Psychological Setting
This literature review and critical evaluation focus on applying Cognitive Behavioral Therapy (CBT) to reduce falls in dementia patients within a rehabilitation/recovery community (KRAUS et al., 2008). The placement setting for this study is a rehabilitation center that provides care to elderly individuals with dementia who risk falling to or due to illness and injury. Rehabilitation centers focus on restoring patients’ physical, mental, and emotional well-being through various therapies and interventions (World Health Organization, 2021).In terms of the organization, the rehabilitation center is a healthcare organization that provides care to elderly individuals with dementia who are at risk of falling (Gell & Patel, 2018). The organization is designed to give tailored care to each patient’s needs. It hires healthcare experts specializing in caring for people with dementia (Gould, 2009). Similarly, the center is a controlled environment that provides a safe and supportive atmosphere for dementia patients (Ries, 2022). The setting is meant to reduce the possibility of falls and other injuries.
The rehabilitation center is outfitted with sophisticated equipment and technology to ensure patient’s safety and well-being (Mills et al., 2017). Cognitive Behavioral Therapy (CBT) is a psychotherapeutic approach often used by rehab support workers and physiotherapists to help their patients overcome psychological and emotional barriers to recovery. The process begins by identifying negative thought patterns or behaviors hindering the patient’s progress, such as fear of movement or catastrophizing pain. The therapist then helps the patient to reframe these thoughts, replacing them with positive, realistic, and empowering beliefs. This is often done through talk therapy, relaxation techniques, and mindfulness exercises. By focusing on changing the patient’s mindset and behavior, CBT can help reduce anxiety, improve self-esteem, and increase the patient’s overall sense of well-being, promoting physical healing and improving the rehabilitation process’s outcome.
Medication administration, physical and occupational therapy, and monitoring patients for indicators of falls are all part of the staff’s routines and responsibilities (Currie, 2008). Employees ensure patients receive the care and assistance required to preserve their physical and mental health (Currie, 2008). Staff are appropriately trained concerning the unique needs of people with dementia and adhere to a stringent code of conduct to ensure patient safety and well-being. The staff receives regular training on the latest techniques and best practices in dementia care (Surr et al., 2017). The staff is supervised by healthcare professionals specializing in providing care to patients with dementia. The center also provides a wide range of services and interventions to support the physical and mental well-being of patients with dementia (Logsdon et al., 2007). These interventions include physical, occupational, speech, and cognitive behavior therapy. Those that require rehabilitation are typically elderly and suffer from dementia. They require particular care in order to maintain their health. The Rehabilitation Center provides care that is individualized for each patient. Patients receiving treatment at a rehabilitation facility are subject to stringent regulations. This organization adheres to rules to provide the highest quality treatment for dementia patients. (Fazio, 2018)
Theoretical Framework.
Cognitive-behavioral therapy (CBT) is a psychological framework widely applied in treating various mental health disorders, including anxiety, depression, and phobias (Kaczkurkin & Foa, 2015). CBT is based on the premise that thoughts, feelings, and behaviors are interrelated and that changing one of these components can result in changes in the others (American Psychological Association, 2017). This theoretical framework is built on the cognitive model, which suggests that psychological distress is due primarily to distorted or irrational thinking patterns (American Psychological Association, 2017). The cognitive model suggests that individuals with mental health disorders often have a negative bias in their thinking, which leads to negative feelings and maladaptive behaviors (Southam-Gerow, 2011). In CBT, the therapist and client work together to identify and challenge these negative thought patterns through cognitive restructuring, which involves replacing irrational or negative thoughts with more balanced and realistic ones (Southam-Gerow, 2011). This technique changes individuals’ interpretations of their experiences, leading to more positive emotions and adaptive behaviors. Another technique used in CBT is behavioral activation, which involves encouraging clients to engage in activities that they find rewarding or enjoyable, even if they initially lack motivation (Uphoff et al., 2019). This technique aims to break the cycle of inactivity and withdrawal that often accompanies depression and other mental health disorders and to increase feelings of pleasure and accomplishment (Uphoff et al., 2019). Exposure therapy is another important technique used in CBT, particularly in treating anxiety disorders and phobias (Sars & van Minnen, 2015). Exposure therapy involves gradually exposing the individual to the feared situation or object in a safe and controlled environment to reduce their anxiety and fear response (2022). This technique is based on the principles of classical conditioning and aims to reduce the individual’s fear response through repeated exposure to the feared stimulus.
Literature Review
The literature review indicates that cognitive-behavioral therapy (CBT) interventions effectively reduce falls in older adults, including those with dementia. Several studies have demonstrated the effectiveness of CBT interventions in reducing falls in older adults, such as Dorresteijn et al. (2016) systematic review, Lee and Yu’s (2020) study, Sherrington et al.’s (2019) study, and Clemson et al.’s (2004) study. However, each study has methodological flaws that limit its generalizability and reliability.
Dorresteijn et al. (2016) systematic review included a limited number of studies, and some had small sample sizes. The authors searched five electronic databases and included nine studies that met their inclusion criteria. However, the authors acknowledged that their search may have missed some relevant studies, and they did not conduct a meta-analysis due to the heterogeneity of the studies. Additionally, some studies had small sample sizes, which may limit the generalizability of the findings.
Lee and Yu’s (2020) study had a small sample size and only included participants from one facility, limiting generalizability. The authors conducted a randomized controlled trial with 28 participants with dementia and demonstrated that a multifactorial intervention, including CBT, effectively reduced falls. However, the study only included participants from one facility, which may limit the generalizability of the findings to other settings. Additionally, the small sample size may limit the study’s statistical power.
