caring for a patient with dementia essential care for health care assistants clinical update study...
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Caring for a patient with Dementia
Essential Care for Health Care Assistants
Clinical Update Study DayClare Prout
Ref: NICE-SCIE Guideline
Public Perception?What do you think the general perceptions
and characterisations of dementia are?
Term to describe a collection of symptoms
Changes become disabilities when environmental supports fail to adapt
Circulation
The brain is nourished by one of the body's richest network of blood vessels.
Ref: Alzheimer’s societywww.alzheimers.org.uk
Circulation
Ref: Alzheimer’s societywww.alzheimers.org.uk
Arteries carry blood to the brain.
Approximately 20% of the oxygen is absorbed here.
Circulation
Ref: Alzheimer’s societywww.alzheimers.org.uk
In addition to arteries, this network of vessels includes veins and capillaries
Neurons
Ref: Alzheimer’s societywww.alzheimers.org.uk
Cell signalling
Ref: Alzheimer’s societywww.alzheimers.org.uk
Plaques and tangles
Ref: Alzheimer’s societywww.alzheimers.org.uk
Physiological effects
Ref: Alzheimer’s societywww.alzheimers.org.uk
Healthy Brain
Advanced Alzheimer’s
Earliest stages
Ref: Alzheimer’s societywww.alzheimers.org.uk
• Learning and
memory
• Thinking and
planning
Mild to Moderate stages• Memory, thinking and
planning• Speaking and
understanding speech• Sense of place in
relation to the environment
Ref: Alzheimer’s societywww.alzheimers.org.uk
Severe Alzheimer’s disease
Ref: Alzheimer’s societywww.alzheimers.org.uk
Anterograde Amnesia
Dysphasia / Aphasia
Disinhibition
Dyspraxia / Apraxia
Behaviour that challenges
People with dementia who develop behaviour that challenges should be assessed at an early opportunity to establish the likely factors that may generate, aggravate or improve such behaviour.
Pain is one of the commonest causes of distressed and challenging behaviour in the person with dementia
My name is Mary and I don’t know this place. I don’t know how I got here but I don’t like it. There are other people sitting nearby but they don’t speak to me. My back is sore ---my legs are sore------my head hurts.Two young ones came up to me and said “we’re waiting for you to see the doctor “. They don’t need to shout, I can hear them fine. I won’t be telling them anything anyway; I’ll just end up in the hospital if I say I’m sore. I want to go home, I don’t like it here.
• Cause rapid changes in mood, behaviour and physical function (such as sleep patterns, appetite and mobility) - we see this in our day -to -day working practice.
• Lead to modulation in neuro-chemicals that work within the pain pathways in the brain such that the perception of the pain can be increased.
Assessment of Pain in Dementia
• Interpretation and expression of pain can be different – the brain is not functioning normally.
• Assessment hampered by communication difficulties. As dementia progressed the person may lose language skills and an awareness of their body ‘geography’.
• The person lacks the ability to understand what is happening to themselves and they react through behaviour
Activity - Case study
• Jack 80 yrs old with known Alzheimer’s disease
• He can communicate but has limited speech & word finding difficulties.
• He normally eats well and enjoys watching TV
• He suddenly stops eating and drinking• Over the next few days – his carers cannot
persuade him to eat – he turns away and is increasingly upset and now starts to cry when they offer food.
• He is withdraw and cannot be distracted with the TV
• He hold his head and face and is moaning off and on.
• He will not let the carers assist him with washing and nor will he brush his teeth
What’s the Diagnosis?
Person Centred Care?What can we do?Engagement and involvement of the individual and their main carer is a fundamental principle to getting personalised care right.
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Getting to know me..
• The person still remains.• How does the dementia
affect their view of what is going on around them?
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