Dementia Care Evolution: Traditional to Modern Approaches

Dementia care has evolved from institutionalization to person-centered approaches that emphasize aging in place, holistic support, and therapeutic counseling for both patients and caregivers managing anxiety, depression, and stress associated with cognitive decline.

Worried about what dementia care looks like for you or a loved one? Dementia care has transformed dramatically from the days of automatic institutionalization to today's compassionate, person-centered approaches that support both patients and families through therapeutic interventions.

Traditional Versus Modern Approaches To Dementia Care: How Treating Dementia Has Evolved Over Time

Updated October 9th, 2024 by ReachLink Editorial Team

Medically reviewed by ReachLink Clinical Staff

The physical and behavioral symptoms of dementia have been documented for many years, and conceptions of the disease have radically evolved over time. Clues to how dementia was originally perceived can be found within the word “dementia” itself: it is based on the Latin root “demens,” which means “out of one’s mind.”

Early understandings of dementia

Originally, dementia was employed as a diagnosis whenever anyone demonstrated symptoms of any type of psychiatric or neurological condition that prevented them from living what was considered a “normal” life. What we now consider to be dementia, loss of cognitive function, fell into that category.

Eventually, age-associated dementia came to be understood as a condition distinct from other psychiatric illnesses that affected mental well-being. Healthcare professionals referred to the disease as “senility” or “going senile.”

Symptoms were thought to be an inevitable part of the process of growing older, not something that could be addressed, treated, or mitigated through any sort of specialized services. This blanket assumption that age was the sole cause of dementia showed a lack of understanding of the variety of conditions (and symptoms) associated with dementia development, which scientists and researchers now know include Alzheimer’s disease, cardiovascular events, and specific changes in the brain.

In both instances, when “dementia” was used as a catch-all diagnosis, and “senility” was used specifically for age-related cognitive decline, the end result was usually institutionalization.

More recent conceptions of dementia

Dementia was not understood to be a health condition that required care until the 19th century. In the early 20th century, it was standard practice for doctors to classify people with dementia who could no longer live independently as “insane” so that they could be placed in state mental hospitals, which were paid for by the government. Once someone was diagnosed with dementia, it was thought that they had no hope of future improvement or stability, so placing them in an institution was considered the most humane action to take.

In the decades between 1930 and 1950, some researchers started shifting their view of dementia away from a “lost cause” mentality and toward analysis of the condition as a primarily psychosocial problem. In other words, dementia was understood to be more common in older people, but its progression depended on a number of external factors and was not necessarily inevitable, as had always been thought.

This change in attitude sparked discussion of what constituted proper elder care and whether society was failing at meeting the needs of older Americans. Some historians argue that this shift in conversation about what it means to age helped prompt major milestones like the creation of the Medicare program, which provides all eligible Americans over the age of 65 with health care.

By 1970, the general societal conception of dementia was that it was a disease that could be prevented and potentially one day cured, not an inevitable part of becoming older.

Modern frameworks for understanding dementia

While the creation of Medicare and the widespread acceptance of dementia as a disease that could be mitigated are largely considered to be positive steps in the field of dementia care, some scholars argue that these shifts may have had unintended negative consequences. When dementia was considered to be an unstoppable component of aging, mainstream attitudes toward aging were largely fatalistic, with most Americans believing that their quality of life would steadily decline in older age. The understanding that dementia could potentially be prevented or cured shifted expectations around the aging process, which may have further stigmatized dementia, now that it was no longer considered an inevitable outcome.

Additionally, once dementia was understood to be a disease, policymaking conversations about the condition could become a little apocalyptic. With the rapid aging of American society, some policymakers argued that if a treatment or cure for the condition was not found as soon as possible, the entire American healthcare system could become overwhelmed.

In order to heighten a sense of urgency around dementia treatment, advocates have also attempted to portray dementia as a condition that causes high levels of suffering, negatively impacts a person’s quality of life, and eventually leads to total and irrevocable loss of personhood and sense of self. This profile of dementia, while potentially leading to more funding for research, tends to be a narrow conception of the disease and is typically not accurate except for late-stage and severe forms of the condition. This perspective can lead to further stigmatization of patients living with dementia.

