Dementia research is desperately underfunded. For every person living with dementia, the annual cost to the UK economy is over £30,000 and yet only £90 is spent on dementia research each year.

https://www.alzheimers.org.uk

These changes are often difficult for carers to deal with. It can help if carers remember that they are partly caused by damage to the person's brain. Someone may react more emotionally to a situation than might be expected (eg by becoming tearful or agitated) because some of their factual memories or ability to think clearly about the situation have declined. It is important to look beyond the words or behaviours you can see to the feelings that the person might be trying to express. Strong emotions may also be caused by unmet needs. Carers should try to work out what these needs are and meet them where possible.Frustration is a common emotion that individuals with Alzheimer’s disease experience, and often on a daily basis. (Alzheimer’s Society, 2020)

Internal Environment: It can be extremely frustrating for a person with Alzheimer’s disease as they experience changes in both their physical and cognitive abilities. Feelings of loss of control is also thought to add to the frustration that they face. 

Physical Environment: The physical environment can act as a contributing factor to a person’s emotional reactions. Clutter, overstimulation and poor sensory environment can often be confusing, adding to a person’s frustration

Psychosocial environment: The approach of caregivers can contribute to a person’s accumulating frustration. For example, expecting too much or too little of the individual 

https://www.nhs.uk/conditions/alzheimers-disease/

https://www.nhs.uk/conditions/dementia/behaviour/

https://alzheimersprevention.org/4-pillars-of-prevention/pillar-2-stress-management/

-Cost effective 

-Proven to slow down cognitive decline and improves mood regulation (Panzaet al, 2018)

-Combining different types of exercise to improve strength, fitness and balance may help individuals to become more mobile and more able to carry out everyday activities independently

-Limitations

-Those who take part in exercise programs may be more prone to injury and hospitalization, as exercise can often be too much for someone of this age group

-Individuals with mobility issues may need someone to supervise them during their exercise making it a difficult intervention to implement on a large scale basis

-Exercise has been proven as a successful outlet for aggression and frustration (O’connor et al, 1999), however it does not directly solve the initial problem of why the individual is initially frustrated
Validation Therapy

-Individuals feel valued and less of a burden

-Has been found to slow down the progression of cognitive decline and lower the risk of depression (Pinquart& Forstmeier, 2012) 

-The individual is made to feel that their emotions and frustrations are valid

-Could prove expensive 

-Only as affective as the caregiver / therapist administering the therapy 

-There is insufficient evidence from trials to draw any reliable conclusions about the effectiveness of validation therapy 

-Much of the research focuses on caregiver wellness rather than the benefits that the therapy has on patients 

-It has been found that validation therapy can agitate some individuals as much as it helped others, therefore results are often inconclusive and are dependent on personality types of the individual (Erdmann & Schnepp, 2016).

-Has proven to enhance mood, cognitive functioning and alertness during sessions and at short term (Prettymanet al, 2004)

-Enables positive interactions between patient and caregiver Limitations

-Has not shown long term effectiveness in mood enhancement (Cornell, 2004)

- Is not cost effective 

-Difficult to access for those not in care homes with a Multi Sensory Room 

-Can be difficult to access for individuals living alone and not in an care home setting

Pinquart, M, Forstmeier, S. (2012) Effects of reminiscence interventions on psychosocial outcomes: A meta- analysis. Aging & Mental Health, Vol.16(5), p.541-558

-Acceptance: Many participants accepted that Alzheimer’s disease was just another challenge in life or just a part of ageing to help them accommodate to the condition

-Consequence of life changes: Many participants made statements such as ‘its probably from all the head injuries from when I played rugby’ or ‘I knew it was coming, my mother had it’

-Uncertainty: Some individuals did not have a good understanding of what Alzheimer’s disease was or what was happening to them 

-Loss: All participants experienced feelings of loss with regards to their loss of cognitive abilities or loss of self

-Frustration: All participants reported feeling frustrated upon diagnosis and frustrated that they could not recall specific memories 

-Denial: Many individuals experienced denial upon diagnosis, attributing their memory loss to a normal part of ageing
Cheng, S. T., Chow, P. K., Song, Y. Q., Edwin, C. S., Chan, A. C., Lee, T. M., & Lam, J. H. (2014). Mental and physical activities delay cognitive decline in older persons with dementia. The American Journal of Geriatric Psychiatry, 22(1), 63-74.

