Further knowledge in dementia part 1

1. South West Dementia Partnership Further knowledge in dementia part 1

2. Welcome Introductions Group Agreement What will be achieved from this session? South West Dementia Partnership Further knowledge in dementia part 1 Mention Group rules: Confidentiality Timing Respect for others views Encourage discussion and questions Mention Group rules: Confidentiality Timing Respect for others views Encourage discussion and questions

3. Main Talking Points How the brain is affected when a person has dementia Person centred care and positive communication How physical health is important to a person with dementia South West Dementia Partnership Further knowledge in dementia part 1 Are there any specific questions relating to any of these What might not be answered today will look for other ways to signpost /get further information Are there any specific questions relating to any of these What might not be answered today will look for other ways to signpost /get further information

4. South West Dementia Partnership Further knowledge in dementia part 1 The occipital lobe is located at the back of the brain, and deals primarily with visual information from the eyes. The parietal lobe lies in the upper-rear portion of the brain, and is concerned with information about spatial relationships, perception and magnitude. The temporal lobe lies beneath the parietal lobe and is involved in memory and language. The frontal lobe can be thought of as our 'executive' or 'management' centre (Source Alzheimers society factsheet : the brain and behaviour ((encourage people to look this up))The occipital lobe is located at the back of the brain, and deals primarily with visual information from the eyes. The parietal lobe lies in the upper-rear portion of the brain, and is concerned with information about spatial relationships, perception and magnitude. The temporal lobe lies beneath the parietal lobe and is involved in memory and language. The frontal lobe can be thought of as our 'executive' or 'management' centre (Source Alzheimers society factsheet : the brain and behaviour ((encourage people to look this up))

5. Changes in dementia Difficulties with: Getting lost Forgetting & losing things Finding the right words Expressing strong feelings in an appropriate way Making decisions and judgements Managing social situations Managing money and finances South West Dementia Partnership Further knowledge in dementia part 1 Explain how changes in the brain lead to different difficulties.Explain how changes in the brain lead to different difficulties.

6. The different types of dementia Alzheimer’s disease Vascular dementia Lewy Body dementia Frontal temporal dementia Parkinson’s Disease Korsakoff’s Syndrome CJD South West Dementia Partnership Further knowledge in dementia part 1 Check what people might already know about these before going on to next slidesCheck what people might already know about these before going on to next slides

7. Alzheimer’s disease Most common form of dementia Progresses gradually over time The damage to the brain cells usually starts in the temporal lobe of the brain which results in a person having problems with short term memory and new learning Damage to all areas of the lobes of the brain is common as the disease progresses South West Dementia Partnership Further knowledge in dementia part 1 This is the most common form of dementia. It progresses gradually over time The way the disease progresses tends to follow a predictable pattern The damage to the brain cells usually starts in the temporal lobe of the brain which results in a person having problems with short term memory and new learning. Damage to all areas of the lobes of the brain is common as the disease progresses This is the most common form of dementia. It progresses gradually over time The way the disease progresses tends to follow a predictable pattern The damage to the brain cells usually starts in the temporal lobe of the brain which results in a person having problems with short term memory and new learning. Damage to all areas of the lobes of the brain is common as the disease progresses

8. Vascular dementia Sometimes referred to as ‘stroke related dementia’ multi infarct / single infarct dementia The damage to the brain cells are dependent on where the blood vessel damage occurs Sometimes it is described as ‘stepwise’ in the way the changes occur The way the disease progresses is very variable from person to person South West Dementia Partnership Further knowledge in dementia part 1

9. Lewy Body dementia This dementia shares similarities with both Alzheimer’s and Parkinson’s diseases Lewy bodies are tiny round deposits found in the nerve cells which disrupt the brains normal functioning Hallucinations and delusions are commonly experienced The person with Lewy body dementia may react badly to anti-psychotic medications South West Dementia Partnership Further knowledge in dementia part 1

10. Tom Kitwood and psychological needs of people with dementia Person centred care in practice Positive communication in distressing situations Person centred care and positive communication South West Dementia Partnership Further knowledge in dementia part 1

11. Tom Kitwood South West Dementia Partnership Further knowledge in dementia part 1 Tom Kitwood was a psychologist who was a pioneer in the field of dementia care. He was a senior lecturer at Bradford University in the 1980s where he researched and wrote about ‘person centred’ dementia care. His aim was to understand, as far as is possible, what care is like from the standpoint of the person with dementia.   His book ‘Dementia Reconsidered’ written in 1997 brought together much of his work and is still widely referenced today. He was very keen to challenge the way that people with dementia are treated and to move away from viewing dementia from purely a medical viewpointHe identified a number of psychological and social factors which humans need to be met in order to maintain well-being:Tom Kitwood was a psychologist who was a pioneer in the field of dementia care. He was a senior lecturer at Bradford University in the 1980s where he researched and wrote about ‘person centred’ dementia care. His aim was to understand, as far as is possible, what care is like from the standpoint of the person with dementia.   His book ‘Dementia Reconsidered’ written in 1997 brought together much of his work and is still widely referenced today. He was very keen to challenge the way that people with dementia are treated and to move away from viewing dementia from purely a medical viewpointHe identified a number of psychological and social factors which humans need to be met in order to maintain well-being:

