Working with Adults;Dementia

Ian Mathews

Senior Lecturer in Social Work

What is (senile) dementia?‘Dementia’ is an umbrella term ~ there are over ? different types of

dementia

NB the power of language;Senile dementiaAlzheimer’s (disease)Cognitive impairment

• Dementia with Lewy body• Multi infarct dementia/Vascular disease

• Alcohol related dementia (Korsakoff’s syndrome)• Huntington’s disease• Creutzfeldt-Jakob Disease (CJD) ~bovine spongiform

encephalopathy (BSE), a form of prion disease affecting cattle.

Some of the characteristics of dementia

• Memory impairment; particularly short term memory loss

• Language impairment• Disorientation in time & space

( ‘wandering’)• Changes in personality• Mood changes• Self neglect• Disinhibited behaviour Eg

uncharacteristic sexual or aggressive behaviour

• The ability to ‘reason’ or to plan ahead

NSF for older people, DOH 2001

• How can you diagnose dementia?

• What are the causes of dementia?

• How can you treat dementia?

Keady & Nolan (1995) stage model of dementia

Slipping; minor lapses in memory & behaviourSuspecting; people & those around them suspect that

something is wrongCovering up; conscious & deliberate attempts to

compensate for loss of functionRevealing; difficulties shared with those closest tot eh

individualConfirming; acknowledgement, followed by diagnosisMaximising; strategies devised to maximise functioningDisorganisation; cognitive & physical difficulties become

increasingly apparentDecline; needs increase & residential care may be requiredDeath;

The incidence of dementia

• There are currently 700,000 people with dementia in the UK. • There are currently 15,000 younger people with dementia in the UK. • There will be over a million people with dementia by 2025. • Two thirds of people with dementia are women. • 60,000 deaths a year are directly attributable to dementia. • The financial cost of dementia to the UK is over £17 billion a year. • 64% of people living in care homes have a form of dementia. • Two thirds of people with dementia live in the community while one

third live in a care home.

www.alzheimers.org.uk

The prevalence of dementia

Age

40 – 65

65 -70

70 – 80

80 plus

Crawford & Walker (2005 p 72)

Prevalence

1 in 1,000

1 in 50

1 in 20

1 in 5

Living well with dementia;The National Dementia Strategy

DOH 2009A five year plan backed with £150 million over the first two years

Has three main aims;1. Ensure better knowledge about dementia & remove the stigma; for professionals &

public;

• people currently wait up to three years before reporting symptoms of dementia to their doctor;

• 70% of carers report being unaware of the symptoms of dementia before diagnosis;

• 64% of carers report being in denial about their relative having the illness;

• 58% of carers believe the symptoms to be just part of ageing;

• only 31% of GPs believe they have received sufficient basic and post-qualification training to diagnose and manage dementia

( DOH 2009:26)

Aim 2. Ensure early diagnosis, support & treatment for people with dementia, their family & carers

Positive about prevention in dementia – what’s good for your heart is good for your head

• The current evidence base suggests that up to 50% of dementia cases may have a vascular component (ie vascular dementia or mixed dementia). This holds out the possibility of preventing or minimising dementia by means of promoting better cerebrovascular health.

• Current health promotion messages on diet and lifestyle and actions such as health checks are therefore likely to have a positive effect.

(DOH 2009:24)

Aim 2 contd- Ensure early diagnosis, support & treatment for people with dementia, their family & carers

• early provision of support at home can decrease institutionalisation by 22%

• even in complex cases, where the control group is served by a highly skilled mental health team, case management can reduce admission to care homes by 6%;

• older people’s mental health services can help with behavioural disturbance, hallucinations and depression in dementia, reducing the need for institutional care

Aim 3 - Develop services to meet changing needs

• Appointment of dementia advisors• Development of carers groups & innovative

services ( ‘dementia cafes, dementia choirs,• Improve ‘Community personal support

services’• Emphasise the benefits of personalisation for

people with dementia ( individual budgets)• Provision of respite care & ‘Intermediate care’

The concept of ‘personhood’

• To be counted as a person, and so have ‘personhood’, some people think an individual should have qualities like insight, rationality and memory.

• Discuss!(Killick J & Allan K

2001:17)

Malignant social psychologyKitwood T (1997)

• Disempowerment: Not letting someone do what they are capable of doing.

• Treachery: Tricking someone into taking medication by hiding it in food

• Infantilization: Talking to them like a baby

• Intimidation: Making someone frightened

• Labelling: Using their diagnosis as the main way of understanding their behaviour

• Stigmatizing: treating someone as an outcast

• Outpacing: Talking, giving information, and providing choices too quickly, so the person can’t keep up.

Malignant social psychology

• Invalidation: Not taking the persons feelings seriously

• Ignoring: Talking over their head, not including them

• Withholding: Not giving the attention they need

• Disruption: Breaking into a persons conversation or activity rudely, stopping them carrying on with whatever they were doing.

• Mockery: Making fun of people

• Disparagement: Saying critical things about someone, which will damage their self esteem.

• Imposition: Forcing someone to do something, not giving choices.

ReferencesCrawford K & Walker J (2005) Social work with older people, Exeter,

Learning MattersDepartment of Health (2001) National Service Framework for older

peopleDepartment of Health (2009) ‘Living well with dementia’ the National

Dementia StrategyKeady, J., & Nolan, M( 1995) Assessing coping responses in the early

stages of dementia, British Journal of Nursing, 4, 309-14Killick J & Allan K (2001) Communication and the care of people with

dementia, Buckingham, Open University pressKitwood T, (1997) ‘Dementia reconsidered; the person comes first’,

Buckingham, Open University press