We have no cure for dementia. It is associated with cognitive decline and makes everyday living increasingly difficult. Communication is affected. The scale of dementia is daunting. People with dementia suffer physical and psychological problems, confusion, stigma and limited availability of professional support. The World Health Organisation has produced an infographic to share the key statistics (WHO, 2017). Dementia is very complicated, and it has physical, psychological, social and spiritual effects. Actually, it’s complicated for everybody! How can we tackle such complexity? When things are complex, we need complex solutions. To understand all the variables, a framework or model is needed.
The Model for Dementia Palliative Care project intends to review various models to help our thinking and devise a way forward for palliative dementia care. This blog post proposes one model to inform the debate which is the Hodge’s Health Career Model. This is only one model. There are many more to consider!
The Hodges’ Health Career Model was developed to help in this type of situation (Jones, 2000). It provides a kind of window with four panes (see figure 1). It has a hard mechanical side and a softer human side. It helps to think about individual aspects and wider issues for the whole population.
Moving around the four corners we have the science and medicine corner; personal and psychological corner; family and social corner; the policy and political corner. By covering all these aspects, the whole ‘problem’ with dementia can be better understood.
The science aspects help healthcare professionals to deal with dementia, so we can start to overcome problems with pain and other symptoms. The personal aspects involve important early and later psychological concerns. It is worth thinking about our personal lives, stories and memories. These are the things that make us who we are and can help with our Quality of Life. Life stories are useful in the care of everyone, but especially in cognitive decline.
The social quadrant emphasises the need for family, community and wider society to play a part. In some places, dementia friendly environments play a part. A dementia-friendly environment is a place where people who are living with dementia are respected and supported. Everyone plays a part in building a society where dementia is understood.
Lastly Hodges Health Career Model has the policy pane in the window. This is critical in getting the evidence into practice through the writing and implementation of policy and local guidelines to cover practice, education, training, research, and leadership.
Hodges model helps to bring it all together. Try it. Take a small page: mark it out into four quadrants. Put your most important aspect of physical care in the top right. Put your biggest psychological aspect in the top left. Put a social care aspect in the lower left quadrant. Put a useful policy statement in the lower right. Go round again, this time thinking what you can do with these issues. Go round again, adding more concerns. Hodges provides a framework to enable important issues to be mapped. By doing this, we gain a better understanding on how to care for ourselves and each other.
This blog is drawn from a public lecture given 13/4/19 as part of BNA FESTIVAL: BRAIN RESEARCH – ask the scientist!
- DOYLE, M. and JONES, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing, 20: 631-640.
- World Health Organisation. (2017). Infographic on dementia. Available at: https://www.who.int/mental_health/neurology/dementia/infographic_dementia/en/ Accessed 18 May 2019