Social work and Family Care for Dementia Patients

Care for People with Dementia

During the progression of symptoms from earliest signs through end of life, the impact of dementia on individuals suffering from the syndrome is increasingly devastating, as the effects on loved ones, family members and friends involved in their care. Help for progressive functional losses in dementia are provided by a combination of paid and family care, and it is reasonable to believe the quality of this care is directly related to the quality of life for the person living with dementia. Alzheimer’s disease may be the most comprehensive studied disorder of dementia, and research findings in this area offer compelling information about the impact of dementia on patients, families and society. For people with Alzheimer’s disease, 70 per­cent of all care is provided informally in their homes by dedicated loved ones (Alzheimer’s Study Group [ASG], 2008). In the United States in the year 2008, nearly 10 million unpaid caregivers, including family members, friends and neighbors, provided 8.5 billion hours of care for a loved one with Alzheimer’s disease, representing an average of 863 hours of care per caregiver per year and an economic value of US$94 billion. More than 40 percent of these unpaid caregivers experience very high levels of emotional stress, and nearly one-third develop clinical depression (AA, 2009). Family caregivers of people with dementia also experience many more health problems than their non-care giving peers, and have measurably reduced life expectancies.

The personal, familial, social and economic costs of unpaid, in-home dementia care cannot be ignored. At the same time, a continuum of health, mental health and aging services programs in both community and institu­tional settings provide formal care services. Dementia increases the average total cost of health and long-term care by more than 300 percent. In the United States, the added healthcare costs associated with dementia correlate with more than three times as many hos­pital stays and 30 percent more physician visits on average (ASG, 2008). The true costs of other essential services, such as personal care or social day care, are more difficult to estimate due to private payment arrangements and disconnected service systems, but such services surely amount to considerable additional expenses.

The reasons for the high costs of dementia care are many, but a central factor in the equation is the complexity of needs of elderly persons who have pervasive functional disabilities associated with dementia, as well as numerous co-occurring medical conditions. In addition, dementia compli­cates routine health practices and impedes independent compliance with treatment regimens, as individuals with dementia are more likely to mismanage medications and basic routines of self-care. The competence of medical practice in dementia care, in terms of diagnostic functions, patient care, disease alteration and symptom management remains limited (Boustani et al., 2007). In formal care systems, for which extraor­dinary financial investments by society are made and which continue to demonstrate considerable room for improvement in the quality of dementia care, competent practice is the responsibility of professionals from every healthcare discipline.

Professional Roles in Dementia Care

Capable social workers are needed to fill a crucial function at the front-line of service provision for older adults with dementia. Social work’s unique set of skills, values, resources and roles, as well as discipline-spanning location within care teams, position social workers well for providing supportive, therapeutic and educational services to individuals living with dementia and to their family members and other caregivers. Social work values, for example, celebrate human dignity, person-centered care, integ­rity, social justice and professional competence, and, therefore, are ideally suited to aiding professionals in facing the complex ethical dilemmas and practice decisions associated with addressing the care needs of individuals with dementia (Parker and Penhale, 1998; Parsons, 2005).

Social workers are called upon to perform dementia-related tasks in a wide diversity of settings throughout the continuum of care. Social workers in nurs­ing homes throughout the United States encounter 50 to 80 percent of resi­dents with dementia. These residents frequently experience symptoms of pain, agitation and depression, requiring a fully interdisciplinary approach to care, and relying upon doctors, nurses and nursing assistants, social workers, and other types of professionals such as physical therapists, occupational therapists and dieticians (Chapman and Toseland, 2007). In such long-term care settings, social workers may focus on interdisciplinary team development, resource management, provid­ing education to staff and families of residents, and advocacy. Acute care hospital social workers also often encounter many older individuals living with dementia, and their family caregivers, in times of crisis, when the need for care frequently surpasses the capabilities of the caregiver. In community-based care for people with dementia, which is the growing trend of care utilization in most developed countries, social workers are often performing in a case management role focused on organizing and coordinating services (Hughes et al., 2005).

Knowledge and skills used by social workers in this context may be very similar to each other. However, it is necessary to recognize common social functions as well as action functions to design appropriately. Development of social workers in the rotation and flexibility of the multiple roles that overlap additional functions help from other professionals in the care of dementia patients can make significant progress in the creation, implementation, evaluation and dissemination of multiple interventions in dementia care. However, the lack of supporting evidence for extensive intervention by social work in the field of aging research is needed to prioritize dementia also subject to special study.

The International Association of Social Work (NASW) in long-term care and geriatric social workers in the field of aging and the diseases associated with this period refers to the following diagram:

Figure 1: The Role of Professional Social Workers in Long-Term Care

Sajjad Majidi Parast
Research Manager of Hana Social Work Clinic
Ph.D student of social work, Allameh Tabataba’i University, Tehran

References:

1. Alzheimer’s Disease International (2008). Available at: http://www.alz.co.uk/research/statistics.html
2. Alzheimer’s Study Group (ASG) (2008). A National Alzheimer’s Strategic Plan: The Report of the Alzheimer’s Study Group. Available at: http://www.alz.org/documents/national/report_ASG_alzplan.pdf.
3. Boustani, M., G. Sachs and C.M. Callahan, (2007). Can Primary Care Meet the Biopsychosocial Needs of Older Adults with Dementia?. Journal of Geriatric Internal Medicine 22(11): 1625–27.
4. Chapman, D.G. and R.W. Toseland (2007). Effectiveness of Advanced Illness Care Teams for Nursing Home Residents with Dementia. Social Work, 52(4): 321–9.
5. Hughes, J., C. Sutcliffe and D. Challis (2005). Standards in Dementia Care. Abingdon: Taylor & Francis Group. 197–204
6. Parker, J. and B. Penhale (1998). Forgotten People: Positive Approaches to Dementia Care. Aldershot: Ashgate.

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