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Session 2Session 2Principles of person centred dementia care
“Getting to Know Me”Enhancing Skills in the Care of People with Dementia
2.1
Aims
To present a holistic understanding of dementia indicating the range of factors that may impact on a person’s experience of dementia
2.2
Enriched model of dementia
Experience of dementia =
Neurological impairment +
Health +
Personality +
Biography / life story +
Social (and physical) environment
(adapted from: Kitwood 1997)
2.3
Neurological ImpairmentNeurological Impairment
2.4
Brain and behaviour:• People with dementia will be affected in different ways.
Cognitive damage may give rise to a wide variety of impairments including (amongst many other things):
• Impaired memory: often short-term affected first...• Apraxia – problems with purposeful actions...• Aphasia – speech and language impaired...• Agnosia – recognition of things, words, people etc...• Visuospatial dysfunction – depth perception...• Regulation of behaviour – disinhibition...• Impaired motivation – difficulty initiating actions...• Perseveration – becoming “stuck” in an activity...• More information is available on the Alzheimer’s Australia
DVD ‘Understanding the brain and behaviour’ (2004)
2.5
Health
• Physical and mental health can have a significant impact on well-being• People with dementia are at a greater risk of delirium
(acute confusion)• People with dementia are also at a greater risk of
depression than the wider population• Sensory loss e.g. sight and hearing may exacerbate
communication difficulties or disorientation• Pain is often poorly detected in people with dementia• As dementia becomes advanced people experience
losses to physical function
2.6
Delirium• Delirium (or acute confusional state) is characterised by
disturbed consciousness and cognitive function or perception, it often has a rapid onset and a fluctuating course.
• It may be caused by any acute physical illness (e.g. urine or chest infections) or drugs (e.g. opiates) and is a serious medical condition.
• Delirium can be hypoactive or hyperactive but some people show signs of both (mixed). Hypoactive and mixed delirium can be more difficult to recognise.
• It is imperative to rapidly identify and treat the underlying cause.
(NICE Clinical Guideline 103,2010)
2.7
Personality
• All of us are different...
• Who we are and the kind of person we are can have a great impact on how we might respond to having dementia and to the support and care we may (or may not) receive...
2.8
Biography/life history
• Our lives and our personal histories are unique to us all
• As more recent memory becomes impaired, events from long ago may become confused with present experience.
• Knowledge of a person and their past may aid understanding of puzzling behaviours and language
• As longer term memory can be a strength for people with dementia reminiscing can be a positive experience
2.9
Social environment
• Autonomy, dignity, participation, control, opportunities for purposeful occupation and leisure are all vital to our personhood
• People with dementia can be disabled by poor or impoverished social environments
• The quality of individualised care, communication and emotional support experienced by people in hospitals will have a significant impact on well-being and function
2.10
Physical environment
Physical environments may contribute to enabling or further disabling people with dementia
The hospital environment may be very disabling to a person with dementia
(We will explore the physical setting in another session)
2.11
What can we influence?
Neurological impairment ? +
Health? +
Personality ? +
Biography / life story ? +
Social (and physical) environment ?
2.12
Person with DEMENTIA
PERSON with dementia
2.13
References:
Brooker, D (2007) Person-Centred Dementia Care: making services better. London. Jessica Kingsley
Kitwood, T (1997) Dementia Reconsidered: the person comes first. Open University Press
NICE (2010) Delirium, diagnosis, prevention and management. Clinical Guideline 103 for people with dementia
2.14
