Research into quality dementia care and the best ways of supporting carers provides important insights into improving quality of life of people with dementia, their families and carers.
Research into improving quality of life for people with dementia
While there is currently no cure for dementia, research has shown that there is much scope to improve the quality of life of people living with dementia through management of symptoms and providing a supportive environment. Person centred care is considered important. This involves developing a thorough understanding of the individual person and giving consideration to their cultural background, personal history, social and family networks and preferences for activities in designing their care.
There are a wide range of non-drug alternative therapies that may be effective for people with dementia. These include therapies aimed at improving understanding and communication as well as therapies aimed at managing behavioural and psychological symptoms of dementia.
Therapies such as validation therapy, reality orientation and reminiscence therapy aim to facilitate understanding and communication, but may also have positive effects on anxiety and mood.
- Validation therapy uses communication strategies to encourage people with dementia by accepting their reality.
- Reality orientation provides information about the environment to orientate a person with dementia to their surroundings using aids and prompts.
- Reminiscence therapy promotes memory and recall by reviewing past events, assisted by multimedia memory aids.
There is some limited evidence that these therapies may be beneficial in improving behaviour, mood and possibly cognition. However, only a small number of studies have been undertaken and more rigorous study is needed to demonstrate the effectiveness of these alternative therapies.
Another alternative approach involves sensory therapies. Sensory therapies use stimulation of the different senses such as touch, smell, hearing and sight to promote wellbeing and reduce stress and anxiety in people with dementia. Sensory therapies include art therapy, music therapy, aromatherapy and touch therapy as well as snoezelen therapy.
Snoezelen rooms are multi-sensory environments containing different lighting effects, touchable surfaces, music and aromas to stimulate various senses. Snoezelen may have short term effects in promoting positive mood and reducing anxiety, although little research has been undertaken to fully document the approach.
More research is needed to examine the role of alternative therapies in improving quality of life for people with dementia.
There are many interventions which aim to help people with dementia maintain independence and keep active. Some use exercise training or memory training to promote both physical fitness and brain function. In one study, a combination of reality orientation, thinking exercises and training in activities of daily living produced positive effects on both thinking and behaviour. Other studies have indicated that exercise training can positively affect thinking, physical fitness and mood in people with dementia.
Research suggests that good dementia care should involve creating opportunities for people to utilise their remaining abilities. Activities should be related to interests that were important or enjoyable to the person before the onset of dementia and enjoyable for them now. Everyday activities and culturally or personally significant activities can promote self -esteem, dignity and wellbeing.
Many people with dementia develop behavioural and psychological symptoms over the course of the condition, such as anxiety, depression, aggression, wandering, agitation or loss of inhibitions. A great deal of research is dedicated to examining strategies to assist in recognising the causes of changed behaviours and in managing behaviour.
Sometimes medications are prescribed to treat behavioural and psychological symptoms of dementia. Research suggests that some of these can be very beneficial, such as drugs used to treat depression. However, recent findings have called into question the safety of some other drugs, such as antipsychotics, for people with dementia. Research is continuing to find the safest and most effective drug treatments.
Management using alternative therapies rather than drugs is a focus of current research. Recent reviews of the research in this area found that treatments with moderate or large effect sizes included aromatherapy, ability-focused carer education, bed baths, preferred music, recreation therapy and muscle relaxation training. Although relatively little research has established the effectiveness of these therapies, many believe that they can be useful in alleviating psychological and behavioural symptoms for people with dementia. In general, it appears as though therapies individually tailored for the person with dementia may be most useful.
Research into supporting carers of people with dementia
Another major element in dementia care research is identifying effective ways of providing support and training to carers and family members of people with dementia. Carers face many challenges and are at increased risk of stress, depression and other illnesses. Research in this area focuses on interventions that can best support them in a range of ways.
Research shows that when family members and carers are educated about the disease and involved in the person’s care, the person with dementia benefits. When the family and carer of a person with dementia understand the disease and learn how to communicate and interact with the person in ways appropriate to the disease stage, they are better able to reduce behavioural problems and improve the quality of life for all involved.
Carer interventions come in many different forms, and ongoing research is investigating which programs and components are most beneficial. Evidence supports the use of interventions that go beyond education to include various forms of psychosocial support, including counselling, training in techniques for behavioural management and participation in support groups. Studies show that such programs can reduce depression, anger, tension, fatigue and confusion in carers.
Dementia Australia has produced several publications based on the evidence for effective dementia care, or discussing research in this area:
- Consumer Directed Care: A Way to Empower Consumers?
- Dementia Care and the Built Environment
- Quality Dementia Care
- Respite Care for People Living with Dementia “It’s more than just a short break”
Submissions to Australian Government
- Dementia: Facing the Epidemic
Quality Dementia Care papers
- A Guide to Practice in Residential Aged Care Facilities for all Staff
- A Guide to Practice for Managers in Residential Aged Care Facilities
- Nurturing the Heart: Creativity, Art Therapy and Dementia.