Complementary and Integrative Health Care Management of Dementia among the

Elderly in Cavite

Comprehensive Research Literature

This part contains a review of related literature and investigations that the researcher

has conducted in order to shed insight into the topic under research.

REVIEW OF RELATED LITERATURE (RRL)

LOCAL LITERATURE

In the Philippines, there were approximately 2,010 people who died from Alzheimer’s

disease and other forms of dementia in that year. The Philippines has the 172nd highest

death rate of the disease in the world. However, most cases are usually in the western

countries. Alzheimer's disease affects around 5.8 million persons in the United States aged

65 and older. Eighty percent are 75 years or older. The disease is expected to affect 60 to

70 percent of the approximately 50 million people with dementia worldwide. Cruz et al.

(2020). The mental health needs of older adults with dementia have been largely neglected,

especially in low‐and middle‐income countries like the Philippines. In the Philippines, there

are estimated to be 10 million seniors, a number that might increase to 20 million by 2040. A

significant proportion of people in this growing community are affected by dementia. And

according to Dr.Ampil during the Philippine Council for Health Research and Development

(PCHRD) (2022). About 35.6 million people suffer from dementia worldwide with 7.7 million

new cases every year based on the World Health Organization (WHO) report. In taking care

of people with dementia, family members and workers in the Philippines found to practice

non-pharmacological therapies at home such as reminiscence and music. Although

dementia is not curable, medication and non-pharmacological therapies are necessary to

improve the quality of life of dementia patients. Yet, with poverty and expensive cost of

dementia treatments, addition to this many patients in the country could not afford such
treatments. However, exploring non-pharmacological therapies for dementia patients, Dr.

Ampil and her co-researchers initially found low-cost interventions that could be

administered at home: reminiscence therapy and music therapy. In reminiscence therapy,

dementia patients are encouraged to remember by discussing past activities, events, and life

experiences using photographs, household and other familiar items. Alternatively, music

therapy allows patients to listen to familiar music, play instruments, and write songs. These

simple non-pharmacological therapies such as reminiscence and music can be standardized

so that people at home can easily give them to people with dementia. In past years, a new

crisis known as Covid-19 has affected millions of people worldwide, which the continuous

COVID-19 epidemic continues to have an adverse physical and emotional impact on older

individuals, makes the situation worse. The danger of infection, complications, and even

death is greater in seniors. Access restrictions as part of COVID‐19 protocols in

establishments that cater to dementia care (e.g., diagnostic consul-tations, pharmacological

treatment, cognitive rehabilitation, counseling and/or psychotherapy, and occupational

therapy, among others) cause disruptions in the supposedly holistic and optimal

management of dementia. However, despite this problem there are recommendation offered.

Firstly, while there is recent progress in the mental health laws in the Philippines (e.g., The

Philippine Mental Health Act or the Republic Act 11036), mental health services and

provisions specific to the elderly with dementia are yet to be realized. This entails providing

further training among mental health professionals (e.g., psychiatrists, psychologists, and

counselors) on systematic evaluation and evidence‐based therapeutic approaches for the

elderly with dementia, especially in the rural areas in the country, which have less access to

mental health information and services. Next, there is a need to integrate medical/physical

health and mental health services for the elderly with dementia within the country's

healthcare system to ensure the confluence of collaborative and multidisciplinary

interventions. Doing so can help in addressing their needs through a holistic approach.

Additionally, there is a need for more active multidisciplinary and transdisciplinary research

programs that focus on the unique experiences, social and institutional support, and living
conditions of Filipino elderly with dementia, to aid in creating innovative and context‐specific

solutions to improving their physical and mental health and quality of life. Soriano et al

(2022)

FOREIGNE LITERATURE

According to WHO (2021). Dementia is a syndrome in which there is global deterioration in

cognitive function beyond what might be expected from the usual consequences of biological

ageing including memory, learning, orientation, language, understanding, and judgment.

