Behaviours that challenge us: part 1Behaviours that challenge us: part 1South West Dementia Partnership Further knowledge in dementia part 1

Welcome

Introductions

Group Agreement

What will be achieved from this session?

South West Dementia Partnership Further knowledge in dementia part 1

Main Talking Points

Key theoretical issues and background when considering behaviours that challenge us.

Generalised solutions and tools to help when supporting someone with dementia and minimising distressful behaviours and situations.

South West Dementia Partnership Further knowledge in dementia part 1

Defining behaviours that challenge us

Angry (aggressive) behaviour. Excessive walking (wandering behaviour). Repetitive behaviours. Vocally disruptive behaviours Sexual expressive behaviours

Identify examples of these

South West Dementia Partnership Further knowledge in dementia part 1

A bio-psychosocial approach

a person’s behaviour is the result of the interactions between:

biological aspects, psychological and social environment.

taking an ‘inquiring’ approach to discovering helpful approaches.

South West Dementia Partnership Further knowledge in dementia part 1

Physical needs and physical health Maslow’s (1943) ‘hierarchy of needs’ is often

portrayed in the shape of a pyramid, with the most fundamental level of needs at the bottom. This first layer is sometimes referred to as ‘physical’ or ‘physiological’.

Air, water, and food are requirements for survival in all animals, including humans.

South West Dementia Partnership Further knowledge in dementia part 1

South West Dementia Partnership Further knowledge in dementia part 1

South West Dementia Partnership Further knowledge in dementia part 1

Essential physical needs

When a person has dementia their ability to meet these needs becomes increasingly dependent on the support of others.

Maintaining a person’s essential physical needs requires a high degree of observation and imagination on the part of those providing support.

Powell J (2007) Difficulties in understanding With permission

Psychological & Social Needs

South West Dementia Partnership Further knowledge in dementia part 1

Malignant Social Psychology

Disempowerment Objectification Invalidation. Infantilisation Impact of interpersonal interactions: What

happens within an interaction has an enormous effect on how a person feels.

South West Dementia Partnership Further knowledge in dementia part 1

 Changes to information processing and emotional responses

Influence of Personality People with dementia retain the essence of their personality however personality traits may become exaggerated.

Neurological Impairment Changes to information processing and emotional

responses Feeling + Thinking = Behaviour Or (Amygdala + Frontal Lobe= Behaviour)South West Dementia Partnership Further knowledge in dementia part 1

South West Dementia Partnership Further knowledge in dementia part 1

Delirium, hallucinations and delusions

National Institute for Health and Clinical Excellence describes delirium as a ‘disturbance of consciousness or perception and confusion’.

A hallucination is an experience of any of the 5 senses that appears to the person experiencing it as real, but that reality is not shared by others.

A delusion is a belief that a person holds, despite evidence to the contrary, and is resistant to all reason.

South West Dementia Partnership Further knowledge in dementia part 1

Impact of the environment :

South West Dementia Partnership Further knowledge in dementia part 1

Considering the impact of the environment and noise (Powell 2007) With permission

Verbal communication

Lighting/Heating Lack of signs Poor layout of a room which does not allow for

moving around Number of people in a room Changes in routine, rushing. Lack of ‘comfort cues’

South West Dementia Partnership Further knowledge in dementia part 1

General ways of helping

Communication Life history Environment Observation tools Validation Therapy Working with families and friends - Relational

approach Medication

South West Dementia Partnership Further knowledge in dementia part 1

Communication

Upholding a person’s well being. This can be done by: Connecting with the person at any opportunity and

when engaging in any care tasks. Talking to the person in a way that is appropriate for

their age and status. Talking calmly and with empathy when a person with

dementia is having difficulties.

South West Dementia Partnership Further knowledge in dementia part 1

Life history In workbook 1 (chapter 7) and workbook 2 (chapter 5)

the importance of life history work was discussed. Finding out about a person may need exploring in an ongoing way rather than a ‘task’ to be completed in a ‘session’.

Some of the ideas as to what to include can be to use specific formats. For example the ‘Clipper Questionnaire’ by purchasing Jennie Powell (2007) Care to Communicate or gathering information using headers from a variety of sources for example the Alzheimer’s Society ‘This is Me’ format.

South West Dementia Partnership Further knowledge in dementia part 1

Environment When thinking about having a positive environment for a

person it is essential to consider a variety of factors: What are the person’s past wishes and preferences

regarding spending time in company? What is the person’s present response to being with

others? Are individual comfort cues available for the person such

as favourite pieces of furniture/blankets?

.

South West Dementia Partnership Further knowledge in dementia part 1

Environment What objects are available to touch/hold that might be

engaging /comforting What is the background noise and how is the person

responding to this? Are there opportunities for the person to move around

should they wish? Are there clear signs to direct the person to the toilet? Is there the opportunity for the person to access food

and/or drinks?

South West Dementia Partnership Further knowledge in dementia part 1

Observation tools There are various different observational tools with

the most recognised being Dementia Care Mapping (DCM) and SOFI (Short Observational Framework for Inspection).

DCM is an observational tool which provides a format for observing and recording life through the eyes of a person with dementia.

Also a new Person, Interaction, Environment (PIE) observational method is being piloted for use in general hospital wards.

South West Dementia Partnership Further knowledge in dementia part 1

Validation Therapy In the 1960s Naomi Feil, developed an approach

which she named ‘validation therapy’ Using validation is to hold less regard for the content

of a person’s speech for example the facts of what is said, and instead to link with how a person may feel through a person’s tone of voice and their body language.

This is widely used today in the field of dementia

South West Dementia Partnership Further knowledge in dementia part 1

Working with families and friends - Relational approach When a person has dementia it has an effect on all

members of the person’s family and friends. Working closely with a person’s relatives and friends

is therefore vital. Sometimes this is described as a ‘Relational

Approach’. Identify ways to engage positively with a person’s

relatives and friends

South West Dementia Partnership Further knowledge in dementia part 1

MedicationAnti-Psychotics There has been much focus on how and when anti

psychotic medication for people with dementia is used. Several studies have highlighted concern and indicated significant risks relating to their use.

There have been many non pharmacological interventions described throughout this workbook. You will remember that anti psychotic medication should be used only once all other non pharmacological interventions have been considered.

South West Dementia Partnership Further knowledge in dementia part 1

MedicationAnti-Psychotics Antipsychotics such as Haloperidol, Olanzapine and

Risperidone should only be considered once all other possible approaches have been tried.

Identify the risks and assess against the benefits. Start with a low dose. Set a review date.

South West Dementia Partnership Further knowledge in dementia part 1

Medication: Acetylcholinesterase (AchE) Medication and Memantine

These medications do not ‘cure’ dementia but in certain cases can help to slow down the rate of progression of the illness.

In March 2011 the review and re-appraisal of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease resulted in a change in the guidance.

South West Dementia Partnership Further knowledge in dementia part 1

Medication: Acetylcholinesterase (AchE) Medication and Memantine

Donepezil, galantamine and rivastigmine are recommended as options for managing mild as well as moderate Alzheimer’s disease, and

Memantine is recommended as an option for managing moderate Alzheimer’s disease for people who cannot take donepezil, galantamine or rivastigmine and as an option for the later stages of Alzheimer’s disease

South West Dementia Partnership Further knowledge in dementia part 1

Main Talking Points re-visited: Any questions?

Key theoretical issues and background when considering behaviours that challenge us.

Generalised solutions and tools to help when supporting someone with dementia and minimising distressful behaviours and situations.

South West Dementia Partnership Further knowledge in dementia part 1