dementia interdisciplinary

DIGNITY AND DEMENTIA IN AN INTERDISCIPLINARY SETTING 1
Dignity and Dementia in Interdisciplinary Team Work
1222
Silberman School of Social Work

Introduction
As social workers our mission is to enhance, empower and advocate for the well being of
all people, specifically the vulnerable populations (NASW, 2008). Through mindful practice we
aim to minimize oppression, fight social injustice and empower our clients thus promoting their
physical, mental and social well-being (WHO, 2012). A population is requiring more attention
due to demographic shifts surrounding aging and longevity, is dementia is a topical public health
issue that social workers need to be prepared to address (Chapman et al., 2007). Our mindful
practice coupled with our collaboration on interdisciplinary teams and addressing the power-
privilege relationships that exist, allows us to best serve our clients with dementia.
Dementia
Dementia is characterized and described by its progressive nature and irreversible
damage to the brain which impacts memory, reasoning, cognitive function and the ability to
communicate (Askham, 1995). Dementia has emerged has one of the most critical public health
issues of the 21st century with widespread social, economic and political implications (Schulz et
al., 2004; WHO et al., 2012). Dementia has both social and political implications and from a
societal perspective, impacts the lives of approximately the 15.5 million caregivers who have
provided over 17.7 billion hours of unpaid care valued at 220.2 billion dollars ( Alzheimer’s
Association, 2014). Financially, because of the physical and emotional burden of caregiving,
dementia caregivers incurred an additional 9.3 billion dollars linked to their own health and
mental health concerns (Alzheimer’s Association, 2014). On the political front, dementia has
been cited as a major public health issue by the World Health Organization in their report
“Dementia: a public health priority” which aims to increase educational information, raise
awareness about dementia and improve care for individuals with dementia (WHO, 2012).

The growth of the aging population has resulted in an increase in cases of dementia
(Bamford et al., 2000). Due to this increase in longevity and the projected increase in dementia
cases from 5.2 million to 16 million by 2050, social work education can highlight the importance
of working on interdisciplinary teams to address the complex health needs of this vulnerable
population (Alzheimer’s Association, 2014). However, in order to best serve these clients
practicing mindfulness and minimizing the power- privilege relationship that can often exist in
the interdisciplinary setting is essential. We must be prepared to serve diverse populations of
vulnerable populations including, the elderly and individuals with dementia (Hyde, 2004).
A Mindful Practice
Mindfulness is an important aspect of social work. Practitioners who work on an
interdisciplinary team face challenges regarding roles, expertise, and decision making with other
members of the team and must be mindful of these issues and how they impact their relationships
with their clients (American Association of Colleges of Nursing, 2011). Being culturally aware
and having self-awareness is important when working with individuals with dementia, as it
minimizes the power and privilege relationship. As a practitioner, being sensitive to a client’s
way of thinking, their emotions and their sense of self is necessary to provide good service (Brill,
2005). As social workers we must have a mindful practice, be culturally aware and be in control
of our own self-awareness to minimize the power-privilege relationship that often exists in a
counseling setting (Epstein, 1999 & Pinderhughes, 1989). Agencies should be person centered
and focused on empowering clients through building on a strengths perspective (Hyde, 2004).
For example, an individual with dementia may have the inability to verbally communicate but
can communicate using non-verbal gestures. It is important to try to be an active listener and
watch their body language, thus supporting their ability to communicate, which is a strength. In
addition, social workers must be non-judgmental and emphasize the importance of establishing a

therapeutic relationship that is based on ego psychology with the client to help them reach
treatment goals (Goldstein, 1995). Often for individuals with dementia, forming relationships are
more complex due to the nature of their mental health issues (WHO, 2012). Individuals with
dementia may be distrustful, confused or show levels of anxiety. Therefore forming a therapeutic
holding environment will provide safety and support (Goldstein, 2001). In order to form an
optimal holding environment, Goldstein (2001) suggests an environment that is “consistent and
empathetic.” The consistency of an interdisciplinary team will help assist the individual with
dementia’s ability to stay in a holding environment. The identification that clients have different
needs is important specifically when working with individuals with cognitive impairment;
consistency is critical (American Association of Colleges of Nursing, 2011). A client’s
demeanor and experience with care can additionally be linked to their presenting stage of
dementia (Alzheimer’s Association, 2014A). As social workers, we must often act as an
intermediary working with the patient and the other disciplines, advocating for the client as well
as working on an interdisciplinary team. Practitioners need to remain sensitive, ethical and be
concerned with their client’s dignity (Manthorpe et al., 2010).
Dignity and Empowerment
Person centered care values personhood and choice (Molony et al., 2013). Because an
individual with dementia may have different needs, it is important to acknowledge the
progressive nature of the disease and be mindful that this cognitive impairment does not
minimize a person’s ability to be in the moment and make their own decisions (Molony et al.,
2013) Working with individuals with dementia often requires the collaboration of an
interprofessional team (physicians, nurses, social workers, allied health professionals) to tackle
all aspects of care relating to the illness (Chapman et al., 2007). To address pain, agitation,
depression and other conditions research has shown an improved quality of life through

