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“Getting to Know Me” “Getting to Know Me” Enhancing skills in the care of people with dementia in general hospitals. © Greater Manchester West Mental Health NHS Foundation Trust
Session 1: ◦ Dementia, an introduction Session 2: ◦ Principles of person centred dementia care Session 3: ◦ Communication Session 4: ◦ The hospital environment and its impact on people with dementia Session 5: ◦ Opportunities for meaningful occupation and valuing the expertise of friends and family Session 6: ◦ Understanding and responding to behaviours that challenge Programme. © Greater Manchester West Mental Health NHS Foundation Trust
Over the four sessions we will be showing clips from a DVD showing Ann and Mike who both have a diagnosis of dementia, and Brian who cared for his wife who had dementia. Ann, Mike and Brian live in the Greater Manchester region and they will be sharing their experiences of living with dementia and their reflections on care for people with dementia in hospitals DVD. © Greater Manchester West Mental Health NHS Foundation Trust
Session 1 Dementia: an introduction 1.1 © Greater Manchester West Mental Health NHS Foundation Trust “Getting to Know Me” Enhancing Skills in the Care of People with Dementia in General Hospitals
To reflect on the lived experience of dementia in the hospital setting To be able to define what dementia is To be aware of the main causes of dementia and the key features of these To consider signs and detection/diagnosis of dementia in hospital Aims: 1.2 © Greater Manchester West Mental Health NHS Foundation Trust
Imagine… You are sat in unfamiliar clothing, beside a bed in a room with 3 other beds and lockers, you think it might be a hospital but it is strange and unfamiliar... You cannot recall how you got here... You don’t know what is about to happen, but you have a sense of dread... The smells, noises, sights and people – those who appear ill and those in uniform moving about with purpose – are all puzzling and unsettling... You recognise no-one... You are hungry and thirsty... Occasionally, you summon the courage to call out to people who walk close by. Many ignore you, those who stop and speak to you talk quickly in a language you can make no sense of, and then they swiftly depart... When you get up your movements are unexpectedly slow and laboured... Finally, when you try to seek a way out of this strange and unfamiliar place, a person in a uniform prevents you leaving… 1.3 © Greater Manchester West Mental Health NHS Foundation Trust
What will you be thinking...? What will you be feeling...? What will you want to happen/who will you want to see? What might you do...? 1.4 © Greater Manchester West Mental Health NHS Foundation Trust
By 2025 one million people in the UK will have dementia… Who is affected? 1.5 © Greater Manchester West Mental Health NHS Foundation Trust
There are over 750,000 people in the UK with dementia There will be over a million people with dementia by 2021 The proportion of people with dementia doubles for every 5 year age group One third of people over 95 have dementia Women make up two-thirds of all people with dementia Only 40% of people with dementia receive a diagnosis Source: Alzheimer’s Society 2011 Facts and figures 1.6 © Greater Manchester West Mental Health NHS Foundation Trust
“A typical general hospital of 500 beds on an average day…” will be occupied by: ◦ People with a depression96 beds ◦ People with a delirium66 beds ◦ People with dementia102 beds Royal College of Psychiatrists (2005) Prevalence of dementia in general hospitals 1.7 © Greater Manchester West Mental Health NHS Foundation Trust
Good quality early diagnosis and intervention for all Improved quality of care in general hospitals Living well with dementia in care homes Reduced use of anti-psychotic medication National Dementia Strategy: Priority Objectives Department of Health (2010) 1.8 © Greater Manchester West Mental Health NHS Foundation Trust
Increased length of stay Higher mortality More likely to move into institutionalised care National Dementia Strategy 2009 Outcomes for people with dementia 1.9 © Greater Manchester West Mental Health NHS Foundation Trust
“A collection of symptoms, including a decline in memory, reasoning and communication skills, and a gradual loss of the skills needed to carry out daily activities. These symptoms are caused by structural and chemical changes in the brain as a result of physical diseases such as Alzheimer’s Disease” Alzheimer’s Society (2007) Dementia UK What is dementia? 1.10 © Greater Manchester West Mental Health NHS Foundation Trust
