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we help to improve
social care standardsDementia and assisted living technologies
Dementia and assisted living technology
This module is just one of a number of
resources supporting Skills for Care’s
assisted living technologies learning
and development framework.
Dementia and assisted living technology
Use of an image showing a specific product is illustrative only and does not constitute an endorsement of the product or the company who supplied the image.
Welcome, introductions and house
keeping
The Audience
This module will be relevant to members of the social care
workforce, particularly those working with people with
dementia and their carers.
It is particularly relevant to those who wish to know more
about dementia and how ALT can support people to live
happier, safer and more independent lives.
Task 1
In groups spend 5 minutes
discussing why you are here
and your aims for the day.
Aims of today By the end of the module you will;
understand what dementia is and its causes
be able to state the early signs of dementia
be aware of the impact of dementia on the NHS, social care, families and the individual
understand the importance of correct assessment of individuals with dementia and
their carers
be able to identify some of the solutions including assisted living technologies, that
may assist the individual, their families and carers
understand the links between assisted living technologies and the common core
principles for supporting people with dementia.
Task 2
In your groups discuss what
dementia is and write down how
you think it is defined.
Definition of dementia
The term dementia refers to a ‘set of symptoms
including memory loss, mood changes and problems
with communication and reasoning’
Dementia is NOT ‘a natural part of growing old. It is
caused by diseases of the brain, the most common
being Alzheimer's’. Alzheimer’s society, 2012
Alzheimer’s society, 2012
Common core
Principles Principle 1: Know the early signs of dementia.
Principle 2: Early diagnosis of dementia helps people receive
information, support and treatment at the earliest possible stage.
Principle 3: Communicate sensitively to support meaningful interaction.
Principle 4: Promote independence and encourage activity.
Principle 5: Recognise the signs of distress resulting from confusion and respond by
diffusing a person’s anxiety and supporting their understanding of the events they
experience.
Principle 6: Family members and other carers are valued, respected and supported just
like those they care for and are helped to gain access to dementia care advice.
Principle 7: Managers need to take responsibility to ensure members of their team are
trained and well supported to meet the needs of people with dementia.
Principle 8: Work as part of a multi-agency team to support the person with dementia.
Prevalence
Alzheimer’s society
Prevalence
Alzheimer’s society
Task 3
Think about people you know or have
cared for. What excuses do they give when
they forget things and why do you think
they do this?
From your experience and knowledge what
do you think causes dementia?
Causes of dementia
Alzheimer’s disease (62%) – This is the most common cause which involves changes within the
structure of the brain and also a reduction of the chemicals that help transmit messages.
Vascular dementia (17%) – This is considerably less than Alzheimer’s, this is due to reduced
blood supply to parts of the brain. This is often caused by Transient Ischaemic Attacks (TIA’s or
mini strokes) or a Cerebrovascular accident (stoke).
Mixed Dementia (10%) – This is due to combination of the two above.
Dementia with Lewy bodies (4%) – This is much less common and is caused by brain cell
irregularities often causing symptoms commonly seen in Alzheimer's disease and Parkinson’s
disease.
Other causes of dementia (7%) – There are some diseases that have dementia like symptoms
which include, Creutzfeldt-Jakob disease, multiple sclerosis, Huntingdon's disease and Alcohol
related brain damage.
Early signs of dementia One of the core principles for supporting people with dementia is recognising the early signs. These
symptoms may include;
loss or lapses of recent memory
poor concentration
problems communicating
getting lost in familiar places
making mistakes in a previously learned skill (e.g. cookery)
problems telling the time or using money
changes in sleep patterns and appetite
personality changes-the brain does not process images as normal
mood changes or uncharacteristic behavior (in later stages this will become
more pronounced). Adapted from Common core principles for supporting people with dementia (SFC)
Treatment For Dementia
No single treatment has yet been developed that slows, changes or
reverses the progressive decline of brain functions.
There are a number of potential drug and non-drug therapies, that focus
on treating some of the symptoms of dementia.
People with dementia are at an increased risk of physical health problems.
‘For these reasons, high quality support to remain independent and have
the best quality of life are crucial to people with dementia.’
0
5
10
15
20
25
1 2 3 4
£12bn £8bn £5bn £23bn
Task 4Below is a chart displaying four columns 1,2,3 and 4, this represents billions of pounds
spending per year on health and social care for the following conditions – Cancer, heart
disease, dementia and stroke.
