1 / 64

Caring for people suffering from dementia

Caring for people suffering from dementia. Class 3A 2005 . Definisjon off dementia.

cisco
Download Presentation

Caring for people suffering from dementia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Caring for people suffering from dementia Class 3A 2005 Kirsten Halse spring 2005

  2. Definisjon off dementia • Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is a disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. Consciousness is not clouded. Impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour or motivation. (Warner et al 2002 p. 90) Kirsten Halse spring 2005

  3. Definition of dementia • Dementia come from the Latin word demens. It means: without mind. • Alzheimer's disease has been given the name after the doctor who first described the illness in 1910. His name was Alzheimer. (Burns in Jacoby & Oppenheimer 2002 p. 501) Kirsten Halse spring 2005

  4. Who is the person suffering from dementia Kirsten Halse spring 2005

  5. Who is the person suffering from dementia Kirsten Halse spring 2005

  6. Who is the person suffering from dementia Kirsten Halse spring 2005

  7. Who is the person suffering from dementia Kirsten Halse spring 2005

  8. Who is the person suffering from dementia Kirsten Halse spring 2005

  9. Who is the person suffering from dementia Kirsten Halse spring 2005

  10. Who is the person suffering from dementia Kirsten Halse spring 2005

  11. History Kirsten Halse spring 2005

  12. What happens • First there is the gradually advancing failure of mental powers such as memory. Reasoning and comprehension. Much here can be attributed directly to the brain being less efficient; its function has declined and usually there is degeneration in its actual structure. Kirsten Halse spring 2005

  13. What happens • Second there are changes in the social-psychological environment – in patterns of relationship and interaction. Those changes can be part of the disease or they can occur because of the responses the person gets from the surroundings. (Kitwood 1997 p. 20) Kirsten Halse spring 2005

  14. Symptoms or characteristic features of the disease dementia. Cognitive impairment - Decline in memory • Short-time memory • Long-term memory, e.g. semantic memory, episodic-memory, procedural memory. • Abstract memory • Recognise, identify • Recall, call back to mind • The memory for making plans Kirsten Halse spring 2005

  15. Cognitive Impairment - continued • Decline in comprehension • Decline in the ability to orientates oneself in relation to time, person and place. • Decline in the ability to learn • Deficit in language, anomia, aphasia Kirsten Halse spring 2005

  16. Cognitive Impairment - continued • Apraxia • Agnosis • Decline in the function of the will, the ability to decide for something and do it. • All those different impairment results in a decline in the ability to care for oneself in the daily life. Reduced ADL. Kirsten Halse spring 2005

  17. Psychological impairment • Tendency to isolate oneself, to withdraw from people • The interest in ones surroundings falls, less interested in other people and things • The person can become apathetic • psychological unstable, more irritated • Decline in judgment Kirsten Halse spring 2005

  18. Psychological impairment • Depression • Anxiety • Aggression towards other people – catastrophic reactions • Personality characteristics are maintained or exaggerated in some persons and may otherwise be altered in others • Forgetting of feelings connected to incident Kirsten Halse spring 2005

  19. BPSD 90% of all patients suffering from dementia will have some kind of BPSD symptoms BPSD = Behavioural and Physical Symptoms of Dementia These symptoms can both be of psychological and behaviour character Kirsten Halse spring 2005

  20. Delusions Misidentification syndrome Hallucinations Depression, mood changes Anxiety Unrestrained behaviour Physical and verbal restlessness Aggression, treats or violence Call out, cry out Wandering Sleep disturbance Wandering (20%) Excessive motor activity, restless, purposeless activity Collecting things Conspicuous eating and sexual behaviour (Thomas and O‘Brien inJacoby and Opperheimer p. 512- 518, Matteson et..al 1997 p. 297-298 BPSD Kirsten Halse spring 2005

