Professional Documents
Culture Documents
Beyond
Disease
REVISED EDITION
Prologue
Read This First (and Last)!
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2 Dementia Beyond Disease
Pharmacological Approaches
Why Nonpharmacological
Interventions Do Not Work
This provocative heading may seem out of line for the author of a book
called Dementia Beyond Drugs. Rest assured, I remain firmly rooted in
the belief that most distress arises as expressions of unmet needs, and
that drugs are not the answer. The problem lies not in that underlying
4 Dementia Beyond Disease
All of the above suggests that, in spite of our efforts to reduce the use
of potentially harmful medications, we are still not going about it the
right way. Our federal government is right to be concerned about the
overuse of such medications in people living with dementia, but a di-
rective to reduce medication use by “X” percent by a given date (and
the pledges of long-term care organizations to do so) puts the cart be-
fore the horse and sets us up for short-term gains that cannot be sus-
tained over time.
In this book, I argue that although I am a strong supporter of re-
ducing our reliance on psychotropic drugs, this is not our primary goal.
It is a highly desirable outcome, but it is not the place to start. Fur-
thermore, I do not even believe that reducing distress should be our
primary goal. Once again, it is a very desirable long-term outcome, but
distress is the “cough,” not the “pneumonia.”
I believe that our primary goal is to enhance well-being. This is a
concept I discuss briefly in Dementia Beyond Drugs, but my subsequent
work has convinced me that it is the central issue in improving the lives
of people with dementia, and it provides the best vehicle for creating
sustainable success.
In this book, I will expand on this primary goal of well-being to
show how the concepts can be applied to the everyday lives of people
with dementia, regardless of where they live or who provides their
support.
I will present a framework for understanding well-being based on
seven “domains”: identity, connectedness, security, autonomy, meaning,
growth, and joy, (Fox, et al., 2005). A chapter is devoted to each of the
domains of well-being, and each is explored in a variety of ways. We
will look at the universal features of each domain and the intrinsic and
extrinsic factors that can threaten it for a person whose cognitive abili-
ties are changing.
The concept of “culture change” will again rear its head in this
book, as we examine what needs to be done to operationalize this ap-
proach in various living environments. I will share many true stories
that demonstrate the power of a well-being approach to greatly im-
prove the lives of people who live with dementia, and their care part-
ners as well.
Prologue 7