Dementia Awareness Training

1. Dementia Awareness Training Stuart Harper-Reynolds – Named Nurse Adult Safeguarding Transforming our services - Putting patients first -Valuing our people -Health and wellbeing

2. Introduction • Who we are • Aims of session • HEE Tier 1 training • Dementia Friend • Barbara’s Story

3. What is Dementia? • The term Dementia is used to describe the collection of symptoms including a decline in memory, reasoning and communication skills, and a gradual loss of skills needed to carry out daily activities. • These symptoms are caused by structural and chemical changes in the brain as a result of physical diseases such as Alzheimer’s disease.

4. Symptoms of Dementia • Loss of memory – problems with day to day memory with difficulty recalling events that happened recently • Concentrating, planning and organising – difficulties making decisions , solving problems or carrying out a sequence of tasks • Language – difficulties in understanding what people are saying and or finding the right word for something

5. Its normal to forget , but sometimes its important to look deeper • What most people don’t know is there are many conditions that can mimic dementia. • Walking out of ASDA and not remembering where you parked the car is one thing, walking out of ASDA and not knowing if your car is red, green or blue, is something else.

6. Types of Dementia Vascular Frontotemporal Alzheimer’s Lewy Body

7. Alzheimers • Become confused and frequently forget the name of people , places , appointments and important events • Experience mood swings due to frustration from increasing memory loss • Become more withdrawn – due to loss of confidence or to communication problems • Difficulties carrying out every day difficulties • Cognition generally declines steadily over time • Caused by proteins that tangle in the brain

8. Vascular • Problems with speed of thinking , concentration and communication • Depression and anxiety accompanying the dementia • Symptoms of stroke such as physical weakness or paralysis • Periods of severe acute confusion- prone to delirium • Tends to progress in a step down presentation • Caused by vascular events- e.g stroke, damage to blood vessels and restricting blood flow to areas of the brain

9. Lewy Body • Experience problems with attention and alertness • Often have spatial disorientation • Difficulty in planning ahead and coordinating mental activities • Shares similar characteristics to Parkinson's disease including slowness , muscle stiffness , trembling and shuffling , changes in voice and lack of facial expression, hallucinations/delusions • This makes lewy body difficult to diagnose • Confusion can fluctuate rapidly from very confused to lucid • Very sensitive to antipsychotic medication • Can form paranoid beliefs- people stealing from them • Caused by clumps of proteins that develop inside nerve cells that block messages in the brain. They reduce the levels of chemical messengers and cause nerve cells to die.

10. Fronto - temporal • Lack of insight and loss of ability to empathise with others • More likely to have difficulties with language and emotional responses. • Become extrovert when previously outgoing and withdrawn when previously outgoing • Behave inappropriately/impulsive behaviours more likely • Lose inhibitions- verbally as well as physically • Can become aggressive • Develop routines – for example compulsive rituals • Caused by damage to the frontal/temporal lobes in the brain. Also sometimes referred to as ‘Picks disease’.

11. How common is it? • As people live longer , the number of people with dementia is set to increase. • Nationally it is estimated that the numbers will nearly double over the next 30 years to 1.7 million people living with dementia in the UK.(Alzheimer’s Society 2009) • It is estimated 61% of people with dementia are women and 39% are men.(Alzheimer’s Research 2014)

12. The prevalence of various forms of Dementia

15. Prevention • There is growing evidence indicating that certain medical conditions such as high blood pressure, diabetesand obesity may increase the risk of Dementia. • A healthy lifestyle may reduce the risk (Alzheimer’s Society, 2014)

16. Why diagnose and treat Dementia early? Improved quality of life • Early diagnosis and intervention improves quality of life for people with dementia • Early intervention has a positive effect on the quality of life of family carers • Counselling can be beneficial in the early stages for the person receiving the diagnosis. Allows patients/families to make informed choices about care • Can plan for the future e.g. Legal Power of Attorney (LPA) • Delay and prevent unnecessary admissions to care homes

17. Diagnosis • Blood tests to rule out any physical health reasons for an impaired memory • History taking – talk to the person and someone who knows them well • Cognitive tests of mental abilities (ACE-III) • A scan of the brain • A diagnosis may take weeks / months

18. Living Well • A diagnosis of Dementia may bring some challenges however it is still possible to live well with some simple changes and actions. • People with Dementia want to carry on going about their daily lives and feel included in their local community, but they sometimes need a helping hand to do so • This may include supporting people to adapt their homes, and promoting independence and social inclusion in their local area.

19. All About Me – Unique Individual

20. Importance of Communication Communication is at the heart of everything we do in our lives. It enables us to express a need , want or desire and it allows us to share information and be sociable. A person with dementias ability to communicate is based on the progression of the disease

21. Common Problems with communication • Word finding difficulties • Reduced understanding of language and concepts • Repeating words over and over • Unable to state the name of an object • Loses train of thought • Writing reading skills deteriorate • Saying very little • Gestures more than speaks • Difficulties in processing information or instructions • Decision making/judgement

22. Behaviours that Challenge • 90 % of people with dementia experience behavioural and psychological symptoms at some point (Alzheimers Society 2013). • Cohen -Mansfield (2001) suggests that challenging behaviour in dementia often reflects an attempt by a person to signal that a need is currently not being met. • A persons personality endures through the course of dementia and their individuality will be apparent in various stages and different stages of their illness

23. What might behaviours that challenge look like? • Challenging behaviour presents due to an unmet need. • It may result from an individual feeling threatened, fearful, anxious, suffering delusions or hallucinations or it may be in response to a difficult situation or a misinterpretation of the actions of other people • May be simply be a result of an individual trying to express that they are hungry, thirsty or in pain • ‘Maureen’ example

24. Delirium • Sudden onset of confusion/deterioration in cognition. • Generally, treat the cause, the symptoms improve. • 4AT delirium assessment tool (now in falls pathway) • People with dementia are more likely to experience delirium- (cognitive reserve) • Trakcare delirium alert symbols now in place. Red brain active delirium, Purple brain at risk of delirium/history of delirium. • New delirium care plan available in ‘nursing patient safety’- care plans SOP, (nursing care plan for acute confusion)

25. Family, Carers and Friends • The majority of care for people with Dementia is undertaken by their family carers. It is important that the carer is supported to maintain their own health and wellbeing. • The Prime Ministers Challenge on Dementia includes the aspiration that carers of people with Dementia “be made aware of and offered the opportunity for respite, education , training, emotional and psychological support so that they feel able to cope with their caring responsibilities and to have a life alongside caring”. • Johns Campaign available for carers that support the patient whilst in hospital. It can allow meal discount at the canteen, the person can order from the ward meal provision, and reduced car parking costs. It can be two named carers/family members (available on sharepoint).

26. What isDementia Friends? • Dementia Friends is the UK’s biggest ever initiative to change the way people think, act and talk about dementia. • It’s led by Alzheimer’s Society as part of its work to create ‘Dementia Friendly Communities’. • It aims to help people understand what dementia is, how it can affect a person, and how we can each help people affected by dementia. • You can become a dementia friend by going on the Alzheimers society website where you will find more information.

27. Checklist for staff • Complete AMT regularly, and include in discharge summary. • Use and read the All about me, it will really make a difference to the persons stay. • Is Johns Campaign applicable to support carers who support our patients? • Consider the persons ‘reality’ during intervention and relate that to presentation • Consider Delirium • Dementia alert symbol present on patients names board