Understanding Dementia: Brain Effects, Person-Centered Care, and Physical Health

1. South West Dementia Partnership Further knowledge in dementia part 1

2. Welcome • Introductions • Group Agreement • What will be achieved from this session?

3. Main Talking Points • How the brain is affected when a person has dementia • Person centred care and positive communication • How physical health is important to a person with dementia

5. Changes in dementia Difficulties with: • Getting lost • Forgetting & losing things • Finding the right words • Expressing strong feelings in an appropriate way • Making decisions and judgements • Managing social situations • Managing money and finances

6. The different types of dementia • Alzheimer’s disease • Vascular dementia • Lewy Body dementia • Frontal temporal dementia • Parkinson’s Disease • Korsakoff’s Syndrome • CJD

7. Alzheimer’s disease • Most common form of dementia • Progresses gradually over time • The damage to the brain cells usually starts in the temporal lobe of the brain which results in a person having problems with short term memory and new learning • Damage to all areas of the lobes of the brain is common as the disease progresses

8. Vascular dementia • Sometimes referred to as ‘stroke related dementia’ • multi infarct / single infarct dementia • The damage to the brain cells are dependent on where the blood vessel damage occurs • Sometimes it is described as ‘stepwise’ in the way the changes occur • The way the disease progresses is very variable from person to person

9. Lewy Body dementia • This dementia shares similarities with both Alzheimer’s and Parkinson’s diseases • Lewy bodies are tiny round deposits found in the nerve cells which disrupt the brains normal functioning • Hallucinations and delusions are commonly experienced • The person with Lewy body dementia may react badly to anti-psychotic medications

10. Person centred care and positive communication • Tom Kitwood and psychological needs of people with dementia • Person centred care in practice • Positive communication in distressing situations

11. Tom Kitwood

12. Think of ways you might uphold a person’s well being in each of these areas

13. Person centred care in practice Key difficulties and responses • When the person is confused by past memories • Positive and effective communication in distressing situations

14. When the person is confused by past memories: • Consider is it possible to orientate the person to reality? • Validating/ agreeing with the person’s feelings • Explore past memories that the person is experiencing • Provide reassurance and comfort

15. Positive communication in distressing situations Responding to distress and frustration: • Do not argue with the person – focus less on the factual content of what is being said and more on how the person is feeling • Do not blame the person for being distressed • Try not to take it personally if the person displays angry behaviour towards you • It may help to try and distract the person with everyday routines such as meals /walks

16. Responding to distress and frustration: • Consider the person’s sense of ‘reality’ and respond to this - using reminiscence to link to past stories in the person’s life and asking questions to engage the person. • Look to identify how the person is feeling and respond to this. • Identify ‘themes’ and plan accordingly.

17. Verbal communication • Speak in a calm way; notice the tone of your voice • Use short sentences giving small amounts of information • Make time for the person to answer • Don’t argue about facts or try to ‘correct’ the person

18. Identify the non verbal skills that are being used in this communication

19. Non-Verbal Communication • Move to the person’s level • Gain eye contact where possible • Use gestures, objects or signals as well as words e.g. show the person an object that relates to what you are saying

20. General health and well being • Exercise: does the person have opportunities to move around? • Good diet: is the person getting enough to eat, is this a balanced diet and nutritional? • Having enough fluids: is the person getting enough to drink? • Being free from pain and infection • Environment: is the room warm/cool enough?

21. Focus on physical health in order to: • Reduce the risk of delirium • Reduce potential communication difficulties where a person is trying to express these needs • Increase an individuals wellbeing

22. Main Talking Points re-visited: Any questions? • How the brain is affected when a person has dementia • Person centred care and positive communication • How physical health is important to a person with dementia