1. WELCOME! PLEASE SIGN THE REGISTER IN BLOCK CAPITALS Thank you

2. Specialist Dementia Training

3. Introductions and Domestics Welfare facilities Health and Safety Please switch mobile phones off or to silent. Introductions

4. Aim To give carers a Greater understanding of dementia.

5. Learning Outcomes Understand what is meant by the term dementia; the common causes; their signs and symptoms and related risk factors; and what is commonly mistaken for dementia

6. Learning Outcomes Be advised of the law relating to supporting people with Dementia and their carers

7. Learning Outcomes Understand how different people may experience dementia because of factors such as age, type and level of ability and disability

8. Learning Outcomes Have an understanding of how the physical and social environments may enable people with dementia to achieve their potential and understand and manage risks

9. Learning Outcomes Understand different ways to meet a person’s communication needs and preferences and facilitate positive interactions

10. Learning Outcomes Have an awareness of the Medical and Social Models of dementia

11. Learning Outcomes Understand some aspects of services eg. person centred planning and how to be involved

12. Learning Outcomes Managing your own feelings and getting help and advice

13. What is Dementia?

14. Dementia is used to describe the symptoms that occur when the brain is affected by specific diseases and conditions. Dementia is a chronic progressive problem of cognition which is failure of the brain’s functions.

15. What is Dementia? Dementia affects people at different stages of life, affects different parts of the brain and at different speeds.

16. Dementia Facts 2 thirds of people with dementia are women 15,000 of those are under 65 At present it is estimated that 700,000 people have some form of dementia, 1/120 people. It is estimated that by 2025 over 34 million people world wide will suffer some form of dementia. ( stats taken from NICE- national institute for health care excellence )

17. What can be mistaken for dementia?

18. What can be mistaken for Dementia? Age related impairment

19. What can be mistaken for Dementia? Depression

20. What can be mistaken for Dementia? Delirium

21. What can be mistaken for Dementia? Other illnesses

22. Some Common types of dementia Name Some

23. Some Common types of dementia Alzheimer's Disease

24. Some Common types of dementia Parkinson’s Disease with Dementia

25. Some Common types of dementia Vascular Dementia

26. Some Common types of dementia Fronto-temporal Dementia (PICKS)

27. Some Common types of dementia Lewy Bodies

28. Some Common types of dementia Korsakoffs Syndrome

29. Alzheimer’s Disease This is the most common type of Dementia Alzheimer’s disease changes the brain’s structure, which leads to the death of brain cells, this disrupts the brain’s usual activity. People with Alzheimer’s disease also have a shortage of chemicals involved with the transmission of messages with the brain

30. Vascular Dementia Vascular Dementia is another common form of dementia and is triggered by blockages to the blood vessels (Vascular system) in the brain. Not enough blood and oxygen reach the nerve cells so they die. Areas of the brain tissue that have died in this way are called infarcts, so vascular dementia is also called multi- infarct dementia. It is easier to think of vascular Dementia as a series of strokes that result from other health problems such as high blood pressure. TIA’S (Transient ischemic attack )

31. Fronto-temporal Dementia & PICKS In fronto-temporal Dementia damage is usually focused in the front part of the brain. Personality and behaviour are initially more effected than memory. Pick’s Disease is the older name for what is now known as a variant of Fronto-temporal Dementia. Typically the onset occurs between the ages of 40 and 70.

32. Dementia with Lewy Bodies Dementia with Lewy Bodies is another common form of dementia and can affect as many as one in ten people with dementia. Lewy Bodies appear in the neurons which are breaking down. When Lewy Bodies are in deep regions of the brain that affect control of movement they cause Parkinson’s Disease.

33. Korsakoff’s Syndrome Korsakoff’s syndrome is a brain disorder that is usually associated with heavy drinking and drug abuse over a long period. Although this is not strictly speaking Dementia, people with the condition do experience short-term memory loss and this through an excessive lifestyle can develop into Vascular Dementia/Alzheimer's Disease This type of dementia can be cured unlike other types discussed, to diagnose this, the person needs to be without alcohol or drugs for 6 weeks

34. Associated Risks Poor mobility- leading to increase in falls. Poor judgement- this can lead to items being dropped, poor eye sight, not knowing what objects. Wandering out of one’s home. The person becoming aggressive physically.

