneficial in the treatment of dementia. Some systematic reviews have attempted to evaluate the efficacy of psychotherapeutic intervention with dementia patients, but have failed to differentiate between the different stages of dementia (for example, Koger and Brotons, 2002). This is unfortunate, since stage of dementia is likely to be vital to the patient’s responsiveness to psychotherapeutic intervention and is an important consideration in planning health care services.
Therefore, a systematic review was undertaken by Bates et al (2004) that assessed if psychosocial interventions are effective for people with mild to moderate dementia. Two of the studies reviewed by Bates et al (2004) were appraising reality orientation therapy (ROT). The ROT intervention is used with confused patients with dementia who are experiencing disorientation as to time, place and persons in their environment. There are variations in how it is delivered but a typical model is proposed by Savorani et al (2004) of formal classroom instruction to familiarise the care-giver and patient with the method, and then a period of continuous exposure to the method in the natural setting of the patients home or hospital environment. The considerable interest in ROT is based on its person centred methods that are respectful of others, and value the patient with dementia and provide opportunities for reminiscence, validation of experience and improve sensory-motor stimulation to promote patient communication and quality of life (Savorani et al, 2004). The aim of ROT is to recruit functions such as attention to facilitate retrieval or temporal and spatial references and personal and interpersonal traces from mneumonic stores. ROT exploits clear and repeated references to time, space, and persons integrated in the patient’s habitat to provide a fixed reference points and retrain orientation in confused objects (Baldelli et al, 2002, p 16). The ROT philosophy is that dementia related confusion occurs when the patient is understimulated, there is a lack of insistence that normal behaviours are achieved by the patient, and when desired behaviours are achieved by the patient they are not reinforced positively by care-givers. Mental stimulation is assumed to improve clarity of mind by activating dormant neural pathways in the brain and requiring patients to use appropriate behaviour, and function independently.
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