Most of the research on intervention for dementia has investigated strategies for minimizing the psychiatric and behavioral symptoms. The symptoms include agitation, withdrawal from social activities, depression and psychosis which in turn affects the quality of life in patients with dementia. It is widely accepted that non pharmacological interventions have the potential to improve the outcomes, include behaviors, cognition and functional abilities. An increasing number of non-pharmacological therapies are now available for people with dementia. It should be noted that there are several areas of overlap between these therapies and, in fact, each approach is rarely used in isolation (Ballard et al, 2001).
The efficacy of behavioural therapy has been demonstrated in the context of dementia in only a small number of studies (Burgio & Fisher, 2000). For example, there is evidence of successful reductions in wandering, incontinence and other forms of stereotypical behaviours (Woods, 1999). Meares & Draper (1999) presented case studies testifying to the efficacy of behavioural therapy, but they noted that the behaviours had diverse causes and maintaining factors, and advised that behavioural interventions must be tailored to individual cases.
Emotion Oriented Approach:
The approach consists of validation, Snoezelen and reminiscence. Validation is a way of communicating, developed as an approach for persons suffering from dementia, in which recognition and validation of emotions from an empathic attitude is central. The basis of validation is the assumption that all behaviours have a meaning. Validation was developed by Naomi Feil (1967, 1984, 1989, and 1992). The method focuses on the emotional content, recognize and confirm emotions and restore persons self esteem. According to Feil, validation results in a reduction in negative affect (crying, punching, hitting) and an increase in positive affect (laughing, talking, helping others). The intervention studies that examined a broader group of dementing elderly persons show that participation in a validation group may result in an improvement in ADL-functions and an increase in verbal and non- verbal expression during group meetings (Fritz, 1986; Peoples, 1982; Babins et al., 1988).
Snoezelen is an individually oriented activity during which various sensory perceptions and experiences of the demented elderly are stimulated. This generally takes place in a special room, using light, sound, smells and tangible materials (Baker et al., 1997). Many studies (Holtkamp et al,1997; Kragt et al,1997;Moffat et al,1993; Baker et al,1997) found that Snoezelen had positive effects. During the Snoezelen sessions the people were happier and expressed interest. At the same time feelings of anxiety and sorrow decreased.
The purpose of reminiscence is to improve intrapersonal and interpersonal functioning by means of reliving, structuring, integrating and exchanging memories (Bremers and Engel, 1989, in DroÈ es, 1991, p. 118). Several aids can be used, including: photographs, songs, scrapbooks and old objects. Research regarding the effect of reminiscence in elderly people with dementia is still in the early stages (DroÈ es, 1991; Gagnon, 1996; Woods and McKiernan, 1995; Woods, 1996). The findings of studies conducted up to 1990 are mainly positive with regard to social interaction (Kiernat, 1979; Gardella, 1985; Orten et al., 1989), interest (Kiernat, 1979) and cognitive functioning (Gardella, 1985; Baines et al., 1987).
Stimulation Oriented Approach:
It comprises of art and music therapy. Art therapy has been recommended as a treatment for people with dementia as it has the potential to provide meaningful stimulation, improve social interaction and improve levels of self-esteem (Killick & Allan 1999). Activities such as drawing and painting are thought to provide individuals with the opportunity for self-expression and the chance to exercise some choice in terms of the colours and themes of their creations. Several studies have reported benefits gained by people with dementia from music therapy (Killick & Allan, 1999). The therapy may involve engagement in a musical activity (e.g. singing or playing an instrument), or merely listening to songs or music. Lord & Garner (1993) showed increases in levels of well-being, better social interaction and improvements in autobiographical memory.
Cognitive Oriented Approach:
It consists of activities and reality orientation. Activity therapy involves a rather amorphous group of recreations such as dance, sport, puzzles and drama. It has been shown that physical exercise can have a number of health benefits for people with dementia, for example reducing the number of falls and improving mental health and sleep (King et al, 1997) and improving their mood and confidence (Young & Dinan, 1994). In addition, Alessi et al (1999) found in a small-scale controlled study that daytime exercise helped to reduce daytime agitation and night-time restlessness.
Reality orientation is one of the most widely used management strategies for dealing with people with dementia (Holden & Woods, and 1995). It aims to help people with memory loss and disorientation by reminding them of facts about themselves and their environment.