Connecting People, Connecting Support Transforming the allied health professionals' contribution to support people living with dementia in Scotland. Elaine Hunter, National AHP consultant, Alzheimer Scotland @elaineahpmh Alison McKean, AHP post diagnostic lead, Alzheimer Scotland @AliAHPDem @AHPDementia #AHPConnectingPeople

Scotland’s national context Estimated 90,000 people living with dementia in Scotland. By 2020 it is estimated that there will be around 20,000 new cases diagnosed each year. People living with dementia have a high prevalence of comorbid medical conditions Most people living with dementia live in the community

Scotland’s dementia strategy “Our shared vision is of a Scotland where people with dementia and those who care for them have access to timely, skilled and well-coordinated support from a diagnosis to end of life which helps achieve the outcomes that matter to them” Scottish Government 2017 Third dementia strategy

Scotland’s Dementia Strategy Commitment 10 2017-2020 “We will support the implementation of the new national AHP Framework Connecting People, Connecting Support. Scotland’s National Dementia Strategy 2017-2020 Lots of factors can impact on a person’s dementia – Agnes Houston from Scottish Dementia Working Group has done some great work around Dementia is more than memory – looks at sensory challenges Environment can also impact Dementia is everybody’s business People with dementia have comorbidities Given we know all of this, how do we as AHPs best meet the needs of people living with dementia:

Evidence for action www.alzscot.org/ahp “The document presents an evidence-informed case to support an approach to practice for AHPs working with people living with dementia – what we call the AHP approach – with the intention of promoting local integration and implementation” In order to try to make sense of our role, AHP approach was designed in order to articulate our contribution. No copyright in headings All interrelated otherwise it won’t work – give example of how going in to aae impacts on others e.g.

How to make it happen : 4 ambitions 1. Enhanced access I am supported to look after my own health and wellbeing & do the things that matter most to me. I feel I get the support I need to keep on with my caring role for as along as I want to do that. 2. Partnership and integration I feel I am treated as a person by the people doing the work, we develop a relationship that helps us to work well together 3. Skilled AHP workforce I feel I get the support and resources I need to do my job well 4. Innovation, improvement & research The right care for me is delivered at the right time Emphasise partnership working between AHPs and plwd but also partners such as other health professionals, third sector etc

Adapting Everyday Environments Enabling environments Using everyday technology Equipment and adaptations to the home

Principles of dementia friendly environments Everyone is different and experience of living with dementia will be different The environment can have a significant impact on the independence and wellbeing of people living with dementia General principles from research and experience Art is how to apply the principles

‘As time goes on, it throws all sorts of new challenges your way ‘As time goes on, it throws all sorts of new challenges your way. But my outlook on life is very positive.... I’m trying to adapt my house to enable me to stay independent for as long as possible. The sooner you make changes, the sooner you get used to them. As time goes on it makes it harder to adapt, so adapting now will make things easier in the future...... Remember, a diagnosis doesn’t mean you’re at the end of your journey with dementia – you’re at the start of a new journey and thinking positively and adapting to new ways will help make that journey more manageable.’ Wendy Mitchell Has anyone read Wendy Mitchell’s book? – Somebody I Used to Know

Quiz

Question 1 Compared with the eyes of a person in their 20s, roughly how much light do the eyes of a person in their 60s need? a) The same b) Double c) A third d) Half

Name 4 ways in which you could increase light levels Question 2 Name 4 ways in which you could increase light levels

Question 3 Which is the best sign out of these in terms of dementia friendliness? What are your reasons? (pictures courtesy of Bing search for toilet sign / toilet sign dementia friendly)

Name 3 health benefits of getting outside Question 4 Name 3 health benefits of getting outside

Question 5 Which is the best toilet from a dementia friendly perspective and why: (pictures courtesy of Bing search for toilet seat / toilet dementia friendly / toilet seat Louis Vuitton)

Question 6 Contrast is an important feature in dementia friendly design in order to increase visibility and assist in spatial awareness. Is the following statement True or False: “Using different colours creates contrast”

Question 7 Between which of the following would good contrast be a good thing (more than one may apply): Door handles against the door Flooring between rooms Edge of steps against the step Furniture and floor Wall and floor

Question 8 What would be your advice about which chair is better and why? Pictures courtesy of Bing search for chairs dementia, www.dayex.co.uk and www.renrayheatlhcare.com

Discussion Resources and top tips: Are there any resources or sources of information would you recommend to your colleagues / clients and their relatives? Do you have any top tips to share from practice regarding making environments enabling for individuals living with dementia?

Answers – Qu 1 Light for a person in 60s or older b) Double As we age the lens of the eye thickens and yellows and we need at least double the light levels. Glare can be difficult to tolerate so this needs to be managed. Attention also needs to be paid to shadow or reflection which can also cause difficulties

Answers – Qu 2 Increase light levels cleaning the windows; drawing back the curtains; cutting back overhanging foliage from the windows; increasing the luminosity of light bulbs (within safe limits); extra lamps; consider the design and colour of light shades; painting walls a pale shade to reflect light; keeping glasses clean. Always be aware of glare and shadows though, and have ways of managing this.

Answers – Qu 3 Toilet sign This one because it has a toilet on it as well as text and the text is not all in capitals. All of these signs have contrast between the lettering / picture and the background of the sign which is important. It would also be important that the sign contrasted with the door that it is on so that it is easily seen. Unless a sign is a directional sign (with a clear arrow), it should go on the door it belongs to, not on the wall next to it. The recommended height for hanging a sign is 1.2m from the floor to the base of the sign.

