luke tanner
TRANSCRIPT
© Dementia Care
Matters 2009
=
Feeling at home in yourself
Feeling … peaceful
settledcalm contentsafesecure belongingcapablecomfortablepresenthappyfreeconfident able
A personA placeA thing
that helps you feel at home in yourself !
Identity
ComfortInclusion
Occupation
LOVE Attachment
Your well being is sustained by your relationship to
people, places & things.
Behavioural and Psychological Symptoms of Dementia
• Screaming
• Restlessness
• Physical Aggression
• Agitation
• Wandering
• Anti-social behaviours
• Cursing• Shadowing• Anxiety• Depression• Withdrawal• Hallucinations• Delusions• Psychosis
We rely on these relationships to keep our stress (arousal) at a comfortable levels and avoid escalated negative emotions (affect).
“Affect Regulation”
These relationships shape how we feel
Think of a time in your life when you felt stressed.
Discuss in pairs
How did you know you were stressed?
What do you do when you are stressed?
Who/What helped?
Feeling Stressed!
Hot
Sweaty
Palpitations
Racing mind
Restless
Muscle Tense
ShallowBreathing
indigestion
Head ache
Shout Swear
Cry RestlessReactive
ShutdownWithdraw
Controlling
WorryingObsessive
Hyper Sensitive
IrritableAggressiveAccusative
ArgumentativeAgitatedParanoid
Eat CleanTake dog for a walk
Smoke DrinkGo for a walk
Take time out
Have a bath
Tidy the house
Solve the problemSeek helpCall a friend
Watch TVListen to Music
Go shoppingWork Exercise,
Meditate
Angry
Anxious
Panicked
FearfulRage
Tearful
Think of a time in your life when you felt bored.
Discuss in pairs
How did you know you were bored?
What do you do when you are bored?
Who/what helped?
Feeling Bored!
Tired
Lethargic
HeavyLow
Slow
Absentminded
Numb
Depressed
Frustrated
IrritableSad
DespairLoss
WorthlessEmpty
Grief Shame
Wandering Sleepy
DisengagedListless
DistractedRestless
Wander
AgitatedIrritable
Day dreamy
AttentionSeeking
Withdrawn
RepetitiveComplain MoanySwitch off
ANYTHING!Read
Watch TV
TidyClean
Call a friend
Sort
Go shopping
Emails
TextsComputer game
SudokuIroning
Listen to radio
Self regulation - helps to keep our stress at a comfortable levels (arousal) and avoid escalated negative emotions (affect).
Our coping strategies help us feel at home in
ourselves
Self Regulation
To stay in our comfort zone we need the following abilities –
• To know and manage our feelings and emotions
• To reflect and respond adaptively to situations
• To communicate our feelings and needs effectively
• To make use of these abilities in relationships
These processes require “Neural Integration” i.e. different parts
of the brain working with each other in the service of self
regulation. (D.Siegal)
The capacity for self regulation is undermined by the
neuropathology of a dementia!
Hot
Sweaty
Palpitations
Racing mind
Restless
Muscle Tense
ShallowBreathing
indigestion
Head ache
Shout Swear
Cry RestlessReactive
ShutdownWithdraw
Controlling
WorryingObsessive
Hyper Sensitive
IrritableAggressiveAccusative
ArgumentativeAgitatedParanoid
Angry
Anxious
Panicked
FearfulRage
Tearful
Tired
Lethargic
HeavyLow
Slow
Absentminded
Numb
Depressed
Frustrated
IrritableSad
DespairLoss
WorthlessEmpty
Grief Shame
Wandering Sleepy
DisengagedListless
DistractedRestless
Wander
AgitatedIrritable
Day dreamy
AttentionSeeking
Withdrawn
RepetitiveComplain MoanySwitch off
Loss of capacity to self regulate
=
Vulnerable to traumatic stress + heightened negative emotion
Hyper or hypo arousal leads to intense negative emotions
Symptoms of Traumatic Stress
Ref. L. Cozolino, S. Porges
Feeling.. Peacefulbelongingcapablecomfortablepresenthappyfreeconfident ablesettledcalm contentsafesecure
depends more on the quality of our relationships
Relationships
Opportunities for “interactive regulation”
Comfort – calming/soothing, people, places and things …
Occupation –Stimulating/enlivening, people, places and things …
Relationships with people places and
things need to meet our attachment needs
Consider -
the peoplethe placesthe things
that help you feel at home in yourself?
