Skip to main content
×
Home
    • Aa
    • Aa

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

  • Aimee Spector (a1) and Martin Orrell (a2)
Abstract
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.

Copyright
Corresponding author
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: a.spector@ucl.ac.uk.
References
Hide All
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, 4146.
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, 135144.
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. 134). Cambridge: Cambridge University Press.
Bender M. and Cheston R. (1997). Inhabitants of a lost kingdom: a model of the subjective experiences of dementia. Ageing and Society, 17, 513532.
Blennow K., De Leon M. and Zetterberg H. (2006). Alzheimer's disease. Lancet, 368, 387403.
Breuil V. et al. (1994). Cognitive stimulation of patients with dementia: preliminary results. International Journal of Geriatric Psychiatry, 9, 211217.
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, 124133.
Brooker D. (2004). What is person-centred care in dementia? Reviews in Clinical Gerontology, 13, 215222.
Butler R. N. and Lewis M. L. (1982). Aging and Mental Health, 3rd edn. St Louis: CV Mosby Company.
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.
Cohen-Mansfield J. (2000). Heterogeneity in dementia: challenges and opportunities. Alzheimer's Disease and Associated Disorders, 14, 6063.
Davis D. H. J. (2004). Dementia: sociological and philosophical constructions. Social Science and Medicine, 58, 369378.
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, 12311238.
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. 145160). Chichester: Wiley.
Dröes R. M. (1991). In Beeweging: Over Psychosociale Hulpverlening aan Demente Ouderen. Utrecht: De Tijdstroom.
Engel G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196, 129136.
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, 6880.
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.
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, 12911292.
Gorelick P. (2004). Risk factors for vascular dementia and Alzheimer's disease. Stroke, 35, 26202622.
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. 1435), London: Routledge.
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, 399406.
Katzman R. (1993). Education and the prevalence of dementia and Alzheimer's disease. Neurology, 43, 1320.
Kitwood T. (1990). The dialectics of dementia: with particular reference to Alzheimer's disease. Ageing and Society, 10, 177196.
Kitwood T. (1993). Towards a theory of dementia care: the interpersonal process. Ageing and Society, 13, 5167.
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. 313), London: Routledge.
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, 498504.
Lawlor B. A. (2004). Behavioural and psychological symptoms in dementia: the role of atypical anti-psychotics. Journal of Clinical Psychiatry, 65 (Suppl. 11), 510
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, 779783.
Lyman K. A. (1989). Bringing the social back in: a critique of the biomedicalization of dementia. The Gerontologist, 29, 597605.
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, 4662.
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, 354362.
Orrell M. and Bebbington P. E. (1998). Life events and cognition in dementia. Ageing and Mental Health, 2, 5359.
Sabat S. R. and Harre R. (1992). The construction and deconstruction of self in Alzheimer's disease. Ageing and Society, 12, 443461.
Snowdon A. (2003). Healthy ageing and dementia: findings from the Nun study. Annals of Internal Medicine, 139, 450454.
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, 248254.
Stern Y. (2002). What is cognitive reserve? Theory and research application of the reserve concept. Journal of the International Neuropsychological Society, 8, 448460.
Willis T. (1684). Practice of Physick (trans. Pordage S.). London: Dring, Harper and Leigh.
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. 523548). Chichester: Wiley.
World Health Organization (2002). Towards a Common Language for Functioning, Disability and Health. Geneva: World Health Organization.
Zimmerman S. et al. (2005). Attitudes, stress and satisfaction of staff who care for residents with dementia. The Gerontologist, 45, 96105.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 63
Total number of PDF views: 419 *
Loading metrics...

Abstract views

Total abstract views: 2246 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd October 2017. This data will be updated every 24 hours.