Adult Community Care

Working with Adults; Dementia Ian Mathews Senior Lecturer in Social Work

What is (senile) dementia? ‘Dementia’ is an umbrella term ~ there are over ? different types of dementia NB the power of language; Senile dementia Alzheimer’s (disease) Cognitive impairment • Dementia with Lewy body • Multi infarct dementia/Vascular disease • Alcohol related dementia (Korsakoff’s syndrome) • Huntington’s disease • Creutzfeldt-Jakob Disease (CJD) ~bovine spongiform encephalopathy (BSE), a form of prion disease affecting cattle.

Some of the characteristics of dementia • Memory impairment; particularly short term memory loss • Language impairment • Disorientation in time & space ( ‘wandering’) • Changes in personality • Mood changes • Self neglect • Disinhibited behaviour Eg uncharacteristic sexual or aggressive behaviour • The ability to ‘reason’ or to plan ahead NSF for older people, DOH 2001

• How can you diagnose dementia? • What are the causes of dementia? • How can you treat dementia?

Keady & Nolan (1995) stage model of dementia Slipping; minor lapses in memory & behaviour Suspecting; people & those around them suspect that something is wrong Covering up; conscious & deliberate attempts to compensate for loss of function Revealing; difficulties shared with those closest tot eh individual Confirming; acknowledgement, followed by diagnosis Maximising; strategies devised to maximise functioning Disorganisation; cognitive & physical difficulties become increasingly apparent Decline; needs increase & residential care may be required Death;

The incidence of dementia • • • • • • • •

There are currently 700,000 people with dementia in the UK. There are currently 15,000 younger people with dementia in the UK. There will be over a million people with dementia by 2025. Two thirds of people with dementia are women. 60,000 deaths a year are directly attributable to dementia. The financial cost of dementia to the UK is over £17 billion a year. 64% of people living in care homes have a form of dementia. Two thirds of people with dementia live in the community while one third live in a care home.

www.alzheimers.org.uk

The prevalence of dementia Age 40 – 65

Prevalence 1 in 1,000

65 -70

1 in 50

70 – 80

1 in 20

80 plus

1 in 5

Crawford & Walker (2005 p 72)

Living well with dementia; The National Dementia Strategy DOH 2009 A five year plan backed with £150 million over the first two years Has three main aims; 1. Ensure better knowledge about dementia & remove the stigma; for professionals & public; • people currently wait up to three years before reporting symptoms of dementia to their doctor; • 70% of carers report being unaware of the symptoms of dementia before diagnosis; • 64% of carers report being in denial about their relative having the illness; • 58% of carers believe the symptoms to be just part of ageing; • only 31% of GPs believe they have received sufficient basic and post-qualification training to diagnose and manage dementia ( DOH 2009:26)

Aim 2. Ensure early diagnosis, support & treatment for people with dementia, their family & carers

Positive about prevention in dementia – what’s good for your heart is good for your head •

•

The current evidence base suggests that up to 50% of dementia cases may have a vascular component (ie vascular dementia or mixed dementia). This holds out the possibility of preventing or minimising dementia by means of promoting better cerebrovascular health. Current health promotion messages on diet and lifestyle and actions such as health checks are therefore likely to have a positive effect. (DOH 2009:24)

Aim 2 contd- Ensure early diagnosis, support & treatment for people with dementia, their family & carers

• early provision of support at home can decrease institutionalisation by 22% • even in complex cases, where the control group is served by a highly skilled mental health team, case management can reduce admission to care homes by 6%; • older people’s mental health services can help with behavioural disturbance, hallucinations and depression in dementia, reducing the need for institutional care

Aim 3 - Develop services to meet changing needs

• • • •

•

Appointment of dementia advisors Development of carers groups & innovative services ( ‘dementia cafes, dementia choirs, Improve ‘Community personal support services’ Emphasise the benefits of personalisation for people with dementia ( individual budgets) Provision of respite care & ‘Intermediate care’

The concept of ‘personhood’ • To be counted as a person, and so have ‘personhood’, some people think an individual should have qualities like insight, rationality and memory. • Discuss! (Killick J & Allan K 2001:17)

Malignant social psychology Kitwood T (1997) • Disempowerment: Not letting someone do what they are capable of doing. • Treachery: Tricking someone into taking medication by hiding it in food • Infantilization: Talking to them like a baby • Intimidation: Making someone frightened

• Labelling: Using their diagnosis as the main way of understanding their behaviour • Stigmatizing: treating someone as an outcast • Outpacing: Talking, giving information, and providing choices too quickly, so the person can’t keep up.

Malignant social psychology • Invalidation: Not taking the persons feelings seriously • Ignoring: Talking over their head, not including them • Withholding: Not giving the attention they need • Disruption: Breaking into a persons conversation or activity rudely, stopping them carrying on with whatever they were doing.

• Mockery: Making fun of people • Disparagement: Saying critical things about someone, which will damage their self esteem. • Imposition: Forcing someone to do something, not giving choices.

References Crawford K & Walker J (2005) Social work with older people, Exeter, Learning Matters Department of Health (2001) National Service Framework for older people Department of Health (2009) ‘Living well with dementia’ the National Dementia Strategy Keady, J., & Nolan, M( 1995) Assessing coping responses in the early stages of dementia, British Journal of Nursing, 4, 309-14 Killick J & Allan K (2001) Communication and the care of people with dementia, Buckingham, Open University press Kitwood T, (1997) ‘Dementia reconsidered; the person comes first’, Buckingham, Open University press