Outcome 1 – Understand the neurology of dementia.
1.1) The brain is a complex organ containing around 100 billion cells, and it is divided up into different areas controlling different functions of the body. When dementia occurs some of these cells will sop working properly and will affect the way a person thinks, communicates and remembers things. A healthy brain will comprise of a hippocampus, cerebral cortex and ventricles of regular size and shape, in a brain affected by dementia there will be shrinkage of the cortex, the ventricles will be enlarged and the hippocampus will shrink.
The more common types of dementia include:-
- senile dementia usually in the over 65’s
- early onset dementia occurs in the under 65’s
- Alzheimer’s disease occurs when nerve cells and their links die out in various parts of the brain.
- Vascular Dementia is caused by a lack of oxygenated blood to the brain, causes could be high blood pressure or high cholesterol.
Rarer forms of dementia include:-
- Creutzfeldt Jakob Disease and is caused by prion disease which is a protein found in mammals and can be passed on through the food chain.
- Biswanger’s Disease occurs when blood vessels in the deep white matter of the brain are damaged.
- Fronto temporal dementia affects those parts of the brain and occurs in younger people and usually affects men.
- Lewys Bodies are tiny protein deposits found in the nerve cells of the brain and can alter the way the brain functions.
1.2) The brain could be described as a filing cabinet for memories and when dementia occurs in an individual, those memories can become misplaced and lost. There are different types of memory impairment experienced by individuals as shown below:-
- Short term memory loss for a person with dementia can mean not remembering something spoken 10 minutes ago but recalling events from WW2 quite clearly, this was the case with my mother.
- a difficulty recognising people and remembering their names.
- repeating conversations just spoken a short while earlier.
- repeating questions just asked.
- forgetting appointments.
- unable to recall what they have eaten or whether they have eaten, one of our service users we have to sit with whilst she eats her lunch.
- forgetting where they live.
- forgetful with personal care issues.
- forgetting where they live.
- personality changes becoming introverted or extroverted.
1.3) We have already seen hat the brain contains 100 billion cells which are called neurons. When the neuron is off it’s at rest but when it’s on it fires electrical impulses along it’s body to the axon. The axon then releases a chemical such as dopamine which controls body movements, serotonin which can affect one’s mood, anxiety, aggression, acetycholine which controls attention, learning and memory, glutamate which makes the link between neurons and is essential for long term memory.
When a person whom is unaffected by dementia sees a person the right hand side of the brain registers the fact whilst the left hand side of the brain processes the information and is able to recognise whom the person is. When someone is affected by dementia to the right side of the brain, they’ll see the person but not recognise them. When the neurons on the left side of the brain are damaged they will have difficulty with language, organising things, depression.
In my role as a carer, I attend to service users displaying depression, they recognise me as a carer but don’t remember my name even after 2 years, and even aggression on one occasion.
1.4) People may suffer a loss of memory for reasons other than dementia, as shown below:-
- people may suffer a blow to the head, a stroke, an aneurism which may all result in varying degrees of memory loss.
- benign and malignant brain tumours can affect speech, movement, hearing etc. depending upon which part of the brain is affected.
- encephalitis is an inflammation of the brain usually caused by a viral infection.
- Huntington’s disease is an hereditary degenerative disease of the central nervous system, it can cause emotional, intellectual and movement problems.
- Hydrocephalus is a build up of cerebro spinal fluid on the brain. It can lead to problems with organisation, short term memory, organisation and coordination.
- people whom suffer from a lack of sleep may experience memory difficulties.
Other conditions that may cause changes in an individual’s condition include stroke, Lyme Disease, stress, Parkinson’s Disease and multiple sclerosis.
1.5) We all have good days and bad days and the same applies to a person with dementia. On a bad day we will want to get what ever activity we are engaged in over and done with: whilst on a good day time flies. The same applies to a person with dementia but on a more basic level; a good day could be get up, wash, dress, eat cereal, make cup of tea and take tablets. A bad day could be get up and eat cereal without milk.
An explanation for the above change is that the person affected may have gone to stay with family for a few days and are out of their familiar surroundings. Stress can be another reason, the person knows they have forgotten to do something, stress levels rise adding to memory difficulties, confusion and frustration. As the condition progresses more day to day support is going to be required.
My own experience of this includes meeting an elderly lady whom on the surface appeared to be a very jolly person until I had answered the same question 3 times in 5 minutes, found the tea bags in the freezer and ice cream in the oven.
Outcome 2 – Understand the impact of recognition and diagnosis of dementia.
2.1) Receiving a diagnosis of dementia can be a frightening experience and all sorts of negative images can be conjured up. Receiving an early diagnosis can be beneficial for the individual, their family and friends, for example:-
- it rules out other treatable illnesses.
- allows the individual to access advice, information and support.
- it allows the family to plan for the future.
An early diagnosis allows the individual to receive treatment that may slow down the progress of dementia and help with some of the symptoms. Additionally advice and support groups can be accessed. The family and friends have time to understand what the future has in store for them.
Regarding financial matters, the individual has time to make arrangements for the payment of bills, receipt of any monies, prepare a will, plan a funeral. Early on the individual may wish to carry on working, leading an active life as possible. They may want to contact social services to see what help is available in the community. They may want to prepare their home when dementia takes more of a hold on the individual, eg. labelling cupboards, using an appropriate calendar, labelling doors etc. The important thing is to continue with a near as possible normal life for as long as possible.