All in all, the alarm around dementia has led in part to an intensified focus on finding a treatment or cure, with less resources devoted to caring for people who are already impacted by the disease.

Current best practices for dementia care

Modern medicine has come a long way from the time when patients with dementia were automatically institutionalized and segregated from the rest of society. Holistic care—understanding the dementia patient as a whole person who may require different forms of care in different areas of their life—and person-centered care, which treats the dementia patient’s needs as the first and foremost priority, are considered pillars of the modern dementia care system.

Today, the medical establishment recognizes that in many cases, “aging in place,” or the practice of a person remaining in their home as they become older, can be the most beneficial option. Living in familiar spaces may help older adults retain a sense of independence and community engagement that may act as a protective factor against some of the worst symptoms of dementia.

However, living entirely independently may not be possible for some older adults, which is where in-home care can step in to fill in some of the gaps, for example, by driving an older person around when they no longer feel comfortable operating a motor vehicle. Family members often step up as informal caregivers in these situations, although there is a limit to what family caregivers can provide. For example, most loved ones of individuals with dementia are not trained in administering intravenous medication.

If in-home care is not financially or logistically feasible, memory care facilities can employ the latest knowledge and research in dementia care to support an older person as they enter the later stages of the disease. Future developments in dementia care may involve the use of assistive technologies to help patients preserve a sense of selfhood and dignity.

The role of therapeutic support in dementia care

Although dementia care may be better understood now than at earlier points in history, living with the disease or caring for a person with dementia can still take a significant emotional and mental health toll. The challenges faced by both individuals with dementia and their caregivers extend beyond the purely medical aspects of the condition.

For people in the earlier stages of dementia, therapeutic counseling can provide valuable support in processing the diagnosis, managing anxiety and depression that often accompany cognitive changes, and developing coping strategies for maintaining quality of life. Family members and caregivers also frequently experience stress, grief, guilt, and burnout as they navigate the complex demands of supporting a loved one with dementia.

Working with a licensed clinical social worker can help address these psychosocial dimensions of dementia care. Through therapeutic interventions, individuals and families can explore communication strategies, process difficult emotions, access community resources, and develop resilience in the face of ongoing challenges.

Accessing mental health support through telehealth

Dementia can sometimes create barriers to traditional in-person mental health care. A person living with dementia may not feel comfortable driving themselves to an appointment, or a dementia caregiver may not want to leave their loved one alone. In these instances, telehealth counseling can serve as a viable solution.

Research shows that telehealth therapy can be just as effective as traditional in-person therapy at addressing mental health concerns, including those impacting people with dementia and their caregivers. One study analyzed a group of dementia caregivers who participated in online therapy with telephone support, and they reported significant improvement in mood and mental health.

ReachLink’s telehealth platform allows individuals and families affected by dementia to access licensed clinical social workers from the comfort and familiarity of their own homes. This eliminates transportation challenges, reduces the stress of navigating unfamiliar environments, and provides flexible scheduling that can accommodate the unpredictable nature of caregiving responsibilities.

Through secure video sessions, clients can engage in evidence-based therapeutic approaches that address the specific challenges associated with dementia—whether that’s managing caregiver stress, processing grief and loss, improving family communication, or developing practical coping strategies for daily life.

Takeaway

Approaches to dementia care have significantly evolved over time, moving from institutionalization as the primary response to a more nuanced understanding that emphasizes person-centered care, aging in place when possible, and holistic support that addresses both medical and psychosocial needs.

If you are experiencing symptoms of dementia or if you have a loved one living with dementia, you may benefit from seeking therapeutic support to manage the emotional challenges that often arise from this condition. The complexity of dementia care extends beyond medical treatment to encompass the psychological, social, and relational dimensions of living with or caring for someone with cognitive decline.

ReachLink’s licensed clinical social workers are experienced in helping individuals and families navigate the unique challenges of dementia. Our telehealth platform makes it possible to access quality mental health support without the logistical barriers that can make traditional therapy difficult for those affected by dementia. If your present circumstances make it challenging to leave home, or if you’re seeking flexible, accessible counseling services, consider exploring how ReachLink’s telehealth approach might support your mental health needs during this difficult time.