Currently more than 55 million people live with dementia worldwide, and there are nearly 10

million new cases every year. It primarily affects adults over the age of 65, and more

frequent in those who are in their eighties and nineties. Alzheimer's disease is the most

common form of dementia and may contribute to 60-70% of cases. Dementia is currently the

seventh leading cause of death among all diseases and one of the major causes of disability

and dependency among older people globally. It has physical, psychological, social and

economic impacts, not only for people living with dementia, but also for their carers, families

and society at large. Shaji et al (2018), There are specific non-pharmacological interventions

targeting the cognitive as well as non-cognitive symptoms and challenging behaviors seen in

dementia. Non-pharmacological therapies for cognitive symptoms should be encouraged for

people with mild to moderate dementia of all forms. They improve cognition in such people

regardless of whether any medication is prescribed or not. They are also beneficial in

improving and maintaining their functional capacity. This is based on the belief that lack of

cognitive, accelerates cognitive deterioration. In this regard, reality orientation and

reminiscence therapy are beneficial. While non-cognitive symptoms and challenging

behaviors should be adjusted to each patient with caregiver participation. The assessment

should be comprehensive, taking into consideration the person's physical condition, any

undiagnosed pain or discomfort, drug side effects, psychological variables, cultural and

religious background, and physical environmental elements. Non-pharmacological therapies

available, including aromatherapy, multisensory stimulation, music/dancing therapy,

massage, and animal assisted therapy. The availability of treatment should be considered,

as well as the person's preferences, skills, and abilities. Alzheimer's Society (2019).

Complementary therapies can be used alongside conventional medicines to reduce

symptoms or improve the quality of life for elderly people who are living with dementia.

Although there’s no cure for dementia, there is a range of therapies that can help people

living with the condition. These include herbal medicine, aromatherapy and massage, music,

dance, pet therapy, dolls therapy and other psychosocial therapies, acupuncture and dietary

supplements. These therapies are used in dementia care and can be useful, particularly in

the later stages of the disease. And these therapies help them to relax, soothe agitation and

evoke memories from the older person’s youth and give them a feeling of well-being. And

they may become generally livelier and improved communication with others. It has also

been shown to help people to deal with problems arising from health issues such as heart

disease and cancer. Kwon et al (2021). Complementary and integrative medicine (CIM)

brings conventional and complementary approaches together in a coordinated way. CIM

encompasses a broad range of approaches, including nutritional (e.g., herbs), psychological

(e.g., mindfulness), physical (e.g., acupuncture), and their combinations. CIM is a medical

system that has received a significant amount of attention in clinical settings, and integrative

medicine, which combines CIM into conventional medicine, and is considered to be a

possible dementia prevention and management approach. Moreover, CIM includes various

non-pharmacological treatments such as acupuncture, aromatherapy, moxibustion, cupping,

meditation, mindfulness-based interventions (MBIs), and relaxation, that have potential use

in the management of BPSD. One study that involved interviews of AD patients found that

29% of the patients had used CIMs within the preceding six months.
 Experiences of Performing Daily Activities in Middle Aged

REVIEW OF RELATED LITERATURE (RRL)

Autism Spectrum Disorder, commonly referred to as ASD or autism, is a neurological

disorder defined in the Diagnostic and Statistical Manual 5th edition, (DSM-5) that results

from a change in brain function which causes a wide range of manifestations. The cause has

yet to be determined; however, it is commonly thought that a change in brain function occurs

due to genetic variation combined with environmental factors (Kazukauskas, 2018).

FOREIGNE LITERATURE

People with ASD oftentimes have impaired social skills and difficulty participating in social

settings. More specifically, this can present as difficulty with social communication and

forming friendships. Other skills that become troublesome for those with ASD include issues

with attention, empathy, and flexibility. Difficulties with social participation can lead to many

problems as a person with ASD progresses to young adulthood including underemployment,

unemployment, and social isolation. In addition to difficulties with social skills, individuals

with ASD also process sensory stimuli differently. People with ASD may be hyper reactive or

hyporeactive to sensory input. Sensory processing disorder is not unique to ASD; however,

many people with ASD also experience a range of sensory processing deficits. Specifically,

people with sensory processing deficits and ASD tend to overreact to sounds, touch, tastes,

and smells. Additionally, they may have poor eye contact and an avoidance to social touch.

These sensory processing deficits may be linked to problem behaviors and impaired social

skills (Miller-Kuhaneck, 2015). In a study conducted by (Muller et al., 2018) employers

described their experiences with regard to the employment of Project SEARCH interns.

