Cognition/Dementia Care System Care Worker

Education Package for People with

Dementia Living in the Community

2008

2008

 

Cognition/Dementia Care System

Care Worker

Education Package for People with Dementia

Living in the Community 2008 

Copyright Copyright Notice and Disclaimer for the “Clinical Practice Guidelines (Guidelines) and Care Pathways (Pathways) for People with Dementia Living in the Community” and for the “Cognitive/Dementia Care Pathway Education Package (Education Package) for People with Dementia Living in the Community”. These Guidelines and Pathways together with the Education package form the Cognition/Dementia Care System (CDCS). Copyright Notice and Disclaimer These Guidelines, Pathways and Education Package have been developed for use by Health Professionals as a guide to practice which is evidence based and focuses on holistic community support for people who have dementia and their carers. Copyright in these Guidelines, Pathways and Education Package rests with QUT and Queensland Health. These Guidelines and Pathways must not be reproduced or further disseminated without the written consent of the owners of the copyright except as lawfully allowed under the Copyright Act 1968 (Cth). These Guidelines and Pathways have been prepared from information based on a collaborative research project between QUT and Queensland Health and is current at the time of printing. Any tools, scales or other materials not created by QUT and used in these Guidelines and Pathways are reproduced and used by QUT with copyright permissions from the copyright owners. QUT recommends that you obtain copyright permissions from the relevant owners of these materials where appropriate. While QUT has used its best endeavours to ensure that the research and information provided in the Guidelines, Pathways and Education Package is accurate, you use the Guidelines, Pathways and Education Package at your own risk. To the maximum extent permitted by law, QUT, its officers, employees and students exclude all express and implied warranties as to the reliability, accuracy or completeness of the information contained in the Guidelines, Pathways and Education Package. It is not intended that these Guidelines, Pathways and Education Package should override clinical decision making, existing organisational policies and procedures or the wishes of the person with dementia or their carer. QUT, its officers, employees and students will not be liable whether in contract, tort (including negligence), statute or otherwise to the users of these Guidelines, Pathways and Education Package or anyone else for any claim, demand, loss or damage incurred arising from the use of these Guidelines, Pathways and Education Package. Suggested Citation: Carlson, L., Abbey, J., Kocur, J., Palk, E., & Parker, D. (2008). Cognition/Dementia Care System Care Worker Education Package for People with Dementia Living in the Community. Brisbane: QUT

Acknowledgement of Funding This project was funded by a grant from the J.O. and J.R. Wicking Trust which is managed by ANZ Trustees.

It is also acknowledged that staff from the Home and Community Care Program in Queensland Health contributed to this project.

Authors Ms Lynette Carlson, Clinical Nurse Consultant – Dementia Nurse Advisor Primary and Community Health Services, Metro North Health Service District Queensland Health Professor Jennifer Abbey, Professor of Aged Care Queensland University of Technology Ms Jannelle Kocur, Dementia Pathway Project – Project Officer 2004-2005 Primary and Community Health Services, Metro North Health Service District Queensland Health Ms Elizabeth Palk, Senior Research Assistant Queensland University of Technology Dr Deborah Parker, Former Senior Research Fellow Queensland University of Technology

Project Steering Committee Professor Jennifer Abbey, Professor of Aged Care Queensland University of Technology Professor Henry Brodaty, Professor of Psycho-geriatrics University of New South Wales Ms Lynette Carlson, Clinical Nurse Consultant – Dementia Nurse Advisor Primary and Community Health Services, Metro North Health Service District, Queensland Health Professor Anne Chang, Professor of Nursing (Research) Queensland University of Technology and the Mater Health Services Mrs Cathie Cooke, Counsellor/ Advisor, National Dementia Helpline Alzheimer’s Australia, Queensland Professor Mary Courtney, Assistant Dean (Research) Queensland University of Technology Professor Helen Edwards, Head, School of Nursing Queensland University of Technology Mr Richard Fleming Dementia Services Development Centre Hammond Care, NSW Ms Moira Goodwin, Executive Director, Primary and Community Health Services Metro North Health Service District, Queensland Health Ms Stacey Hassall, Senior Policy and Process Facilitator Blue Care, Queensland Mr Tim Heywood, Program Co-ordinator General Practice Queensland Ms Jenni Marshall, Dementia Nurse Advisor RSL Care, Queensland Ms Sandra Mills, Former Research Assistant Queensland University of Technology Ms Deborah Oxlade, Executive Manager, Service Development RSL Care, Queensland Ms Elizabeth Palk, Senior Research Assistant Queensland University of Technology Dr Deborah Parker, Former Senior Research Fellow Queensland University of Technology Dr Jeffrey Rowland, Geriatrician Metro North Health Service District, Queensland Health Dr Elizabeth Whiting, Geriatrician Metro North Health Service District, Queensland Health Mr Raymond Whitta, Area Home and Community Care Manager - Brisbane North Primary and Community Health Services, Metro North Health Service District, Queensland Health

