Certificate in the Principles of Dementia Care

10 October 2016

Explain what is meant by the term ‘dementia’ Dementia is a broad term used to describe the symptoms that occur when the brain is affected by specific diseases and conditions. Dementia is a progressive disease and the symptoms will get gradually worse. | Q2. Describe how dementia can affect a person if the following areas of the brain are damaged by dementia.

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Area of Brain| How damage to this area might affect a person with dementia| Frontal lobe| * Inability to plan a sequence of complex movements * Loss of spontaneity in interacting with others * Loss of flexibility in thinking * Persistence of a single thought * Inability to focus on a task * Mood changes * Changes in social behaviour * Changes in personality * Difficulty with problem solving * Inability to express language| Parietal lobe| * Inability to attend to more than one object at a time * Inability to name an object * Problems with reading, writing and drawing * Difficulty in distinguishing left from right * Difficulty with doing mathematics * Lack of awareness of certain body parts and/or surrounding space that can lead to difficulties in self-care * Difficulties with eye and hand coordination| Temporal lobe| * Difficulty in recognising familiar faces * Difficulty in understanding spoken words *

Difficulty with identification of, and verbalization about objects * Short term memory loss * Interference with long term memory * Increased and decreased interest in sexual behaviour * Inability to categorise objects * Right lobe damage can cause persistent talking * Increased aggressive behaviour| Occipital lobe| * Defects in vision * Difficulty with locating objects in environment * Difficulty with identifying colours * Hallucinations * Visual agnosia * Difficulties with reading and writing| Cerebellum| * Loss of ability to coordinate fine movements * Loss of ability to walk * Inability to reach out and grab objects * Tremors * Vertigo * Slurred speech| Q3. Explain how the following may be mistaken for dementia: a) DepressionDepression is a condition which is caused by chemical imbalances in the brain. Some of the symptoms common to both Alzheimer’s and depression include: * Loss of interest in once-enjoyable activities and hobbies * Social withdrawal * Memory problems * Sleeping too much or too little * Impaired concentrationb) DeliriumDelirium (also known as acute confusional state) is a medical condition that results in confusion and other disruptions in thinking and behaviour, including changes in perception, attention, mood and activity level. )

Age related memory impairmentAge related memory impairment is a natural part of the ageing process. as people get older, changes occur in all parts of the body, including the brain. As a result, some people may notice that it takes longer to learn new things, they don’t remember information as well as they did, or they lose things like their keys or spectacles. | Q4. Give an outline of the following models of dementia. a) The medical model of dementia. The medical model views dementia as a clinical syndrome which is characterised by cognitive impairment about which nothing can be done. it focuses on the disease and places importance on treating the disease rather than the person. It focuses on the impairment as the problem.

This model seeks to create dependency, restrict choice, disempower, devalue and reinforce stereotypes. The social model of dementia. The social model of dementia focuses on the individual, rather than the disease. It seeks to ensure the person’s skills, capabilities and achievements are retained. The social model of care seeks to understand the emotions and behaviours of the person with dementia by placing him or her in the context of his or her social circumstances and biography. By learning about each person with dementia as an individual, with his or her own history and background, care and support can be designed to be more appropriate to individual needs. | Q5. Explain why it is important to see dementia as a disability.

Often when we think of disability we think about people who are physically disabled, for example we might think about a person who is unable to walk. Dementia however can also be very disabling because the damage to a person’s brain prevents them from doing things they were once able to do. The Equality Act 2010 says that a person has a disability if:• They have a physical or mental impairment• The impairment has a substantial and long-term adverse effect on their ability to perform normal day-to-day activities. So, under the Equality Act a person who is living with dementia is recognised as having a disability. Having dementia can affect many different areas of functioning.

A person with dementia may experience:• Emotional impairment• Physical impairment• Difficulty maintaining relationships• Difficulty maintaining functions of daily living• Communication difficulties. Seeing dementia as a form of disability challenges care workers to adapt their care approach. As with any disability, care workers can work with and around the difficulties and compensate for them in other areas thus preventing further disability. | Q6. List the four most common causes of dementia 1. Alzheimer’s disease2. Vascular dementia3. Dementia with Lewy Bodies4. Fronto-temporal dementia| Q7. Describe the signs and symptoms associated with the four most common causes of dementia 1. In the early stages, the person may be mildly forgetful with lapses of memory, difficulty in finding the right words for everyday objects or mood swings.

