Working%20with%20Adults;%20Dementia

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Working with AdultsDementia

• Ian Mathews
• Senior Lecturer in Social Work

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What is (senile) dementia?

• Dementia is an umbrella term there are over ?
  different types of dementia
• NB the power of language
• Senile dementia
• Alzheimers (disease)
• Cognitive impairment
• Dementia with Lewy body
• Multi infarct dementia/Vascular disease
• Alcohol related dementia (Korsakoffs syndrome)
• Huntingtons disease
• Creutzfeldt-Jakob Disease (CJD) bovine
  spongiform encephalopathy (BSE), a form of prion
  disease affecting cattle.

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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?

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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

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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

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The prevalence of dementia

• Age
• 40 65
• 65 -70
• 70 80
• 80 plus
• Crawford Walker (2005 p 72)

• Prevalence
• 1 in 1,000
• 1 in 50
• 1 in 20
• 1 in 5

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Living well with dementiaThe National Dementia
Strategy DOH 2009

• A five year plan backed with 150 million over
  the first two years
• Has three main aims
• 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 200926)

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

• Positive about prevention in dementia whats
  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 200924)

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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 peoples mental health services can help
  with behavioural disturbance, hallucinations and
  depression in dementia, reducing the need for
  institutional care

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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

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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 200117)

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Malignant social psychologyKitwood 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
  cant keep up.

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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.

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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