Models Of Dementia And Models Of Death/dying

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In this essay I will be talking about what theoretical perspectives and models informed my practise when doing my fieldwork. Community care is a social policy that informed my practise because it is long-term care for people who are mentally ill, elderly, or disabled which is provided within the community rather than in hospitals or institutions, especially as applied in the UK under the National Health Service and Community Care Act of 1990. My placement was based at St Joseph’s Hospice, who supports people in East and North East London with serious, life-limiting conditions. St Joseph’s is an independent charity, and only receives 56% of funding from the NHS. For the rest, we are heavily reliant on fundraising efforts and the kind generosity of our community. According to Doel (2010) community work placements not only provide the opportunity for practice learning and experience, ‘it is about the wider thinking, being able to make links between the practice to the academic learning, research and being able to continue the professional development’.

The medical model of Dementia is the main model that influences the care that is given to those individuals who come to St Josephs for their services like Namaste Care, Compassionate Neighbours and the Carers Service. At my placement organisation the community care policy is used in their work this is because they work with social networks and voluntary services where they aim to develop self-help concepts like the background of the policy. The main roles of individuals at the hospice during the delivery of the services is through the help of the organiser and the volunteers just like the way in which the community care policy works. They usually work with older people, persons with disabilities, children under 5 years old. The reason why this is relevant to my community work practise is because I was working with those elderly community members who are suffering from dementia by helping them to improve their quality of life.

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Theoretical ideas like community care services such as Namaste Care are put into place with the intention to help those who need care and support to live with dignity and independence in their own communities and to eliminate social isolation. St Joseph’s Hospice first opened in 1905 and since then has been caring for and supporting people affected by serious illness. The services are aimed at the elderly and they try to improve the quality of life for people with life-limiting conditions and help them live life to the full, to the very end. Supporting families and carers is also an important part of what they do at St Josephs. Care needs can be difficult to measure, and provision also involves matching client expectation, finances available and people willing to do the job. Hence why the roles of volunteers are most definitely valued because those individuals are the ones who are willing to be dedicated to support in providing services like the different types of daytime care outside a person’s home, i.e. day centres, lunch clubs or day hospitals. There is also respite care where it allows carers and people being cared for to have a break from each other. What respite services include a sitting service, family activity arrangements and respite in residential or nursing homes.

The Medical Model of Dementia is another idea that informs my community work practise. From a medical point of view, Dementia is a form of Alzheimer’s and there is no cure, but medications can slow the process down. Dementia can also be described as a typically progressive neurodegenerative disease which is an umbrella term for a range of conditions which primarily affect the neurons in the human brain. This is where the brain disorders are categorised by intellectual decline and slow loss of mental and physical functioning which can lead to disability and death. This only works if it’s caught early enough. This approach has allowed the methods of medical interventions for those people suffering with dementia and it holds the hope that one day some dementia may be preventable or curable. Whilst on placement I learnt that the lack of knowledge individuals have about Dementia is one of the reasons behind the stigma of dementia and this may well underpin many of the problems faced by people with dementia and their carers when seeking help and in their experience of care in different settings purely based on the fact that those individuals who have not come across dementia before are unaware of the difficulties for those with dementia. From my practise at St Josephs I learnt that there are two types of categories individuals who have dementia can be put into these are young onset dementia for those who develop dementia before the age of 65 and late-onset dementia refers to those who develop the illness after the age of 65.

The distinction between young- and late-onset illness still has clinical utility because characteristics of people with dementia differ between young-and late-onset cases, and people with dementia are thought to require and benefit from a different approach, leading to the widespread, but not yet universal, establishment of local specialist young-onset dementia services (Harvey et al., 2003).

Models of Dementia

One of the models of Dementia is the Implementing Innovative Model of Dementia Care: The Healthy Ageing Brain Centre. This is a medical program that provides care within the workplace Health and Safety to patients and family caregiver with concerns about the emotional and cognitive health of the ageing brain. The Healthy Ageing Brain Centre (HABC) is not supported by research funding to deliver care but it has standardised manual and electronic assessment, management, and performance data that facilitate access to research projects.

A ‘model of care’ can be said to be something that provides “the best practice care and services to an individual as they progress through the stages of an illness or condition.” In basic terms, the aim of any care model is to make sure that a person receives “the right care at the right time, that is suitable to their needs delivered by the right people in the right place”.

Many illnesses and conditions can follow an expectable path to which a consistent care model can be effectively used. In the case of dementia, there is no “one size fits all” model of care. The reason for this is because the symptoms that are linked with dementia can be connected to many different causes such as Alzheimer’s disease, severe head injury, strokes or the rise of protein deposits, known as Lewy bodies, which is in the brain. This shows that dementia affects different people in different ways according to a variation of factors including the individual’s age, the area of the brain affected and the underlying cause of the condition.