35. How can we manage the risks? Planning ahead Identifying risks and how to avoid or minimise them Getting support

36. The Medical Model for Dementia. Medical model- this creates dependency, restricts choice, dis-empowers, devalues, reinforces stereotypes and can be thought of as oppressive. The medical model focuses on the impairment as the problem and will focus on cure.

37. The Social Model for Dementia. Social model- this is personal centred, focusing on the rights of the individual, in turn empowering the individual, promoting independence, giving choice and looking at what the individual is able to do.

38. Causes of Behaviour Change Dementia affects people in different ways. Understanding why someone is behaving in a particular way may help carers to cope.

39. Changed Behaviours are Not Deliberate Coping with changed behaviours can be very difficult and is often a matter of trial and error. Always remember that the behaviour is not deliberate. Anger and aggression are often directed against family members and carers because they are closest. The behaviour is out of the person’s control and they may be quite frightened by it. They need reassurance, even though it may often not appear that way.

40. Ways to Cope with Changed Behaviours Provide a calm, unstressed environment in which the person with dementia follows a familiar routine – this can help to avoid some difficult behaviours.

41. Ways to Cope with Changed Behaviours Try to keep the environment familiar. People with dementia can become upset if they find themselves in a strange situation or among a group of unfamiliar people where they feel confused and unable to cope.

42. Ways to Cope with Changed Behaviours If behaviour becomes difficult, do not attempt any form of physical contact such as restraining the person, leading them away or approaching them from behind. Leave them alone until they have recovered or call a college for support.

43. Ways to Cope with Changed Behaviours Don’t take changed behaviour personally.

44. Ways to Cope with Changed Behaviours Try not to raise your voice. Speak slowly in a calm and reassuring voice.

45. Ways to Cope with Changed Behaviours Avoid punishment. The person may not remember the event and is therefore not able to learn from it.

46. Ways to Cope with Changed Behaviours Try to remain detached; do not become provoked or drawn into an argument.

47. Aggression This can be physical, such as hitting out, or verbal, such as using abusive language. Aggressive behaviour is usually an expression of anger, fear or frustration. Remember that:

48. Aggression The aggression may be due to frustration. For instance, locking the door may prevent wandering, but may also result in frustration. Aggressive behaviour may be a way for the person to try to get what they want. Activity and exercise may help prevent some outbursts

49. Ways to Manage Aggression Approach the person slowly and in full view. Explain what is going to happen in short, clear statements such as: ‘I’m going to help you take your coat off’. This may help to avoid the person feeling they are being attacked and becoming aggressive in self-defence. Try to anticipate and respond to the person’s needs.

50. Catastrophic Reactions Some people with dementia overreact to a trivial setback or a minor criticism. This might involve them screaming, shouting, making unreasonable accusations, becoming very agitated or stubborn, or crying or laughing uncontrollably and inappropriately. This tendency to overreact is part of the illness and is called a catastrophic reaction

51. Catastrophic Reactions Sometimes a catastrophic reaction is the first indication that makes relatives aware of the dementia. It may be a passing phase, disappearing as the condition progresses, or it may go on for some time. Some causes of catastrophic behaviour include: Stress caused by the excessive demands of a situation Frustration caused by misinterpreted messages Another underlying illness.

52. Ways to Manage Catastrophic Reactions This behaviour can appear very quickly and can make carers feel very frightened. However, trying to figure out what triggers catastrophic behaviour can sometimes help avoid it. Some carers find that keeping a diary can help to identify the circumstances under which such behaviour occurs. If this isn’t possible, you may find ways to deal with the behaviour quickly and effectively using some of the guidelines listed earlier.