Acknowledgements This project has had significant support from a number of people who have generously contributed their time and resources, providing invaluable advice, support and assistance. The Steering Committee acknowledges the degree of commitment that exists among the service providers already supplying individualised support and care to people experiencing memory concerns or who have a diagnosis of dementia and their families. In particular we would like to thank the following people for their generous contribution of time and expertise to the development of this education package:

− The people who attended the various focus groups, including carers and carer representative groups, multicultural groups, General Practitioners, health professionals and support workers

− Chris Gork, RN - Spiritus − The Brisbane North Dementia Network Group − The Primary and Community Services Dementia Link Group, Metro North Health Service District

We would also like to thank all of the people and organisations nationally and internationally who have granted us permission to include their resources in the Cognition/Dementia Care System Education Package. We would like to conclude by acknowledging and thanking those people who read, offered suggestions and contributed their expertise in providing feedback to assist in the completion of this resource.

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TABLE OF CONTENTS

1 Introduction 9 1.1 What does dementia mean? 9 1.2 What does dementia change? 9 1.3 What are some examples or causes of dementia? 9 1.4 Prevalence 10 1.5 Cognition/Dementia Care System 10 1.6 Scope of the Cognition/Dementia Care System 11 1.7 How do you use the Cognition/Dementia Care System? 11

2 Recognition, Assessment & Diagnosis Phase 12 2.1 Detection – recognise changes in memory or thinking 13 2.2 Clincial assessment 13 2.3 Functional assessment 13 2.4 Informing the patient and carer 14

3 Post Diagnosis, Monitoring, Management & Care Phase 16 3.1 Helping the person with dementia 16 3.2 Behavioural management – understanding behaviour 17 3.3 Helping the carer – interventions to support the carer 17 3.4 Respite care 18 3.5 Respite & community packages requiring ACAT approval 19 3.6 Care worker’s post diagnosis, monitoring, management and care phase care pathway 20

4 The Advanced Phase 21 4.1 Helping the person with dementia – a palliative approach 21 4.2 Helping the carer 22

Appendix 1: Guidelines for memory and cognition (confused thinking) recognition 24 Appendix 2: Warning signs for dementia 26

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1 Introduction

1.1 What does dementia mean? Dementia:

• is a term used to describe symptoms of a range of illnesses that effect the brain • is usually progressive • reduces a person’s mental and physical abilities

The effect of dementia on each person is different.

1.2 What does dementia change? The person with dementia has changes to their:

• social skills and speech • ability to learn • memory • quality of life

NB:

Younger people can have dementia Dementia is not a normal part of ageing

1.3 What are some examples or causes of dementia?

• Alzheimer’s disease • Vascular disease • Frontal Lobe dementia • Lewy Body Disease • Encephalitis • head injury • problems with, or addiction to, alcohol

NB:

Some people have more than one type of dementia The Alzheimer’s Australia website has more information about this (http://www.alzheimers.org.au/content.cfm?topicid=134)

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1.4 Prevalence A report by Access Economics [1] said:

• that in 2005 there would be more than 200,000 people with dementia in Australia • by 2050 the number of people with dementia will be more than 730,000 or 2.8%

of the population • each State and Territory has different numbers of people living with dementia • the number of people with dementia in Queensland, Northern Territory and

Western Australia is growing at a faster rate than in the other States and Territories

NB: The Alzheimer’s Australia website has more information about this (http://www.alzheimers.org.au/content.cfm?topicid=348)

High-quality dementia care for people living in the community will rise over the coming decade. The National Framework for Action on Dementia [2] identifies the value of care across the course of the illness and in all health care settings.

