Support to people living with Dementia

1. Support to people living with Dementia CHCAC319A

2. Learning Objectives/ elements • 1. Provide support to those affected by dementia • 2. Use communication strategies which take account of the progressive & variable nature of dementia • 3. Provide adequate activities to maintain dignity, skills and health of client at optimum levels • 4. Implement strategies which minimise the impact of behaviours of concern • 5. Implement self care strategies

3. Understanding Dementia Dementia: • Is a general term used to describe problems with memory and thinking, which leads to a decline in social skills and behaviour and indicates that something is wrong with the brain. • Causes a decline in a persons cognitive function – memory loss, communication difficulties & a decline in physical, emotion and social abilities. • Occurs progressively, which impacts on an individuals ability to carry out a normal life

4. Most common types of Dementia • Vascular Dementia • Strokes (many and small) Multi infarcts (TIA) • Alzheimer’s Disease • Plaques, tangles and transmitter defects to brain 20 -30% of all dementia’s 50-70% of all dementia’s

5. Less common types of Dementia • Transmitter Damage • Physical Damage • Toxic Damage • Genetic Disorder • Infections • Parkinson’s Disease • Injury , tumours • Korsakoff’s Syndrome • Huntington’s Disease • AIDS, syphilis, Creutzfeldt-Jakob Disease (Mad Cow)

6. Demographics of dementia • It is estimated that around 200,000people in Australia have dementia. • With the projected rise of Australia's aged population, it is estimated the number of people living with dementia will increase to almost 465,000 by 2031. • Dementia is one of the major reasons why older people enter residential aged care or seek assistance from community care programs. • Dementia can happen to anyone. It can affect people in their 30s, 40s and 50s. • it is more common over the age of 65 • one in four people over the age of 85 have the condition. Stats : Economics (2005) Dementia Estimates and Projections: Australian States and Territories. Alzheimer’s Australia, Canberra.

7. Signs and symptoms of dementia • Apathy & withdrawal, loss of initiative • Loss of ability to perform every day tasks • Problems with language • Misplacing things • Changes in mood or behaviour. • Progressive & frequent loss of memory • Confusion • Personality change • Disorientation to time & place • Poor or decreased judgement • Problems with abstract thinking

8. Progression of Dementia • lose control of their bowel/bladder • wander and pace around • hallucinate or have delusions • behave in a way that is a challenge to manage. • lose their communication skills • become disorientated to time, place and people • lose the ability to do everyday tasks

9. Diagnosis • GP’s neurologists, psycho-geriatrician, ACAT, psychologists rule out other conditions that may cause dementia, especially those that may be reversible. • Diagnostic process is complex and usually involves a combination of tests and investigations to assess change over time • screening tests, such as the Mini-Mental Status Examination (MMSE) • Neuropsychological assessments consider aspects of cognition, including memory recognition and concentration • Radiography - CT, PET & MRI Scans

10. Differential diagnosis of dementia Some conditions present like signs and symptoms of dementia. These may be reversible and include: • depression • acute confusion/delirium (caused by infection, dehydration, constipation) • anxiety • tumours • vitamin deficiencies. • Endocrine disorders

11. Remember: Although the risk of developing AD increases with age, AD and dementia symptoms are Not part of normal ageing. AD & other Dementing disorders are caused by diseases that affect the brain.

12. Impact on client, carer’s, family & society untiunitunbit2

13. IMPACT - society • There are currently around 245,000 people with dementia in Australia. • By mid-century, we will have over 1.13 million Australians with dementia. • Dementia is the leading single cause of disability in older Australians (aged 65years or older) • It is one of the fastest growing sources of major disease burden, overtaking coronary heart disease in its total wellbeing cost by 2023.

14. Impact- society • Dementia will become the third greatest source of health and residential aged care spending within about two decades. • By the 2060s, spending on dementia is set to outstrip that of any other health condition. It is projected to be $83 billion (in 2006-07 dollars • (previous two slides)Alzheimer ‘s Australia report by Access Economics-Keeping dementia front of mind: incidence and prevalence 2009-2050. 2009

15. Impact for clients with Dementia People with dementia may need assistance with: • Remembering • Re -orientating • Communicating • Self-care • Safety • Eating and drinking • Going to the toilet • grieving because of the awareness of the effects of the disease • reliving a memory of loss. • Anxiety & challenging behaviours • Dependence on others • disorientation

16. Who are carers? • Spouses – the largest group. Most are older with their own health problems. • Daughters – the second largest group. Called the “sandwich generation,” many are married and raising children of their own. Children may need extra support if a parent’s attention is focused on care giving. • Grandchildren – may become major helpers. • Daughters-in-law – the third largest group. • Sons – often focus on the financial, legal, and business aspects of care giving. • Brothers and Sisters – many are older with their own health problems. • Other – friends, neighbors, members of the faith community. NIA: Unravelling the mystery of AD