As Alzheimer’s progresses, the person may routinely forget recent events, names and faces and have difficulty in understanding what is being said. The person may become confused when handling money and undergo personality changes, appearing to no longer care about those around them. Swings are common and the person may become tearful for no apparent reason, or become convinced that someone is trying to harm them. In advanced cases people may also adopt unsettling behaviour like getting up in the middle of the night or wander off and become lost. Some people lose their inhibitions and sense of what is acceptable behaviour, undress in public or make inappropriate sexual advances.

The person may become incontinent, have difficulty eating and drinking and may become completely dependent on others. 2. Symptoms usually develop suddenly and progress in a step like way where a sudden worsening is followed by a period of stabilisation. Common symptoms include poor concentration and difficulties with communication. memory loss may also lead to confusion. As vascular dementia does not affect all of the brain, the individual may be able to retain more of their abilities and memory loss may not appear until later in the progression of the disease. This means that the individual may be more aware of their deteriorating health and may therefore be more at risk of depression. 3.

Dementia with Lewy Bodies is a progressive disease and individuals may experience: * Problems with attention and alertness * Problems with spatial disorientation * Difficulty with “executive function”, which includes difficulty in planning ahead and coordinating mental activities * Muscle stiffness * Trembling of the limbs * A tendency to shuffle when walking * Loss of facial expression * Changes in the strength and tone of the voice * Hallucinations4. Typically, during the initial stages of Fronto-temporal dementia, the person’s memory is still intact but their personality and their behaviour changes. People with Fronto-temporal dementia may: * Lack insight, and lose the ability to empathise with others.

This can make them appear selfish and unfeeling * Become extrovert when they were previously introverted, or withdrawn when they were previously outgoing * Behave inappropriately – for example: making tactless comments, joking at the wrong moments or being rude * Lose their inhibitions – for example: exhibiting sexual behaviour in public * Become aggressive * Be easily distracted * Develop routines – for example: compulsive rituals| Q8. Outline five factors that could increase the risk of developing one of the four different types of dementia 1. Age is the most significant known risk factor for dementia. the chances of developing dementia increase with age, however, dementia is not a normal part of the ageing process. 2. Gender can play a role as women have a slightly increased risk of developing Alzheimer’s disease.

Vascular dementia on the other hand is more common in men. 3. Genetics. People with a family history of dementia are at greater risk of developing it. 4. Medical history. Specific medical conditions can increase a person’s chances of developing dementia. These include conditions such as Multiple Sclerosis, Huntington’s Disease, Down’s Syndrome, and HIV. Conditions that affect the heart, arteries or blood circulation can particularly increase the risk of a person developing vascular dementia. People who suffer severe or repeated trauma to the head are at a increased risk of developing dementia. 5. Environment and Lifestyle. A person’s lifestyle choices can affect their chances of developing dementia.

This includes a unhealthy diet, high in saturated fats, smoking, excessive alcohol, lack of physical activity or exposure to high amounts of aluminium. | Q9. Identify the prevalence rates for five types of dementia. There are currently 800,000 people with dementia in the UKThis equates to:Alzheimer’s disease = 62% – 496,000Vascular dementia = 17% – 136,000Mixed dementia = 10% – 80,000Dementia with Lewy Bodies – 4% – 32,000Fronto-temporal dementia = 2% – 16,000| Q10. Describe how the following factors can affect an individual’s experience of dementia a) AgeBeing diagnosed with dementia at any age can be devastating, but particularly for people that are diagnosed at a younger age.

Although the symptoms of dementia are similar whatever a person’s age, younger people with dementia may have different needs for example: * Dependent children * Be in work at the time of diagnosis * Have financial commitments, such as a mortgage * Find it more difficult to rationalise losing skills at a young age * Find it more difficult to access information and supportb) Type of dementiaAlzheimer’s is a gradually progressive form of dementia. Over time the person may lose more of their everyday skills and abilities and may eventually be unable to perform the simplest of everyday tasks without encouragement, support and supervision. Vascular dementia tends to affect only specific areas of the brain. his means the individual may be able to retain more of their abilities and memory loss may not appear until later in the progression of the disease. This means that the individual may be more aware of their deteriorating health, and may therefore be at risk of depression. People with Fronto-temporal lobe dementia tend to be less forgetful than people who have Alzheimer’s disease. Their memory tends to remain intact but their personality and behaviour noticeably changes. Dementia with Lewy Bodies interrupts the brain’s normal functioning and affects the person’s memory, concentration and speech skills. It has similar symptoms to Parkinson’s disease such as tremors, slowness of movement and speech difficulties. | Q11. What effect can negative attitudes have on a person with dementia?

