Dementias are incurable, painless, but emotionally distressing illnesses which progressively impact upon a person’s capacity. Affecting an estimated 850,000 people aged 65 and over in the UK, numbers are set to rise as life expectancy grows1. There are also over 40,000 people with ‘young dementia’, diagnosed before the age of 652.
Impact on mental health
Living with dementia commonly gives rise to feelings of depression anxiety and loss, as people struggle to adjust to changes in their cognition, behaviour and personality. Studies suggest that prevalence of depression for people with vascular dementia may be 30%3 with dementia associated with other conditions increasing risk of depression to over 40%4.
Mental ill health is one of the greatest health challenges of this decade for all age groups, with approximately 25% of older adults affected by depression5; This figure rises to 40% of people living in care homes. It is estimated that 69% of care home residents have dementia6.
In the early stages, depression and dementia are difficult to distinguish and can give rise to an assumption that changes are related to a dementia, when in fact they may be treatable and reversible and not part of a neurological condition at all. The difficulty in diagnosis is enhanced by the negative stereotypes associated with age and dementia.
Counselling can relieve the symptoms of depression. Over time, if the changes in the person’s cognition and behaviour continue to increase, then it is most likely that there is an underlying dementia as well.
Depression is most commonly treated with medication. Studies have indicated that anti-depressant medications are less effective for people with dementia and that there is a significantly increased risk of dementia with antidepressant use7.
Social impact of dementia
Stigma and stereotyping of dementia can prevent people from acknowledging symptoms and obtaining the help they need. It can cause individuals and organisations to behave in ways that are unhelpful, emphasising the symptoms of dementia rather than supporting the abilities that people with dementia have.
It is common for people with dementia to experience loss of contact with friends and reduction in social interaction, sexual relationships, and cessation of social activities they previously enjoyed. This makes the person with dementia at increased risk of loneliness and social isolation. Studies have suggested that loneliness impacts on the mental and physical health of older people.8
Making sense of self – the role of counselling
BACP believes that the aim of counselling is to provide opportunity for a person to tell their story, help them to understand themselves better and make positive changes in their life. Therapy should not be denied to an older person because they are living with dementia.
In her book Living Well And Dying Well – Tales of counselling older people, humanistic therapist Helen Kewell advocates that ‘when we come to our meetings with older adults in the therapeutic space, we are free from prejudice, focused on empowerment and allow for the same growth-oriented curiosity and enquiry and powerful moments of interrelating that that we would hope to co-create with anyone of any age who chooses to come to counselling.’9
NICE guidelines (2018) encourages person-centred care of people with dementia, asserting the value and individuality of people living with dementia, and critically ‘the importance of relationships and interactions with others to the person living with dementia, and their potential for promoting well-being.’10
MacDonald (2017) argues that in the absence of finding a cure, the significant increases in medical knowledge about dementia in recent years have exacerbated, not diminished fear of the condition. Urging an alternative to a purely medical-model view of dementia, one that focuses on its social and relational impact, MacDonald concludes that ‘when people with dementia are held in connection, they live a better life’.11
A growing evidence-base
Despite limited research into counselling for people with dementia, there is growing evidence of its value in case studies and counselling literature12.
Author, counsellor and supervisor Danuta Lipinska who has worked with clients with dementia for many years in the USA and UK explains how the empathy and positive regard at the core of her person-centred therapy work enables clients with dementia to tell their story with ‘no pressure on the client to say the right words in the right order or to be smart, logical of even understandable’.13
Counselling has been shown to help people living with dementia to make sense of living with the condition. On its web site The Alzheimer’s Society recommends talking therapies for people living with dementia, acknowledging that psychological approaches are particularly appropriate because they focus on the individual and their viewpoint. It states that ‘talking therapies offer someone living with dementia the opportunity to speak openly about their feelings and can help them to adjust to and live with their condition more successfully.’14
Recommendations
Action is required to ensure that access to choice of talking therapy is made available to people living with dementia who have anxiety or depression or who wish to explore issues of identity and to make plans for the future.
BACP is concerned that this message is not currently being heard by people affected by dementia or those close to them and calls for more research in this area alongside greater recognition of the benefits of talking therapies for people with dementia in policy and service commissioning.
If you have any comments or feedback on this issue, please email publicaffairs@bacp.co.uk
References
1 Alzheimer’s Society (2015) Dementia UK Update
2 Alzheimer’s Society (2015) ibid.
3 Enache D, Winblad B, Aarsland D. Depression in dementia: epidemiology, mechanisms, and treatment. Curr Opin Psychiatry 2011;24:461-72.
4 Reijnders JS, Ehrt U, Weber WE, Aarsland D, Leentjens AF. A systematic review of prevalence studies of depression in Parkinson’s disease. Mov Disord 2008;23:183-9.
5 Age UK (2016) Hidden in Plain Sight – The unmet mental health needs of older people.
6 Alzheimer’s Society (2015) ibid.
7 Wang YC, Tai PA, Poly TN, et al. Increased Risk of Dementia in Patients with Antidepressants: A Meta-Analysis of Observational Studies. Behav Neurol.2018;2018:5315098. Published 2018 Jul 10. doi:10.1155/2018/5315098
8 Luanaigh and Lawlor (2008) Loneliness and the health of older people
9 Kewell H (2019) Living Well and Dying Well – Tales of counselling older adults. PCCS Books
10 NICE (2018) Dementia: assessment, management and support for people living with dementia and their carers.
1 Macdonald, Gaynor. (2017). Death in life or life in death? Dementia's ontological challenge. Death Studies. 42. 10.1080/07481187.2017.1396398.
12 Orgeta V, Qazi A, Spector A E, Orrell M (2014) Psychological treatments for depression and anxiety in dementia and mild cognitive impairment (Review) Cochrane Database of Systematic Reviews Issue 1 Art.No: CD009125
13 Lipinska D (2009) Making Sense of Self – Person centred counselling for people with dementia. Jessica Kingsley Publishers
14 Alzheimer’s Society. ‘How talking therapies help someone with dementia and their carer.’ www.alzheimers.org.uk/about-dementia/treatments/talking-therapies-benefits Accessed June 2019.