53. Hoarding People with dementia may often appear driven to search for something that they believe is missing and to hoard things for safekeeping. Some causes of hoarding behaviours include:

54. Hoarding Isolation – when a person with dementia is left alone or feels neglected, they may focus completely on themselves. The need to hoard is a common response. Memories of the past – events in the present can trigger memories of the past, such as living with brothers and sisters who took their things or living through the Depression or a war with a young family to feed. Loss – people with dementia continually lose parts of their lives. Losing friends, family, a meaningful role in life, an income and a reliable memory can increase a person’s need to hoard. Fear – a fear of being robbed is another common experience. The person may hide something precious, forget where it has been hidden and then blame someone for stealing it.

55. Ways to Manage Hoarding Learn the person’s usual hiding places and check there first for missing items. Provide a drawer full of odds and ends for the person to sort out, as this can satisfy the need to be busy. Make sure the person can find their way about, as an inability to recognise the environment may be adding to the problem of hoarding.

56. Repetitive Behaviour People with dementia may say or ask things repeatedly. They may also become very clinging and shadow the person caring for them, even following them to the toilet. These behaviours can be very upsetting and irritating for carers

57. Ways to Manage Repetitive Behaviour If an explanation doesn’t help, distraction sometimes works. A walk, food or doing a favourite activity might help. It may help to acknowledge the feeling expressed; for example, ‘What am I doing today?’ may mean that the person is feeling lost and uncertain, and a response to this feeling might help. Do not remind the person that they have already asked the question. Repetitive movements may be reduced by giving the person something else to do with their hands, such as a soft ball or clothes to fold.

58. Things to remember Dementia can lead to behaviour changes, which may cause distress for the person with dementia and place added pressure on carers. Understanding why someone is behaving in a particular way can help families and carers to cope. Discuss your concerns about behaviour changes with a senior member of staff. Always remember that the behaviour is not deliberate.

59. What is a life history? A person’s past is a vital part of their dementia experience. Knowing about a person’s history helps you to support the person with dementia today.

60. What is a life history? A life history is more than just a series of life events. It includes:

61. What is a life history? Beliefs / values /religion / faith.

62. What is a life history? Likes / dislikes.

63. What is a life history? Important events, accomplishments and disappointments..

64. What is a life history? People – spouse, partner, friends, family, colleagues - and pets.

65. What is a life history? Favourite or significant places, important objects and possessions.

66. What is a life history? Talents/skills/capabilities.

67. What is a life history? Hobbies and interests.

68. What is a life history? Education and work life.

69. What is a life history? Habits.

70. What is a life history? How a person reacts to situations

71. How do I find out about life history? Start with the person you are caring for - if their memory allows. Recent history is as valuable as past history but the person with dementia will probably have better recall of older memories.

72. How do I find out about life history? Collect the information in stages. A person with dementia may not be able to concentrate on one subject for very long.

73. How do I find out about life history? Use prompts such as a particular era – when the person was at school, their first job/child. Find out what was happening in the country or locality at that time to give shape to the recollections – this is especially helpful if the person has great difficulty trying to locate old memories.

74. How do I find out about life history? Using props from a bygone age to prompt reminiscence can be useful for gathering information and stimulating old memories

75. How do I use life history? You can use the person’s experiences and their ‘well known’ or esoteric words in your conversations with them.

76. How do I use life history? Sometimes you can adjust how you care for the person to incorporate their old habits and routines.

77. How do I use life history? You could give a person the chance to talk about their past in a positive way, share their memories and make conversation more meaningful.

78. How do I use life history? The person may have a collection of old photographs that you could identify and label. This will allow you and others opportunities to chat about who is in a photo, where a photo was taken, holidays, places, pets etc.

79. How do I use life history? Sharing life history with younger family members or carers can give them a different perspective on the person they see before them now.

80. How do I use life history? http://www.bbc.co.uk/learningzone/clips/758 0.flv http://www.bbc.co.uk/learningzone/clips/758 0.flv

81. Sexuality and Intimacy The need for closeness is a very important and natural part of people’s lives, including people with dementia. Intimacy is the giving and receiving of love and affection. It involves caring touch, empathic understanding, comfort in times of need and a feeling of safety in relationships.