collaboration of an interdisciplinary team (Chapman et al., 2007). When working with an older
adult with dementia, respecting and being mindful of their dignity, which is an integral part of
quality of life is imperative. As an individuals’ dementia progress it is important to be mindful of
their self-worth, autonomy and privacy (Kane et al., 2003). Research conducted by Manthorpe et
al. (2010) found that dignity around the disclosure of a diagnosis of dementia was important in
context. Due to the increase in the aging population, disclosure of dementia diagnosis will
become more prevalent and a priority (Manthorpe et al., 2010). In addition to disclosure, the
manipulation of an individual with dementia, although seen as deceptive, professionals need to
assist their client’s autonomy and quality of life (Manthorpe et al., 2010). Infringements on
dignity are major concerns for professionals providing care however enforcement of human right
principles from the government may be required in the future (Manthorpe et al., 2010). With the
goal of providing good quality of life and care, dignity acts as a catalyst to force professionals to
properly address older adults with dementia in relation to their human rights.
Ethics of Care
As social workers, we adhere to the NASW Code of Ethics, which acts as a guidelines for
our ethical behavior when working with vulnerable populations (NASW, 2008). Within an
interdisciplinary setting good care is exemplified by the negotiation between practitioners, the
client and often the caregiver (Barnes et al., 2008). To create a holding environment when
working with a vulnerable population it is important to be attentive, responsible, competent, and
responsive and build trust (Barnes et al., 2008). Due to the power-privilege relationship between
the client and practitioner creating a safe holding environment built on trust, respect and dignity
will minimize the power privilege relationship as well as oppression. Barnes et al. (2008)
promotes that the development and implementation of practice policy specifically relating to

ethic of care principles can promote an effective dialogue between practitioner, client and
caregiver.
Importance of Interdisciplinary Team Work and Dementia
Working on an interdisciplinary team with individuals with dementia it is important to be
mindful of creating a therapeutic relationship in which the social worker is mindful of the power-
privilege and anti-oppressive lenses. Because of the growing population of older adults and the
growing population of individuals with dementia, working on an interdisciplinary team to work
with this vulnerable population is important. Because of their special care needs, in conjunction
with their cognitive impairment, an interdisciplinary team is best suited to address all aspects of
the client’s environment. Valuing the client’s biological, psychological and social history should
be used to promote positive well being (Molony et al., 2013). Examining a client with dementia’s
social, environmental, financial, spiritual and psychological is important because it can impact
both the therapeutic relationship and holding environment (Molony et al., 2013). (Additionally,
forming therapeutic relationships and planning early in the diseases progression may improve
possible ethical challenges in later life (Molony et al., 2013).
Interdisciplinary
Research shows that interdisciplinary teamwork is the most comprehensive way to
deliver support and services to individuals with dementia and their caregivers (Manthorpe et al.,
2003). Having knowledge about the interdisciplinary aspects of aging specifically in medicine,
gerontology and psychiatry with an aging focus will help for dementia specific care (Kaplan et
al., 2013). Social work practices have replaced the biomedical model, which focused on
biochemical, pathological and physiological aspects of the disease and failed to examine social
influences (Kaplan et al., 2013) Dementia care is often provided in a care triad composed of the
individual with dementia, the caregiver and health care professionals based on the person

