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Using a biopsychosocial model of dementia as a tool to guide clinical practice

Published online by Cambridge University Press:  18 June 2010

Aimee Spector  and
Martin Orrell
Aimee Spector*
Affiliation:
Department of Clinical, Educational and Health Psychology, University College London, U.K.
Martin Orrell
Affiliation:
Department of Mental Health Sciences, University College London, U.K.
*
Correspondence should be addressed to: Dr Aimee Spector, Department of Clinical, Educational and Health Psychology, University College London, 1–19 Torrington Place, London WC1E 6BR, U.K. Phone: +44 (0)20-7679-1844; Fax: +44 (0)20-7916-1989. Email: [email protected].
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Abstract

Background: Over the years, a number of non-medical and psychosocial explanations and models of dementia have been proposed, due to the complex nature of the illness. However, there is a need for a more pragmatic, user-friendly model which takes into account the biological, psychological and social processes.

Methods: Existing models of dementia were amalgamated into a revised, pragmatic model which aims to increase our understanding of the factors that may lead to improvement or deterioration in dementia and to illustrate the role of psychosocial factors in the context of biological processes. The model suggests that in both psychosocial and biological domains there are fixed factors (aspects which relate to history or risk factors and therefore not amenable to change), tractable factors (aspects which may be amenable to change), and interventions with potential benefit.

Results: The trajectory of dementia is presented as a process, beginning with aging and ending in death. Both the fixed and the tractable factors may influence the severity of dementia, affecting function, the speed and nature of the deterioration, and the appropriateness and effectiveness of interventions. A working case example is provided, demonstrating how the model may be used by clinicians when assessing the difficulties of an individual with dementia and identifying ways to improve the quality of life and reduce excess disability for that person.

Conclusions: This model provides a theoretical framework and an ambitious approach to care in dementia which takes into account positive as well as negative factors. We hope it may become a useful tool for researchers and clinicians to help understand what impacts on individuals with dementia and the most appropriate ways to intervene.

