Dementia care

1
South West Dementia Partnership
Further knowledge in dementia part 2
2
Welcome

• Introductions
• Group Agreement
• What will be achieved from this session?

3
Main Talking Points

• Behaviours that challenge us
• Knowledge about the different medications
  available for people with dementia
• Different legislation which effects people with
  dementia
• The importance of working with family and friends
  of people with dementia
• End of life care

4
Behaviours That Challenge Usresponding to
emotional distress expressions of anger
excessive walking

• When a person is showing signs of agitation such
  as
• hitting out at others or
• walking around continuously
• it is important to consider this as a form of
  communication or a response to unmet needs.

5
Check through a number of factors

• What is the environment like? Is this distressing
  the person? Has something significant
  changed/been moved?
• What is going on physically for the person? Eg
  is the person walking in response to the need for
  exercise?
• Is the person in pain?
• Consider what triggers the person may have from
  the past that links with this behaviour

6
Consider what is happening within the
interaction?

• Is the person being
• Ignored
• shouted at
• blamed
• belittled
• spoken to as a child
• ridiculed
• handled insensitively?

7
Be mindful of the experience of the person

• What to do
• Think if there is anything you are doing which is
  making the situation worse?
• Stay Calm
• Allow for space and back away if necessary
• Speak slowly and gently

8
Medication for people with dementia

• ACIs (acetylcholinesterase inhibitors)
• Anti- Psychotics (also known as neuroleptics or
  major tranquillisers)
• What are they?
• When are they used?

9
ACIs (acetylcholinesterase inhibitors)

• Different Types

• What they do

• Help to improve the symptoms of Alzheimers
  Disease.
• May slow down the progression of symptoms,
  delaying deterioration in some people.
• Recommended for people with mild-moderate
  Alzheimers Disease

• Aricept
• (donepezil hydrochloride),
• Exelon
• (rivastigmine)
• Reminyl
• (galantamine)

10
Antipsychotic medication

• Different Types

• What they do

• Haloperidol
• (Haldol, Serenace)
• Olanzapine
• (Zyprexa)
• Quetiapine
• (Seroquel)
• Risperidone
• (Risperdal)

• originally developed and are effective for the
  treatment of people with schizophrenia
• used for the treatment of restlessness in people
  with dementia.
• benefits are very limited over longer periods

11
Side effects of antipsychotic medication

• Drowsiness
• Dizziness and/or the person being unsteady
• Stiffness of the limbs (which can resemble
  Parkinsons disease)
• Risks for some people of strokes particularly
  after being on medication for longer periods

12
Important points relating to anti- psychotic
medication

• The minimum correct dose is prescribed.
• A review date set.
• The person with dementia must be monitored
  regularly for side-effects.
• For people with Lewy Body Dementia it is
  recognised that antipsychotics may be
  particularly dangerous.
• Involving a persons relatives in the decision to
  provide medication where the person is unable to
  consent to the treatment.

13
Case Study

• Mr White has a mixed dementia. He is restless and
• walking around in the evenings.
• What alternatives would you explore before
  considering the use of anti psychotic medication?

14
Different legislation which effects people with
dementia
15
Mental Capacity Act

• A presumption of capacity
• Individuals being supported to make their own
  decisions
• Best interests
• Unwise decisions
• Less restrictive option

16
The Deprivation of Liberty Safeguards (DoLS)

• When a person who has dementia is in a care home
  or a hospital, the hospital or care home will
  need to consider if restrictions are being
  applied when caring for that person.
• If the restrictions are significant, then a
  decision will need to be made by the hospital or
  care home about whether it will be necessary to
  make an application for authorisation to deprive
  the person of their liberty.

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Supporting and working with families and friends
of people with dementia

• For carers of people with dementia there are a
  number of factors which might affect their
  situation
• feeling they have lost their partner, parent or
  friend and experiencing emotions similar to a
  bereavement
• extra financial burden
• an increased risk of mental health problems, in
  particular depression and anxiety

19

• feelings of guilt
• coping with the stigma of dementia
• the reaction and response of others
• coping with changes in the persons ability to
  cope with everyday life
• Consider ways to respond to
• these needs

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End of Life care issues

• Consider any advance care planning
• Link to support for information about Liverpool
  Care Pathway
• Knowledge of pain assessment tools
• Communication skills
• Difficulties with eating/drinking/taking
  medication

22
Final Points

• Focus on stepping across to be with the person
  with dementia in their world.
• Use imagination to improve understanding of the
  persons experience, in the context of their life
  history and their needs.
• Be generous in taking time to try and understand.
  

23
Main Talking Points re-visited Any questions?

• Behaviours that challenge us
• Knowledge about the different medications
  available for people with dementia
• Different legislation which effects people with
  dementia
• The importance of working with family and friends
  of people with dementia
• End of life care