1. Dementia Awareness Chwe Wythnos lecture programme 2013

2. Learning Outcomes This session will help you to understand: 1.What the dementia syndrome is 2.What the commonest illnesses are that cause dementia 3.Principles for effective communication with a person who has dementia 4.Why behaviour can change

3. The Dementia Syndrome Dementia is classed as a clinical syndrome not an illness. A syndrome is a general collection of signs and symptoms caused by a specific illness.

4. The Dementia Syndrome The dementia syndrome is defined by the World Health Organisation as being: ‘… due to disease of the brain, usually of a chronic and progressive nature, in which there is disturbance of multiple cortical functions, calculation, learning capacity, language and judgement. Symptoms have been consistently present for six months or longer and consciousness is not clouded.’

5. Presentation Each person with dementia is a unique individual but there are common signs and symptoms: Loss of memory. Mostly related to short term memory that leads to the person asking repetitive questions. Additionally delays in accessing stored information can lead to increased frustration. Disorientation. The layman's term is ‘confusion’ – a state where the person is unsure about such things as: the correct time or date; the place; the identities of others (even familiar) and ultimately the self.

6. Difficulty functioning Loss of independent ability to perform essential and complex activities of daily living. Over time the person becomes more dependent on the help and support of others. Mood or behaviour change Not uncommon but NOT always related to changes in the brain. Most behaviours that challenge are a reaction to what is happening to the person with dementia. Communication difficulties Inability to find the right words particularly the names of people. The person may substitute an incorrect word, or may not find any word at all.

7. The Illnesses that cause dementia Alzheimer’s disease. Vascular dementia’s. Lewy body dementia. Fronto temporal dementia’s. Creutzfeldt-Jacob disease. Parkinson’s disease. Huntington’s chorea. Alcohol related. AIDS related. Down’s syndrome related.

8. Alzheimer’s disease Commonest form, about 60% of cases. Gradual onset and progression. Steady global deterioration. Primary disease of the brain. Generalised atrophy of the brain.

9. The Alzheimer’s affected brain in comparison to the normal elderly brain (left) the dark areas represent loss of brain cells which brings about many of the symptoms of dementia.

10. Dementia associated with cerebrovascular disease Second commonest, about 35% of cases. Encompasses a lot of conditions. Sudden onset. Stepwise or sporadic decline. Primary diseases are cardiovascular and cerebrovascular. Specific sites of brain damage.

11. In comparison to the normal brain (left) the presence of damage from a stroke (red box) can bring about the sudden onset of symptoms of dementia.

12. Conditions that mimic dementia (Pseudo Dementia) Hypothyroidism Vitamin B 12 deficiency Alcohol abuse Normal pressure hydrocephalus Depression Infection

13. Prevalence Across the world there are estimated to be 30 million people with dementia. A new case every 7 seconds. By 2050 there will be 100 million people with dementia. In the UK there are estimated to be 800,000 people with dementia.

14. Prevalence In Wales there are estimated to be 43,600 people with dementia. In the area covered by BCUHB there are estimated to be 20,400. By 2021 this will have increased by 26% to approximately 25,700.

15. Prevalence The greatest risk factor for dementia is increasing age. IncidencePrevalence MaleFemaleMaleFemale 60-64 0.2 0.4 65-69 0.20.31.61.0 70-74 0.60.52.93.1 75-79 1.41.85.66.0 80-84 2.83.411.012.6 85-89 3.95.412.820.2 90+ 4.08.222.130.8

16. The General Hospital Two thirds of all medical beds are occupied by people aged over 65 years. A third of this group have dementia. Most admissions were preventable and most people are medically fit for discharge but social care is delayed.

17. Effective communication Communication may be difficult, but it is possible. Speak calmly, clearly and at a slightly slower pace. Use short simple sentences. Ask one question at a time. Allow the person time to respond. If the person does not understand, rephrase rather than repeat.

18. Behaviour and dementia As dementia develops, behaviour changes may emerge that can be confusing, irritating or difficult for others to deal with, leaving carers, partners and family members feeling stressed, irritable or helpless. By learning to understand the meaning behind the actions, it can be easier to stay calm and deal effectively with the challenges that arise.

19. Behaviour and dementia Behaviour also serves a function and we are challenged to determine what that function may be: –to communicate an unmet need. –to meet the unmet need. –to express frustration that the need is unmet.

20. A holistic model of explanation - Stokes & Goudie (2002) Environment SocialBuilt Situation Dementia Morbidity Neuropathology Medication Disability Psychogenic Life History Personality Context Health Person Interpersonal relationships Attitudes Care practices Architecture Living arrangements Interior design

21. To Summarise Dementia is a syndrome caused by a number of illnesses. Dementia has a major impact on those affected. Dementia is becoming a growing challenge.

22. To Summarise The signs of dementia are well known and needs can be met. Effective communication is possible. Behaviours can emerge that we find challenging. Behaviours are not solely due to changes in the brain.

23. What Next? Take the information sheets away with you, read them and discuss with colleagues. Ask your line manager about opportunities for more detailed training. Search for Dementia Web on the intranet and access more information and e-learning modules. Encourage the use of ‘This is Me – Dyma Fi’ when a person with dementia comes into care. Talk to that person and their family about who they are and their normal routines at home.