1.5 Cognition/Dementia Care System The Cognition/Dementia Care System Education Package has been developed to complement the Clinical Practice Guidelines (Guidelines) For The Care of People With Dementia Living in the Community and Care Pathways (Pathways) For Queensland 2008 and includes care strategies without using medications. The education package covers information from the recognition of dementia as an illness, until the person’s death. The Cognition/Dementia Care System is based on evidence. It may assist you to:

• provide care for and build on what the person with dementia can do • provide support for the person’s carer and family members

The aims of the Cognition/Dementia Care System are to:

• provide evidence based information to help the person with dementia to live in the community for as long as this is desirable and practical

• help people to recognise signs of memory and confused thinking (cognition) problems, so that the right assessments can be done and care can be planned

• help service providers to have a similar and co-operative approach to care • provide information on dementia for service providers and carers • provide forms that help staff to plan and provide suitable care in the community

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1.6 Scope of the Cognition/Dementia Care System The journey of the person with dementia and their carer usually takes place over a number of years. Care may be available from a variety of services. The Guidelines and Pathways and Education Package are presented in three phases. Each phase includes the challenges faced by people with dementia and their carers as the dementia progresses. The phases are:

1. Recognition, assessment and diagnosis phase 2. Post diagnosis, monitoring, management and care phase 3. The advanced phase

You will find that in each phase there is a system which you can follow and this will support the care you provide to the person who has dementia, their carer and family members.

1.7 How do you use the Cognition/Dementia Care System? People who may recommend that a person’s care is planned by the pathway can be:

• General Practitioners (GPs) • health professionals • people in the community • staff who work with various service providers

Below is an outline of the Cognition/Dementia Care System starting points for a person with signs of memory loss and/or confusion.

Phase 1 Phase 2 Phase 3 If the person has memory/ confused thinking (cognition) problems and no diagnosis of dementia If the person has been diagnosed with dementia BUT the type of dementia is unknown

The person has a diagnosis of dementia

The person who has dementia is in the Advanced Phase

Why would the person with dementia stop being on the pathway?

• medical investigations have found that the memory or confused thinking (cognition problem) has been caused by something other than dementia

• the person has been admitted to permanent residential care • the person has passed away

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2 Recognition, Assessment & Diagnosis Phase

In this phase of care it is important for all care workers to: • help to recognise signs of memory and confused thinking problems • tell the supervisor of the changes they have noticed (see Appendix 1)

The supervisor can arrange for the right assessments to be done. The onset of dementia is very gradual, and it is often not possible to identify when symptoms first presented. Alzheimer’s Australia has identified some signs of early dementia that may serve as prompts for carers to seek professional assessment [3]. The person may:

• appear more apathetic, with less sparkle • lose interest in hobbies or activities • be unwilling to try new things • be unable to adapt to change • show poor judgement and make poor decisions • be slower to grasp complex ideas and take longer with routine jobs • blame others for ‘stealing’ lost items • become more self-centred and less concerned with others and their feelings • become more forgetful of details of recent events • be more likely to repeat themselves or lose the thread of their conversation • be more irritable or upset if they fail at something • have difficulty handling money

NB: Refer to the Guidelines and Pathways for further information on the definition of dementia and different types of dementia

Practice Tip Be aware of, and allow for, hearing and vision difficulties Consider each person and carer as an individual. For example, consider their cultural background, religious beliefs, sexual preferences, language issues, family systems/ relationships and customs. Alzheimer’s Australia provides a resource kit, Perceptions of Dementia in Ethnic Communities, providing community profiles of various culturally and linguistically diverse (CALD) groups. The profiles include general information regarding the CALD group, their perceptions of dementia and care and issues to consider in providing appropriate services. The kit can be found via: http://www.alzheimers.org.au/upload/CALDPerceptionsOct08.pdf

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2.1 Detection – recognise changes in memory or thinking The care worker reports any concerns about changes to the health professional or care manager. What do I do? Refer to the ‘Warning Signs for Dementia’ information sheet (see Appendix 2)

Report any changes to the health professional or care manager

2.2 Clinical assessment The health professional will start the assessment process. Will I be involved in the assessments?

The health professional may ask you questions about the person and their circumstances

What are some other things that may cause memory loss or confused thinking?