Sherrington et al.’s (2019) study was limited to community-dwelling older adults and did not include those in residential care settings. The authors conducted a randomized controlled trial with 534 participants and found that exercise interventions effectively reduced falls. However, the study only included community-dwelling older adults and did not include those in residential care settings, which may limit the generalizability of the findings to other populations.
Clemson et al.’s (2004) study did not have a control group, limiting the ability to determine the effectiveness of the intervention. The authors conducted a pre-post-intervention study with 60 participants and found that a group-based CBT intervention effectively reduced falls. However, the study did not have a control group, which may limit the ability to determine the effectiveness of the intervention.
In light of this information, the literature review suggests that CBT interventions that include cognitive and physical components effectively reduce falls in older adults, including those with dementia. However, there are methodological limitations in the studies reviewed, such as small sample sizes, limited generalizability, and the need for control groups. Therefore, further research is needed to establish the effectiveness of CBT interventions in reducing falls in older adults and to address the methodological limitations of previous studies. Researchers should conduct randomized controlled trials with larger sample sizes and diverse populations to ensure the generalizability and reliability of the findings.
Critical Evaluation
The literature on using Cognitive Behavioral Therapy (CBT) to decrease falls in patients with dementia shows promise, yet there are limitations to the current research. One potential limitation of CBT for dementia patients is that it may not be practical for some individuals(John D. Piette et al., 2004). Dementia patients often have difficulty with memory and executive functioning, which are necessary for cognitive restructuring, a key component of CBT. Furthermore, some patients may need help understanding the rationale for treatment, making it challenging to engage them in therapy (Chen et al., 2023). Caregivers play a critical role in supporting patients with dementia, but they may lack the training and knowledge required to facilitate CBT effectively. In some cases, cultural or ethnic differences may also impact the feasibility and acceptability of CBT interventions for dementia patients (Chen et al., 2023).
As such, it is necessary to explore alternative interventions that may be better suited for dementia patients. One such intervention is The COM-B model, a theoretical framework that can identify the factors contributing to a specific behavior. This framework can be used as an alternative to CBT (Cognitive Behavioral Therapy) for developing interventions that target negative behaviors. The COM-B model stands for “Capability, Opportunity, and Motivation – Behavior.” According to the model, all behaviors result from the interaction between an individual’s capabilities, opportunities, and motivations. Capability refers to an individual’s physical and psychological ability to perform a behavior. Opportunity refers to the environmental factors that influence behavior, such as the availability of resources or the physical environment.
Motivation is the psychological factors influencing behavior, such as beliefs, attitudes, and emotions. Using the COM-B model, one can identify which factors contribute to negative behavior, such as exercise non-adherence. For example, an individual who struggles with exercise adherence may have a physical capabilities issue, such as a lack of strength or endurance. Alternatively, the opportunity to exercise may be limited due to a lack of access to a gym or equipment. Finally, the motivation to exercise may be low due to negative attitudes towards exercise or a lack of belief in its benefits. Once the factors contributing to the negative behavior have been identified using the COM-B model, interventions can be developed to target those specific factors. For example, if the issue is a lack of physical capability, the intervention may involve working with a physical therapist to develop a strength training program. Suppose the issue is a need for more opportunities. In that case, the intervention may involve finding ways to make exercise more accessible, such as creating a home gym or finding low-cost exercise options. Finally, the issue is a lack of motivation. In that case, the intervention may involve cognitive restructuring to change negative attitudes towards exercise or finding ways to increase the individual’s belief in the benefits of exercise.
Application to the Setting
The use of Cognitive Behavioral Therapy (CBT) in reducing falls among older adults provides a promising framework for its application to the rehabilitation/recovery community for dementia patients. According to a study by Chua et al. (2019), CBT effectively reduces falls in older adults by modifying their behavior and thinking patterns. CBT is also adaptable to the specific needs of dementia patients at risk of falls (Chua et al., 2019). By using cognitive restructuring techniques, patients can identify and challenge maladaptive thoughts that may contribute to falls. Moreover, behavioral activation techniques can encourage patients to engage in physical activity to improve balance and coordination (Morgan & White, 2019). Therefore, the application of CBT in dementia patients can aid in reducing falls and improving their overall physical health. Theoretical frameworks of CBT can be effectively applied to the rehabilitation/recovery community for dementia patients to impact their physical and mental health positively.
Future Directions
Future research should investigate the effectiveness of Cognitive Behavioral Therapy (CBT) in reducing falls in dementia patients, taking into account the specific needs of this population (McLaren et al., 2023). One area of research could focus on developing and testing tailored interventions that address the unique cognitive, physical, and emotional challenges of dementia patients. Researchers could also investigate the role of family members and caregivers in supporting the implementation of CBT interventions (McLoughlin, 2022).
Standardized interventions should be used to ensure that findings can be compared across studies (Lau & Holbrook, 2017). This could involve using established CBT protocols or developing new protocols for dementia patients. Further investigation is needed to determine this population’s optimal dosage and duration of CBT interventions. This could involve exploring the effects of shorter, more intensive interventions versus longer, less intensive interventions or investigating the effects of maintenance therapy (Reid et al., 2021).
Methodologically, future studies should use rigorous designs such as randomized controlled trials with larger sample sizes and consider using mixed methods to capture both quantitative and qualitative data. Longitudinal studies could also be conducted to investigate the long-term effects of CBT interventions on fall prevention and other outcomes related to dementia (Guetterman & Fetters, 2018).
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