centered approach (Adams et al., 2005).
Power Privilege in Interdisciplinary Setting
The dynamics of power and privilege needs to be addressed in elder care service models
because of the overlapping of functions and collaborative work with older adults (Kaplan et al.,
2013). Due to the progressive nature of dementia, difficulties within an interdisciplinary team are
likely (biological, psychological and social domains) (Kaplan et al., 2013). Social workers
should be responsible for advocating and articulating the complex needs of individuals with
dementia through addressing psychosocial implications (Kaplan et al., 2013). Additionally as
social workers, we must act as the intermediary to connect other health professionals who are
serving individuals with dementia. Trained practitioners are needed to support the social
workers’ commitment to the anti oppressive lens (Kaplan et al., 2013).
Factors
An older adult with dementia’s dignity and autonomy require the respect of caregivers
and health care professionals. To minimize external and internal problems which impact a
client’s ability to feel empowered, as social workers we must address these concerns. Through
mindful examination of our professional status, therapeutic relationships, and communication, as
social workers working with individuals with dementia, we aim to minimize external or internal
concerns.
Professional Status
Historically social workers have struggled to assert their professional status (Kaplan et
al., 2013). Often in interprofessional teams, social workers’ views are often dismissed due to the
interdisciplinary focus social work (Kaplan et al., 2013). Working on an interdisciplinary team as
social workers must affirm the importance of their role and contributions to an interdisciplinary

team (Kaplan et al., 2013). In the future, multidisciplinary teams will grow in importance in the
quality of care they provide to clients(Chapman et al., 2007). Even though the social worker is
an integral piece of the team, the role of the social worker is understudied (Chapman et al.,
2007).
Therapeutic Relationships and Communication
Creating a therapeutic relationship with an individual with dementia can prove difficult.
In order to best serve our clients, research demonstrates that relationships between the social
worker and clients that build on trust yield positive outcomes for the individual (Molony et al.,
2013). Using language that is difficult for a client to comprehend is not appropriate as it creates a
rift in forming a relationship or meeting them on their level (Burghardt, 2011). We must be
mindful not only in our practice but also in our attitudes because they impact our creation of self-
awareness and lead to cultural awareness (Brill, 2005).
Research conducted by Manthorpe et al. (2013) found that it was important for
interdisciplinary teams to meet regularly and build working relationships. The ability to promote
communication of an individual with dementia can be linked to dignity and autonomy. It is
important to enable dementia communication. Respecting the individual’s ability to communicate
their wants, desires or feelings whether verbal or non verbal is important to be mindful of
(Adams et al., 2005). Additionally being mindful of stimuli that could impact the individual’s
ability to communicate and promoting participation are essential pieces to minimizing
oppression. Also, providing opportunities to speak, being sensitive to non verbal cues, valuing
contributions and promoting decision making are important in the helping process. However, it is
important to be mindful of behaviors such as interrupting, speaking on behalf of, rephrasing,
using of complex language, taking sides, ridiculing, ignoring, as well as not including the person
with dementia in the conversation can derail communication and in the end does not serve to

empower the individual (Adams et al, 2005). This form of behavior promotes oppression and
social injustice as well as can be a trigger for anxiety or depression for an older adult.
Mindful Implications
Predicted demographic changes associated with older adults will increase future needs
(Toofany, 2008). Further innovative educational programming would be useful for practitioners
working with older adults with dementia (Adams et al., 2005). When working with different
mental cognition we must be mindful because awareness impacts empowerment (Epstein, 1999).
The World Health Organization and Association for Nursing outline educational and practice
competencies for practitioners working on interdisciplinary teams (American Association of
Colleges of Nursing, 2011).
Conclusion
Because the goal of the social worker is to improve a clients’ quality of life, for
individuals with dementia, although competencies on exactly how to assist this population are
unclear, roles within the aging as well as health care systems provide guidelines (Kaplan et al.,
2013). With the overall goal to improve the well-being of the individual with dementia,
interdisciplinary teamwork has been proven effective. The effectiveness of interdisciplinary team
work can be attributed to the multi-faceted staff who works together to share role specific
knowledge, as well as possess the skills to improve the patient experience (Nancarrow et al.,
2013). Practitioners need to be sensitive to the complex needs of an individual with dementia. If
practitioners are sensitive to the cognitive, physical, biological and spiritual changes occurring in
individual with dementia, they are more likely to be mindful in their practice, ultimately
promoting the well-being of the client. Interprofessional collaboration will strengthen the future
care services for future generations (WHO, 2010). With the goal to improve health outcomes,
interprofessional education and collaboration will create a practice ready workforce to provide

comprehensive services to individuals with dementia (WHO, 2010).
This was an interesting paper that provided a lot of important information within the
context of the PL foundations, power, oppression, mindfulness, etc. Well Done!
98
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