Depression in patients with dementia : a comparison of institutionalisation and assisted living

Abstract

Objectives The aim of this study was to determine the effect that institutions have on persons with dementia. Two long-term settings which have contrasting philosophies of care were compared. Traditional institutions which are led by ritual and rationalistic decisions and Assisted Living which promotes psychosocial interaction. Research Question A PICO question was formulated: In patients with dementia, does living in an institution lead to higher level of depression than assisted living? It identifies persons with dementia as the study-population, institutions as the intervention, assisted living as the comparison and depression as the expected-outcome. Methods Inclusion and exclusion established: no particular types of dementia were excluded; both qualitative and quantitative approaches were included. A literature search on the University of Malta library databases was carried out. From this search four research articles were selected for appraisal. These dealt with the multifaceted issue of quality of life - including depression. Findings The evidence shows that neither traditional institutions were the independent variables in relation to depression for persons with dementia nor that depression is the dependent variable in persons with dementia in relation to the type of long-term setting the person resided in. The coexistence of both depression and dementia is hard to distinguish. However despite this lack of evidence, the study shows that in long-term settings were persons with dementia are encouraged to maintain a healthy psychosocial interaction the process of dementia is relented. Recommendations and Implications for Practice The author adopts a Person-Centred Care approach and describes four implications for practice. The author argues that healthcare professionals need to abandon biomedical approaches which treat dementia as brain pathology and deploy a dialectical approach which takes in consideration both the cognitive processes in the brain and the changes in the psychosocial environment.