  21. Anxiety • Associated with dementia. • Anxiety reactions can be manifested in various ways; somatic complaints, rigidity in thinking and behaviour, insomnia, fatigue, hostility, restlessness, pacing, fantasizing, confusion, increased dependency. (Eliopoulos 2005 p.454) • Patients without speech often shows their anxiety in behaviour pattern, sometimes as physical aggression. Kirsten Halse spring 2005

  22. Anxiety • Treatment of patients with dementia, anxiety and delusions are;- environmental - medications • The goal is to reduce both the anxiety and the psychiatric symptoms as delusions and hallucinations Kirsten Halse spring 2005

  23. Depression • Prevalence of depression: • 15 to 25% in community based elders • 25% in older adults who are residence of long-term care facilities • Depression can occur in the early stage of dementia as the patient becomes aware of declining intellectual abilities (Eliopoulos 2005 p. 452) Kirsten Halse spring 2005

  24. Insomnia Fatigue Anorexia, weight loss, Constipation, Guilt, Apathy, remorse Hopelessness, Helplessness Feeling of being a burden Loss interest in people Physical complaints, headache, indigestion Altered cognition The symptoms of depression can mimic those of dementia (Eliopoulos 2005 p.449-453) Depression - symptoms Kirsten Halse spring 2005

  25. The onset of symptoms tends to be rapid Disturbed intellectual function Disorientation of time and place Altered attention span Worsened memory Labile mood Meaningless chatter Poor judgement Altered level of consciousness, mild drowsiness Disturbance in sleep-wake cycles can occur Physical signs such as slower psychomotor activities (Eliopoulos 2005 p.442-444) Delirium - symptoms Kirsten Halse spring 2005

  26. Other symptoms • Neurological symptoms, more primitive reflexes late in Alzheimer's disease • Instability • Incontinence • Weight loss (people with Alzheimer's disease lose weight over 3.5 times the rate of healthy age-matched controls (Thomas & O'Brian in Jacoby & Oppenheimer p. 519). Kirsten Halse spring 2005

  27. Different types of dementia • Alzheimer's disease is the most common cause of dementia in the older adult 60%. • The symptoms of this progressive, degenerative disease develops gradually and progress at different rates among affected individuals. Kirsten Halse spring 2005

  28. Dependency over the years Kirsten Halse spring 2005

  29. Developmental of the disease • Although staging of the disease can help predict its general course and anticipate plans or care, it must be appreciated that many factors affect the progression of the disease and that there will be individual variations. Kirsten Halse spring 2005

  30. Different types of dementia • In addition to Alzheimer's disease, dementia may be caused by a variety of pathologies. • Vascular dementia 25%. Kirsten Halse spring 2005

  31. Vascular dementia • This form for dementia results from small cerebral infarctions. • Damage to the brain tissues can be diffuse or localised. • The onset is more rapid and the disease progresses more predictably than Alzheimer's disease. • The risk factors are smoking, hypertension, hyperlipidemia, inactivity and a history of stoke or cardiovascular diseases Kirsten Halse spring 2005

  32. Frontotemporal dementia • The characteristic of this form of dementia is that the frontal lobes of the brain is affected. • Behavioural rather than cognitive abnormalities in the early stages are common. • Rather than poor memory early cognitive changes can include impairment in the abstract thinking, speech and language skills. Kirsten Halse spring 2005

  33. Other types of dementia • Lewy body dementia • Parkisons`s disease • Creutzfeldt-Jacobs disease • Wernicke encephalopathy Kirsten Halse spring 2005

  34. Other types of dementia Potentially Reversible causes of Dementia • Emotional disorders • Metabolic and endocrine disorders • Eye and ear dysfunction • Nutritional deficiencies • Tumor and trauma • Infections • Arteriosclerotic complications (Linton &Matteson p293 in Matteson et.al 1997) Kirsten Halse spring 2005