-Normalization: Many individuals normalize the disease, for example viewing it as a normal part of ageing to help them accept the diagnosis

-External memory aids: such as diaries, calendars and notes around the house

-Routine: Individuals in the early stages of Alzheimer’s disease create a routine for themselves to make the disease more predictable and manageable 

-Medication: Many individuals have reported that medication such as anti-dementia drugs had helped them to feel as though their condition was stable. The medication may make individuals feel as though they are somewhat in control of the disease, however often individuals with Alzheimer's disease require reminders from caregivers of when to take their medication.
Park, M., Sung, M., Kim, S. K., Kim, S., & Lee, D. Y. (2015). Multidimensional determinants of family caregiver burden in Alzheimer's disease. International Psychogeriatrics, 27(8), 1355-1364.

Martin et al (2012) suggested 5 Self Management Techniques, however they do come with challenges.

1.Relationship with Carer/Family: Carer should encourage people with dementia to self manage and they should do activities together as acouple. However, care roles may not always be clear. 

2.Maintaining an active lifestyle: People with Alzheimer’s want to be able to take basic care of themselves. Elderly people are not encouraged to stay active and often do not have access to activities

3.Psychological Wellbeing: Increasing security, self-efficacy and self-esteem. Some have more difficulties than others with this and many may be in denial or completely give up on themselves 

4.Memory Techniques: Memory techniques are not routinely taught

5.Information: Being informed about their disease and what outcome to expect. Often individuals may not take on board the information of their illness due to memory issues or denial
Martin, F., Turner, A., Wallace, L. M., & Bradbury, N. (2012). Conceptualisation of self-management intervention for people with early stage dementia. European journal of ageing, 10(2), 75–87. 

The intervention that I am proposing is providing patient care but promoting independence among Alzheimer’s patients 

This intervention is aimed at Alzheimer’s patients who require minimal-medium care

The carer showing the individual how to carry out personal grooming and they then copy with guidance 

Making a cup of tea or dinner with the patient rather than for them 

It is expected that this intervention would decrease frustrations in sufferers because they will feel as if they’re capable of small tasks and will feel a sense of accomplishment. Further, helping the carer to carry out these tasks provides social stimulation and would be expected to make them feel less of a burden.

With this intervention, carers would receive training and a manual on promoting more independence for individuals with early to mid stages of Alzheimer’s disease

This intervention would work better than those discussed previously as it addresses why many individuals face frustration, which is often the inability to carry out daily activities 

Rather than provide a short term outlet for frustration which is provided through exercise and sensory rooms, this intervention deals with the root cause of where the frustration begins

This intervention would be cost effective as it would just mean a newer more advanced training style for caregivers, it would also enable the caregivers to carry out other tasks whilst the individual is showing independence

Furthermore, the more care companies that take on board this independence promotion technique, the more large scale this can be, helping more individuals to feel less useless

1)   Health behaviours are not always rational

2)   The model only focused on the individual and ignores social/environmental factors

3)   The role of emotional factors was not considered

4)   Outcome expectancy and self-efficacy were not considered

 

According to the HBM, a health-promoting behaviour is more likely to occur if the individual feels threatened by her/his current behavioural patterns through perceived susceptibility and severity, and believes that a specific behavioural change will result in a valued outcome at acceptable cost where perceived benefits outweigh perceived barriers. Moreover, an internal or external stimulus to change behaviours (cues to action), desire to achieve an outcome (general health motivation), and confidence in being able to perform the desired behaviours (self-efficacy) are needed (Glanz et al, 2008).

Evaluation of the Health Belief Model:
The model has the potential to provide a comprehensive understanding of the influence of social, economic and environmental factors on health behaviours. However, when in use the HBM is primarily focused on the measurements of susceptibility and severity alone (e.g. Chen & Land, 1990)

In a study carried out by Yarbrough & Braden (2001) they used the HBA as a guide for predicting breast cancer screening behaviours. They concluded that the application of the model was inconsistent and that it explained a maximum of 47% of observed variance in screening behaviour when socio-economic status was included. Otherwise the predictive power was even lower. 

Further, although the HBM may be used to derive information that may then prompt interventions designed to change health beliefs and behaviours, using the model itself cannot inform decision making as to how the interventions should be structured.