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![iceberg analogy. Adapted with permission from [17].](profile/Ian-James/publication/274667140/figure/fig1/AS:874054747701254@1585402299971/iceberg-analogy-Adapted-with-permission-from-17.png)
![Figure 1. iceberg analogy. Adapted with permission from [17].](profile/Ian-James/publication/274667140/figure/fig1/AS:874054747701254@1585402299971/iceberg-analogy-Adapted-with-permission-from-17_Q320.jpg)
Contexts in source publication
Context 1
... an accurate assessment of a presentation would require gathering background information regarding the context, including details about the proximal and distal features (i.e., here and now, and contextual aspects). Some of the contextual features influencing behavior are presented in Figure 1, which is termed the 'iceberg analogy'. ...
Context 2
... elements outlined in Figure 1 are reflected in the clinical framework used by the Newcastle Challenging Behaviour Team (Figure 2) [30]. This ...
Context 3
... members of the team use a 12-14-week protocol, delivering a biopsychosocial model of treatment. This carer-centered, person-focused approach seeks to work collaboratively with the care home staff to establish a formulation that includes all the features of the iceberg analogy (Figure 1), in addition to undertaking a functional analysis of the BC [8]. ...
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Academics are always interested in debating the study of emotions across cultures and languages. This is due to the diverse ways that emotions can be expressed in different contexts and situations in each language and culture. This article aims to discuss the meaning of Balinese Lexicons dealing with emotions. The theory applied is Natural Semantic...
Citations
... To achieve a full understanding of people's behaviour we need to undertake a holistic analysis, which includes personal, social and contextual information. The Iceberg Analogy outlined below provides a helpful rationale and useful guidance on what information is required (Kitwood, 1997;James & Hope, 2013). ...
... The three emotions most frequently associated with BtC are anxiety, anger and depression (James & Hope, 2013). Cognitive therapists such as Beck (1976) tell us that we experience anxiety when we think we cannot cope and see ourselves as being vulnerable. ...
A publication for the British Psychological Society examining non-pharmacological treatments in the management of behaviours that challenge.
... Although antipsychotic medications decrease the frequency of the expression of delusions in dementia patients, there is concern that they may cause long-term harm and hasten death. Antipsychotic treatment is reported as having proved lethal in 1% of cases [35]. Non-pharmacologic treatments include keeping patients occupied with activities they enjoy, making their physical and social environment as comfortable as possible, and communicating with them frequently, clearly, and soothingly. ...
... Single solutions to delusions are never sufficient by themselves because many both distal and proximal factors contribute to a complex symptom or to a behavior [35]. Multiple approaches have been shown to work best [38]. ...
Background: The elderly with dementing illness often present with psychotic symptoms such as delusions, but the thematic content of delusions in the elderly differs from that of delusions expressed by younger individuals, and can be pathognomonic of early dementia.
Aim: The aim of this paper is to review the recent literature on the delusion of theft, the most prevalent delusion in the elderly, in order to arrive at a deeper understanding of its sources and to identify successful therapeutic approaches.
Method: The literature from 2000 to the present was searched on the Google Scholar database using relevant search terms. Several older classical papers were also referenced.
Results: Understanding the origins of the delusion of theft – multiple losses, attempts at attributing such losses to an outside source, attempts at reliving a happier past – helps in devising responses that are comforting to the patient. The distress that often accompanies the delusion of having been robbed can be decreased by nursing home improvements in the handling of personal possessions, by the correction of sensory deficits, and by the provision of activities that distract from loneliness. Attention to stimuli that trigger the delusion helps to limit its occurrence. Medications may help, but can sometimes make matters worse.
Conclusion: Understanding that delusional thinking can arise from sensory and cognitive deficits is critical to empathic caregiving and also to the lessening of caregiver burden.
Objective:
NICE guidelines recommend non-pharmacological interventions as the first-line approach for the management of behaviours that challenge. Recent work, however, highlights dissatisfaction with the lack of detailed guidance in the national guidelines regarding non-drug interventions. This study examines the views of practitioners regarding non-pharmacological treatments. It further explores perspectives on non-pharmacological strategies used in the management of agitation occurring within episodes of behaviours that challenge.
Methods:
Forty-two experienced practitioners attended a workshop where behaviours that challenge were described as occurring in three phases of agitation, using a framework adapted from the Positive Behaviour Support framework (pre-agitation, triggering and escalating, high level). The participants were asked to populate a template derived from the adapted framework. The completed templates recorded the clinical strategies the participants found useful to (i) prevent the occurrence of agitation, (ii) de-escalate distress and (iii) deal with perceived high levels of agitation.