Put them in the correct order of spending. Alzheimers Research Trust 2010
0
5
10
15
20
25
Dementia Cancer Heart Disease Stroke
£12bn £8bn £5bn£23bn
How did you do? surprised?
Most of the cost of dementia – £12.4 billion per year - is in
unpaid carers. Social care costs are £9 billion, health care
£1.2 billion and productivity losses £29 million.
Alzheimers Research Trust 2010
Prevalence of Dementia
Around 60% of people with
dementia live at home, with
spouses or family members
acting as carers.
There are suggestions that 30%
of beds on older persons wards
are occupied by those with
dementia
Housing LIN 2012
Carers
In the UK there are 670,000 people acting as main carers for
people with dementia.(Alzheimer's society 2012).
Unpaid caring can be for more than 50 hours per week (NHS
Survey of carers 2009/10).
Carers UK (2010) state that within the next 3 to 4 years the
numbers requiring care will exceed that able to provide unpaid
care.
Task 5
We’ve looked at lots of hard facts about
dementia, but what about the human impact?
Watch this clip and reflect on your thoughts
about it;
http://www.youtube.com/watch?
v=b7ZcbHrJP6o&feature=player_embedded
Risks for people living with dementia in their home.
Falls leading to injury and hypothermia
Fire, flood or harm due to inappropriate use
of household appliances - leaving the cooker on,
leaving taps on
Admitting unwelcome visitors or harassment
Failure to take medications or taking too many
Leaving home at inappropriate times and/or
getting lost.
Risks for people living with dementia in their home.
Many of these problems may be seen as ‘not coping’ or ‘not being safe’ and
may be used as reasons to move the individuals away from own homes to
another place of care.
ALT can assist in decreasing many of these risks and therefore
potentially allow the individual to stay in their own home
environment.
Dementia policy - the role of
Assistive technologyThe National Dementia Strategy was published in 2009 and
makes explicit reference to the potential benefits of telecare....
Three key steps Ensure better knowledge of dementia and remove the stigma Early diagnosis, support and treatment Develop services to meet changing needs better
The needs of people with dementia and their carers should be included in the development of housing options, assistive technology and telecare. As evidence emerges, commissioners should consider the provision of options to prolong independent living and delay reliance on more intensive services.
The Prime Minister’s challenge on
dementia Delivering major improvements
in dementia care and research by 2015: A
report on progress
What are Assisted Living Technologies
(ALT)? Skills for Care define ALT as including;
telecare - the use of technology, including monitors and sensors, to promote
independent living and support to people in need of care to live longer at
home, in homely environments and in their communities
digital participation services – can help people stay connected to their
communities and loved ones. They can enable social interaction and provide
education, entertainment and access to information. Examples might be the
use of social networking sites or video-links to keep in touch with
geographically remote family or friends. By doing so, services can help to
reduce the risks associated with social isolation.
Adapted from Lewin et al 2010 Lewin, D, Adshead S, Glennon B et al (2010) Assisted Living Technologies and Disabled People in 2030. London; Plum Consulting
What are Assisted Living
Technologies (ALT)? Wellness Services – are technologies that support
people to have healthier lifestyles. They can help
people reduce their chances of becoming ill and can
help those with chronic conditions to care for
themselves. Examples might be a smartphone
application to support someone to give up smoking.
Another example might be a piece of wearable
technology that monitors how much exercise someone
does every day to promote greater physical activity.
Adapted from Lewin et al 2010 Lewin, D, Adshead S, Glennon B et al (2010) Assisted Living Technologies and Disabled People in 2030. London; Plum Consulting
Who can use Assisted Living
Technologies (ALT)?
ALT can be used to help people with many different
requirements, needs and goals. For the rest of the workshop,
we will focus on dementia as a condition where ALT can
support the family and carers.
However, for a broader view of the potential benefits of ALT,
please look at the other resources supporting the Skills for
Care learning and development framework.
www.skillsforcare.org.uk/
assistedlivingtechnologyresourcehub
Task 6
Think about people you meet regularly. Have you come
across any ALT, at work or in your home life? Write down
the examples of ALT with reasons why you think they are
used.
If you haven’t had experience of ALT think about the
definition of ALT, can you identify any individuals that may
benefit from such technology?
