Session 2 Principles of person centred dementia care “Getting to Know Me” Enhancing Skills in the Care of People with Dementia 2.1

Aims  To present a holistic understanding of dementia indicating the range of factors that may impact on a person’s experience of dementia 2.2

Enriched model of dementia Experience of dementia = Neurological impairment + Health + Personality + Biography / life story + Social (and physical) environment (adapted from: Kitwood 1997) 2.3

Neurological Impairment 2.4

Brain and behaviour: People with dementia will be affected in different ways. Cognitive damage may give rise to a wide variety of impairments including (amongst many other things): Impaired memory: often short-term affected first... Apraxia – problems with purposeful actions... Aphasia – speech and language impaired... Agnosia – recognition of things, words, people etc... Visuospatial dysfunction – depth perception... Regulation of behaviour – disinhibition... Impaired motivation – difficulty initiating actions... Perseveration – becoming “stuck” in an activity... More information is available on the Alzheimer’s Australia DVD ‘Understanding the brain and behaviour’ (2004) 2.5

Health Physical and mental health can have a significant impact on well-being People with dementia are at a greater risk of delirium (acute confusion) People with dementia are also at a greater risk of depression than the wider population Sensory loss e.g. sight and hearing may exacerbate communication difficulties or disorientation Pain is often poorly detected in people with dementia As dementia becomes advanced people experience losses to physical function 2.6

Delirium Delirium (or acute confusional state) is characterised by disturbed consciousness and cognitive function or perception, it often has a rapid onset and a fluctuating course. It may be caused by any acute physical illness (e.g. urine or chest infections) or drugs (e.g. opiates) and is a serious medical condition. Delirium can be hypoactive or hyperactive but some people show signs of both (mixed). Hypoactive and mixed delirium can be more difficult to recognise. It is imperative to rapidly identify and treat the underlying cause. (NICE Clinical Guideline 103,2010) 2.7

Personality All of us are different... Who we are and the kind of person we are can have a great impact on how we might respond to having dementia and to the support and care we may (or may not) receive

Biography/life history Our lives and our personal histories are unique to us all As more recent memory becomes impaired, events from long ago may become confused with present experience. Knowledge of a person and their past may aid understanding of puzzling behaviours and language As longer term memory can be a strength for people with dementia reminiscing can be a positive experience 2.9

Social environment Autonomy, dignity, participation, control, opportunities for purposeful occupation and leisure are all vital to our personhood People with dementia can be disabled by poor or impoverished social environments The quality of individualised care, communication and emotional support experienced by people in hospitals will have a significant impact on well-being and function 2.10

Physical environment  Physical environments may contribute to enabling or further disabling people with dementia  The hospital environment may be very disabling to a person with dementia (We will explore the physical setting in another session) 2.11

What can we influence? Neurological impairment ? + Health? + Personality ? + Biography / life story ? + Social (and physical) environment ? 2.12

Person with DEMENTIA PERSON with dementia 2.13

References:  Brooker, D (2007) Person-Centred Dementia Care: making services better. London. Jessica Kingsley  Kitwood, T (1997) Dementia Reconsidered: the person comes first. Open University Press  NICE (2010) Delirium, diagnosis, prevention and management. Clinical Guideline 103 for people with dementia 2.14