• infections, for example, urinary tract infection, wound or chest infection • constipation • dehydration – not drinking enough • medications

NB:

Differential diagnosis – It is important that you tell the health professional all you know about the person you are caring for and their family. For example, there may have been a recent death which has left the person depressed.

2.3 Functional assessment The health professional will check:

• safety at the person’s home • what the person can and can not do for themselves

Again, you may be able to help by describing the person’s day to day routines. For example, if they drive a car or things they may like do such as making jam, cooking etc.

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2.4 Informing the patient and carer The GP or specialist and the health professional will usually give information to the person if they are diagnosed with dementia. Occasionally, there may be a good reason for the person not to be informed, for example, in some cultures receiving such a diagnosis may be detrimental to the person so it is important to respect this decision. People with dementia and their families will need ongoing support to cope with the diagnosis [4-6]. Practice Tip Tell the health professional or care manager if the person with dementia or their carer needs more information Be as supportive as possible and ask for help if you feel you are unable to answer all questions

What can I do? The care worker assists the health professional/ care manager to:

• develop a care plan • review care plan 3 monthly or earlier if the person’s condition changes

The care worker then follows the care plan

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3 Post Diagnosis, Monitoring, Management & Care Phase During this time the needs of the person with dementia will change and increase. They may need a lot of help in the home or admission to a residential facility. Issues that may be of concern for the person with dementia [3] are that they may:

• be forgetful of recent events and memory for the distant past seems better, but some details may be forgotten or confused

• be confused regarding time and place • become lost if away from familiar surroundings • forget names of family or friends, or confuse one family member with another • forget saucepans and kettles which they have put on the stove • leave gas unlit • wander around streets, perhaps at night, sometimes becoming lost • behave inappropriately - for example, going outdoors in their nightwear • see or hear things that are not there • become very repetitive • be neglectful of hygiene or eating • become angry, upset or distressed through frustration

Practice Tip Be aware that a person’s personality may change and this may cause distress to both the person with dementia and their carers

3.1 Helping the person with dementia What can I do? Follow the care plan and ensure maintenance of function by promoting and maintaining independence Promote scheduled (planned) toileting and prompted voiding Care workers are encouraged to contribute to the care plan development and review

Practice Tip White boards, calendars, touch lamps, electronic pill reminders, notices on doors and labelling the toilet with a picture etc can all be useful at this stage to assist the person’s memory or to maintain independence. The Alzheimer’s Australia website has more information (http://www.alzheimers.org.au/content.cfm?infopageid=604& CFID=717089&CFTOKEN=22672376#th)

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3.2 Behavioural management – understanding behaviour The person living with dementia may have a behaviour which causes concern. What can I do? Report any changes to behaviour which may cause concern, to the care manager and follow the behaviour strategies outlined in the behaviour care plan Report any signs or symptoms of pain as this may be a source of agitation Changes in the person with dementia may also be due to other treatable difficulties such as depression or delirium. It is therefore important to discuss these changes with the care manager.

NB: The Alzheimer’s Australia website has more information about behaviour changes and management (http://www.alzheimers.org.au/content.cfm?topicid=62)

3.3 Helping the carer – interventions to support the carer Caring for someone with dementia in the community can be physically and emotionally challenging and for some carers this may impact on their own physical and mental health. There is evidence to suggest that the prevalence and incidence of depressive disorders is increased in carers of people living with dementia [7, 8]. What can I do? Please discuss any concerns of carer changes and refer these to the care manager. This may include discussions that the carer has had with the care worker about the following:

• Respite and centre based day care which may enable people to stay in their homes for longer

• Financial assistance which may assist the carer to cope with the financial impact of caring

• Difficulties which may arise as an outcome of the impact of caring on the relationship between the person with dementia and the carer

Care workers are encouraged to contribute to the care plan development and review

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3.4 Respite care Referral to respite and centre based care may enable people with dementia to stay in their own homes longer [9]. Respite or short break care, needs to suit both the person with dementia and the person caring for them. Please note that there are criteria for access to some types of respite. Types of respite available Centre-based day care

Respite provided at the centre from several hours to a few days a week in a group setting. Some centres also provide weekend and overnight respite.

In-home respite

Respite provided in the person’s home. Some people prefer a familiar environment and respond better to 1:1 activities/ company.

