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 Table of Contents  
COMMENTARY
Year : 2021  |  Volume : 2  |  Issue : 3  |  Page : 39-41

Nonpharmacological intervention module for graded domiciliary care in dementia care at community level: A novel endeavor


1 Department of CM and FM, AIIMS, Guwahati, Assam, India
2 Department of Psychiatry, Malda Medical College, Malda, West Bengal, India
3 Department of Psychiatry, North Bengal Medical College, Siliguri, West Bengal, India

Date of Submission21-May-2021
Date of Decision14-Jun-2021
Date of Acceptance16-Jun-2021
Date of Web Publication28-Dec-2021

Correspondence Address:
Nilanjana Ghosh
Department of CM and FM, AIIMS, Guwahati, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jssrp.jssrp_11_21

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  Abstract 


Mental health is an oftly neglected topic more so due to stigma associated with the disease. Hence, availability of a user-friendly module can be of immense help to carers improving their mental health, as they often suffer from depression. This in turn may lead to clinical improvement of the patient as well. Integrating each family member into the care practices is also equally important. Nonpharmacological interventions once designed and structured will lead to a standardized care continuum at the community level for all patients and will help as a ready reckoner for the careers to compare their work or call out to each other during times of need. Even the burden on hospitals will decrease which will then mainly focus on patient monitoring pharmacological interventions.

Keywords: Care in community, dementia care, dementia in community, non pharmacological intervention


How to cite this article:
Ghosh N, Mukherjee B, Layek A. Nonpharmacological intervention module for graded domiciliary care in dementia care at community level: A novel endeavor. J Surg Spec Rural Pract 2021;2:39-41

How to cite this URL:
Ghosh N, Mukherjee B, Layek A. Nonpharmacological intervention module for graded domiciliary care in dementia care at community level: A novel endeavor. J Surg Spec Rural Pract [serial online] 2021 [cited 2022 Jun 28];2:39-41. Available from: https://jssrp.org/text.asp?2021/2/3/39/334042




  Dementia Top


Dementia is the disease, downhill course, and burden, and caregivers are usually untrained with no clue what to do. Takes a toll on them, many suffer from depression, mostly first-degree female relatives. Dementia is an often neglected aptly repeated issue which looms large not only in textbooks of mental health but also in community at large. It remains a gray zone where no defined rules and codes exist and when a family gets diagnosed with a demented member amidst them, they are at a loss so as to how to cope and tide over, creating more mayhem in the process. The financial burden superadded with the fact that it's not going to heal but only deteriorate adds to the confusion.[1]

As stages vary, hence, graded care may be provided at domiciliary level with the help of a structured module by caregivers at community level. Nonpharmacological interventions once designed and structured will lead to a standardized care continuum at the community level for all patients and will help as a ready reckoner for the careers to compare their work or call out to each other during times of need. Even the burden on hospitals will decrease which will then mainly focus on patient monitoring pharmacological interventions.

Hence, an operationally feasible, user-friendly structured booklet outlined care practices for each dementia grades along with the emergency management, and contact numbers may increase compliance of caregivers and help improve the quality of standard care. With aim to triage cases and help the caregivers and eventually the health system, this module has been developed by experts and validated. If found effective and operationally feasible intervention, it may be incorporated in mainstream for widespread dissemination. DHS, heath has also been shown the module which is as follows. The module has been developed maintaining standard protocols, extensive literature review, and expert opinion which was mainly evidence based. Expected benefits are risk reduction is expected to occur with structured module implementation. Patient wellness will increase and caregivers will be more confident in delivering care.

Although some evidence-based intervention work in the same line has been done by Sangath Goa, however, there is a dearth of any published literature from Darjeeling district or North-East part of India. These parts of the country have variegated sociocultural context and are perceived to be neglected. More so, in times of COVID, accessibility of health care is limited. Mental health is an oftly neglected topic more so due to stigma associated with the disease. Hence, availability of a user-friendly module can be of immense help to carers improving their mental health, as they often suffer from depression. This in turn may lead to clinical improvement of the patient as well. Integrating each family member into the care practices is also equally important

In the aforesaid context, a project is proposed to be planned with the help of administrative support and funding agencies who work in areas of mental health with the following objectives.

