“Getting to Know Me” “Getting to Know Me” Enhancing skills in the care of people with dementia in general hospitals. © Greater Manchester West Mental Health

““Getting to Know MeGetting to Know Me””Enhancing skills in the care of people with dementia in general hospitals

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© Greater Manchester West Mental Health NHS Foundation Trust

Session 1: ◦ Dementia, an introduction

Session 2: ◦ Principles of person centred dementia care

Session 3:◦ Communication

Session 4: ◦ The hospital environment and its impact on people with dementia

Session 5: ◦ Opportunities for meaningful occupation and valuing the expertise of

friends and family Session 6:

◦ Understanding and responding to behaviours that challenge

Programme

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Over the four sessions we will be showing clips from a DVD showing Ann and Mike who both have a diagnosis of dementia, and Brian who cared for his wife who had dementia.

Ann, Mike and Brian live in the Greater Manchester region and they will be sharing their experiences of living with dementia and their reflections on care for people with dementia in hospitals

DVD

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Session 1Session 1

Dementia: an introduction

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“Getting to Know Me”Enhancing Skills in the Care of People with Dementia in General Hospitals

To reflect on the lived experience of dementia in the hospital setting

To be able to define what dementia is

To be aware of the main causes of dementia and the key features of these

To consider signs and detection/diagnosis of dementia in hospital

Aims:

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Imagine…• You are sat in unfamiliar clothing, beside a bed in a room with 3 other

beds and lockers, you think it might be a hospital but it is strange and unfamiliar...

• You cannot recall how you got here ...• You don’t know what is about to happen, but you have a sense of

dread...• The smells, noises, sights and people – those who appear ill and

those in uniform moving about with purpose – are all puzzling and unsettling...

• You recognise no-one...• You are hungry and thirsty...• Occasionally, you summon the courage to call out to people who walk

close by. Many ignore you, those who stop and speak to you talk quickly in a language you can make no sense of, and then they swiftly depart...

• When you get up your movements are unexpectedly slow and laboured...

• Finally, when you try to seek a way out of this strange and unfamiliar place, a person in a uniform prevents you leaving…

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What will you be thinking...?

What will you be feeling...?

What will you want to happen/who will you want to see?

What might you do...?

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By 2025 one million people in the UK will have dementia…

Who is affected?

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There are over 750,000 people in the UK with dementia

There will be over a million people with dementia by 2021

The proportion of people with dementia doubles for every 5 year age group

One third of people over 95 have dementia Women make up two-thirds of all people with

dementia Only 40% of people with dementia receive a

diagnosisSource: Alzheimer’s Society 2011

Facts and figures

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“A typical general hospital of 500 beds on an average day…” will be occupied by:

◦ People with a depression 96 beds◦ People with a delirium 66 beds◦ People with dementia 102 beds

Royal College of Psychiatrists (2005)

Prevalence of dementia in general hospitals

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Good quality early diagnosis and intervention for all

Improved quality of care in general hospitals

Living well with dementia in care homes Reduced use of anti-psychotic medication

National Dementia Strategy:Priority Objectives

Department of Health (2010)

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Increased length of stay Higher mortality More likely to move into institutionalised

care

National Dementia Strategy 2009

Outcomes for people with dementia

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“A collection of symptoms, including a decline in memory, reasoning and communication

skills, and a gradual loss of the skills needed to carry out daily activities.

These symptoms are caused by structural and

chemical changes in the brain as a result of physical diseases such as Alzheimer’s

Disease”

Alzheimer’s Society (2007) Dementia UK

What is dementia?

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Causes of dementia

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Mixed (AD and VaD)

Other causes

Fronto-temporal lobe demenitia

Lewy body dementia

Vascular dementia

Alzheimer’sdisease

Dementia

62%

17%

4%

5%

10%

2%Dementia UK 2007

Causes of dementia

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Alzheimer’s disease

How it affects the brain:

◦ Plaques and tangles

◦ Depletion of important neuro-transmitter brain chemicals

◦ Atrophy of affected regions of the brain

◦ Gradual, persistent decline in cognitive functioning

Difficulties experienced:

• Gradual onset

• Memory loss

• Word finding difficulties

• Recognition difficulties

• Disorientation

• Increasing problems with everyday tasks

• Changes to mood

• Other…

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Vascular dementia


◦ Disease to blood vessels depriving areas of the brain of oxygen

◦ May arise from infarcts affecting larger vessels or from small vessels disease

◦ Often co-exists with Alzheimer’s disease


Onset can be abrupt Step-like progression Losses similar to

Alzheimer’s but some abilities may remain intact

There may be more unpredictability re changeable mood and behaviour

People may have greater levels of self-awareness

Small vessel disease can affect walking

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Lewy Body Dementia


◦ Protein deposits occurring in nerve cells in areas of the brain

◦ Accounts for about 4%* of all dementias in England

◦ On the same spectrum to Parkinson’s disease with dementia

*Alzheimer’s Society (2007)


• Fluctuating episodes of lucidity and confusion

• Auditory and visual hallucinations

• Parkinsonian symptoms are likely

• People are more prone to falls• Disturbed nights with

nightmares and hallucinations may be present

• Sensitivity to neuroleptic/anti-psychotic medications

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Fronto-temporal dementia

Includes:

◦ Frontotemporal lobar degeneration (FTLD) or Behavioural Variant FTLD or Pick’s disease

◦ Progressive non-fluent aphasia (PNFA) or primary progressive aphasia (PPA)

◦ Semantic dementia (SD)

How it affects the brain: • Damage to frontal and

temporal lobes

• Predominantly affects people under 65

• 30-50% of people may have a family history

Adapted from Rohrer et al PDSG (2009}

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Fronto-temporal dementia

Difficluties experienced may include:

◦ Apathy

◦ Changes to personality

◦ Obsessive compulsive behaviours

◦ Disinhibition

◦ Difficulties with language (PNFA)

◦ Loss of knowledge of word meanings (SD)

Adapted from Rohrer et al PDSG 2009

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Identifying dementia• 50% of dementia in hospitals is undiagnosed (NHS Confederation,

2010)

• Delirium (acute confusion) and depression are also common in older people in hospital.

• A diagnosis of dementia should be made only after a comprehensive assessment, which should include:– history taking– cognitive and mental state examination– physical examination and other appropriate investigations including blood

tests– a review of medication

• Other tests may include:– Structural imaging – CT and MRI– Neuropsychological testing

• People assessed for the possibility of dementia should be asked if they wish to know the diagnosis and with whom they wish the diagnosis to be shared

(NICE/SCIE Dementia Guidelines)

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Ann, Mike and Brian...

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Alzheimer’s Society (2007) Dementia UK Department of Health 2010 Quality outcomes for people with dementia:

Building on the work of the National Dementia Strategy

Department of Health (2009) Living well with dementia: A National Dementia Strategy

NICE/SCIE Dementia Guidelines (2006)

NHS Confederation 2010 Acute awareness: improving hospital care

Roherer, J & Warren, J. Frontotemporal dementia (on-line) http://pdsg.org.uk/clinical_information (Accessed on 22 March 2011)

Royal College of Psychiatrists (2005) Who Cares Wins

References:

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Documents

“Getting to Know Me” “Getting to Know Me” Enhancing skills in the care of people with dementia in general hospitals. © Greater Manchester West Mental Health