Models of Death/Dying:

The model was first introduced by Swiss-American psychiatrist Elisabeth Kübler-Ross in her 1969 book “On Death and Dying” and was inspired by her work with terminally ill patients and has received much criticism in the years since. In summary, The Kubler Ross Model was developed by Kubler-Ross and colleagues it is a five-stage model of death and dying. These stages have different emotional responses that people go through in reply to the knowledge of death. They are commonly referred to by the acronym of DABDA and are denial, anger, bargaining, depression and acceptance.

The first stage is denial this is where the patients / the individuals are in shock as they have just received that bad news. This is where they do not want to believe that they are ill. For example, when I was on placement at the hospice when a patient was diagnosed with a terminal illness, they believe the news is incorrect and they wanted to get tested again for reassurance. The hospice uses the teachings and the understandings of the Kübler-Ross Model to make sure that their patients are getting treated with dignity and respect as for many years, people with terminal illnesses were an embarrassment for doctors.

Once the denial and shock start to fade, the healing process begins. At this point, the emotional state of mind that an individual was once hiding starts to come out. And then the individual moves on to the anger stage. During this stage the individual recognises that the denial cannot continue, which makes them become irritated, especially at those individuals that are close. An example of when I was on placement, I came across an individual who was in the anger stage and didn’t want to believe she had dementia initially therefore her getting angry at her daughter was the way in which she responded. The model says that psychologically a person suffering from this phase would usually respond in the following: ‘ ‘How can this happen to me?”, Why me? It’s not fair!’

The third stage is known as “Bargaining”. This is when the individual struggles to find meaning and starts reaching out to other individuals by sharing their stories, with this the hope that the individual can avoid the cause of their sadness by the method of negotiation. They may deceptively make themselves believe that they can avoid the grief through a type of negotiation. Depression is the fourth stage; it is a commonly recognised method of grief. Most people immediately associate depression with grief as the “present” emotion of the individual. Being depressed is the replacement for anger with a sense of great loss and this usually occurs when the individual cannot deny the fact they are suffering from an illness. From reading current literature, I understood that during the fourth stage, the individual despairs at the acknowledgment of their mortality. In this state, the individual may become quiet, refuse visitors and spend most of their time of the time sad. In the last stage of acceptance individuals embrace their expected future or another tragic event that they may be going through.

In conclusion, Dementia has to do with the loss of memory and can shorten a person’s ability. It is important for individuals to understand that behavioural troubles are common in patients with dementia and should be expected. With Dementia it is not a specific disease, and that there is no known cure, but medications can temporarily improve the symptoms. People assume that those with dementia often deliberately misbehave but that is not always the case, individuals need to understand what the person suffering with dementia is feeling and understand what is happening from their point of view. There is almost always an explained reason for the behaviour once we understand the reason, we can address it, for example the individual might be in pain, but they have difficulties expressing it.

From being on placement at St Josephs I found out that the Race Demographics within the organisation could have an influence on the recruitment of the volunteers. One thing the organisation are struggling with is to get volunteers that represent the demographics of the area and the community members for example majority of the White Volunteers and the Namaste Care Department are in need for Sylheti Bangladeshi, Gujarati, Turkish and Caribbean Volunteers. This could be linked to the fact that most of the staff members are all White, in order to make a change and attract volunteers of more diverse backgrounds, the Namaste Team needs to be more diverse in culture. One benefit of services like Namaste Care is that they work with individuals to improve the quality of life by using sensory activities which allows everybody to get involved in and it is beneficial and available to all regardless of their communication and language barriers.

The Kubler-Ross Model is a tried recommendation that there is no wrong or right way to work through your heartache and it is normal that your personal experiences may differ as you work through the grieving method and its different stages. From my profession practise I learnt that Language matters when talking to individuals with dementia as we need to avoid discriminatory language and using phrases that may make them feel as if they are being mollycoddled. I also learnt that people need us to understand what they are thinking and feeling.

Criticisms of the five-stage model of grief centre mostly on a lack of experimental research and empirical evidence supporting the stages as described by Kübler-Ross and, to the contrary, practical support for other approaches of the expression of grief. From a social perspective, dementia be one of the ways in which an individual’s personal and social capacities may change for a variety of reasons, and changes in such capacities are only experienced as disabilities when environmental supports not adaptable to suit them. Counselling is a more solid approach toward grief. Support groups, bereavement groups, or individual counselling can help you work through unresolved grief. This is a beneficial treatment alternative when you find the grief event is creating obstacles in your everyday life. That is, you are having trouble functioning and need some support to get back on track. From a social perspective, dementia be one of the ways in which an individual’s personal and social capacities may change for many reasons, and changes in such dimensions are only experienced as disabilities when environmental supports are not adaptable to suit them.


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