12. Think of ways you might uphold a person’s well being in each of these areas Uphold the person’s identity For example: Respecting the person by addressing them by the name they wish to be called Seeking out opportunities to explore the life history of the person through talking to friends and family members Engage the person in occupation For example: Supporting and encouraging the person to engage in meaningful tasks at whatever level the person is able and comfortable to do. Provide comfort For example: Demonstrating warmth and acceptance of the person when talking with them Enable attachment For example: Recognising the important feelings a person may have for past or present relationships Being sensitive to recognise the person’s sense of reality Include the person in what is happening For example: Enabling a person to be involved both physically and psychologically   Upholding these needs will have an effect on the person’s well being. Not having these needs met will potentially lead to ill being, that is feelings of distress and discomfort. Uphold the person’s identity For example: Respecting the person by addressing them by the name they wish to be called Seeking out opportunities to explore the life history of the person through talking to friends and family members Engage the person in occupation For example: Supporting and encouraging the person to engage in meaningful tasks at whatever level the person is able and comfortable to do. Provide comfort For example: Demonstrating warmth and acceptance of the person when talking with them Enable attachment For example: Recognising the important feelings a person may have for past or present relationships Being sensitive to recognise the person’s sense of reality Include the person in what is happening For example: Enabling a person to be involved both physically and psychologically   Upholding these needs will have an effect on the person’s well being. Not having these needs met will potentially lead to ill being, that is feelings of distress and discomfort.

13. Person centred care in practice Key difficulties and responses When the person is confused by past memories Positive and effective communication in distressing situations South West Dementia Partnership Further knowledge in dementia part 1

14. When the person is confused by past memories: Consider is it possible to orientate the person to reality? Validating/ agreeing with the person’s feelings Explore past memories that the person is experiencing Provide reassurance and comfort South West Dementia Partnership Further knowledge in dementia part 1 Responding to the person with dementia when the person is confused by past memories: If a person with dementia is drawing from memories from the past the person might say such things as: ‘Where is my mother?’ ‘I need to go home to get the tea’   When this happens: Consider is it possible to orientate the person to reality?   Can the person be reassured as to where they are in the ‘here and now’? If ‘Yes’ then provide reassurance and prompts/cues to help the person keep in touch with this information. i.e: visual cues such as pictures/symbols/written words on notices/cards         If however the person is distressed when confronted with the facts of the situation and this distress is difficult for the person to self manage then It might be helpful at these times to consider a number of different approaches such as:   Validating the person’s feelings. For example: ‘Are you feeling lost without your mum?’ ‘You seem very sad not finding your mother’ ‘You seem to really miss your mum?’   Explore past memories that the person is experiencing ‘What was your mother like?’ ‘Can you tell me about your mother?’   Provide reassurance and comfort: ‘It seems very upsetting for you to be still looking for your mother, I’m sure things are ok’ ‘I can see you are upset and worried but it will be all right’ ‘I know you are worried but things are taken care of’ Responding to the person with dementia when the person is confused by past memories: If a person with dementia is drawing from memories from the past the person might say such things as: ‘Where is my mother?’ ‘I need to go home to get the tea’   When this happens: Consider is it possible to orientate the person to reality?   Can the person be reassured as to where they are in the ‘here and now’? If ‘Yes’ then provide reassurance and prompts/cues to help the person keep in touch with this information. i.e: visual cues such as pictures/symbols/written words on notices/cards         If however the person is distressed when confronted with the facts of the situation and this distress is difficult for the person to self manage then It might be helpful at these times to consider a number of different approaches such as:   Validating the person’s feelings. For example: ‘Are you feeling lost without your mum?’ ‘You seem very sad not finding your mother’ ‘You seem to really miss your mum?’   Explore past memories that the person is experiencing ‘What was your mother like?’ ‘Can you tell me about your mother?’   Provide reassurance and comfort: ‘It seems very upsetting for you to be still looking for your mother, I’m sure things are ok’ ‘I can see you are upset and worried but it will be all right’ ‘I know you are worried but things are taken care of’

15. Positive communication in distressing situations Responding to distress and frustration: Do not argue with the person – focus less on the factual content of what is being said and more on how the person is feeling Do not blame the person for being distressed Try not to take it personally if the person displays angry behaviour towards you It may help to try and distract the person with everyday routines such as meals /walks South West Dementia Partnership Further knowledge in dementia part 1