Overnight respite

Overnight respite is available at some day respite centres and this type of respite may not require an Aged Care Assessment to be completed. Staff are available to monitor and support people at the centre.

Cottage respite

Provided in a home-like setting and can be provided from several hours, through to seven days a week. Some centres may offer the respite over a period of weeks.

Short-term residential respite

To be eligible, a current assessment from the Aged Care Assessment Team (ACAT) is usually required. The assessment normally takes some time to process and must be renewed at least every twelve months. Some low and high care residential facilities provide short term respite (up to 63 days in a financial year) so that the carer can have a break. Residential respite is usually accessed on a planned basis although some respite emergencies can be responded to through residential respite if a vacant bed is available.

Commonwealth Carer’s Respite and Carelink Centres’ ‘Working Carers Program’

Provides individualised respite packages tailored to the carer’s needs, provides support and advice regarding education and training and provides access to 24-hour emergency respite assistance. Information regarding the program can be made via Freecall: 1800 059 059*

*Calls from mobile phones attract applicable rates

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3.5 Respite & community packages requiring ACAT approval Residential respite, according to the Department of Health and Ageing is:

“Care given as an alternative care arrangement with the primary purpose of giving the carer or a care recipient a short term break from their usual care arrangement.” [10, p. 114]

Community Aged Care Packages (CACPs), according to the Department of Health and Ageing are:

“Individually planned and coordinated packages of care, designed to meet older people’s daily care needs in the community. CACPs are targeted towards frail older people living in the community who require management of services because of their complex care needs. These people would otherwise be eligible for at least low level residential care.” [10, p. 111]

Extended Aged Care Home packages (EACH), according to the Department of Health and Ageing are:

“Individually planned and coordinated packages of care, designed to meet older people’s daily care needs in the community. EACH packages are targeted towards frail older people living in the community who require management of services, generally including nursing services, because of their complex needs. These people would otherwise be eligible for high level residential care.” [10, p. 112] “An EACH package provides about 19 to 22 hours of assistance each week. Packages are flexible in content but generally include qualified nursing input, particularly in the design and ongoing management of the package.” [10, p. 22]

Extended Aged Care Home - Dementia packages (EACH/D), according to the Department of Health and Ageing are:

“Individually planned and coordinated packages of care, designed to assist frail older people with dementia and behaviours of concern associated with their dementia, who require management of behaviours and services, generally including nursing services, because of their complex needs. These people would otherwise be eligible for high level residential care.” [10, p. 112]

NB: Refer to the information in the Guidelines and Pathways for further information on post diagnosis, monitoring, management and care phase

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3.6 Care worker’s post diagnosis, monitoring, management and care phase care pathway

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4 The Advanced Phase In this phase there is evidence of severe memory impairment and confused thinking. The time of death of a person living with dementia is very difficult to predict. Characteristics of the advanced phase of dementia [3] can include the person:

• being unable to remember - for even a few minutes - that they have had, for example, a meal

• experiencing loss of ability to understand or use speech • being incontinent of urine and faeces • experiencing swallowing difficulties • having no recognition of friends and family • requiring help with eating, washing, bathing, or dressing • being unable to recognise everyday objects • being disturbed at night • being restless, perhaps looking for a long dead relative • being aggressive, especially when feeling threatened or closed in • having difficulty walking, eventually perhaps becoming confined to a wheelchair • experiencing mobility issues and, in the final weeks or months, being bedridden • having uncontrolled movements

4.1 Helping the person with dementia – a palliative approach Adopting a palliative approach to care (this means providing comfort care that will not help the person to get better but will keep them comfortable until they die) benefits the person who has dementia and their family carers [11]. A palliative approach supports the dignity of the person who has dementia and promotes the concept of a comfortable death in the place of choice for the person who is ill.

What can I do?

A health professional/ care manager or GP can schedule a case conference which includes relevant health professionals to discuss the implications for this stage of dementia with the carer. Input from the care worker will be of assistance [11, 12].

Follow the care plan and ensure: • Maintenance of comfort – monitor for any signs of pain or discomfort • Hydration and nutrition – encourage eating and drinking by mouth as long

as able. Do not continue giving food/ fluids if the person is constantly rejecting this and/or coughing/ gagging. Contact the care manager if this is occurring. Artificial tube feeding is not recommended.

