Dementia
Awareness
Training
Stuart Harper-Reynolds
– Named Nurse Adult
Safeguarding
Transforming our services - Putting patients first - Valuing our people - Health and wellbeing
Introduction
• Who we are
• Aims of session
• HEE Tier 1 training
• Dementia Friend
• Barbara’s Story
What is Dementia?
• The term Dementia is used to describe the collection
of symptoms including a decline in memory,
reasoning and communication skills, and a gradual
loss of 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.
Symptoms of Dementia
• Loss of memory – problems with day to day
memory with difficulty recalling events that
happened recently
• Concentrating, planning and organising –
difficulties making decisions , solving problems or
carrying out a sequence of tasks
• Language – difficulties in understanding what
people are saying and or finding the right word for
something
Its normal to forget , but sometimes its
important to look deeper
• What most people don’t know is there are
many conditions that can mimic dementia.
• Walking out of ASDA and not remembering
where you parked the car is one thing, walking
out of ASDA and not knowing if your car is
red, green or blue, is something else.
Types of Dementia
Alzheimers
• Become confused and frequently forget the name of people ,
places , appointments and important events
• Experience mood swings due to frustration from increasing
memory loss
• Become more withdrawn – due to loss of confidence or to
communication problems
• Difficulties carrying out every day difficulties
• Cognition generally declines steadily over time
• Caused by proteins that tangle in the brain
Vascular
• Problems with speed of thinking , concentration and
communication
• Depression and anxiety accompanying the dementia
• Symptoms of stroke such as physical weakness or paralysis
• Periods of severe acute confusion- prone to delirium
• Tends to progress in a step down presentation
• Caused by vascular events- e.g stroke, damage to blood
vessels and restricting blood flow to areas of the brain
Lewy Body
• Experience problems with attention and alertness
• Often have spatial disorientation
• Difficulty in planning ahead and coordinating mental activities
• Shares similar characteristics to Parkinson's disease including slowness , muscle
stiffness , trembling and shuffling , changes in voice and lack of facial expression,
hallucinations/delusions
• This makes lewy body difficult to diagnose
• Confusion can fluctuate rapidly from very confused to lucid
• Very sensitive to antipsychotic medication
• Can form paranoid beliefs- people stealing from them
• Caused by clumps of proteins that develop inside nerve cells that block messages in the
brain. They reduce the levels of chemical messengers and cause nerve cells to die.
Fronto - temporal
• Lack of insight and loss of ability to empathise with others
• More likely to have difficulties with language and emotional responses.
• Become extrovert when previously outgoing and withdrawn when
previously outgoing
• Behave inappropriately/impulsive behaviours more likely
• Lose inhibitions- verbally as well as physically
• Can become aggressive
• Develop routines – for example compulsive rituals
• Caused by damage to the frontal/temporal lobes in the brain. Also
sometimes referred to as ‘Picks disease’.
How common is it?
• As people live longer , the number of people with
dementia is set to increase.
• Nationally it is estimated that the numbers will nearly
double over the next 30 years to 1.7 million people
living with dementia in the UK.(Alzheimer’s Society
2009)
• It is estimated 61% of people with dementia are
women and 39% are men.(Alzheimer’s Research
2014)
The prevalence of various forms of
Dementia
Prevention
• There is growing evidence indicating
that certain medical conditions such
as high blood pressure, diabetes
and obesity may increase the risk of
Dementia.
• A healthy lifestyle may reduce the
risk (Alzheimer’s Society, 2014)
Why diagnose and treat Dementia early?
Improved quality of life
• Early diagnosis and intervention improves quality of life for people with
dementia
• Early intervention has a positive effect on the quality of life of family carers
• Counselling can be beneficial in the early stages for the person receiving
the diagnosis.
Allows patients/families to make informed choices about care
• Can plan for the future e.g. Legal Power of Attorney (LPA)
• Delay and prevent unnecessary admissions to care homes
Diagnosis
• Blood tests to rule out any physical health
reasons for an impaired memory
• History taking – talk to the person and
someone who knows them well
• Cognitive tests of mental abilities (ACE-III)
• A scan of the brain
• A diagnosis may take weeks / months
Living Well
• A diagnosis of Dementia may bring some challenges however it is
still possible to live well with some simple changes and actions.
• People with Dementia want to carry on going about their daily
lives and feel included in their local community, but they
sometimes need a helping hand to do so
• This may include supporting people to adapt their homes, and
promoting independence and social inclusion in their local area.
All About Me – Unique
Individual
Importance of Communication
Communication is at the heart of everything we do in our lives.
It enables us to express a need , want or desire and it allows
us to share information and be sociable.
A person with dementias ability to communicate is based on
the progression of the disease
Common Problems with
communication
• Word finding difficulties
• Reduced understanding of language and concepts
• Repeating words over and over
• Unable to state the name of an object
• Loses train of thought
• Writing reading skills deteriorate
• Saying very little
• Gestures more than speaks
• Difficulties in processing information or instructions
• Decision making/judgement
Behaviours that Challenge
• 90 % of people with dementia experience behavioural
and psychological symptoms at some point
(Alzheimers Society 2013).
• Cohen -Mansfield (2001) suggests that challenging
behaviour in dementia often reflects an attempt by a
person to signal that a need is currently not being
met.
• A persons personality endures through the course of
dementia and their individuality will be apparent in
various stages and different stages of their illness
What might behaviours that
challenge look like?
• Challenging behaviour presents due to an unmet need.
• It may result from an individual feeling threatened,
fearful, anxious, suffering delusions or hallucinations or
it may be in response to a difficult situation or a
misinterpretation of the actions of other people
• May be simply be a result of an individual trying to
express that they are hungry, thirsty or in pain
• ‘Maureen’ example
Delirium
• Sudden onset of confusion/deterioration in cognition.
• Generally, treat the cause, the symptoms improve.
• 4AT delirium assessment tool (now in falls pathway)
• People with dementia are more likely to experience
delirium- (cognitive reserve)
• Trakcare delirium alert symbols now in place. Red brain
active delirium, Purple brain at risk of delirium/history of
delirium.
• New delirium care plan available in ‘nursing patient
safety’- care plans SOP, (nursing care plan for acute
confusion)
Family, Carers and Friends
• The majority of care for people with Dementia is undertaken
by their family carers. It is important that the carer is
supported to maintain their own health and wellbeing.
• The Prime Ministers Challenge on Dementia includes the
aspiration that carers of people with Dementia “be made
aware of and offered the opportunity for respite, education ,
training, emotional and psychological support so that they feel
able to cope with their caring responsibilities and to have a life
alongside caring”.
• Johns Campaign available for carers that support the patient
whilst in hospital. It can allow meal discount at the canteen,
the person can order from the ward meal provision, and
reduced car parking costs. It can be two named carers/family
members (available on sharepoint).
What is
Dementia Friends?
• Dementia Friends is the UK’s biggest ever initiative to change the way
people think, act and talk about dementia.
• It’s led by Alzheimer’s Society as part of its work to create ‘Dementia
Friendly Communities’.
• It aims to help people understand what dementia is, how it can affect
a person, and how we can each help people affected by dementia.
• You can become a dementia friend by going on the Alzheimers
society website where you will find more information.
Checklist for staff
• Complete AMT regularly, and include in discharge
summary.
• Use and read the All about me, it will really make
a difference to the persons stay.
• Is Johns Campaign applicable to support carers
who support our patients?
• Consider the persons ‘reality’ during intervention
and relate that to presentation
• Consider Delirium
• Dementia alert symbol present on patients names
board
