Dementia is a condition caused due to the brain disorder. It is a long-term syndrome and is usually progressive. It is characterized by disruption of several higher cortical functions, which include orientation, memory, calculation, learning capacity, comprehension, thinking, and judgment.
Improvement in the quality of care for people having dementia in general hospitals
Physiotherapy has been good for dementia and has a cost-saving factor for people affected by it, saving up to £6 million per year.
Physiotherapists play a significant role in contributing to discharge planning with a multi-disciplinary team. Earlier, this planning was effective in reducing the time of the patients, with dementia, to stay at the hospital. A hip-fracture patient, at an average, stays for seven days in a hospital.
However, the dementia patients, with hip injury needs to stay for about 14 days and the number accounts to more than 85%. Whereas, some, accounting to 34%, have to stay for at least a month. The extra cost may sum up to for £5,950 a single patient.Falls, the most common cause for getting admitted to a hospital, accounts for 14% of the people with dementia.
The chance of falling is increased by poor balance, and physiotherapy-based exercises can lower the chances, by curing it. Exercises can directly improve the conditions, by having a positive impact on the psychological and behavioral symptoms of dementia. It improves cognitive function and also mood, which in turn reduces the requirement of pharmacological intervention (Mori et al., 2015).
Information suggests it to be an effective kind of work for dementia patients. It has been proved that physiotherapy can lower the probability of having dementia, by delaying both functional and cognitive decline progression.
Dementia has been seen to be maximum in elderly people, who frequently have comorbidities. Physiotherapy guided exercises, which increase physical fitness, also has the potential to lower the factors promoting cardiovascular hazards, and also some other conditions like osteoporosis and diabetes.
Most of the physiotherapists faced difficulty in establishing their interventions, in all specialties and settings, and in justifying their efforts in the process. They reported that the standard mode of outcome measures was not suitable for this kind of population, yet all of them had a general feeling that some outcome measure needed to be used.
A kind of challenge arose among the physiotherapists, who wanted to work with orthopedic doctors, as the working procedures differ in both the professionals. The doctors used the biomedical approach in treating the population, which kind of differed from the priorities of physiotherapy. However, many physiotherapists reported working, in the company of occupational therapists (OTs), mostly in in-patient settings (Hallberg et al., 2016).
The physiotherapists reported of feeling pressured to work by the inappropriate biomedical assessments and results. This, however, was the only approach to learning by the undergraduates.The physiotherapists stated that the biomedical approaches were useless, which urged them to change the way for managing the population (Lords and Rochester, 2016).
Memory difficulties, which is the most usual symptom of dementia, has been hardly tried to overcome by the physiotherapists, the only one being the idea of using memory book, or written instructions, which can enable the patients to have a continuous practice of the exercises independently. Alternatively, they recommended taking the pragmatic approach to overcome this problem.
In addition to a consistent physiotherapist, a routine, created on a daily basis for reducing disorientation, was done alongside, for the treatment of the patients. Many physiotherapists stated the role of environment in this context, with the most suitable one being the familiar or the home environment (Hall et al., 2016).
Adaptation of verbal communication, for example, breaking down of the instructions, usage of short sentences and slow speaking, etc. has been suggested. According to the reports of many physiotherapists, it is also important not to overload a person with verbal input.
Conforming to the fact that acute physiotherapists didn’t consider ‘risk-taking’ as a problem at all, it was also true that, community-based physiotherapists described it as having a powerful effect on their patient management and clinical reasoning. There is always a risk of additional physical injury, by physiotherapy, as it challenges the physical ability of a person. Reported dangers can be asking someone to walk without a walking aid or telling them to go home with a high falling risk. The extent up to which a physiotherapist is accepting this risk was believed to affect the potential of improvement of a person. Some physiotherapists, as it was seen, were not willing to take any risks (Hall et al., 2017).
As briefed in the acute setting, patients frequently have their mobility purposely restricted to try and, in turn, preventing the danger of further falling. This was achieved using sedative, bed rails or demoralize the people who tried to stand or walk. Physiotherapists, by time, realized that this was causing further disabilities to people, slow progress of physiotherapy, and other risk factors such as chest infections, pressure sores, and various cardiovascular complications. Hence, encouraging mobility was their primary aim, along with the fact that imperfect treatments were required once in a while. Avoiding risks were felt by the community and mental health physiotherapists, as to limit the person’s ability from living a fulfilled life (Wood, Alushi and Halmond, 2016).
While dementia education is critical in imparting health care services to dementia patient as well as the patient care giver. But in the context of nonaged care professionals, the educational pattern needs to be changed. In the present essay, it was found physiotherapist’s requirement of dementia knowledge is diverse and demands to address subtle factors. Dementia patient tends to relate their immediate environment with actions taken. Some factors are critical to dementia education as far as professionals other than dementia caregivers are concerned. Communication, meaningful engagement, person-centered care, problem-solving approach, and palliative approach to care. Thus, education in non-dementia care givers must explain the different aspects in simpler terms. Similarly, the required amount of patience required to address dementia patient issues must be addressed.
Hall, A. J., Watkins, R., Lang, I. A., Endacott, R., & Goodwin, V. A. (2017). The experiences of physiotherapists treating people with dementia who fracture their hip. BMC geriatrics, 17(1), 91.
Hall, A., Goodwin, V., Lang, I., & Endacott, R. (2016). Physiotherapy interventions for people with dementia and a hip fracture–a scoping review of the literature. Physiotherapy, 102, e187.
Hallberg, I. R., Cabrera, E., Jolley, D., Raamat, K., Renom-Guiteras, A., Verbeek, H., … & Karlsson, S. (2016). Professional care providers in dementia care in eight European countries; their training and involvement in early dementia stage and in-home care. Dementia, 15(5), 931-957.
LORD, S., & ROCHESTER, L. (2017). Role of the physiotherapist in the management of dementia. Dementia, 220.
Wood, J. H., Alushi, L., & Hammond, J. A. (2016). Communication and respect for people with dementia: student learning (CARDS)–the development and evaluation of a pilot of an education intervention for pre-qualifying healthcare students. International Psychogeriatrics, 28(04), 647-656.