Dementia Care

A Practical Approach

Grahame Smith

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781482245769
• Topic: Medicine
• Subtopic: Health Care Delivery

Dementia is both a personal and a societal challenge. The goal of Dementia Care: A Practical Approach is to focus on how practitioners can meet this challenge with hope and compassion, thereby enabling those with dementia to live well.

The book takes a 'strengths approach' with an emphasis on exploring sustainable strategies. Its content is underpinned by relevant policies and strategies and explicitly links to research evidence while always valuing the voices of those living with dementia.

Covering various dementia strategies, the book provides a clear vision of dementia care delivery and is mapped to the Curriculum for UK Dementia Education. For health care students, the content is also mapped to the requirements of the Health and Care Professions Council and the Nursing and Midwifery Council.

The book includes experiences of people living with dementia, practical examples, self-assessment questions, and key point summaries. It is a valuable resource to practitioners, informal caregivers, families, individuals with dementia or those wanting to know more about the subject.

1	Dementia awareness

SUSAN ASHTON

Aim

Objectives

Overview

Early identification

Assessment

Clinical features

Risk factors

Best practice

Capacity

Chapter summary

Reflection on learning

References

AIM

• To explore what is meant by dementia awareness

OBJECTIVES

• To identify the main types of dementia and their common features

• To demonstrate an understanding of the different types of treatment options

• To understand the role of the nurse when caring for a person with dementia

OVERVIEW

In the United Kingdom there are approximately 820,000 people with dementia. This number is expected to rise as the population ages and physicians become more skilled in diagnosing dementia. Prior to the 1980s it was not uncommon for older people to be admitted to hospital with a preliminary diagnosis of ‘chronic brain failure’ or ‘senile dementia’. Fortunately, as a result of increased interest in dementia by researchers, clinicians and successive governments, both nationally and internationally, there is a recognition that dementia is a complex disease and not just a consequence of growing older. Dementia has been described as a public health priority by the World Health Organisation (WHO, 2012). The WHO (2012) suggested that further improvements are needed to diagnose, offer treatment options and support people and their carers throughout the dementia journey.

There have been numerous reports from the UK government to identify what the health, care and research priorities should be (HM Government, 2007; Department of Health [DH], 2008, 2009a, 2009b). The National Dementia Strategy was launched to focus on what needs to be done from improved diagnosis to end-of-life care to improve the care and treatment of people with dementia (DH, 2009). It acknowledged a lack of appropriate research, care and treatment and called for a ‘transformation’ in the quality of care provided to people with dementia and their families or carers (DH, 2009a).

The education of all health and social care staff is also considered a priority to ensure people with a diagnosis of dementia are cared for in an appropriate and supportive way. NHS England has identified minimum standards of education and training with the Department of Health (DH) to familiarise people and raise awareness with recognising and understanding dementia, to interact with those with dementia, and to be able to signpost patients and carers to appropriate support. The learning outcomes for this training must be:

• Better diagnosis, training and care of those with dementia

• Staff will have a greater awareness and confidence to support patients affected by dementia

• Staff will be able to identify the early symptoms of dementia

• Staff will be aware of the needs of patients affected by dementia and their families and carers to enable them to provide safe, dignified and compassionate care

• General practitioners (GPs) will be able to identify and work with patients affected by dementia

• Staff will be able to signpost patients and carers to appropriate support

• Staff will have raised awareness of the increased likelihood of mental health problems in those with long-term conditions

This chapter utilises a scenario-based approach throughout to explore the issues within a practice context.

Rosie is 75 years old. She has always been described as a bit eccentric. She has never followed the crowd. When she was younger, she travelled the world, usually backpacking and taking different jobs as she went along. Her favourite pastimes have included going to Rolling Stones concerts and riding a motorcycle. She married when she was 30 years old and had one child, Sarah. Sarah died of cancer at the age of 31, so Rosie cared for her only grandchild, Jenna, who was 13 years old at the time of Sarah’s death. Rosie is now 75 and has always been a bit forgetful and easily distracted. When Jenna points out her recent memory losses Rosie just laughs and says, ‘Oh it’s just old age’. Jenna is not convinced, but as long as Rosie is happy and managing her own life she is not too worried.

