New Treatment for Dementia Improves Wellbeing
Oliver James Discusses Penny Garner's SPECAL Method of Care
Aug 11, 2008
Leading Clinical Psychologist and author Oliver James' new book, Contented Dementia, discusses the SPECAL approach, pioneered by Penny Garner. SPECAL has been found to increase wellbeing of dementia sufferers and faciliate their care in a more respectful manner. However, some argue that the ethics of the approach are questionable.
SPECAL Method of Care for Alzheimers Patients
Cassandra Jardine, in Dementia: The Past Makes Sense of the Present, interviews Oliver James and Penny Garner, Oliver James' mother-in-law. Garner developed the Specialised Early Care for Alzheimer's (SPECAL) after her own mother started to show signs of dementia. The method works whether the cause of dementia is Alzheimer's Disease, strokes or diabetes.
Because dementia affects short-term memory, patients lose track of what they are doing, making everyday living and care very difficult. However, long-term memory is still working well. SPECAL takes advantage of this by using the person's past as a reference point to make sense of their present.
For example, if the patient was formerly a frequent traveller, and he suddenly became anxious in the doctor's waiting room, he could be reassured that his plane is about to arrive soon.
Commended by the Alzheimer's Society
Oliver James, in My Mother Was Back: The Lights Were On (The Guardian, August 2, 2008) explains that the SPECAL method has been commended in reports from both the Royal College of Nursing and the Alzheimer's Society. He is so enthusiastic about this method that he wrote a book about it, Contented Dementia: 24-hour Wraparound Care for Lifelong Wellbeing (Vermillion, 2008), based on his detailed observations of Penny Garner's work.
It is not a matter of simply allowing the patient to live in a make-believe world of the past, says James. In fact, the person with dementia is usually more motivated to continue with the routines of eating, washing and going to the toilet if they are engaged in a narrative that makes sense to them, rather than feeling continually disorientated.
Ethics Questions Around the SPECALMethod
Over the years, says James, many have questioned the ethics of Garner's approach. Surely it is lying to a patient to tell them they are in the departure lounge of an airport, when they are in fact in the doctor's waiting room? James argues that this is in fact far more ethical than a 'commonsensical' approach, as it respects the patient's view of reality and cares for them within that framework.
SPECAL Care Reduces Need for Medication and Improves Wellbeing
A key improvement is the reduced need for anti-psychotic drugs, which James argues should not be diagnosed anyway, since the patients are not psychotic but merely operating from a different part of their memory. The side-effects of these drugs can even lead to premature death, says James.
Key to this method of care is avoiding questions, which often only serve to confuse the dementia sufferer, causing distress. Imagine how it feels to be constantly unsure of where one is or who one is talking to. Add a question that cannot be answered into this mix, and it is little wonder that aggressive, frustrated responses often result.
The Specialised Early Care for Alzheimer's Method, pioneered by Penny Garner, has the potential to revolutionise treatment for dementia sufferers. Instead of prescribing drugs to reduce their distress, their wellbeing can be significantly improved by the use of communication that respects their own reality and uses their past history to help carers understand them.
For further information see Specal.
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