17. AD takes a huge physical and emotional toll. Caregivers must deal with changes in a loved one’s personality and provide constant attention for years. Thus, caregivers are especially vulnerable to physical and emotional stress. Peer support programs can help link caregivers with trained volunteers. Other support programs can offer services geared to caregivers dealing with different stages of AD. NIA unraveling AD Support for Caregivers

18. For the Carer • Make it an aim to share the care of the person with dementia • • Don’t hesitate to ask for help • • Suggest specific ways that friends and family can help • • Organise regular breaks for yourself. • A friend or relative may be able to care for the person with dementia on a regular basis • Find out about respite options in your local area Alzheimer’s Australia : www.alzheimers.org.au

19. For the Carer • A consistent schedule can make life a little easier when living with a person with dementia • • It often helps to remember that the person with dementia is not being difficult on purpose, but that their emotions and behaviours are affected by dementia • • Learning as much as possible about dementia and encouraging friends and relatives to do so as well can be helpful • • It is important to talk things over with family, friends and other people in a similar situation • • Look after yourself by looking after your diet, get regular exercise and maintain your social contacts and lifestyle • • Be realistic about what you can expect of yourself, and recognise that taking care of yourself is better for everybody • Alzheimer’s Australia : www.alzheimers.org.au

20. For Family & Friends • Provide information about dementia. Useful material is available from Alzheimer’s Australia, much of it in community languages as well as English • • Explain that outwardly a person with dementia may look fine, but that they have an illness, which although devastating, is not contagious • • Accept that some friends may drift away • • Ask visitors to come for short times and not too many at once • • Suggest activities for the visit such as going for a walk, bringing a simple project to do together or looking at a photo album • • Prepare visitors for any problems with communication, and suggest ways that they might deal with these • Alzheimer’s Australia : www.alzheimers.org.au

21. Community resources • Who can help? • Commonwealth Respite and Carelink Centres around Australia provide information about the range of community care programs and services • available to help people stay in their own homes. Call 1800 052 222 or visit www.commcarelink.health.gov.au • Commonwealth Carer Resource Centres provide carers with information and advice about relevant services and entitlements. • Contact your closest Commonwealth Carer Resource Centre on • 1800 242 636.

22. Community resources • Another useful source of information is the Carers Association. The Australian Government has published a Carer Information Kit that provides information about the support and services that are available to carers and offers practical assistance. www.carersaustralia.com.au • The Dementia Behaviour Management Advisory Service (DBMAS) is a national telephone advisory service for families, carers and care workers who are concerned about the behaviours of people with dementia. The service provides confidential advice, assessment, intervention, education and specialised support 24 hours a day, 7 days a week and can be contacted on 1800 699 799. • National Dementia Helpline can be contacted on 1800 100 500 or visit Alzheimer’s Australia at www.alzheimers.org.au

23. Elder Abuse Clinical • Short term memory impairment • Dementia • Depression • Physical dependence • Substance abuse Situational Isolation Poor social functioning Recent bereavement Types of elder abuse: • Physical • Chemical • Sexual • Financial • Emotional REPORTING

24. The impact of dementia on brain functioning

25. Alzheimer’s Disease • Most common form of Dementia 60-70% attributed to Alzheimer’s Disease • Alzheimer's disease is a physical disease which attacks the brain resulting in impaired memory, thinking and behaviour.  • The disease is named for the German physician, Alois Alzheimer who, in 1907, first described it.

26. Plaques and Tangles: The Hallmarks of AD As brain cells die, the substance of the brain shrinks. Abnormal material builds up as “tangles” in the centre of the brain cells and “plaques” outside the brain cells, disrupting messages within the brain, damaging connections between brain cells. This leads to the eventual death of the brain cells and prevents the recall of information. Dementia with Lewy Bodies: plaques and tangles which interfere with normal brain function. An actual AD plaque An actual AD tangle

27. Symptoms of Alzheimer’s Disease • Persistent and frequent memory difficulties, especially of recent events • Vagueness in everyday conversation • Apparent loss of enthusiasm for previously enjoyed activities • Taking longer to do routine tasks • Forgetting well-known people or places • Inability to process questions and instructions • Deterioration of social skills • Emotional unpredictability

28. Stages Of AD • Mild = Early stage The mild stage is typified by impairments of mental ability as well as mood swings. • Moderate = Mid stage Behavioural disturbances usually increasingly develop • Severe = Late stage Physical problems are dominant The individual course of the disease is individual & varied.