Keywords

modelAlzheimer'stheoryinterventionvascular dementia
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Special Issue 6: Focus on training in psychogeriatrics , September 2010 , pp. 957 - 965
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Bahro, M., Silber, E. and Sunderland, T. (1995). How do patients with Alzheimer's disease cope with their illness? A clinical experience report. Journal of the American Geriatrics Society, 43, 41–46.CrossRefGoogle ScholarPubMed
Ballard, C., Bannister, C., Solis, M., Oyebode, F. and Wilcock, G. (1996). The prevalence, associations and symptoms of depression amongst dementia sufferers. Journal of Affective Disorders, 36, 135–144.CrossRefGoogle ScholarPubMed
Baltes, P. B. and Baltes, M. M. (1990). Psychological perspectives on successful aging: the model of selective optimization with compensation. In Baltes, P. B. and Baltes, M. M. (eds.), Successful Aging: Perspectives from the Behavioural Sciences (pp. 1–34). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Bender, M. and Cheston, R. (1997). Inhabitants of a lost kingdom: a model of the subjective experiences of dementia. Ageing and Society, 17, 513–532.CrossRefGoogle Scholar
Blennow, K., De Leon, M. and Zetterberg, H. (2006). Alzheimer's disease. Lancet, 368, 387–403.CrossRefGoogle ScholarPubMed
Breuil, V. et al. (1994). Cognitive stimulation of patients with dementia: preliminary results. International Journal of Geriatric Psychiatry, 9, 211–217.CrossRefGoogle Scholar
Brody, E. M., Kleban, M. H., Lawton, M. P. and Silverman, H. A. (1971). Excess disabilities of mentally impaired aged: impact of individualized treatment. Gerontologist, 11, 124–133.CrossRefGoogle ScholarPubMed
Brooker, D. (2004). What is person-centred care in dementia? Reviews in Clinical Gerontology, 13, 215–222.CrossRefGoogle Scholar
Butler, R. N. and Lewis, M. L. (1982). Aging and Mental Health, 3rd edn. St Louis: CV Mosby Company.Google Scholar
Clare, L., Woods, R. T., Moniz-Cook, E. D., Orrell, M. and Spector, A. (2003). Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia Cochrane Database of Systematic Reviews, 4, CD003260.Google Scholar
Cohen-Mansfield, J. (2000). Heterogeneity in dementia: challenges and opportunities. Alzheimer's Disease and Associated Disorders, 14, 60–63.CrossRefGoogle ScholarPubMed
Davis, D. H. J. (2004). Dementia: sociological and philosophical constructions. Social Science and Medicine, 58, 369–378.CrossRefGoogle ScholarPubMed
De Ronchi, D., Fratiglioni, L., Rucci, P., Paternicò, A., Graziani, S. and Dalmonte, E. (1998). The effect of education on dementia occurrence in an Italian population with middle to high socioeconomic status. Neurology, 50, 1231–1238.CrossRefGoogle Scholar
Downs, M., Clare, L. and Anderson, E. (2008). Dementia as a biopsychosocial condition: implications for practice and research. In Woods, R. and Clare, L. (eds.), Handbook of the Clinical Psychology of Ageing, 2nd edn (pp. 145–160). Chichester: Wiley.CrossRefGoogle Scholar
Dröes, R. M. (1991). In Beeweging: Over Psychosociale Hulpverlening aan Demente Ouderen. Utrecht: De Tijdstroom.Google Scholar
Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196, 129–136.CrossRefGoogle Scholar
Finnema, E., Droes, R. M., Ribbe, M. and Tilberg, W. (2000). A review of psychosocial models in psychogeriatrics: implications for care and research. Alzheimer's Disease and Associated Disorders, 14, 68–80.CrossRefGoogle ScholarPubMed
Folsom, J. C. (1966). Reality orientation for the elderly mental patient. Paper presented at the 122nd Annual Meeting of the American Psychiatric Association, May 1966.Google Scholar
Fratiglioni, L., Wang, H., Ericsson, K., Maytan, M. and Winblad, B. (2000). Influence of social network on occurrence of dementia: a community-based longitudinal study. The Lancet, 355, 1291–1292.CrossRefGoogle ScholarPubMed
Gorelick, P. (2004). Risk factors for vascular dementia and Alzheimer's disease. Stroke, 35, 2620–2622.CrossRefGoogle Scholar
Haberg, B. (1997). The dementias in a psychodynamic perspective. In Meisen, B. M. L. and Jones, G. M. M. (eds.), Care-Giving in Dementia, Research and Applications. Volume 2 (pp. 14–35), London: Routledge.Google Scholar
Hall, G. R. and Buckwalter, K. C. (1987). Progressively lowered stress threshold: a conceptual model for care of adults with Alzheimer's disease. Archives of Psychiatric Nursing, 1, 399–406.Google ScholarPubMed
Katzman, R. (1993). Education and the prevalence of dementia and Alzheimer's disease. Neurology, 43, 13–20.CrossRefGoogle ScholarPubMed
Kitwood, T. (1990). The dialectics of dementia: with particular reference to Alzheimer's disease. Ageing and Society, 10, 177–196.CrossRefGoogle Scholar
Kitwood, T. (1993). Towards a theory of dementia care: the interpersonal process. Ageing and Society, 13, 51–67.CrossRefGoogle Scholar
Kitwood, T. (1997). The concept of personhood and its relevance for a new culture of dementia care. In: Meisen, B. M. L. and Jones, G. M. M. (eds.), Care-Giving in Dementia, Research and Applications. Volume 2 (pp. 3–13), London: Routledge.Google Scholar
Laurin, D., Verreault, R., Lindsay, J., MacPherson, K. and Rockwood, K. (2001) Physical activity and risk of cognitive impairment and dementia in elderly persons. Archives of Neurolology, 58, 498–504.Google ScholarPubMed
Lawlor, B. A. (2004). Behavioural and psychological symptoms in dementia: the role of atypical anti-psychotics. Journal of Clinical Psychiatry, 65 (Suppl. 11), 5–10Google Scholar
Low, L. F., Brodaty, H. and Draper, B. (2002). A study of pre-morbid personality and behavioural and psychological symptoms of dementia in nursing home residents. International Journal of Geriatric Psychiatry, 17, 779–783.CrossRefGoogle ScholarPubMed
Lyman, K. A. (1989). Bringing the social back in: a critique of the biomedicalization of dementia. The Gerontologist, 29, 597–605.CrossRefGoogle Scholar
Netten, A. (1991). A positive experience? Assessing the effect of the social environment on demented elderly residents of local authority homes. Social Work and Social Sciences Review, 3, 46–62.Google Scholar
Nygren, B., Aléx, L., Jonsén, E., Gustafson, Y., Norberg, A. and Lundman, B. (2005). Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old. Aging and Mental Health, 9, 354–362.CrossRefGoogle ScholarPubMed
Orrell, M. and Bebbington, P. E. (1998). Life events and cognition in dementia. Ageing and Mental Health, 2, 53–59.CrossRefGoogle Scholar
Sabat, S. R. and Harre, R. (1992). The construction and deconstruction of self in Alzheimer's disease. Ageing and Society, 12, 443–461.CrossRefGoogle Scholar
Snowdon, A. (2003). Healthy ageing and dementia: findings from the Nun study. Annals of Internal Medicine, 139, 450–454.CrossRefGoogle ScholarPubMed
Spector, A. et al. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. British Journal of Psychiatry, 183, 248–254.CrossRefGoogle ScholarPubMed
Stern, Y. (2002). What is cognitive reserve? Theory and research application of the reserve concept. Journal of the International Neuropsychological Society, 8, 448–460.CrossRefGoogle ScholarPubMed
Willis, T. (1684). Practice of Physick (trans. Pordage, S.). London: Dring, Harper and Leigh.Google Scholar
Woods, R. and Clare, L. (2008). Psychological interventions with people with dementia. In Woods, R. and Clare, L. (eds.), Handbook of the Clinical Psychology of Ageing, 2nd edn (pp. 523–548). Chichester: Wiley.CrossRefGoogle Scholar
World Health Organization (2002). Towards a Common Language for Functioning, Disability and Health. Geneva: World Health Organization.Google Scholar
Zimmerman, S. et al. (2005). Attitudes, stress and satisfaction of staff who care for residents with dementia. The Gerontologist, 45, 96–105.CrossRefGoogle ScholarPubMed