2.2) It is important to monitor an individual’s health on a regular basis so that any changes are recognised and their needs met. Any changes should be recorded in accordance with the organisation’s policies.
In the early stages of dementia, an individual may have good days and not so good days, they may remember your name: or they can’t remember their own birthday, they may remember The Blitz or are adamant that you did not say something.
Whilst getting an individual use to new ways, eg. taking tablets at different times they may become confused and prefer the old way. Objects will be misplaced and looked for.
Recording all of these events and times are important as changes can be observed, the family can be involved and changes noted and professionals are kept appraised of the situation. The individual’s GP may wish at sometime to alter medication.
It’s important to monitor changes affecting behaviour, memory, personality, coping with daily living skills, are care strategies working, does the individual still enjoy certain activities, record all medications taken.
2.3) The process of reporting possible signs of dementia in a person might not necessarily be through a visit to their GP. There is a process to follow and it’s essential that all organisations involved have proper records.
The National Institute for Clinical Excellence has set down proper guidelines for supporting people with dementia, but this also includes early diagnosis of dementia. Any person showing signs of mild cognitive impairment should be considered for referral. A diagnosis should only be made following an assessment that includes a personal history, a cognitive and mental state examination, a physical examination, a review of medication plus over the counter remedies.
As a care worker I could not contribute to all of the above, but I would certainly notice a change in an individuals appearance, have they lost weight, do they appear unkempt, are they wearing the same clothes, do they smell, and report any of this to my team leader/supervisor. I would be aware of any medication they take plus over he counter remedies such as throat lozenges, cough medicine, and again I would report this. I would expect this information to contribute to the process of diagnosing dementia in a person.
2.4) One reaction of a person hat has just been diagnosed with dementia is hat of denial, which is understandable if they are functioning quite normally. One theory on loss or grief has identified 5 stages:-
- denial – are you sure
- anger – impossible, it must be some one else, don’t be silly
- bargaining – the beginning of acceptance of the facts
- depression- feeling sorry for oneself
- acceptance – I’ve got it now let’s get on
The fear for the individual is that they lose control of their life and their future, they fear that they will become a burden to family and friends, and start blaming themselves and wonder if the condition was avoidable.
After the initial impact of receiving a diagnosis of dementia, family and friends should rally around having regard for the individual and identify where support is available. They should be advised of treatments, identify local care and support services, support groups, financial and legal advice, advocacy, local information sources including libraries and voluntary groups.
The confidentiality of the individual has to be remembered and respected, they might not want their family to be advised!
Outcome 3 – Compare a person centred approach and a non person centred approach to dementia care.
3.1) A person centred approach to dementia care will involve the individual, their family, friends, persons that play an important part in their life, organisations and agencies. When determining their needs we would look at gender, ethnicity, religion, age and personal care required. We would also look at how able the individual is, their health, are there any sensory impairments, any health issues, diet, oral hygiene, communication problems they may prefer to talk in Welsh. Once the individual’s needs are identified plans can be drawn up that meet those needs, involve the relevant agencies and work alongside family and friends.
A non person centred approach to dementia care could be where the individual is placed in a care home, expected to get up at a certain time, have breakfast, go to the day room, have lunch, may be visited in the afternoon or go out, have tea, go to the day room, go to bed. This sort of regime made caring an easy task for the staff involved but did nothing to address the needs of the individuals affected whom may still have been very active in the community as well as at home.
In today’s current climate of restraint and funding cuts it has to be asked which type of care is cheaper and more beneficial to the individual?
3.2) The individual with dementia will experience will fluctuating abilities and needs and by learning about that person, their history, will go some way towards meeting their needs, by sharing the experience with colleagues and management will allow for a more successful strategy.
By updating the care plan when there are any changes will allow for a more stable environment to be maintained. Additionally, consider having a regular team to provide support any new members being accompanied, keep the surroundings the same ensuring the individual is in familiar surroundings, and maintain regular routines eg. getting up at 8.00.
The individual may begin to wander, become incontinent, become agitated, repeat things, become paranoid but by targeting various areas of support when the need arises may help to alleviate the situation. For example a former colleague of mine, whom has Parkinson’s finds it helpful to attend regular meetings of a Parkinson’s group and we still have a good chat and he has kept his sense of humour.
3.3) Being diagnosed with dementia can be quite a traumatic event, but need it be? Ask anyone on the street what they understand or know about dementia and they will conjure up an image of an elderly person mumbling to themselves, wandering around aimlessly requiring 24 hour care, the carer or partner being on the verge of a nervous breakdown, sadly an image often repeated on television.
3.4) The above mentioned fears about dementia, living with the shell of a person, can be overcome. Firstly, the individual, the family and friends need to understand the condition that they face and how best they can support each other through the changes that will take place. Information is readily available from GP’s, libraries, the internet, numerous organisations and agencies.
From there plans will be formulated for the future, initially are may be provided by close family, but this could shift to the use of carers as the condition worsens and eventually being admitted into a suitable care home.
The main thrust of care and support should however be aimed at the individual remaining in their home for as long as possible. To achieve this we may use memory joggers label each room, make the home safer by installing grab rails, use lists for making a cup of tea etc. Finally, family and friends can receive counselling, where they can express their fears and receive professional guidance.