Caring for a patient with Dementia Essential Care for Health Care Assistants Clinical Update Study Day Clare Prout Ref: NICE-SCIE Guideline

Public Perception? What do you think the general perceptions and characterisations of dementia are?

Term to describe a collection of symptoms Changes become disabilities when environmental supports fail to adapt

Circulation The brain is nourished by one of the body's richest network of blood vessels. Ref: Alzheimer’s society

Circulation Ref: Alzheimer’s society Arteries carry blood to the brain. Approximately 20% of the oxygen is absorbed here.

Circulation Ref: Alzheimer’s society In addition to arteries, this network of vessels includes veins and capillaries

Neurons Ref: Alzheimer’s society

Cell signalling Ref: Alzheimer’s society

Plaques and tangles Ref: Alzheimer’s society

Physiological effects Ref: Alzheimer’s society Healthy Brain Advanced Alzheimer’s

Earliest stages Ref: Alzheimer’s society Learning and memory Thinking and planning

Mild to Moderate stages Memory, thinking and planning Speaking and understanding speech Sense of place in relation to the environment Ref: Alzheimer’s society

Severe Alzheimer’s disease Ref: Alzheimer’s society

Anterograde Amnesia Dysphasia / Aphasia Disinhibition Dyspraxia / Apraxia

Behaviour that challenges People with dementia who develop behaviour that challenges should be assessed at an early opportunity to establish the likely factors that may generate, aggravate or improve such behaviour.

Pain is one of the commonest causes of distressed and challenging behaviour in the person with dementia My name is Mary and I don’t know this place. I don’t know how I got here but I don’t like it. There are other people sitting nearby but they don’t speak to me. My back is sore ---my legs are sore------my head hurts. Two young ones came up to me and said “we’re waiting for you to see the doctor “. They don’t need to shout, I can hear them fine. I won’t be telling them anything anyway; I’ll just end up in the hospital if I say I’m sore. I want to go home, I don’t like it here.

Cause rapid changes in mood, behaviour and physical function (such as sleep patterns, appetite and mobility) - we see this in our day -to -day working practice. Lead to modulation in neuro-chemicals that work within the pain pathways in the brain such that the perception of the pain can be increased.

Assessment of Pain in Dementia Interpretation and expression of pain can be different – the brain is not functioning normally. Assessment hampered by communication difficulties. As dementia progressed the person may lose language skills and an awareness of their body ‘geography’. The person lacks the ability to understand what is happening to themselves and they react through behaviour

Activity - Case study Jack 80 yrs old with known Alzheimer’s disease He can communicate but has limited speech & word finding difficulties. He normally eats well and enjoys watching TV

He suddenly stops eating and drinking Over the next few days – his carers cannot persuade him to eat – he turns away and is increasingly upset and now starts to cry when they offer food. He is withdraw and cannot be distracted with the TV He hold his head and face and is moaning off and on. He will not let the carers assist him with washing and nor will he brush his teeth

What’s the Diagnosis?

Tips for preventing aggressive behaviour If the person with dementia does not seem to be coping well, reduce any demands and make sure they have an unrushed and stress-free routine. Try to remember that the person may not understand what you are trying to do and why. When possible, explain things calmly and in simple sentences, allowing the person more time to respond than they would have needed before the dementia. Find tactful ways to offer help without seeming to take over - Guide or prompt the person, and break tasks down into easily manageable steps, so that they can do as much as possible for themselves. Try not to criticise, and do your best to hide any irritation that you feel. Avoid situations where the person is set up to fail. Praise any achievements, and focus on the things that the person can still do, rather than what is no longer possible. Watch out for warning signs, such as anxious or agitated behaviour or restlessness, and take action immediately to help the person feel more calm and reassured.

Person Centred Care? What can we do? Engagement and involvement of the individual and their main carer is a fundamental principle to getting personalised care right. 27

Getting to know me.. The person still remains. How does the dementia affect their view of what is going on around them?

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