What is it about them that helps you feel at home?
1. A Dementia 2. Culture of Care
changes your relationships to people, places and things.
People
Language Behavior Body Language
Institutions!
“Units” “Wards” “Suites”
Nothing – no thing!
Touch things in scheduled activities
NO – THING !
© Dementia Care
Matters 2009
=
© Dementia Care
Matters 2009
=
Emotionally intelligent staff
Responsive to feelings & needs
Recognise that every interaction shapes
quality of life
Look more like friends than people in charge
Sit down and hang out
Eat with people living with dementia
Close, loving and affectionate
Understand the difference between care
and control
© Dementia Care
Matters 2009
© Dementia Care
Matters 2009
Removal of Them and Us Barriers
No more trolleys or uniforms
Shaped by the life history of individuals in care
People look and feel free
Institutionalfeatures removed
Relaxed ‘go with the flow’ feel
No sense of the rigid routines
Lots of 30 second connections
Lots of 60 second activities
Adapted to individual needs/abilities
Stuff everywhere i.e. “clutter”
Relates to individual life history
Triggers emotional memories
Matched to stages of dementia
Half done things to finish off
Themed and staged activities
Enables people to occupy themselves independently
of carers
Comfort objects, sensory calming things.
Household items and sensory stimulating things
Group Living
Attachment needs
Care Tasks
Reducing Routine Bound Care
Being a Butterfly
Change the moment
Turn tasks into experiences
Spontaneous and go with the flow
Go along with different realities
Focus on social interaction
Use stuff in interactions
Stage activities rather than run them
Aware of controlling language & behaviours
People experiencing the early stage of a dementia
People experiencing a different reality
People experiencing the late stages of a dementia
Lots of opportunity for domestic activitiesAccess to domestic and functional household itemsSmall reminiscence groups, themed reminiscence boxesLots of opportunity for conversation and “banter” during care giving interactionsPartnerships in domestic and daily living activitiesGreater independence in daily living tasks
Domestic things/tasks/jobs laying around half done and to be finishedThemed and personalisedrummage boxesOpportunities for people to live out the past jobs, vocations, roles that may be part of their realityLots f stuff to hand to rummage through
A care team that can role play and go along with different realities to meet underlying emotional needs rather
Comfort objects, dolls, stuffed toys to hand
Soft and textured fabricsOpportunities for sensory stimulation and soothing at different times of daySensory items related to individuals life history immediately to hand/within reachA care team that is able to be still, close, affectionate, tactile to meet attachment needs
MATCHED CAREGIVING & THE STAGES OF A DEMENTIA
10%5%
70%
10%5%
0%10%20%30%40%50%60%70%80%
Positive Social Positive Care Neutral Negative
Protective
Negative
Restrictive
Dementia Care Matters Study (c) - 700 Audits Across
UK - Average Results
Quality of life is determined by quality of relationshipswith people places and things
=
Dementia Care Matters Butterfly Household Model of Care
A therapeutic environment between people, places & things that meets peoples individual attachment needs
42 Accredited Butterfly Care Homes in UK, Ireland, Canada & Australia
15 Butterfly projects UK, Ireland, Canada & Australia
You’re a person, in a place, with things!
What can you do to create a culture of care that helps people with a dementia feel at home?
“Contact with dementia or other forms of cognitive disability can - and indeed should - take us out of our customary patterns
of over busyness, hyper-cognitivism and extreme talkativityinto a way of being in which emotion and feeling are given a much larger place …. they are asking us, so to speak, to heal
the rift in experience that western culture has engendered, and inviting us to return to aspects of our being that are much older
in evolutionary terms: more in tune with the body and its functions, closer to the life of instinct.”
Kitwood, T. 1997. Dementia Reconsidered: The Person comes First. Buckingham: Open University Press.
Attachment Interactions
Dementia Care Matters Butterfly Home
Dementia Care Matters Butterfly Home
24 hour visible and available snacks
Dementia Care Matters Butterfly Home
Behavioral & Psychological Symptoms
Wandering Listless DisengagedDistractedDespairingLow self esteemGriefShameDay dreamyAttention SeekingParanoia
RepetitiveMoodySwitched offAbsent mindedDepressedFrustratedAnxiousAngryFearPanic
SwearingCrying RestlessnessReactivityShutdownWithdrawWorryingIrritabilityAggressionArgumentativeAgitatedShouting
Symptoms of Dementia or traumatic stress? Focus on the individual or the quality of their relationship?