• Symptom management – antibiotics may be prescribed as a comfort measure for infection

• Management of behaviours – discuss any behaviours of concern with the care manager

• Report any changes or concerns to the care manager The care worker is encouraged to contribute to care plan development and review

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NB: Further information about palliative care guidelines can be found on the Caresearch (www.caresearch.com.au) and Palliative Care Australia (www.paliiativecare.org.au) websites

4.2 Helping the carer What can I do? Refer any carer changes or concerns to the care manager. This includes discussions the carer may have with respect to:

• Respite care – referral to respite and centre based day care centres may enable people to stay in their own homes for longer

• Tensions in the relationship which may have arisen or become more difficult due to the impact of caring on the relationship between the carer and the person with dementia

• Grief and bereavement - GPs and other health professionals can maintain an awareness of the psychological impact of caring for someone at the end-of-life and assess the need for referral to a specialist practitioner or appropriately funded service

The care worker is encouraged to contribute to case conferencing and care plan development and review

NB: Refer to the information in the Guidelines and Pathways for further information on the advanced phase

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Appendix 1: Guidelines for memory and cognition (confused thinking) recognition

Care Worker

Guidelines for Memory and Cognition

(Confused Thinking) Recognition

NAME………………………………………….. PLEASE AFFIX ID LABEL CENTRE…………………………………………

UR NUMBER…………………………………… DOB………………………………………………

Care Worker

Purpose: To provide a guide for staff to follow when caring for the client living with dementia and their carer. It is to be used as a ‘working document’ and will assist in identifying early memory or thinking changes. The document may be shared with other service providers. The guidelines provide a flow chart for each discipline and a trigger form to identify the concern or change. Directions for use: Please follow the flow chart provided in Appendix 2 as this provides direction in terms of

actions to be taken when a memory cognition problem is identified Please comment on any other changes identified, for example, out of date food in the

refrigerator, medications lying around Please refer to the ‘Warning Signs for Dementia’ sheet (Appendix 3) for triggers that may

identify changes Tick the appropriate boxes provided to identify the change/ concern Document how long the client has had these ‘warning signs’ of memory or thinking changes. Please sign and date in the appropriate place Refer to the health professional/ care manager for follow up and further assessment The form is to be filed in the clients chart

Source: Alzheimer’s Association http://www.alz.org/AboutAD/Warning.asp

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Memory loss is not a normal part of ageing. Identifying early signs of memory loss and cognition problems is very important. Early diagnosis of dementia enables suitable choices regarding care and treatment to occur. CARE WORKER CASE MANAGER Please comment on any other changes identified and provide details where possible, for example, medications found under her bed. Comment:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please turn over if more room required…………

Care Worker

Guidelines for Memory and Cognition

(Confused Thinking) Recognition

NAME………………………………………….. PLEASE AFFIX ID LABEL CENTRE…………………………………………

UR NUMBER……………………………………

DOB………………………………………………

Memory / cognition problem identified

Complete ‘Warning Signs of Dementia’ Sheet

Attach the ‘Warning Signs of Dementia’ sheet to the Alert Form if an Alert Form is used by your organisation

Contact the health professional / care manager to notify of the Alert and Give the forms to them as soon as possible

Refer alert to Registered Nurse / Case Manager for further assessment.

If other service involved send/fax copy of this form and completed assessments

Document

alert in clients

progress notes

An alert is received from a care worker

Date and sign the ‘Warning Signs of Dementia’ form when received

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Appendix 2: Warning signs for dementia Please Note: Please file this form in the clients chart

Tick box if Warning

Sign is Observed

Warning Signs

Memory Loss. Forgetting recently learned information is one of the most common early signs of dementia. A person begins to forget more often and is unable to recall the information later. What’s normal? Forgetting names or appointments occasionally.

Difficulty performing familiar tasks. People with dementia often find it hard to plan or complete everyday tasks. Individuals may lose track of the steps involved in preparing a meal, placing a telephone call or playing a game. What’s normal? Occasionally forgetting why you came into a room or what you planned to say.

Problems with language. People with Alzheimer’s disease often forget simple words or substitute unusual words, making their speech or writing hard to understand. They may be unable to find the toothbrush, for example, and instead ask for “that thing for my mouth”. What’s normal? Sometimes having trouble finding the right word.

