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Understanding Dementia Colin MacDonald Trainer in Dementia Care

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1 Understanding Dementia Colin MacDonald Trainer in Dementia Care

2 Dementia: some important facts An organic (physical) illness Irreversible damage to brain cells Progressive decline – ending in death Affects approx. 750,000 people in UK Prevalence increases with age (demographic changes) More common in women Increased prevalence in long term care settings Major source of increased pressure and stress on carers and organisations

3 Dementia is often associated with challenging behaviour BUT it is NOT an inevitable consequence of the disease Process ! !

4 Dementia: its importance quantified? In the United States it takes: * 1,500 hours of training, passing a proficiency and written exam to get a license to be a Barber or Beautician; * 400 hours of training, passing a proficiency and written exam to get a license to be a Dog Groomer; * 75 hours of training, passing a proficiency and written exam to get a license to be a Paid Care Worker/Front-line Worker.

5 Changes to the brain Characterised by a decline in: cognitive abilities memory thinking learning reasoning emotional control social behaviour motivation

6 Types of Dementia

7 Dementia – what it isnt Not the same as normal ageing - some symptoms may be similar - Not severe or progressive - Do not normally die from normal ageing (esp < 10 years) Confusion (acute confusional states or delirium) Brain Damage (one-off) Pychiatric illnesses

8 Understanding the Persons reality and experience What is it like to have dementia? Try to imagine the experience… BUT CAN WE !!

9 Whose experience? Throughout the ordeal you have to rely on your own strength of character. But the harsh reality is that control is out of your hands. You go from being confident to a terrified, lonely, simple human being at the mercy of others. Weeks are punctuated by isolation, fear, boredom, an awful, tragic, mind numbingly terrible time Ref. The Last Escape. J. Nicol. Penguin

10 The Experience of Dementia (from R. Davis – My Journey Through Alzheimers Disease). The blackness – the sudden and devastating loss of memory files World closing in – security and confidence Coping with stress / agitation – physical exertion !!? Others reaction to you – - the diagnosis - secrecy and paranioa - being talked over.. - childish/scornful reaction

11 The experience of Dementia Consider: Trying to make sense of an increasingly unfamiliar world Unable to make sense of the immediate environment Unable to access areas of memory Being disorientated – to time, place or person Unable to respond to emotional demands as before Being unable to verbally communicate your needs Loss of strengths – weaknesses come to the fore Loss of personal identity and control over your life Being ignored, talked over or treated as stupid Individual coping skills

12 Attitudes, views, and beliefs about older people What about us? An ageist society? Stereotypes? Perceptions of behaviour Negative and nihilistic views Care models and approaches Custodial and authoritarian attitudes Inflexible routines and task orientated care Focus on safety and physical care only WILL ALL CONTRIBUTE TOWARDS BEHAVIOUR THAT WE FIND CHALLENGING!

13 The disabling impact of the environment Does it make sense to the person? Lack of information Reduced Visual Access Lack of signs, cues and landmarks Areas of importance not highlighted Inappropriate lighting Too much noise and conflicting stimuli Patterned carpets and shiny flooring Caution with mirrors

14 Reduce the impact of the environment Reduce the impact of the environment Good signage Large size Right height Use of strong contrasts Yellow highly visible Symbol and text On doors, not beside

15 Burnett Pollock Associates

16 Decoration Enable access Restrict access Burnett Pollock Associates


18 Final Point Dementia as a disability is something that CAN be compensated for. The person with dementia cant adapt to us – we need to adapt our social and built environment around the person.

19 Thank You

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