Dementia Awareness Community This training guide is not for stand-alone use. It is specifically designed for use alongside more comprehensive face-to-face training with the Trust s Clinical Dementia Educators. Face to face training completed alongside booklet Trainer s signature: Date: Staff s signature: Date:
What is Dementia? This training guide is designed for use alongside face to face training with the Clinical Dementia Educators. A loss of mental ability severe enough to interfere with normal activities of daily living, lasting more than six months, not present since birth and not associated with a loss or alteration of consciousness o Dementia is an umbrella term for over 100 types of conditions that affect the brain. o The most common type of Dementia is Alzheimer s Disease followed by Vascular Dementia. o One in six people over 80 will develop dementia; approximately 800,000 in the UK. Why diagnose? Enabling people to live well with Dementia Rule out other conditions and causes of confusion (3D s) Access information and support Plan for the future Allow for use of drugs where appropriate We use the memory questions in the falls assessment to screen people 75 and over, but this screen can be used for anyone you think may have Dementia. If a problem is indicated the abbreviated mini mental score is completed and the results are faxed to the patients GP. This is part of the Dementia CQUIN.
Types of Dementia. Alzheimer's Dementia This is the most common cause of Dementia affecting approximately 2/3 people in the UK. People in the early stages of Alzheimer s disease may experience lapses of memory and have problems finding the right words. As the disease progresses they may: Become confused and frequently forget the names of people, places, appointments and recent events; Experience mood swings; Become more withdrawn; Have difficulty carrying out everyday activities Eventually, they may need help with all their daily activities. Some people with Alzheimer s dementia may be receiving medication to slow down the rate of decline (these are held in the emergency medicine cabinet). Vascular Dementia Vascular dementia is the second most common form of dementia after Alzheimer's disease. People with vascular dementia may particularly experience: Problems with speed of thinking, concentration and communication; Depression and anxiety; Physical weakness or paralysis; Memory problems (although this may not be the first symptom); Seizures; Periods of severe (acute) confusion; Visual mistakes and misperceptions; Changes in behaviour; Hallucinations; Problems with continence; Psychological symptoms such as becoming more obsessive. Mixed Dementia and Rarer Forms of Dementia Some people have more than one type of dementia; this is described as mixed Dementia. They may present with a complex set of symptoms. There are over 100 types of Dementia, many related to specific conditions. Some do not show memory problems as the primary symptoms, they may have specific symptoms associated with them
Understanding the person. Dementia does not rule out a person s ability to have capacity. Please ensure you are familiar with the Code of Practice and have up to date training, there is a code of practice in each area. Common problems that may arise when someone is living with Dementia Not going to the GP Losing Important things Becoming lost Unsafe task performance Repeated calls and contacts Pacing, Searching Following carer givers Undressing Resisting care Swearing and cursing Striking out at others Contractures and immobility Mixing day and night No solid sleep time Not eating or drinking Rummaging These problems may indicate the person has an unmet need so it is important to identify and communicate these problems between services both in hospital and at home. Some people may bring a This is me or an All about me document with them. Information from these documents can be added to the Forget-me-not card that is placed by the bed to help everyone taking part in their care get to know them and meet their needs. Dementia Folder-All wards have access to Forget-Me-Not on Cardea and many areas have a folder with further information about Dementia, carer support, sign-posting information and activity resources.