29. Severe AD In severe AD, extreme shrinkage occurs in the brain. Patients are completely dependent on others for care. Symptoms can include weight loss, seizures, skin infections, groaning, moaning, or grunting, increased sleeping, loss of bladder and bowel control. Death usually occurs from aspiration pneumonia or other infections. Caregivers can turn to a hospice for help and palliative care. (NIA) Unraveling the mystery of AD sl.21

30. Supporting the person with Dementia Communication

31. The normal process of communication • 1. Sender – sends the message • 2. The message – verbal or non verbal • 3. The channel – messages are sent through a variety of channels – senses • 4. The receiver – receives the message and interprets it • 5. The impact – reaction to the message

32. Dementia causes a decreasing ability to communicate verbally • Difficulties include: • Ability to express themselves clearly • Take in what has been said • People from a NESB may revert to their first language • Challenging behaviours may result due to such difficulties in communicating

33. Non verbal Communication • Makes up to 55% of our communication and is very powerful. This is our body language such as: • Tone of voice, volume of voice • Facial expression • Touch, gestures, appearance, posture, silence, dress,

34. As a carer • Do not take it personally if a patient takes a dislike to you • Be aware of the non verbal communication (smiling, touch gestures) • Consider the patients perception of reality

35. Understanding the stages of Dementia and its impact on communication • Early Stage • Ability to think of the right words • Fewer topics, speaks less and conversation is dull • Middle Stage • Knowing when to reply • Vague • End Stage • Putting sentences together • Words may be lost • Non verbal

36. Strategies to Communicate with people with Dementia • Reality Orientation • Validation Therapy • Reminiscence • Reflective Listening

37. Barriers to communication • Limited attention span • Cannot remember words • Multiple step instruction may lead to confusion • Inability to concentrate • Need more time to respond • Difficult behaviour • Additional impairments may also hinder communication further

38. Person centred approach • Valuing the individuality of every person • Relating to the person rather than the illness • Maximising autonomy, independence and participation • Responding to the needs of the whole person; • Providing an environment and experiences that are enriching and meaningful; • A partnership between care providers and family and friends of the person with dementia. • Dementia is the condition not the person

39. Supporting the person with Dementia Activities

40. Strategies for daily activities and recreation to sustain wellbeing • Task modification • To ensure comprehension • Cues to complete tasks • Provide a method to assess ‘difficulties’ a person may have with one/any task • To assist where possible whilst maintaining independence

41. What is a task? • Activities of daily living (ADL) • Activities we normally do on a day to day basis such as washing, eating • Recreational Activities • Activities we do for pleasure such as listening to music, playing cards

42. Purpose of activities • Keep active • Sense of accomplishment • Makes us feel worthwhile and feel good • Enhances emotional wellbeing • To maintain activities you will need to know: • Patients history

43. Designing Activities for people with Dementia • Provide an appropriate activity • Consider the following – likes/dislikes, past history, suitable environment, capabilities, disabilities, equipment required, safety aspects, planning or liaising with others • Group or individual activities • When designing an activity for a person with dementia remember to use all of the senses

44. Supporting the person with dementia Challenging Behaviour

45. Indentifying behaviours of concern • Anxiety • Wandering • Aggression • Depression • Confusion • Hallucinations • Agitation • Disinhibited behaviour

46. Strategies to assist challenging behaviours • Reassure and support the person • Try to respond calmly and gently • Address the underlying feeling if possible • Try to reduce the demands made on the person • Be aware of the warning signs of aggression • Eliminate possible causes of stress • Ensure that there is an unrushed and consistent routine • Spend time explaining what is happening avoid confrontation. • suggest an alternative activity • Make sure the person gets enough exercise • Make sure they are comfortable

47. Reasons for behaviours • Environmental • Noisy • Strange / new • Fear • Misunderstanding • Need for attention • Health factors • • Fatigue • • Disruption of sleep patterns • • Physical discomfort such as pain, fever, illness or constipation • • Physical changes in the brain • • Adverse side effects of medication • • Impaired vision or hearing • • Hallucinations

48. Restraints • Restraint is the use of physical, chemical or psychological means of deliberately preventing someone from moving freely. • Types of restraints include: posey belt, lap belt, bed rails, water chairs, deep chairs, sheets, mittens and medication

49. Potential harm from restraints • The following is a list of possible side effects due to restraints • Decreased muscle strength • Increased confusion • Loss of self worth • Increase in falls

50. Use of restraints • Written doctors order that states: type of restraint, how it is to be applied, length of time, review date, signature of person applying and releasing restraint • Written consent from the persons guardian or next of kin is also required • Documentation of behviour