Negative attitudes can only serve to further disable people by:Forcing compliancePatronising themStigmatisationNot acknowledging their experiences or feelingsExclusionDenying choiceFailing to promote independenceHumiliating them and failing to promote their self-esteem| Q12. What effect can positive attitudes have on a person with dementia? Positive attitudes are empowering, enabling and can help people with dementia feel good about themselves through feeling valued and respected and being given consideration to their perspective, feelings, emotions and choices. | Unit 2. Q1. Describe what is meant by a person centred approach to dementia care.

Person-centred care places the person, and not their dementia, at the centre of their care. The needs and emotions of each individual are the focal point around which everything else is geared. Person-centred care is based on the principles of holistic care. This means that it considers the whole person, meeting the person’s whole needs, and not just their physical needs. These needs include love, comfort, identity, occupation, inclusion and attachment. We all share these needs but people with dementia require greater support from others in order to meet them. | Q2. Outline the benefits of working in a person-centred way for the individual, staff and the organisation.

Individual * Promotes autonomy * Promotes choice * Builds a relationship which is based on trust and respect * Provides a sense of hope * Acknowledges recognition of the individual * Enables remaining abilities to be used * Gives the individual a sense of purpose * Empowers the individual * Improved sense of well-being * Promotes a positive healthcare experience * Reduces levels of anxietyStaff * Staff members are more comfortable caring for people they know * They form a strong partnership with individual’s and their families * They know a person’s preferences, can anticipate a person’s needs and can adapt care accordingly * Staff are highly valued in person-centred care organisations * They work more efficiently in person-centred care environments and can devote time where it is most needed.

Organisation * The organisation is likely to have better quality outcomes due to the ability of staff to identify and respond appropriately to changes in service user’s condition * The organisation is likely to gain referrals from people who have a good experience and recommend the care setting to others as a place of care * The organisation is likely to have better staff retention due to a strong relationship between staff and service users. | Q3. Describe the role that carers can have in the care and support of people who have dementia A carer’s role includes helping the person with some or all of the activities of daily living, from intimate personal care to housework; supporting the person in meaningful occupation; providing constant reassurance where the person fears being alone; helping with, or managing, financial and legal matters; providing emotional, and many other, forms of support.

Caring and supporting for someone with dementia involves dealing with a lot of change and can be stressful. It can take time to adapt as carers face changes around roles, work, finances and lifestyle. | Q4. Explain the benefits of developing a personal relationship with carers. Developing working relationships with carers has many benefits, including: * Increased cooperation * Mutual respect * Coordinated services * Trust * Improved communication * Willingness to exchange and share information relating to the individual * Consistent approach to care * Reduced likelihood of stress * And improvements in sense of well-being| Q5.

Describe the roles of ten types of health and social care professionals who may be involved in the support of people with dementia 1. Neurologists are specialist doctors, who specialise in nervous system disorders, including conditions of the brain. 2. Geriatricians are doctors who specialise in the care of older people3. Clinical psychologists are specialists in the behavioural and mental functions of the brain4. Nurses work with people who have dementia and those who care for them in a variety of roles5. Physiotherapists can advise on exercise for people at all stages of dementia. They can also advise carers on safe ways of helping someone to move. 6.

Speech and language therapists can advise someone with dementia, and their carer, on ways of communicating more effectively and on relieving any swallowing difficulties. 7. Domiciliary carers, also known as home carers, provide care in the individual’s own home. it involves help with personal care and household tasks for the frail or those with long term care needs. Domiciliary care makes it possible for service users to remain in their own home, rather than use residential or nursing care homes, enabling them to maintain comfort and personal independence within their local community. 8. Day care provides care for a person during the day. it is provided away from the person’s home and transport is usually arranged as part of the service.

Day care offers benefits, both to the person that receives it, and to any carers who look after them. 9. District or community nurses are members of the primary care team. They have extra training and provide advice and care for people at home and carry out various tests and assessments. 10. Independent Advocates provide important support to individuals who may need or want help in speaking up, getting involved in their own care or accessing services. | Q6. Give three examples to explain when it might be necessary to refer to others when supporting individuals with dementia 1. Being unable to meet the needs of the person with dementia2. The individual’s condition deteriorates3. The carers physical and mental health is at risk. | Q7.

Explain how you could access additional support from other agencies when supporting individuals who have dementia. Information on what is available locally can usually be obtained from the individual’s G. P. or their local authority Social Services department. Local authority Social Services departments are the main providers of care and support services. If a person with dementia or there carer is in need of support they should contact the local social services department to explain. The department will then carry out an assessment of the person’s needs and identify what services should be appropriate to meet those needs. this is known as a community care assessment.

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