Ecopsychosocial Interventions in Cognitive Decline and Dementia

Abstract

Dementia is a major medical and social scourge. Neither pharmacological nor nonpharmacological interventions and treatments have received sufficient funding to be meaningful in combatting this tsunami. Because the term-"nonpharmacological"-refers to what these interventions are not, rather than what they are, nonpharmacological treatments face a special set of challenges to be recognized, accepted, funded, and implemented. In some ways, the current situation is analogous to using the term "nonhate" to mean "love." This article presents a carefully reasoned argument for using the terminology "ecopsychosocial" to describe the full range of approaches and interventions that fall into this category. These include interventions such as educational efforts with care partners, social support programs for individuals with various levels of dementia, efforts to improve community awareness of dementia, an intergenerational school where persons with dementia teach young children, and the design of residential and community settings that improve functioning and can reduce behavioral symptoms of dementia. The proposed terminology relates to the nature of the interventions themselves, rather than their outcomes, and reflects the broadest range of interventions possible under the present rubric-nonpharmacological. The goal of this new label is to be better able to compare interventions and their outcomes and to be able to see the connections between data sets presently not seen as fitting together, thereby encouraging greater focus on developing new ecopsychosocial interventions and approaches that can improve the lives of those with dementia, their care partners, and the broader society.

Social health and dementia: a European consensus on the operationalization of the concept and directions for research and practice

“…Although the scope of this paper was not a systematic review of the literature, the broad expertise of the INTERDEM Social Health Taskforce members, their different professional and cultural backgrounds, and the methodology followed to achieve the aims of this position paper, which also included a consultation of people with dementia through the EWGPWD, resulted in a broad and rich overview of the state of knowledge regarding social health in dementia. We are aware, though, that as the focus of the article was limited to the operationalization of the concept of social health as described by Huber et al 2011, we did not discuss relevant new related models on health in Alzheimer's disease, such as the eco-psychosocial model (Whitehouse, 2014;Zeisel, Reisberg, Whitehouse, Woods, & Verheul, 2016). Some caution is indicated regarding generalization of the concept of social health.…”

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…15 of the caregiving system, remains important and has been reconceptualised from 'non-pharmacological' interventions to 'ecopsychosocial' interventions. 331 The ResCare studies concluded that the care home industry in England was perhaps not yet ready to fully embrace an infrastructure comprising computerised learning or an IMS for decision-making about the management of CB in dementia (see Chapters 3 and 4). However, the potential for better uptake of e-learning in smaller care homes with less hierarchical leadership and support from the equivalent of an external supervisor, such as trained dementia therapist, may have potential (see Chapter 4).…”

<p>A Scoping Review and Template Analysis of Manual-Based Complex Interventions in Dementia Care</p>

“…Some psychosocial interventions may be described by a clear manual but for complex interventions of a person-centered, relational, psychotherapeutic and/or ecopsychosocial nature, it is highly challenging to narrow down actions and responses in a serial order of events and capture simple interconnections between them. [6][7][8] The level of complexity increases further when interventions are not a planned session-based service, but an interaction intended to be implemented as required or PRN (pro re nata. From Latin, meaning in the circumstances or as the circumstance arises.)…”