ALT and dementia ALT generally falls into two categories
Active Devices-
This requires the user to actively make the device work (e.g. a personal alarm)
Passive devices
This device is one that operates without the user activating it themselves (e.g.
a smoke alarm)
It is more likely that an individual with dementia will use the passive
devices.
Benefits that ALT can bring
It can;
promote independence and autonomy, and control
both for the person with dementia and those around
them
help manage potential risks in and around the home
support the individual and carers reducing early entry
into care homes and hospitals
facilitate memory and recall
reduce the stress on carers, improving their quality of
life, and that of the person with dementia.The Alzheimer’s Society, 2012
Using ALT to support memory
ALT can help orientate people to time and place if they are
having memory problems. Examples might be large display
clocks or talking watches.
ALT can also help people from the early stages of dementia
when their memory becomes less reliable. Examples might
include electronic prompts which remind people if they are
expecting visitors or have other appointments.
Using ALT to support taking
medication regularly Memory problems might affect someone’s ability
to remember to take their medication correctly.
There are a range of different ALTs that can
help here, from simple clocks through to more
sophisticated medication dispensers.
Technology used to assess
behaviour Motion sensors can be placed in the home of someone with
dementia. These sensors can provide a record of movement
that provide data for
Assessment: e.g. Is someone up and about at ‘appropriate’
times? What time and how long for?
Monitoring: Family members or carers can monitor
someone’s behaviour and look for patterns.
One system (others are available) is ‘Just Checking’
http://www.justchecking.co.uk/the-system/index.php
Technology to enhance safety in the
home The changes in individuals with dementia may lead to an increased risk of;
fire
flood
natural gas leak due to cookers being left on.
Simple telecare devices can therefore help provide early warning of hazards:
smoke/heat alarms
flood detectors
natural gas alarms.
These devices link to a call response centre who will alert emergency services, the
individuals carers or relatives.
People with dementia are at particular risk of falls and their after-effects;
2-3 times the risk of falling compared with someone without dementia
60-80% of people with dementia will fall at least once every year
risk of sustaining a fracture is 3-4 times greater than a cognitively healthy person
worse outcomes following treatment for fall-related fracture. Harlein et al (2009)
Falls prevention and detection is extremely valuable for people with
dementia: this may include bed sensors or lights sensors.
Falls and people with dementia
Falls prevention and detection
Automatic lightsChair/bed sensors Fall detectors
Darkness can
increase the risk of
falls. Automatic lights
can be installed which
will come on whenever
the person gets out of
bed.
Used to detect falls
quickly, these alert a
monitoring centre (or, if
appropriate, a live-in
carer) if an individual
gets up and does not
return within a defined
period.
Often worn on a belt, if
an individual does fall,
help is summoned
quickly by a monitoring
centre. This can provide
reassurance and
reduce the health risks
associated with falls.Image provided by Tunstall Image provided by Tynetec Image provided by Tynetec
ALT to promote safer walking
People with dementia are at risk of getting lost, falling, or being involved in an
accident when walking outside their place of residence.
ALT interventions which may be useful:
Automatic voice reminders (triggered by movement) not to leave the house
at odd times.
Door sensors that alert a call centre if the door is opened at certain times
(e.g. during the night).
Safe walking systems can be carried or worn by users. These devices –
which can be within mobile phones or watches – include GPS that allows a
person’s position to be located.
ALT and Reminiscence
Aids for reminiscence − There are different multimedia
software available to facilitate conversation and encourage
memories this can be achieved by looking at photographs or
films about how life used to be, and playing familiar music or
favourite songs to the person.
Talking photo albums can also be useful reminiscence aids, this
where a message can be recorded for each photograph. http://www.youtube.com/watch?v=r0nx1g4Dtr4
The Alzheimers society
ICT and dementia SCIE have put together a website
looking at information and
communication technology (ICT)
in activities for people with
dementia.
Aimed at managers and staff in
the care sector, and those who
organise activities for people with
dementia.
The technology can be used to
find pictures, information,
entertainment, keeping in touch
and reminiscence activity.
Technology to promote health in people with dementia
The presence of more than one disease is common in people with dementia.
Some people may benefit from the remote monitoring of vital signs (telemonitoring) but this has not really been evaluated in people with dementia.
Other diseases will include many of the long-term conditions, for example heart failure, chronic obstructive pulmonary disease (COPD).
In addition, medication reminders and dispensers may help with physical disease management.