  35. Presence of cognitive impairment • The prevalence rate across Europe are estimated as 4.5% of men and 6.5% of women over 60. • Over 90 years of age the rate are estimated as 32% of men and 35 of women (Warner et al.2002, p. 95) • In Norway there are around 70.000 people with dementia. The number will increase because the amount of elderly people will increase. Kirsten Halse spring 2005

  36. Alzheimer's disease - Prevalence Kirsten Halse spring 2005

  37. Treatment There is none specific treatment for the disease dementia Treatment focus on: • Milieu therapy • All diseases must be taken care of • Medication Kirsten Halse spring 2005

  38. What do people with dementia need • Comfort • Attachment • Inclusion • Occupation • Identity • Love (Kitwood1997) Kirsten Halse spring 2005

  39. What do people with dementia need (Kitwood1997) Kirsten Halse spring 2005

  40. What do people suffering from dementia need - identity • To have an identity is to know who one is, in cognition and feelings. • It means having a sense of continuity with the past; a “narrative” to present to others. • It involves creating a kind of consistency across the different roles and context of present life. (Kitwood 1997p. 83) Kirsten Halse spring 2005

  41. What do people suffering from dementia need - identity • Help the person to remind who his is by using- photographs of the patient and family- personal possessions in the room- dressed like they use to- talk with the patient about his life. Can be done individually and in groups - Reminiscence. Kirsten Halse spring 2005

  42. What do people suffering from dementia need - inclusion • Everybody has a need for being part of society. • The need for inclusion comes poignantly to the surface in dementia in so-called attention-seeking behaviour. Tendency to cling. • Person with mental impairment are not easily included in everyday life. Kirsten Halse spring 2005

  43. What do people suffering from dementia need – occupation • The need for occupation is present in people with dementia. It is manifested, for example, when people want to help or take part in activity. • Helps the person to feel part of life and valuable Kirsten Halse spring 2005

  44. What do people suffering from dementia need - Occupation • Help and support the person in relation to self-care – involving the person. • The person does as many daily activities as his is able to. (Eliopoulos 2005 p 447) • The purpose is to:- promote mastering- make sure the patient do have meaningful day- increase quality of life Kirsten Halse spring 2005

  45. What do people suffering from dementia need - comfort • The word comfort carries meanings of tenderness, closeness, the soothing of pain and sorrow, the calming of anxiety, the feeling of security. • To comfort another person is to provide a kind of warmth and strength which might enable the person to remain in one piece when his is in danger of falling apart. • In dementia the need for comfort is likely to be especially great when a person is dealing with a sense of loss. (Kitwood 1997 p. 81) Kirsten Halse spring 2005

  46. What do people suffering from dementia need - attachment • The need for attachment remains when a person has dementia; it may be as strong as in early childhood. • Life for persons with dementia are overshadowed by new uncertainties and anxieties. • People with dementia are continually finding themselves in situations that they experience as “strange” and that this activates the attachment need. (Kitwood 1997 p. 82) Kirsten Halse spring 2005

  47. Maintaining Personhood Maintaining Personhood • When physical needs have been met, this is the central task of dementia care. It involves enabling the exercise of choice, the use of abilities, the expression of feeling, and living in the context of relationship Kirsten Halse spring 2005

  48. Communication with a person suffering from dementia • Communication can be affected early on in dementia. • A reduced ability to communicate has an impact on relationship as well as on the well-being of the patient and on the early stages of management. (Pearce in Jacoby & Oppenheimer 2002 p. 584) Kirsten Halse spring 2005

  49. Communication with person suffering from dementia • To a person in a nursing home the nurse talks about something which is going on now. The person does not answer regarding what the nurse talks about. • Why not ??? – maybe he or she is another place in his life Kirsten Halse spring 2005

  50. Communication with a person suffering from dementia – reality orientation Reality orientation were designed to help reduce confusion and disorientation in people suffering from dementia The idea was to orientate people to who they were, where they were and present time. Reality orientation can be useful Kirsten Halse spring 2005

More Related