I have a new press kit for my book available through Health Professions Press.
Here’s a portion of the interview. Check back next week to read more.
Dementia Beyond Drugs
Changing the Culture of Care
by G. Allen Power, M.D.
Q: What is culture change and why is it necessary?
A: The culture change movement began as a means to transform nursing homes from sterile institutions into more life-affirming homes for our elders. The institutional approach to care sees elders primarily for their diseases and deficits, rather than as whole people. Accordingly, it creates an environment that places tasks before relationships, perpetuates helplessness, and corrodes meaning
for those who live there. This approach has made home- and community-based care institutional as well.
Well-intentioned changes to dementia programs fall short because of the overriding negative effects of this care environment. It is only through transformation to a new system of care that we can make significant headway in reversing the damaging effects of institutionalized living.
Q: The title of this book refers to two concepts, dementia medication and culture change. How are they related?
A: Behavioral distress in dementia is largely a function of the care environment, which creates unmet needs and erodes well-being. We see the behavioral distress as the problem, rather than a symptom of these larger issues, and so we respond with sedating medications to reduce the behaviors.
Culture change challenges us to look deeper for the unmet needs, and to create opportunities for well-being as a means to relieve distress.
Q: What are some of the key differences between the institutional and the experiential models of care?
A: The institutional model focuses on disability and decline; it fails to recognize the strengths and abilities retained even in advanced stages of the illness. As such, it sees behavioral distress as neuropathology and tries to “control” it through medication use. It doesn’t recognize the critical influence of the care environment on the individual’s well-being.
The experiential model views people with dementia in a more holistic manner. I ask the reader to consider dementia primarily as “a shift in the way a person experiences the world.” Rather than trying to “normalize” the person’s perspective, we recognize his own unique point of view and find ways to change the care environment to create a world in which he can continue to succeed.
Think of it as being similar to the way we build ramps to enable people in wheelchairs to continue to be successful in accessing the world around them. We don’t ask them to walk; instead we shape the environment around their needs.