The personal care home where I am doing my field placement is a place where diverse groups of people gather and work. Those groups consist of residents, families, staff, volunteers, visitors, and so on. The majority of people are old older adults with dementia who are in closer to the end of life. As I see these people, I feel that I am lucky because I am healthier and younger than them and can help them. Now and then, questions arise in my mind about dementia: what is it, what are the risk factors, what issues make residents or families hard to deal with, and how do staff cope, especially social workers in my field placement. Although I have learned about this disease in a few classes, I do not think I really considered this disease from a client-centered perspective because I thought I already knew about dementia well before I took a few courses. However, I found out that I overlooked very sensitive parts, which can be issues among people when I talked with people that I have known for many years. I feel, at the moment, that all my knowledge pieces about dementia are disorganized in my head. I, therefore, will try to make sense of this issue by utilizing my classnotes, textbook and brochures that guest speakers brought. I will look back on myself and think about this disease again. I hope this time can help me to clearly understand some issues arising with the definition of dementia.
To understand better, it is necessary to describe what dementia is. According to the Alzheimer Society of Manitoba (2010), dementia is defined as a disease of brain cells, which causes memory loss, and cognitive impairment. A currently irreversible and slowly progressive disease, dementia is related to a diversity of dementias, such as Alzheimer’s disease (AD) that Vascular Dementia, Frontotemporal Dementia, Creutzfeldt-Jakob Disease, Lewy body Dementia, Parkinson’s disease and Huntington’s disease. All these dementias are different from one another. I do not describe all about these disease here, but further research is needed in order to understand in detail. Dementia is also well-known as a main problem in geriatric care. Of course, as Saxon, Etten, and Perkins (Saxon et al., 2010) note, “…diagnosis of dementia occur[s] in the vast majority of people at the oldest ages…” (p. 189). Often dementia causes disability and morbidity in older people. Degenerative Alzheimer disease, Vascular dementia, B12 deficiency, autoimmune disorders, Parkinsonism, infections, such as HIV/ AIDS, other extra-pyramidal disorders, such as Huntington’s disease, and Trauma can cause dementia (Mackenzie, 2010).
Unfortunately, today’s medical technology cannot help. There is currently no cure for Alzheimer’s disease generates. In terms of caregiving issues, mostly women, especially spouses take responsibility care for their partners of dementia. Sawatzky and Fowler-Kerry (2003) note that “the burden of care often falls disproportionately on mothers, wives and/or daughters, who are unpaid for services. Physical effort, combined with lack of support, medical knowledge and sleep, can often place the health of caregivers at risk” (p. 277). Have you ever thought why women take responsibilities for caregiving more often than men? How should caregivers’ needs be met regarding this issue? In order to meet caregivers’ needs, what policies should be changed? Are there any options to care for people with dementia in the home? Do caregivers in the home should be paid? If caregivers want to care in their home, how can home care social workers assist them? How can social workers help them reduce the sense of burdens?
Making the decision to institutionalize is also an issue in terms of people with dementia. Lundh, Sandberg and Nolan (2000), Nolan and Dellasega (2000) emphasize that “making the decision to institutionalize a loved one is among their most difficult experiences, a time of crisis for the family” (as cited in Caron, Ducharme, and Griffitha, 2006, p. 195). If caregivers choose institutionalization, regardless of the opinion of the cognitively impaired older adults, how should social workers intervene? From caregivers’ perspectives, should social workers respect the caregivers’ decision even if the cognitively impaired older adults do not want to go to an institution? If social workers met family members who were psychologically distressed due to memory loss that caused a bad relationship, how could social workers help them? On the other hand, from clients’ perspectives, if cognitively impaired older family members refuse to go to institutions, should they be at home?
As the Alzheimer society emphasizes, early diagnosis from family is really important to address earlier treatments and to improve the life of people with dementia. Family should look for signs, such as the loss of sense of smell and loss of weight, confusion, decrease of ability to make a decision. Education about Alzheimer’s disease provides behavioural therapeutic strategies, such as activities and music. Such therapeutic techniques can help improve life for both people with dementia and their families. Social workers should think about how they encourage families to be aware of these signs, and how they encourage families to more participate in these therapeutic strategies. If families resisted against participating in these strategies, how could social workers handle this case? Are there any alternative strategies instead of these therapeutic strategies?
According to Saxon et al (2010), “The Alzheimer’s Association reports a prevalence of 5.1 million Americans with Alzheimer’s disease (AD) in 2009 , with a projected increase to 7.7 million in 2030” ( p. 167). The more AD population increases, the more ethical issues maybe increase. Presumably, social workers’ roles are more important than before.
References
Alzheimer Society of Manitoba. (2010). Research: Related dementia-Vascular dementia. Winnipeg, Manitoba: Alzheimer Society of Manitoba.
Caron, C. D., Ducharme, F., & Griffitha, J. (2006). Deciding on institutionalization for a relative with dementia: The most difficult decision for caregivers. Canadian Journal on Aging, 25(2), 193-205.
Mackenzie, C. (2010, October 5). Dementia. Presented at a KIN 2610 lecture at the University of Manitoba, Winnipeg, MB.
Sawatzky, J. E. & Fowler-Kerry, S. (2003). Impact of caregiving: Listening to the voice of informal caregivers. Journal of Psychiatric and Mental Health Nursing, 10, 277-286.
Saxon, S.V., Etten, M. J., & Perkins, E. A. (2010). Physical change and aging (5th. Ed.). New York: Springer Publishing Company
