DEBORAH MCKERN. Aged Care Consultant

Transcription

1 DEBORAH MCKERN Aged Care Consultant

2 CARING FOR DEMENTIA THE BOLD AND THE BEAUTIFUL

3 Prevalence of Neurodegerative Disease In the > 75 year olds: Gait ataxia 50% Visual impairment 38% Cognitive impairment 38% Gait slowing 19% Dementia 17% Parkinson s disease 5%

4 Neurodegerative Disease Impact Among the >85 year olds: 80% need assistance with domestic care 30% require personal care 70% are cognitively impaired (high delirium risk) 70% are mobility impaired (high falls risk)

5 Dementia Incidence is about 2% at 65 years of Age Incidence doubles every 5 years from 65 to 90 years

6 Dementia The average age of people entering into a supported environment is 84 years. 96% have cognitive impairment 34% have a diagnosis of dementia

7 The Cognitive Journey A deficit in functional cognition can occur at any time in a person s life. It can arise as: Minimal memory loss forgetting to do things. Gradual small incremental loss of cognitive ability over many years. Sudden decline in functional cognition resulting from an internal or external head injury. A series of minimal drops in deficits in functional cognition which can be measured month after month through observation by care givers.

8 The Cognitive Journey As memory deteriorates other areas of the brain are affected indicating memory is an essential prerequisite for all higher level cognitive functions. There are three memories which are critical for people to live safely and independently and to look after their own basic needs. These are: 1. Sensory-perceptual memory; 2. Working (short-term) memory; 3. Procedural (long term ) memory;

9 Working memory is a component of brain function called Executive Functions These executive functions include response inhibition which prevents inappropriately acting out and allows impulse control, resistance to distraction and delay of gratification. Working memory permits the retention of past events and allows for self awareness over time. It conducts the flow of internal self talk and other functions that lead to the development of motivation, persistence to achieve a goal and emotional self control. When working memory is impaired the ability of people to control their behavioral responses is impaired; Minimal deficits in functional cognition produce significant adverse changes in patterns of functional behavior;

10 However, the individual s personality determines how adults with cognitive deficits will react to the difficulties they experience when they participate in everyday activities.

11 The Cognitive Journey Working memory To be able to use highly complex decision making processes people need to: Use cognitive processes which are not visible enabling them to recognize understand and react to such things as heat and the speed of a moving object; To understand what it means to have money in the bank or property trust (where money cannot be seen or held in the hand and is intangible) To use automatic unnoticed actions to complete everyday tasks e.g. holding in working memory the location of supplies, utensils and cooking equipment and automatically reaching for them while cooking a meal.

12 Procedural memory is the how to do it memory. People with deficits in functional cognition who are being challenged can cover up their short-comings by automatically using their procedural memories. This may allow them to fool even the most skilled health care worker or clinician

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14 As carers and managers how can we most effectively support people with cognitive impairment? By creating empowering relationships that enable people to have a secure and valid sense of identity, meaning and reality

15 Dementia Management Keep important personal belongings, papers and utensils in a safe place Simplify their environment Reduce sensory stimulation Physical activities and tasks are beneficial Encourage activities that reflect previous work skills or hobbies Complete care giving tasks early in the day Specialized eating utensils manage nutritional intake

16 Dementia Management Non verbal communication : Care givers body language is a direct clue as to how they are feeling and may be interpreted incorrectly by people from different cultures Useful tools; Gentle reminders or prompts Allow more time to complete ADL s Look directly at people, ensure they can see your face Demonstrate an outward calmness Preserve their dignity and self esteem Be flexible and prepared to change daily plans Don t challenge or emotionally pressure as it may escalate

17 People with cognitive disability need to feel secure at all times; Touch is an excellent way of making people feel more secure

18 An environment which is over stimulating can cause bewilderment in those people who are no longer capable of filtering out unwanted sensory information

19 Encourage and support long standing relationships Whatever happened to our sexual relations? I don t know. I don t even think we got a Christmas card from them this year.

20 Nutrition and Fluids Good nutritious food and adequate fluid intake can assist cognitive functioning; A study by Ross Laboratories found that 16 percent of seniors consume fewer than 1000 calories a day, which is insufficient to maintain adequate nutrition. Small frequent highly nutritious meals or finger food may be more appropriate for dementia residents Water, water, water!

21 An environment that meets their core needs Design factors that influence functionality and enhance independence for dementia residents. the smart building; design factors that influence functionality and enhance independence for dementia residents.

22 Safety measures are essential as they help reduce anxiety and lessen the fear of falling.

23 Spill sensors, movement sensors, full hoist capacity, lighting sensors.

24 Smoke detectors, movement sensors, ambient lighting, falls sensors, electrical equipment disengagement.

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26 Caring for Carers How can we care for others when we don t care for ourselves?

27 Occupational stress amongst care staff working in nursing homes: an empirical investigation. Factor analysis of stress questionnaire responses identified five major stress groupings. These were, 'differing expectations about patient care', 'management factors', 'lack of support from other staff', 'feeling inadequately trained to deal with job demands' and 'home-work conflicts'. Examination of stress outcomes showed that many staff were under pressure, with high levels of smoking and alcohol intake. Dunn LA, Rout U, Carson J, Ritter SA May 1994

28 To value and be valued; if we ask our staff to care for their elderly clients we must acknowledge their grief

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30 Moving forward; Living Longer Living Better The Government will expand the Dementia Behavior Management Advisory Services into acute and primary care settings with a particular focus on support for older Australians from culturally and linguistically diverse backgrounds and Aboriginal and Torres Strait Islanders. will give providers an additional $5,789 per year, on top of normal subsidies to support people with severe dementia. Staff will receive improved training, guidelines and procedures will be developed to ensure best practice by aged care providers. will also provide additional financial assistance to people with dementia who are receiving Home Care packages through a new Dementia Supplement of 10% on top of the base funding for the package.

31 Living Longer Living Better To make it easier for older Australians to stay in their home while they receive care, we will: Increase the number of Home Care Packages - from 59,876 to almost 100,000 (99,669). Provide tailored care packages to people receiving home care, and new funding for dementia care. Cap costs, so that full pensioners pay no more than the basic fee.

32 Living Longer Living Better To make sure more people get to keep their family home, and to prevent anyone being forced to sell their home in an emergency fire sale, we will: Provide more choice about how to pay for care. Instead of a bond which can cost up to $2.6 million and bears no resemblance to the actual cost of accommodation, you will be able to pay through a lump sum or a periodic payment, or a combination of both. Give families time to make a decision about how to pay, by introducing a cooling-off period. Cap care costs, with nobody paying more than $25,000 a year and no more than $60,000 over a lifetime.

33 Living Longer Living Better To ensure there are immediate improvements as well, the government will also: Increase residential aged care places from 191,522 to 221,103 Fund $1.2 billion to improve the aged care workforce through a Workforce Compact. Provide more funding for dementia care in aged care, and more support for services. Establish a single gateway to all aged care services, to make them easier to access and navigate. Set stricter standards, with greater oversight of aged care.

34 The cranky old man

35 Thank you