16. Responding to distress and frustration: Consider the person’s sense of ‘reality’ and respond to this - using reminiscence to link to past stories in the person’s life and asking questions to engage the person. Look to identify how the person is feeling and respond to this. Identify ‘themes’ and plan accordingly. South West Dementia Partnership Further knowledge in dementia part 1   Any of the above may be helpful and sometimes a combination of responses or different approaches may be required, at different times, depending on a variety of factors. It can be helpful to think of having a ‘toolbox of approaches’ to use when trying to work out what might work best in any given situation.   However it’s also important that the person with dementia receives a consistent response as this will help to lessen distress with mixed messages being received.   Therefore once an approach has been agreed this should be shared with anyone who may be communicating with the person. For example with other staff members and this can also be noted on their care plan. Task 3 – Mr and Mrs Porter Case Study :   Mr Porter has an Alzheimer’s type dementia and was diagnosed four years ago. He was a builder by trade and retired seven years ago. He has been living at home with his wife and she is his main carer. Mrs Porter has a chronic back problem and Mr Porter has a care worker who comes daily to support him with washing and dressing. One day when the care worker visits, Mrs Porter is looking distressed and says that her husband is constantly talking about ‘getting to the job on time’. This is happening particularly in the evenings and at times she is finding it very difficult to encourage him to settle and go to bed. On two occasions she has locked the door and left him to walk around the house and eventually sleep in his clothes downstairs. Mrs Porter is very distressed and asking what should she do.   Any of the above may be helpful and sometimes a combination of responses or different approaches may be required, at different times, depending on a variety of factors. It can be helpful to think of having a ‘toolbox of approaches’ to use when trying to work out what might work best in any given situation.   However it’s also important that the person with dementia receives a consistent response as this will help to lessen distress with mixed messages being received.   Therefore once an approach has been agreed this should be shared with anyone who may be communicating with the person. For example with other staff members and this can also be noted on their care plan. Task 3 – Mr and Mrs Porter Case Study :   Mr Porter has an Alzheimer’s type dementia and was diagnosed four years ago. He was a builder by trade and retired seven years ago. He has been living at home with his wife and she is his main carer. Mrs Porter has a chronic back problem and Mr Porter has a care worker who comes daily to support him with washing and dressing. One day when the care worker visits, Mrs Porter is looking distressed and says that her husband is constantly talking about ‘getting to the job on time’. This is happening particularly in the evenings and at times she is finding it very difficult to encourage him to settle and go to bed. On two occasions she has locked the door and left him to walk around the house and eventually sleep in his clothes downstairs. Mrs Porter is very distressed and asking what should she do.

17. Verbal communication Speak in a calm way; notice the tone of your voice Use short sentences giving small amounts of information Make time for the person to answer Don’t argue about facts or try to ‘correct’ the person South West Dementia Partnership Further knowledge in dementia part 1

18. Identify the non verbal skills that are being used in this communication

19. Non-Verbal Communication Move to the person’s level Gain eye contact where possible Use gestures, objects or signals as well as words e.g. show the person an object that relates to what you are saying South West Dementia Partnership Further knowledge in dementia part 1

20. General health and well being Exercise: does the person have opportunities to move around? Good diet: is the person getting enough to eat, is this a balanced diet and nutritional? Having enough fluids: is the person getting enough to drink? Being free from pain and infection Environment: is the room warm/cool enough? South West Dementia Partnership Further knowledge in dementia part 1 Maintaining the well being of the person with dementia becomes increasingly difficult as the person needs increasing support to stay physically well. Managing Pain Part of supporting someone with dementia is to ensure they are as free from pain as possible. Being in pain does not have to be an inevitable part of getting older or having dementia so it is important to always be aware of signs that the person with dementia is in pain.   Taking time to get to know the person with dementia can help you see if they are reacting differently, which may indicate they are in discomfort or pain. Regular assessment of pain is an important part of care planning and will help you pick up any problems early on.   Different pain assessment tools can be helpful in identifying whether the person with dementia is communicating that they are experiencing pain.   This can be increasingly important if a person has difficulties verbally expressing their pain. There are many different tools which can help. For example: Disdat/DSDAT (Disability Distress Assessment Tool) PAINAD (Pain Assessment in Advanced Dementia) Maintaining the well being of the person with dementia becomes increasingly difficult as the person needs increasing support to stay physically well. Managing Pain Part of supporting someone with dementia is to ensure they are as free from pain as possible. Being in pain does not have to be an inevitable part of getting older or having dementia so it is important to always be aware of signs that the person with dementia is in pain.   Taking time to get to know the person with dementia can help you see if they are reacting differently, which may indicate they are in discomfort or pain. Regular assessment of pain is an important part of care planning and will help you pick up any problems early on.   Different pain assessment tools can be helpful in identifying whether the person with dementia is communicating that they are experiencing pain.   This can be increasingly important if a person has difficulties verbally expressing their pain. There are many different tools which can help. For example: Disdat/DSDAT (Disability Distress Assessment Tool) PAINAD (Pain Assessment in Advanced Dementia)

21. Focus on physical health in order to: Reduce the risk of delirium Reduce potential communication difficulties where a person is trying to express these needs Increase an individuals wellbeing South West Dementia Partnership Further knowledge in dementia part 1

22. Main Talking Points re-visited: Any questions? How the brain is affected when a person has dementia Person centred care and positive communication How physical health is important to a person with dementia South West Dementia Partnership Further knowledge in dementia part 1