82. Sexuality and Intimacy Sexuality is the feeling of sexual desire and its expression through sexual activity. Like intimacy, it is a natural expression of human need. For many people, however, sexuality goes beyond the narrow concept of sexual intercourse. It is often bound up with many of the broader expressions of intimacy, including physical closeness, kissing and hugging.

83. How are Intimacy and Sexuality Affected by Dementia People with dementia continue to need loving, safe relationships and caring touch. However, they will vary in their individual ways of giving and receiving affection, and the way in which their dementia affects that capacity.

84. How are Intimacy and Sexuality Affected by Dementia As a result of the condition, some people with dementia may become demanding and insensitive to the needs of others, and less able to provide caring support for their family and friends. They may also experience changes in their expression of sexuality. Some people continue to desire sexual contact while others may lose interest in sexual activity. Others may display inappropriate sexual behaviours.

85. How are Intimacy and Sexuality Affected by Dementia Partners may experience a range of feelings about continuing a sexual relationship with someone who has dementia. These may include feelings of rejection, distaste and guilt. It can be helpful to discuss these with a counsellor.

86. Changed Sexual Behaviours It is important to remember that any strange or uncharacteristic behaviour is part of the illness and not directed in a personal way. The person with dementia may no longer know what to do with the sexual desire, or when or where to appropriately exercise the desire.

87. Increased Sexual Demands Some partners find that a person’s desire for sexual activity increases as a result of dementia. This can result in unreasonable and exhausting demands, often at odd times or in inappropriate places. Occasionally aggression may be shown if those needs are not met. A carer may have to keep safely out of the way until there is a mood change. Some partners complain of feeling like an object. Once the person with dementia has had sex or sexual contact, they may immediately forget what has occurred

88. Diminishing Sexual Interest Many people with dementia lose interest in a physical relationship and may become very withdrawn. They may accept physical contact from others, but not initiate affection. Carers may feel hurt and bewildered by the loss of interest.

89. Loss of Inhibitions People with dementia sometimes lose inhibitions and make advances to others, or undress or fondle themselves in public. Sexual advances are sometimes made because the person with dementia mistakes another person for their partner. Sometimes, an action which appears sexual - for example, a woman lifting her skirt - may be an indication of something else, such as the need to go to the toilet.

90. Managing Inappropriate Sexual Behaviours Consider all possible reasons for the inappropriate behaviour. These could include needing to go to the toilet, discomfort or boredom.

91. Managing Inappropriate Sexual Behaviours Gently discourage inappropriate behaviour.

92. Managing Inappropriate Sexual Behaviours Try to remain focused on the person, not the behaviour..

93. Managing Inappropriate Sexual Behaviours Aim to distract the person if possible or redirect them to another activity.

94. Managing Inappropriate Sexual Behaviours Find ways to include different forms of touch in the everyday routine, so that the person gets some physical contact. Massage, holding hands and embracing are ways of continuing to provide loving touch

95. Support for Carers Like all the challenges faced by families and carers of people with dementia, discussing this with an understanding person can help. Support and affection from friends and family can help many carers. Talking about problems in a carer support group can also help. Knowing that others have been through the same experience may assist you to feel that you are not on your own.

96. Stages of Dementia Each person will experience Dementia in their own way, some will have a slow progression and others may progress quickly. The staged model of progression is based on Alzheimer’s Disease as this is one of the most common under the dementia umbrella. Each person will experience Dementia in their own way, some will have a slow progression and others may progress quickly. The staged model of progression is based on Alzheimer’s Disease as this is one of the most common under the dementia umbrella.