Case study
Joan, Doris’s daughter noticed 8 months ago that Doris had become
more forgetful than usual and often forgot how to make a cup of tea,
but she put it down to ‘old age and what do you expect when you are
83?’. Whilst Doris was at a routine visit to the GP’s Joan mentioned
the forgetfulness to him and he decided to investigate this. Doris was
eventually diagnosed with Dementia.
Doris is 83 years old, a widow who lives
with her daughter. Doris came to live
with her daughter when Fred her
husband died 3 years ago, as she just
wasn’t coping on her own.
Joan is worried about how she will cope as Doris has
fallen twice in the last month at night when getting up. Joan
has also noticed that her mum is getting up more frequently
during the night and not always knowing why. Joan isn’t
sleeping well as she feels she’s always listening out for her
mum.
Joan works in a charity shop 2 days a week and a busy
social life. She is finding it more difficult to go there as she
is tired and is constantly worrying if her mum is ok? She
has no one else to help as they are at work and have their
own lives. She has stopped going out and contacting her
friends as she feels she is always ‘moaning and has
nothing to talk about’.
On one of the few days that Joan has
managed to go to the charity shop, she
started talking to one of the regular customers to the
shop about her worry that she would have to
give up her work due to concerns regarding her mum.
As luck would have it she had a friend who had a
similar situation and told her that there were things
available to help.
With a new determination Joan decided to make
some enquiries.
After a few phone calls Joan found that there was
quite a lot that would potentially help her mum
and give her piece of mind at night and when
Doris was on her own at home.
Joan and Doris were visited and were assessed
by a nice lady who seemed to understand what
was happening and has told her about some of
the equipment available. Joan began to feel
optimistic about the future.
Other case studies can be seen on the atdementia.org website
Task 7
Having thought about Doris’s
needs, what ALT may be of
benefit to her?
Collaborative care
For an individual to feel safe, secure and as independent
as long as possible collaborative care is a priority.
Collaboration is ‘a relationship between two or more
people, groups or organisations working together to
define and achieve a common purpose’ Hornby and Atkins (2000)
Collaborative care is a key component in the National
Dementia Strategy 2009.
Initial assessment
During the initial assessment, Doris would have been
asked these questions.
What are your goals and aspirations?
What is important to you?
Do you need help with any aspect of your life?
What help you get now?
What extra help you think you may need?
Initial assessment
Things that have to be considered when
assessing the individual is their ability to
consent regarding ALT.
The next section will look at decision making
of an individual with dementia and ALT.
Active decision making
What is active decision making?
It is the process of decision making that keeps
the individual and their family at the centre,
whether it is about the use of ALT or the
introduction of home care, or going into
alternative accommodation either temporarily or
permanently.
Active decision making
The person with dementia should still be involved in making the
decision – we need to find out their views and wishes.
People who know the person well – family, friends and care
staff – should be consulted.
The decisions should where possible limit restrictions placed
on the person.
Active decision making should be underpinned by an
understanding of ethical principles
What do we mean by ethics? At the broadest level, ethics is the
study of people’s moral behaviour
(e.g. Good/evil; right/wrong).
That may sound rather abstract, but
the aspiration to act ‘ethically’ should
underpin everything we do.
To start, we’ll discuss some broad
ethical principles and healthcare
issues, before looking in more detail
at ALT.
Ethics for social care The most commonly used approach is that of Beauchamp and
Childress (2008) which has four principles
Respect for autonomy: Allowing people to make independent
choices.
Beneficence: Acting in a way that benefits others.
Non-maleficence: The principle of doing no harm.
Justice: Ensuring fairness in care e.g. Making sure that
everyone have the same access to care.
Another Key issue that relates to ethics is mental capacity.
Using active decision making keeps all these principles at the
forefront of any intervention.
Task 8
Ethical principles and ALT
For the ethical principle that your group has been allocated,
think about a possible circumstance where ALT
supports that principle
challenges that principle.
Where there are ethical challenges, how can you work along
side the individual and their families to reach a decision? What
might you need to take into account?
Real world’ ethical concerns
‘Big Brother’Reduced human
contactDependence on
technology
Doubts raised over safety of ‘doctor by broadband’Patients could be put at risk by using internet-based equipment to manage their conditions from home, the lead investigator of a nationwide trial into the technology has warned.