Answers – Qu 4 Benefits of getting outside vitamin D in summer months (good for bones and muscles amongst other things), helps with circadian rhythms (body clock) and may promote sleep, fresh air benefits (e.g. Reduced infection), immune system benefits, opportunity for exercise, opportunity for social contact (e.g. combating loneliness which is increasingly recognised as a public health issue), mood, serotonin levels, reduction in blood pressure, stress reduction

Answers – Qu 5 Best toilet This one because the seat contrasts with the bowl, making it more visible and recognisable. Also the flush is traditional and contrasts with the cistern so can be seen.

Answers – Qu 6 Contrast False. Visual contrast is created by a difference in ‘tone’ (a light shade against a darker shade or vice versa). The same colour (i.e. hue, or position on the colour wheel) may create contrast (e.g. light blue against navy blue) and a different colour may not create contrast (e.g. red against dark brown may not create contrast if they are the same tone, even though they are different colours).

Answers – Qu 7 Which is good contrast a), c), d) and e). Contrast is important to make the door handle, edge of steps and furniture visible. Contrast between walls and floor helps with understanding the 3 dimensions of the room. A continuous tone of flooring is best for mobility, so you wouldn’t want a contrast in the flooring between rooms. A contrast in tone of flooring (e.g. between rooms) can look like a step and could lead to stumbles or falls. Contrast in flooring could also look like a hole (e.g. a dark doormat on a pale floor) and so the person may not wish to walk on

Answers - Qu 8 Chair In terms of dementia-friendly design, the one on the right is traditional in its design and may therefore be recognisable and familiar, it does not have a bold pattern (bold patterns can be confusing), and it is a warm colour (which may look less greyish than cooler colours). Context is important (i.e. the environment in which the chair is in) It seems mid-tone and is likely to contrast both with pale walls and with a darker floor and therefore be visible. (The same chair is available in a very pale tone, but this may mean it is not visible against a white or pale wall and a very dark chair might make it difficult to make out the three dimensions). It also has armrests that might be a reasonable height to gain purchase for transfers.

Thank you, you’ve been lovely contestants! Thanks to: Jilly Polson, IDEAS Team, NHS Dumfries & Galloway for use of quiz

Specialist FEW allied health professionals DRAFT Effective Decision Making in dementia care when people ask for help from allied health professionals Specialist FEW allied health professionals Targeted SOME allied health professionals Universal ALL allied health professionals Awareness ALL allied health professionals This is how we are addressing our contribution going forward

Enhanced access to occupational therapy in living with dementia in Scotland Awareness & Universal Targeted & Specialist (individual) Talk about how all of these include AAE

Twitter Project @AHPDementia Followers: 1,289 Launched January 2018 Currently OT focused #WithOTuCan Linked with Connecting People Connecting Support Other AHPs are about to commence input The @AHPDementia on Twitter is a new page (commenced January 2018) to demonstrate the work of AHPs and the policy document Connecting People Connecting Support (2017). The aim of the account is to reach people living with dementia and their families. Occupational Therapist from the working group are posting daily using the hash tag #withOTuCAN which links with the workplan of the Scottish Occupational Therapy Dementia Working Group easing access to self management advice for people living with dementia, and raise public awareness about the unique knowledge and skills of the Occupational Therapy role for those people living with dementia and their families/carers. Monday to Friday the group tweets on the five areas of connecting people connecting support: adapting every day environments, maximising physical well being, enhancing daily living, supporting family and carers as equal partners, maximising psychological well being which aids focus to the account Keeping it real: tweets are based on experience The response to the account is continually monitored to aid focus and understand what people are looking for to enable the account to be as relevant as possible

Twitter Project @AHPDementia Adapting Everyday environments Top tip: Avoid highly reflective and slippery floor surfaces, as this can be misinterpreted as wet or a step which may cause anxiety. #dementia #WithOTuCAN @alzscot Impressions 4,818 times people saw this Tweet on Twitter

Home Based Memory Rehabilitation Programme Key is to compensate for memory difficulties via: Environmental Adaptation Use of external memory aids Use of internal memory strategies

Further information and key resources Apps: Iridis (University of Stirling Dementia Services Development Centre) - audit tool The Dementia Friendly Home (Alzheimer's Australia) www.fightdementia.org.au Web resources Dementia Enabling Environments (Alzheimer’s Australia and University of Wollongong) https://www.enablingenvironments.com.au Dementia Services Development Centre University of Stirling Virtual Environments- Virtual Hospital (includes garden, cafe and shop) and Virtual Care Home http://dementia.stir.ac.uk/design/virtualenvironments Other web resources Dementia and sight loss resource page http://dementia.stir.ac.uk/design/good-practice-designdementia-and-sight-loss Dementia and Sensory Challenges film Life Changes Trust https://www.youtube.com/watch?v=U_L2107EweQ Publications Dementia & Sensory Challenges: Dementia can be more than memory https://www.lifechangestrust.org.uk/sites/default/files/Leaflet.pdf

Further information Let’s Talk About Dementia Blog: www.alzscot.org/talking_dementia AMcKean@alzscot.org Ehunter@alzscot.org

Elaine Hunter, @elaineahpmh Alison McKean, @AliAHPDem Stay connected Elaine Hunter, @elaineahpmh Alison McKean, @AliAHPDem