Disorientation to time and place. People with Alzheimer’s disease can become lost in their own neighbourhood, forget where they are and how they got there, and not know how to get back home. What’s normal? Forgetting the day of the week or where you were going.

Poor or decreased judgment. Those with Alzheimer’s disease may dress inappropriately, wearing several layers on a warm day or little clothing in the cold. They may show poor judgment, like giving away large sums of money to telemarketers. What’s normal? Making a questionable or debatable decision from time to time.

Problems with abstract thinking. Someone with Alzheimer’s disease may have unusual difficulty performing complex mental tasks, like forgetting what numbers are for and how they should be used. What’s normal? Finding it challenging to balance the check book.

Misplacing things. A person with Alzheimer’s disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl. What’s normal? Misplacing keys or a wallet temporarily.

Changes in mood and behaviour. Someone with Alzheimer’s disease may show rapid mood swings – from calm to tears to anger – for no apparent reason. What’s normal? Occasionally feeling sad or moody.

Changes in personality. The personalities of people with dementia can change dramatically. They may become extremely confused, suspicious, fearful or dependent on a family member. What’s normal? People’s personalities do change somewhat with age.

Loss of initiative. A person with Alzheimer’s disease may become very passive, sitting in front of the TV for hours, sleeping more than usual or not wanting to do usual activities. What’s normal? Sometimes feeling weary of work or social obligations.

How long has the client had these warning signs: ______________________________________ Care Worker Name:_____________________Signature:__________________Date:__________ Alert received by the Health Professional / Case Manager: Name:________________________________Signature:__________________Date:__________ Source: Warning Signs of Alzheimer’s Disease. Chicago, IL: Alzheimer’s Association, 2008

http://www.alz.org/AboutAD/Warning.asp

Warning Signs for Dementia

NAME………………………………………….. PLEASE AFFIX ID LABEL CENTRE…………………………………………

UR NUMBER…………………………………… DOB………………………………………………

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References [1] Access Economics. Dementia estimates and projections: Australian States and

Territories - Report by Access Economics Pty Limited for Alzheimer's Australia.; 2005.

[2] Australian Health Ministers Conference. National Framework on Action for Dementia Consultaton Paper. 2005.

[3] Alzhiemer's Australia. Progression of dementia. Help sheet 1.8. 2005 [cited October 2008]; Available from: http://www.alzheimers.org.au/upload/HS1.8.pdf

[4] Scottish Intercollegiate Guidelines Network. Management of patients with dementia. A national clinical guideline. Edinburgh 2006.

[5] National Collaborating Centre for Mental Health. Dementia: A NICE-SCIE Guideline on supporting people with dementia and their carers. National Clinical Practice Guideline Number 42. Social Care Institute for Excellence National Institute for Health and Clinical Excellence. Leicester: The British Psychological Society and Gaskell 2006.

[6] Patterson C, Gauthier S, Bergman H, Cohen C, Feightner J, Feldman H, et al. The recognition, assessment and management of dementing disorders: Conclusions from the Canadian Consensus Conference on Dementia. Canadian Medical Association Journal. 1999;160(12 Suppl):S1-S15.

[7] American Psychiatric Association. Practice guidelines for the treatment of patients with Alzheimer's Disease and other dementias of late life. American Journal of Psychiatry. 1997;154:1-39.

[8] Cuijpers P. Depressive disorders in caregivers of dementia patients: A systematic review. Ageing and Mental Health. 2005;9(4):325-30.

[9] North of England Evidence Based Guideline Development Project. The primary care management of dementia. Newcastle on Tyne: University of Newcastle on Tyne, Centre for Health Services Research; 1998.

[10] Department of Health and Ageing. Aged Care Assessment and Approval Guidelines, September 2006. In: Ageing DoHa, ed.: Commonwealth of Australia 2006.

[11] Commonwealth Department of Health and Ageing. Palliative care guidelines for residential aged care facilities. 2003 [cited 20/10/2008]; Available from: http://www.apacproject.org.au

[12] Galasko D, Bennett D, Sano M, Ernesto C, Thomas R, Grundman M, et al. An inventory to assess activities of daily living for clinical trials in Alzheimer's Disease. Alzheimer Disease and Associated Disorders. 1997;11(Suppl. 2):S33-S9.