Results:
The Positive Behaviour Support conceptual framework was perceived by participants as helpful in organising their clinical work. A number of interventions were suggested as preventative strategies: music therapy, doll therapy, physical activity and generic person-centred communication skills to enhance wellbeing. In contrast, de-escalation strategies identified by the participants focused on reducing emotional distress. The approaches for dealing with continued high levels of agitation involved a number of "control and restraint" techniques as well as medication.
Conclusion:
The template allowed specialist multidisciplinary professionals to identify skills for the management of distress and agitated behaviour linked to the respective phase of arousal. The template has scope to guide practitioners to identify the detail needed for the management of behaviours that challenge. The findings have the potential to influence the contents of forthcoming guidelines on alternatives to psychotropics in dementia care.
Objectives
Research has found that music-based interventions can decrease behavioral and psychological symptoms of dementia or behaviors that challenge (BPSD/BtC). However, how to effectively implement these interventions is unclear. This study synthesizes available evidence regarding implementation strategies and outcomes of music-based interventions for people with dementia at residential long-term care facilities.
Methods
Study registered with PROSPERO (registration number: CRD42020194354). We searched the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. Inclusion criteria included articles targeting music-based interventions conducted for people with dementia, studies conducted in residential long-term care facilities, and articles that reported implementation strategies and outcomes of the intervention.
Results
Of the included eight studies, half were studies of music therapy and the other half were on individualized music. 49 implementation strategies were reported. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. The most frequently reported implementation outcomes were appropriateness (27.3%), followed by adoption (22.7%), fidelity (22.7%), acceptability (9.1%), sustainability (9.1%), and cost (9.1%). No studies measured feasibility or penetration.
Conclusions
Although various effective implementation strategies were identified, we were unable to examine the effectiveness of individual implementation strategies due to the designs of the selected studies. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on structural aspects.
Aim. The study highlights the different concepts of dementia care models which are used in different care settings and determine the effectiveness and contribute to a better quality of life for people with dementia.
Methods. This literature review use PRISMA process for data collection and analysis. Scientific and professional publications in English were searched through international specialized databases; EBSCO HOST, CINAHL, MEDLINE, PubMed and Wiley Online Library. The review results were founded by key words and then selected according to the publication time frame and other shaped criteria.
Results. In total 1998 references were identified for the thematic content analysis, in the final review we included 29 studies. Two thematic areas were identified according to the keywords and literature search strategy: dementia care models and geriatric models of care. Further, we formed four concepts highlighted in models that reflect the specific characteristics and principles of care: biopsychosocial approach, person-centred care practice, environment of care, and Montessori for dementia care.
Conclusions. Most of featured models advocated the implementation of comprehensive, integrated and person-centred care, focused to honour and integrate an individual’s life story with their needs into daily care as much as possible in an appropriate and customized environment. Currently the most innovative model is based on implementation of Montessori approach into person’s daily activities.
This article identifies the importance of effective communication in delivering care to people living with dementia when their understanding of the situation may differ to ours. The Newcastle Model's biopsychosocial framework is revisited to understand the context in which caregiving takes place, and the article goes on to consider the importance of communication to person-centred care delivery. The special case of lie telling or 'therapeutic untruths' as a communication tool is considered as an often essential way to join with the person's reality, and the practical and ethical dilemmas this poses are considered.
Behaviours that challenge is a term used to describe a cluster of symptoms associated with the experiences of dementia. The biomedical perspective often refers to these as behavioural and psychological symptoms of dementia (BPSD). As the dementia progresses, many people with dementia may experience and display certain behaviours that may be perceived by staff as a challenge. The key focus should be on the significance and meaning of the behaviour, as there is no behaviour displayed by a person with dementia that does not have a meaning, but it is our inability to understand the significance of this that is the issue. Therefore, the key focus should be on establishing the underlying causes by undertaking a differential diagnosis to rule out other factors that may be contributing to the behaviour. This chapter will examine what behaviours that challenge are, the main causes, contributory factors, and the person-centred approaches that need to be considered in the first instance to support the person.
Background:
Therapeutic lies are frequently used communication strategies, often employed when the person with dementia does not share the same reality as the carer (James and Jackman, 2017; Tuckett 2004; Blum, 1994). Their use is complex and controversial, and a number of protocols have been produced to guide their usage (Mental Health Foundation, 2016).
Aims:
The study examined clinicians' perspective on using therapeutic lies in their daily practice and their roles in encouraging the proper use of such a communication strategy.
Method:
This project sampled the views of clinicians, mainly psychologists, before and after attending a workshop on communication in dementia care; they were asked whether psychologists should have a role in teaching others to lie more effectively.
Results:
It was found that following a comprehensive discussion on the use of lies, the clinicians recognized they lied more than they had originally thought, and were also significantly more supportive of having a role in teaching others to lie effectively.
Conclusions:
Clinicians, mainly psychologists, increased their support in the use of therapeutic lying. They considered others would benefit from the psychologists giving supervision in how to lie effectively.