Causes of dementia 1.11 © Greater Manchester West Mental Health NHS Foundation Trust
Mixed (AD and VaD) Other causes Fronto-temporal lobe demenitia Lewy body dementia Vascular dementia Alzheimer’s disease Dementia 62% 17% 4% 5% 10% 2% Dementia UK 2007 Causes of dementia 1.12 © Greater Manchester West Mental Health NHS Foundation Trust
Alzheimer’s disease How it affects the brain: ◦ Plaques and tangles ◦ Depletion of important neuro-transmitter brain chemicals ◦ Atrophy of affected regions of the brain ◦ Gradual, persistent decline in cognitive functioning Difficulties experienced: Gradual onset Memory loss Word finding difficulties Recognition difficulties Disorientation Increasing problems with everyday tasks Changes to mood Other… 1.13 © Greater Manchester West Mental Health NHS Foundation Trust
Vascular dementia How it affects the brain: ◦ Disease to blood vessels depriving areas of the brain of oxygen ◦ May arise from infarcts affecting larger vessels or from small vessels disease ◦ Often co-exists with Alzheimer’s disease Difficulties experienced: Onset can be abrupt Step-like progression Losses similar to Alzheimer’s but some abilities may remain intact There may be more unpredictability re changeable mood and behaviour People may have greater levels of self-awareness Small vessel disease can affect walking 1.14 © Greater Manchester West Mental Health NHS Foundation Trust
Lewy Body Dementia How it affects the brain: ◦ Protein deposits occurring in nerve cells in areas of the brain ◦ Accounts for about 4%* of all dementias in England ◦ On the same spectrum to Parkinson’s disease with dementia *Alzheimer’s Society (2007) Difficulties experienced: Fluctuating episodes of lucidity and confusion Auditory and visual hallucinations Parkinsonian symptoms are likely People are more prone to falls Disturbed nights with nightmares and hallucinations may be present Sensitivity to neuroleptic/anti- psychotic medications 1.15 © Greater Manchester West Mental Health NHS Foundation Trust
Fronto-temporal dementia Includes: ◦ Frontotemporal lobar degeneration (FTLD) or Behavioural Variant FTLD or Pick’s disease ◦ Progressive non-fluent aphasia (PNFA) or primary progressive aphasia (PPA) ◦ Semantic dementia (SD) How it affects the brain: Damage to frontal and temporal lobes Predominantly affects people under 65 30-50% of people may have a family history Adapted from Rohrer et al PDSG (2009} 1.16 © Greater Manchester West Mental Health NHS Foundation Trust
Fronto-temporal dementia Difficluties experienced may include: ◦ Apathy ◦ Changes to personality ◦ Obsessive compulsive behaviours ◦ Disinhibition ◦ Difficulties with language (PNFA) ◦ Loss of knowledge of word meanings (SD) Adapted from Rohrer et al PDSG 2009 1.17 © Greater Manchester West Mental Health NHS Foundation Trust
Identifying dementia 50% of dementia in hospitals is undiagnosed (NHS Confederation, 2010) Delirium (acute confusion) and depression are also common in older people in hospital. A diagnosis of dementia should be made only after a comprehensive assessment, which should include: – history taking – cognitive and mental state examination – physical examination and other appropriate investigations including blood tests – a review of medication Other tests may include: – Structural imaging – CT and MRI – Neuropsychological testing People assessed for the possibility of dementia should be asked if they wish to know the diagnosis and with whom they wish the diagnosis to be shared (NICE/SCIE Dementia Guidelines) 1.18 © Greater Manchester West Mental Health NHS Foundation Trust
Ann, Mike and Brian... 1.19 © Greater Manchester West Mental Health NHS Foundation Trust
Alzheimer’s Society (2007) Dementia UK Department of Health 2010 Quality outcomes for people with dementia: Building on the work of the National Dementia Strategy Department of Health (2009) Living well with dementia: A National Dementia Strategy NICE/SCIE Dementia Guidelines (2006) NHS Confederation 2010 Acute awareness: improving hospital care Roherer, J & Warren, J. Frontotemporal dementia (on-line) http://pdsg.org.uk/clinical_information (Accessed on 22 March 2011) http://pdsg.org.uk/clinical_information Royal College of Psychiatrists (2005) Who Cares Wins References: 1.20 © Greater Manchester West Mental Health NHS Foundation Trust
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