EARLY IDENTIFICATION

Almost all types of dementia are progressive and incurable. The incidence of dementia is similar in men and women (Alzheimer’s Society, 2011). However because their life expectancy is greater and age is a risk factor in dementia, more women are likely to have dementia. Early identification of symptoms is important if appropriate treatment and information are to be given to patients. The National Institute for Health and Care Excellence (NICE, 2015c) suggests referring people with mild cognitive impairment for assessment to memory assessment services. This is important for people in high-risk groups such as those people with learning disabilities, those with Parkinson’s disease or those who have had a stroke.

Typical symptoms might include (Alzheimer’s Society, 2007):

• Loss of memory. This is more than just forgetting where you left the car keys. This might include forgetting the way home, inability to recognise and handle money, or being unable to remember names and places.

• Mood changes. People with dementia may find it difficult to control their emotions, especially if this area of the brain is affected. They may feel sad, angry, or frightened, which may not necessarily be appropriate to the stimulus (e.g. an irrational fear that someone is going to hurt them).

• Communication problems. People with dementia may find it increasingly difficult to talk, read and write and have difficulty with language (e.g. finding the right words for everyday objects such as chair, coat, toilet).

Although some people may be concerned with their symptoms, they might find it difficult to accept a diagnosis of dementia. Alternatively, some people may find it a relief if their recent behaviour has been out of character and they were unable to understand what was happening to them. General practitioners (GPs) are in a good position to identify some of these symptoms if presented by the patient during a consultation. It may be a family member who has recognised something is wrong and has persuaded the person to seek some medical advice. Accurate diagnosis is important to identify the reason for the symptoms and exclude any other cause of the cognitive or memory problems. For example, depression and delirium can sometimes mimic the symptoms of dementia (Weatherhead & Courtney, 2012).

Dementia is a complex disorder and has an unpredictable disease trajectory (Sampson et al., 2008), therefore a patient is often referred to a specialist memory assessment service or memory clinic which often involves a multidisciplinary team of practitioners such as neurologist, psychiatrist, and mental health nurse practitioner.

Nurses working in memory clinics can provide much-needed support and guidance to patients who have recently been diagnosed with dementia and their carers. Admiral nurses are specialist dementia nurses who work with families affected by dementia (Harrison-Denning, 2013).

We return to the scenario with Rosie:

Jenna has a very close relationship with her grandmother Rosie. Recently Jenna has become more concerned about Rosie’s behaviour. She has always been ‘different and unpredictable’ but recently Rosie has been calling Jenna up in the middle of the night saying someone is in the house and is trying to attack her. Jenna has always responded and found nothing untoward. In the morning Rosie does not remember the incident and seems just like her old self. Over the next few months Rosie’s behaviour continued to be unpredictable and Jenna became more worried. Jenna went to visit Rosie and found the fridge full of broccoli. Rosie just said she liked broccoli and avoided answering any questions on this. Jenna considered taking Rosie to see the GP. One night Rose called Jenna on the telephone screaming that someone was in the house trying to rape her. Jenna quickly went to see Rosie to find no one in the house. However, Rosie appeared confused and disorientated and for a short time did not recognise Jenna. The confusion soon subsided and Rosie settled to sleep. The following day Jenna made an appointment with the GP for Rosie.

ASSESSMENT

Dementia is an umbrella term for a variety of diseases of the brain that are progressive and terminal in nature. Dementia is the term used to describe the symptoms that occur when the brain is affected by certain specific diseases and conditions (Smith & McKenzie, 2011). It is an acquired decline in a range of cognitive abilities (memory, learning, orientation and attention) and intellectual skills (abstraction, judgement, comprehension, language and calculation) accompanied by alterations in personality and behaviour which impair daily functioning social skills and emotional control (Bowie et al., 2004; Phillips, Ajrouch, & Hillcoat-Nalletamby, 2010).

There are potentially 200 different types of dementia. The most common are Alzheimer’s disease, vascular dem...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Welcome
• Contributors
• 1 Dementia awareness
• 2 Social policy and dementia
• 3 Assessment
• 4 Case management
• 5 Risk management
• 6 Living well with dementia
• 7 Living with dementia
• 8 Care and compassion
• 9 Pharmacological interventions
• 10 Psychological interventions in dementia
• 11 Technological approaches
• 12 The environment
• 13 End of life care
• 14 Research
• 15 The way forward
• 16 Conclusion
• Index