Presentation on theme: "Understanding Dementia"— Presentation transcript:
1 Understanding Dementia Colin MacDonaldTrainer in Dementia Care
2 Dementia: some important facts An organic (physical) illnessIrreversible damage to brain cellsProgressive decline – ending in deathAffects approx. 750,000 people in UKPrevalence increases with age (demographic changes)More common in womenIncreased prevalence in long term care settingsMajor source of increased pressure and stress on carers and organisationsA person’s gender can have a bearing on their experience of and approach to pain. Under experimental circumstances women are shown to have a slightly “lower threshold, higher rating and less tolerance” (Berkley, 1997 p: 372) to pain than men. Women report more experiences of pain. This is in part due to differences in nerve structures (Hawkes 2000), which result in women experiencing increased levels of hyperalgesia* (Berkley 1997). Pain also interferes to a greater degree with the traditional tasks undertaken by women, for example housework (Oakley, 1974), and this extends into older age (Scudds and Østbye 2001). However, the research as a whole suggests that the differences are negligible and relate more to social and cultural factors.Within most cultures women generally discuss pain more openly and seek assistance when needed (Berkley, 1997). Cultures in which strong male hegemonies exist show lower levels of pain reporting (Skevington 1995), though men have been shown to worry about the meaning of prolonged pain to a greater extent than women (Morin et al., 2000). Different cultures may use various forms of support to address pain. African-Americans have been found to use distraction and praying more than American Caucasians (Edwards et al., 2001) to support them through a physical pain experience. The individual’s historical or religious background can also significantly affect the response to pain (Skevington, 1995; Zborowski, 1952).Particular concern has been raised about the level of discrimination that exists in care for people of different ethnicities in areas such as dementia care (Yeo et al., 1996) and studies have evidenced inequality in the treatment of pain for people from minority ethnic communities (Bonham, 2001; Todd et al., 1993). At a personal level, childhood victimization (Raphael et al., 2001) as well as a family history of pain (Fillingim et al., 2000) are associated with a higher reporting of physical pain.* Referred sensation such as parasthesia like tingles, itch or numbness, changes in the perceived temperature of a body part or a feeling of pressure or constriction (Skevington, 1996)
3 Dementia is often associated with challenging behaviour BUT it is NOT an inevitableconsequence of the diseaseProcess ! !
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 memory thinking learning reasoning Characterised by a decline in:cognitive abilitiesmemorythinkinglearningreasoningemotional controlsocial behaviourmotivation
6 Vascular (Multi-Infarct) Types of DementiaCJDAlzheimer’sAIDs RelatedAlcohol RelatedVascular (Multi-Infarct)Dementia With Lewy Bodies DAT 50-60% VD 20-30, Mixed 10%A significant number of people diagnosed with dementia are found to have tiny spherical structures called Lewy bodies in the nerve cells of their brains. It is thought these may contribute to the death of brain cells. Dementia is often mild at the outset and can be extremely variable from day to day. The symptoms are the fluctuation in the condition, visual hallucinations and extreme sensitivity to classical anti psychotic medications leading to marked symptoms of stiffness, tremor and restriction of movement. Dementia with Lewy bodies sometimes co-occurs with Alzheimer’s disease and Vascular dementia.Alcohol Related Dementia: Korsakoff’s SyndromeToo much alcohol, particularly if associated with a diet deficient in thiamine (Vitamin B1) can lead to irreversible brain damage. This dementia is preventable. If people don’t drink, or they drink at a safe level, they don’t get it. The most vulnerable parts of the brain are those used for memory, and for planning, organizing and judgement, social skills and balance. If drinking stops there may be some improvement. Taking thiamine appears to help prevent and improve the condition.Frontal Lobe Dementiae.g. PicksLewy Body's
7 Dementia – what it isn’t 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 Ref. The Last Escape. J. Nicol. Penguin 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 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 confidenceCoping 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 worldUnable to make sense of the immediate environmentUnable to access areas of memoryBeing disorientated – to time, place or personUnable to respond to emotional demands as beforeBeing unable to verbally communicate your needsLoss of “strengths” – “weaknesses” come to the foreLoss of personal identity and control over your lifeBeing “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 behaviourNegative and nihilistic viewsCare models and approachesCustodial and authoritarian attitudesInflexible routines and task orientated careFocus on safety and physical care onlyWILL ALL CONTRIBUTE TOWARDS BEHAVIOUR THAT WEFIND CHALLENGING!
13 The disabling impact of the environment Does it make sense to the person?Lack of informationReduced Visual AccessLack of signs, cues and landmarksAreas of importance not highlightedInappropriate lightingToo much noise and conflicting stimuliPatterned carpets and shiny flooringCaution with mirrors
14 Reduce the impact of the environment Good signageLarge sizeRight heightUse of strong contrastsYellow highly visibleSymbol and textOn doors, not beside
18 Dementia as a disability is something that CAN be compensated for. Final PointDementia as a disability is something that CAN be compensated for.The person with dementia can’t adapt to us – we need to adapt our social and built environment around the person.
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