Communicating with someone who has a Dementia. Use a consistent positive physical approach Pause at edge of public space Wave and greet by formal name Approach slowly within visual range Introduce yourself Offer your hand and make eye contact If your hand is accepted shake hands Gently switch to hand under hand Move to the side and get to eye level Maintaining contact if gained Respect personal space and wait for acknowlege Sometimes a person with Dementia will show behaviours that are not usual for them. The first course of action should be to use good communication skills to de-escalate the situation: Staying calm. Listening in a calm, affectionate, reassuring manner Avoiding arguing or correcting the patient Using verbal and nonverbal ways of reassuring The use of Anti-psychotic medication in patients with Dementia is tightly restricted due to potential side effects. Please familiarise yourself with the national clinical guideline NICE 42
Be a detective. What happened just before the patient got upset? Look at the environment, the people present, noise, lighting, activity happening around the person. What does the behaviour communicate? Does the person have an unmet need? In pain? Lonely? Toilet? Hungry? Scared? Bored? Tired? What effect are events happening as a consequence of the behaviour having on the person with Dementia? When looking for triggers include: The person s physical health, mood and personal history Possible undetected pain or discomfort Individual biography, including religious beliefs and spiritual and cultural identity Psychosocial factors, environmental factors and the people present Working closely with carers and family Are people s responses reassuring or escalating the situation? First line of intervention how can we meet the unmet need? Pain relief/prevention Social stimulation Provide activity Value personal history through conversation and respect Changes to environment/people Exercise opportunities Daylight and light levels Adapt routine to the person Change people/situation Adapt communication to the person
Fluid and nutrition advice to carers. Dementia can lead to reduced food and fluid intake, this can be due to: decreased recognition of hunger and thirst declining perception of smell and taste the appearence, textures and tastes they enjoy may change dysphagia (swallowing difficulty) Loss of physical control / ability to feed self Difficulty recognising food and utensils Depression (loss of interest) Patients need opportunities to drink and positive statements about drinks throughout the day. Establish preferences then present actual drinks rather than just asking verbally, incorporate drinks into activities. Have ice lollies, jelly, soup or other forms of fluid available. Distinctively coloured crockery can assist people to see the food and drinks clearly and has been shown to increase intake. Avoid patterns as these can appear confusing. Enhancing the appearence, textures and tastes of food can make it more appealing. Some people will begin to prefer stronger flavours or sweeter foods. It is important to adapt food to these changes. Focus on the preferred foods (For example desserts). Nutritional requirements need to be met in the context of food and cultural preferences. If a patients cannot handle utensils, try using modified utensils or finger foods. For patients unable to eat large meals, encourage little and often. Try adding additional calories into foods by adding extras such as cream, cheese or butter. In addition to snacks consider milkshakes, smoothies.
Environment Advice to carers Lighting Maximise daylight (remove nets/blinds); Cut back garden foliage from around windows; Increase wattage of the lights (remembering to check maximum tolerance of old shades/ fittings); Make light and power switches easier to see. Décor Changes can be confusing, especially if the person has lived there for a long time; Flooring-smooth and matte (one colour throughout/carpet bars same colour); Watch out for trip hazards; High contrast skirting boards with doors and walls; Low contrast can be used to keep people safe; Patterns can be problematic; Photographs of people and places. Signage Dementia signage is widely recognised by professionals; Improves independence; Improves quality of life; Makes caring less of a worry. The person with Dementia may have problems to deal with at different stages of their journey. Some difficulties can be anticipated and perhaps avoided with simple changes that can be made around the home. Talking with their relatives and carers they may be able to think of more ideas of their own. Dementia Education Team- If you need help and advice, with regards to dementia care, training and development. Helen Robinson Clinical Educator-Dementia (RGN) Helen.Robinson@stees.nhs.uk Gina Warren Clinical Educator-Dementia (OT) Gina.Warren@stees.nhs.uk Tracy Horton Clinical Educator-Dementia (OT) Tracy.Horton@stees.nhs.uk Dementia Team Telephone: 01642 850850 EXT 55947 Safeguarding Adults- The safeguarding vulnerable adults team provides advice and support for all staff. Out-of-hours please contact the patient safety manager on-call through switchboard JCUH on 01642 850850. Name Title email Helen Williams Specialist nurse safeguarding adults Helen.williams@stees.nhs.uk Safeguarding Telephone: 01642 850850 EXT 52241 Safeguarding Mobile: 07920 212384 Safeguarding Pager: 07699 661053 Social Services- Social services are a department of the local authority with the responsibility for assessing the needs of and providing support for older, disabled or vulnerable people in the community. Social Services Telephone: 01642 850850 EXT 53221