  1. Development of the module and validating it with experts after checking consistency and reliability
  2. Early identification of dementia patients based on warning signs at community level, grading severity of dementia patients by qualified practitioners by FAST staging formulating graded domiciliary nonpharmacological intervention of dementia
  3. Assessing Quality of Life (QOL) of caregivers using a QOL scale and their capacity building enabling them to use the structured module ensuring standardized outcomes.



  Module Method Implementation Top


Required ethical clearance will be taken. The module will be developed using the structured guidelines of module development. Other evidence-based intervention module will be consulted. Once formed its consistency will be checked and reliability assessed by Cronbach's alpha value. The validity will be checked by subject experts, and by translating and back translation, the module will be finalized in vernacular language of the region specific. It will then be piloted, and after the necessary modifications done based on the results, the final module version will be implemented. Department of Psychiatry and Department of Community Medicine along with other agencies working in areas of mental health will collaborate in the process.

The project can be started at community level as a part of DMHP and after documented benefits or clinching evidence of its success empaneled and rolled for NMHP. It can be presented in conferences among eminent academicians for value addition. A 6-month implementation period for DMHP is envisaged in selected areas' caregivers at home setting, and Accredited Social Health Activists, Auxiliary Nurse Midwives, and our front-line health workers will be trained for the purpose, sensitization of the community will be done, and project benefits explained. Fears and queries will be duly addressed QOL questionnaire will be applied to both caregivers. Front-line workers and documented patients both before and after the study were to assess the outcome of the interventions.


  Brief Description of the Module with its Brief Description Top


Dementia is downhill but has grades. Hence, care needs to be customized as well by a rational triaging. Moreover, the newer cases need to be screened for early intervention.[2] Hence, the structured module formed which will consist of:

  • Screening questions: To identify high-risk cases of dementia in the community with set of prefixed four questions. Anyone is diagnostic
  • To get assessed by local medical officer on a FAST staging if screened positive and be graded as mild (1–3), moderate (4–5) snd severe (6–8) and get a magnetic resonance imaging done to corroborate


    • Those diagnosed as mild dementia – Usually have lesser tendency to fall or forgetfulness. Hence, providing support for basic activities of daily living is essential
    • Those diagnosed as moderate dementia - All the steps of mild dementia and to control falls, help with apraxia, feeding the patient with balanced diet and helping with functional clarity decreases so daily activities by self should be encouraged
    • Those diagnosed as severe dementia – medical aid and emergency care will require. Bowel bladder incontinence and diarrhea, pneumonia or opportunistic infections, and bedsores need to be prevented will develop or retention


  • Few salient strategies for caregivers


    • Preventing abuse of elderly
    • Having an emergency contact number and knowing warning signs
    • Having a peer support group and integrate each family member into the care by teaching basic life skills
    • Practicing self-care – To be careful and self-screen if genetic stock of patient and caregiver is same for signs of constant sadness and constant irritability. Proper nutrition, lifestyle changes, and medications. Having breaks and catharsis techniques. Capacity building by trained counselors. Medics and psychologists.


Hence, with support from academia, if this novel, endeavor can be implemented in a booklet user-friendly manual form it will be an example of salutogenesis where health and wellness issues are more stressed to positively impact general well-being. No such study has been conducted, and this is an intervention project which when generates sufficient data can be applied in implementation science domain. This promising yet household primary health care tool-like growth chart is envisaged to bring a sea change.

Acknowledgment

Acknowledges support of Dr. Bhaskar Mukherjee, Associate Professor, Department of Psychiatry, Malda Medical College, West Bengal, and Dr. Abhik Layek, Assistant Professor, Department of Psychiatry, NBMCH.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bloom DE, Luca DL. The global demography of aging: Facts, explanations, future. Handb Econ Popul Aging 2016;1:3-56  Back to cited text no. 1
    
2.
Schulz R, O'Brien AT, Bookwala J, Fleissner K. Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, correlates, and causes. Gerontologist 1995;35:771-91.  Back to cited text no. 2
    




 

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