Ethical benefits
Quality of life
benefit
Enhanced self-care
and independence
Fairer
distribution of
resource
Supporting ethical practice
Holistic assessment
Informed consent
Privacy and dignity
Robust governance
Guidance on ethics in ALT
The Mental Capacity Act (2005)
The Act states that “...a person
lacks capacity in relation to a matter
if at the material time he is unable to
make a decision for himself in relation
to the matter because of an
impairment of, or a disturbance in the
functioning of, the mind or brain”
The Mental Capacity Act (2005) The definition means that individuals receiving AT with dementia may be
deemed to lack capacity. The brief key principles are:
someone should be considered to have capacity unless it can be shown
that they don’t
everything practicable should be done to help someone make a decision
for themselves before deciding that they lack capacity
nobody should be considered to lack capacity simply because they make
an ‘unwise’ decision
anything done for someone lacking in capacity must be done in their best
interests
when acting on behalf of someone who lacks capacity, we must consider
other ways of achieving goals that are less restrictive of the person's
rights and freedom of action.
Remember
“People with dementia should feel
safe and secure and are able to be
as independent as possible”
Promoting Excellence (2011) NHS education Scotland
In summary
Many people with dementia are happier if they can live in their
own home for as long as possible. Living in familiar
surroundings and maintaining regular routines can be
reassuring and with the right support can often help the person
maintain their independence for a longer period of time.
Much can be done to enable someone with dementia to remain
in their own home, even when their dementia is quite advanced.
However, a person with dementia who is living alone will need
increasing support.
Alzheimer’s society
Aims of today By the end of the module you will;
understand what dementia is and its causes
be able to state the early signs of dementia
be aware of the impact of dementia on the NHS, social care, families
and the individual
understand the importance of correct assessment of individuals with
dementia and their carers
be able to identify some of the solutions including assisted living
technologies, that may assist the individual, their families and carers
understand the links between assisted living technologies and the
common core principles for supporting people with dementia.
Common core Principles Principle 1: Know the early signs of dementia.
Principle 2: Early diagnosis of dementia helps people receive
information, support and treatment at the earliest possible stage.
Principle 3: Communicate sensitively to support meaningful interaction.
Principle 4: Promote independence and encourage activity.
Principle 5: Recognise the signs of distress resulting from confusion and respond by
diffusing a person’s anxiety and supporting their understanding of the events they
experience.
Principle 6: Family members and other carers are valued, respected and supported just
like those they care for and are helped to gain access to dementia care advice.
Principle 7: Managers need to take responsibility to ensure members of their team are
trained and well supported to meet the needs of people with dementia.
Principle 8: Work as part of a multi-agency team to support the person with dementia.
ANY QUESTIONS?
If you wish to find out more regarding dementia
Skills for Care provide a range of modules within their Qualifications and Credit
Framework
DEM 201 Dementia awareness
DEM 202 The person centred approach to the care and support of individuals with dementia
DEM 205 Understand the factors that can influence communication and interaction with
individuals who have dementia
DEM 207 Understand equality, diversity and inclusion in dementia care
DEM 305 Understand the administration of medication to individuals with dementia using a
person centred approach
DEM 308 Understand the role of communication and interactions with individuals who have
dementia
DEM 310 Understand the diversity of individuals with dementia and the importance of
inclusion
If you wish to find out more regarding ALT
Skills for Care’s Assisted Living Technologies
Learning and Development Framework.
There are a number of resources available
that may be of use.
Further reading www.dementia2010.org
Alzheimer's Society Assistive technology May 2011
Housinglin.org.uk- Assistive technology as a means of supporting people with
Dementia: A Review. (2012)
JIT (2010) Telecare and Dementia: Using telecare effectively in support of people with
dementia.
Alzheimer's society (2012) Dementia 2012: A National challenge
MCA - Making decisions A guide for people who work in health and social care
http://www.justice.gov.uk/downloads/protecting-the-vulnerable/mca/opg-603-0409.pdf
SCIE. Using ICT in activities for people with dementia -
http://www.scie.org.uk/publications/ictfordementia/files/ictfordementia.pdf
Further reading
www.skillsforcare.org.uk/assistedlivingtechnologies
www.skillsforcare.org.uk
www.skillsforcare.org.uk/
assistedlivingtechnologyresourcehub
Hornby S and Atkins J (2000) Collaborative care:
interprofessional, interagency and interpersonal.
Oxford: Blackwell publishing
www.skillsforcare.org.uk