Project SEARCH is an employment training model currently being implemented across the
United States. It aims to increase employer capacity, as well as the potential for individuals

with disabilities to become employed. A common theme that emerged was that employment

of people with ASD and other developmental disabilities helped to create a positive work

environment. One employer noticed that having an intern from project SEARCH helped to

encourage teamwork and increased team building of everyone in the work environment. In

response to this, staff morale notably increased. From an economic standpoint, concluded

that over time, hiring individuals with disabilities typically does not cost companies more than

other employees. (Hensel, 2017) found that there is an initial investment in the employment

of people with ASD, but once they are employed and trained, they are likely to continue

working for the same company making the company investment pay off. Likewise,

employees with disabilities have been reported to be more dedicated to their jobs. Typically,

these individuals remain in the same job for a longer period of time as compared to

individuals without a disability. Thus, this minimizes the need for the constant re-hiring and

retraining of new employees. Wehman et al., (2012) sought to discover information about

supported employment for those with ASD. One notable finding from this study was that as

time went on, supports in the workplace decreased for those with ASD. This suggests that

these individuals have the potential to participate in competitive employment and as they

become more adjusted to their work environment, their independence increases. Likewise,

as supports decrease over time, so should the cost of providing these services (Wehman et

al., 2012). Nevertheless, despite the benefits to both the individual and the company as a

whole, individuals with ASD still face unemployment and underemployment (Miller-

Kuhaneck, 2015). Although each individual is unique and may experience different

combinations of barriers to participation in the workplace, some of the most common ones

include personal barriers, environmental barriers, and social barriers. It is important to note

that although not discussed further, the effects of larger community resources cannot be

overlooked. Access to transportation, housing, food, healthcare, and an income are

inextricably linked to obtaining employment for all individuals (Nicholas et al., 2018).
LOCAL LITERATURE

There are numerous studies on early life experiences of PWDs and their

accommodation in school. Examples of these are extended time in taking tests, and the use

of different assessment formats, technology, and teaching methods. However, there are

considerably fewer studies on their later life experiences of employment and

accommodations in work settings. Mental disabilities also seem to be overlooked

in comparison to physical disabilities. While it is challenging for many PWDs to find or keep

jobs, individuals within the Autism Spectrum Disorder (ASD) seem to experience

greater difficulties. Statistics show lower employment rates for individuals with ASD

compared to other disability groups Considering that 1% of the world population has ASD,

and that ASD is the third most prevalent developmental disorder in the Philippines the

employment experience of people with ASD is a phenomenon that seem to require more

attention. Studies have shown that people generally consider it a right for PWDs to work and

employers generally have a positive attitude about employing PWDs. However, these do not

equate to PWDs actually getting hired. Pity and humanitarian factors remain the main

motivation in hiring PWDs, which shows that employers do not believe that PWDs

are employed due to their own merits. This is backed by studies that show employers,

clients, and co-workers of PWDs expressing concern regarding PWDs’ productivity, work

performance, possession of necessary job skills, and ability to properly communicate

with employers . There is also discrimination in how employers hire PWDs for blue, rather

than white, collared jobs (Gan, 2018). Not only is there discrimination against PWDs

in general, there is greater discrimination against people with mental disabilities. In

most studies, results found that employers preferred hiring PWDs with physical

disabilities over those with mental or emotional disabilities surveyed companies who

hired PWDs within the span of 5 years and found that companies had a tendency

to hire those with mobility or dexterity disabilities the most, and those with learning
disabilities the least. The reason for companies’ hesitation in hiring those with mental

disabilities could be due to their lack of knowledge on how to make accommodations for a

mentally disabled employee. Those who do hire them may believe no accommodations are

necessary, or refuse to make accommodations, giving PWDs unnecessary difficulty in

adjusting to the workplace (Sung, & Leahy, 2015). This is why those with ASD are not

employed for long periods of time and seem to have the lowest employment rate

among mental disability groups (Hedley et al., 2016 ;Nicholas et al., 2017; Scott et

al., 2017). The hesitation to hire individuals with ASD can be explained by the same

lack of knowledge that surrounds all mental disabilities, reinforced by outdated and

stereotypical ideas Studies mention that individuals with SD may work well, or have jobs,

in computer programming and animation, researching, plumbing, carpentry, car washing,

accounting, bookkeeping, manual jobs in restaurants, shops, libraries, room services,

cleaning services, and assisting in the storage of market products. .Despite

evidence of their capabilities, 59.1% of employers and employees in Stankova and

Trajkovskia’s study (2010) still believed individuals with ASD were unlikely to complete

their tasks, and are better suited for tasks that required physical rather than

psychological abilities. Nonetheless, employers given an opportunity to work with

individuals with AS generally exhibited a positive attitude towards them. More so, in

comparison to those who did not have ASD, individuals with ASD were rated an average or

above average score on work ethic and quality of work in areas involving attention to detail.