97. Activity Think about your Service User and try to identify what signs/symptoms they are experiencing and identify what stages they are in. Are there any changes that might be made in supporting them? 20 Min’s

98. Stages of Dementia Early Can appear slightly confused

99. Stages of Dementia Early Can appear slightly confused May need some extra support

100. Stages of Dementia Early Can appear slightly confused May need some extra support Minor changes in behaviour

101. Stages of Dementia Early Can appear slightly confused May need some extra support Minor changes in behaviour Can be Mistaken as a process of ageing, illness Such as infection

102. Stages of Dementia middle Changes become More marked, can become more forgetful

103. middle Changes become More marked, can become more forgetful Will need More support with Daily living tasks Stages of Dementia

104. middle Changes become More marked, can become more forgetful Will need More support with Daily living tasks At this stage people can become easily Upset, angry And aggressive Stages of Dementia

105. Late The person will be Unable to do any Simple tasks

106. Late The person will be Unable to do any Simple tasks The person may loose the ability to communicate Stages of Dementia

107. Late The person will be Unable to do any Simple tasks The person may loose the ability to communicate Mobility will be Affected, could become confined to bed or wheelchair

108. Dementia Strategies The government have planned a 5 year national strategy called “Living Well with Dementia”, this strategy draws on the recommendations from 2 organisations working with the department of health they are the National Institute for health and Clinical Excellence, the Social Care Institute for Excellence

109. Legislation Relevant to People Suffering with Dementia and their Carers Human Rights Act 1998 Mental Capacity Act 2005 DOLS (Deprivation of liberty safeguards) Enduring Power of Attorney Act 1985 Community Care Act 1990 Mental Health Act 1983 Care Standards Act 2000 Data Protection Act 1998 Equalities Act 2010 Carers (Equal Opportunities) Act 2004

110. Mental Capacity Act 2005 The mental capacity act 2005 provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. It makes it clear who can take decisions, in which situations and how they should go about this. It enables people to plan ahead for a time when they may loose capacity.

111. D.O.L.S. Some people who are either in hospital or living in care homes are unable to make their own decisions because they lack the mental capacity to do so. Under this law an assessment needs to be carried out if someone is being deprived of their liberty, this will be carried out by independent assessors who will then assess the capacity of the person and determine if the deprivation is for the best interest of the person, this will have a timescale to be reviewed. Capacity can come and go and needs to be assessed on the individual at that specific time

112. Care Plans If your service user is receiving a service from the Social Care Department, there should be a Care Plan drawn up. Carers should be involved and below are some questions to ask yourself about this:- What information is important to give service providers to enable them to support our loved ones correctly? Who must be involved in the plan of care for our loved ones? Why are risk assessments important for individuals? Why is it important to assess mental capacity?

113. How can we Help? What daily tasks could the service user’s we support with Dementia find difficult. Think of the support they will need for each and aids you can use to enable them to maintain some independence.

114. Family and Others Supporting family members and others such as friends to understand Dementia and the signs/symptoms will prepare them and also give them a greater understanding of the kind of support that services give to their loved ones. Carers/family/others should also be aware of their rights and support they can access.

115. Communication – some questions to ask yourself How important is communication? Do you think that we communicate effectively with the service user’s we support? What methods of communication are we using? Are our service user’s getting the opportunity to communicate their needs and preferences?

116. Minimising Distress The reasons for the different reactions and behaviour people display who suffer with dementia are not always clear. They may be partly to do with the progression of dementia and partly due to distress. For us to minimise distress we need to make sure that we recognise its existence.

117. Duty of Care: The Code of Practice Social Care staff are registered with the Government’s Care Council and bound by it’s Code of Practice. They must:- protect rights, promote choice and ensure the preferences of individuals are being met. earn and keep the trust of individuals to maintain working relationships. keep individuals safe from harm.

118. Duty of Care: The Code of Practice Social care workers must help individuals to be independent and take risks in a careful way. Social care workers must do the best they can to ensure that individuals are supported in the best possible way and to the highest standard set out in the code of practice.

119. YOU A Care Worker with Knowledge Good skills Compassion = Quality care for someone with dementia.

120. One Last Thing

121. I.C.E I = In C = Case E = Emergency

122. I.C.E Put the contact number in your phone of the person you wish to be informed in case of an emergency (Also good for children ) Then in the name field put in the words ICE and save. This allows the emergency services to contact that person in an emergency

123. Thank you for your time, we hope you enjoyed the course! Do you have any questions?