Caring for a patient with Dementia Essential Care for Health Care Assistants Clinical Update Study Day Clare Prout Ref: NICE-SCIE Guideline.

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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