Despite that, employers still reported the need to be careful about communicating with them

and in overseeing their work. In this endeavor, the role of managers is crucial to the

company. These individuals supervise and interact with employees regularly. As hiring

representatives for the company, they are also responsible for seeking out qualified

individuals (Jones, 2017). It is important, then, to examine their attitudes and intentions to

hire individuals with ASD. In doing so, companies may be able to address major

difficulties in hiring individuals with ASD. Thus, using the theory of planned behavior as
framework, this study looked into the managers ’attitudes and perceptions that shape

their intention to hire/not hire individuals with ASD. (Scott et al., 2017)

The Impact of Nurse-Patient Relationship on Cooperative and Collaborative Quality

Nursing Care in Dasmarinas Cavite

REVIEW OF RELATED LITERATURE (RRL)

FOREIGNE LITERATURE

According to Mula et al (2020), the nurse-patient relationship is one of the aspects that

affects the patient’s autonomy, and there is a direct impact on the quality of care depending

on the type of relationship with the patient. Analysing the types of relationships allow us to

establish new ways of understanding the decision-making capacity of patients in a clinical

setting. The analysis of nursing records and nurse discourses have shown that our

professional practice is not yet totally patient-centred. A good nurse-patient relationship

reduces the days of hospital stay and improves the quality and satisfaction of both. The

nurse recognizes that a good relationship improves the quality and healing results in the

patient. However, in contrast, although the patient’s participation in their decisions is greater,

the good relationship is conditioned by the patient’s submissive role. Effective

communication is one of the foundations of good nursing care. The honest forms of nurse-

patient communication include verbal and non-verbal communication (e.g., body language,

facial expression, gestures, and distance between you and your patients). Effective nurse-

patient communication can improve quality of care and clinical outcomes, and lead to a

relationship that enhances patient satisfaction. And to develop a strong nurse-patient

relationship, some of the most important factors required for good communication are to be
ourself, be honest, be genuine, show the care, and follow through. And most importantly the

importance of the family in communicating with the patient. And responses to the patient

about what we can do versus what we are not able to do for them. However, effective nurse-

patient communication is the biggest challenge for nurses and requires much more than

experience. Njine et. al (2016). The nurse-patient relationship is a key aspect in the

development of nursing care, and this has been also conceptualised as a key element of

holistic care, together with physical and psychosocial dimension, without which it is difficult

to understand the professional goal that drives nurses, which is caring itself. Furthermore, it

has been related to improvements in patient health levels, increased empowerment, and

feelings of security and confidence. Cussóa et al (2022)

LOCAL LITERATURE

However, according to Tappy (2019) The interaction between patients and nurses is

fundamental in their experience of receiving or delivering care. Communication skills in

interaction are firmly established as requisite to developing the patient-nurse relationship

with therapeutic qualities. Therefore, international nursing students in the Philippines need to

be linguistically and culturally competent in order to learn more clinical skills. Otherwise, poor

communication and interaction may have a negative impact on student learning in the

clinical environment. One foreseeable challenge that international nursing students must

face in the Philippines is effective communication with patients during their clinical learning.

The nurse-patient relationship is said to be of importance for patient participation in nursing

car. In the discourse of nurse-patient relationships. There are frequently encountered

concepts like empathy, intimacy, and esthetical distance, concepts relevant to

communication and interaction. This further reflects how strong the concepts of interaction,

communication, and relationship are intertwined. The nurse-patient interaction is also

essential in daily activity to render care to the patient. When a nurse has a good interaction
with the patient, it can result in a good outcome and can increase patient satisfaction. Some

authors even suggested that a nurse must develop a more personal relationship with the

patient as opposed to doctors because nurses spend a lot of time with the patient. It is clear

that nurses are required to develop the skill to interact and communicate effectively in cross-

cultural care encounters. Nurses should be linguistically and culturally competent, and it has

been shown that it can be a factor contributing to the quality of hospital care and patient

satisfaction. Nurses who have a language barrier can either use verbal or nonverbal

strategies to facilitate communication. However, little is known about the experience of the

nursing students during interaction with the patients who speak different language than the

students, and also the experiences of the students in the preparation of clinical exposure

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