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Working with Adults; Dementia. Ian Mathews Senior Lecturer in Social Work. What is (senile) dementia?. ‘Dementia’ is an umbrella term ~ there are over ? different types of dementia NB the power of language; Senile dementia Alzheimer’s (disease) Cognitive impairment Dementia with Lewy body - PowerPoint PPT Presentation
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Working with Adults;Dementia
Ian Mathews
Senior Lecturer in Social Work
What is (senile) dementia?‘Dementia’ is an umbrella term ~ there are over ? different types of
dementia
NB the power of language;Senile dementiaAlzheimer’s (disease)Cognitive impairment
• Dementia with Lewy body• Multi infarct dementia/Vascular disease
• Alcohol related dementia (Korsakoff’s syndrome)• Huntington’s disease• Creutzfeldt-Jakob Disease (CJD) ~bovine spongiform
encephalopathy (BSE), a form of prion disease affecting cattle.
Some of the characteristics of dementia
• Memory impairment; particularly short term memory loss
• Language impairment• Disorientation in time & space
( ‘wandering’)• Changes in personality• Mood changes• Self neglect• Disinhibited behaviour Eg
uncharacteristic sexual or aggressive behaviour
• The ability to ‘reason’ or to plan ahead
NSF for older people, DOH 2001
• How can you diagnose dementia?
• What are the causes of dementia?
• How can you treat dementia?
Keady & Nolan (1995) stage model of dementia
Slipping; minor lapses in memory & behaviourSuspecting; people & those around them suspect that
something is wrongCovering up; conscious & deliberate attempts to
compensate for loss of functionRevealing; difficulties shared with those closest tot eh
individualConfirming; acknowledgement, followed by diagnosisMaximising; strategies devised to maximise functioningDisorganisation; cognitive & physical difficulties become
increasingly apparentDecline; needs increase & residential care may be requiredDeath;
The incidence of dementia
• There are currently 700,000 people with dementia in the UK. • There are currently 15,000 younger people with dementia in the UK. • There will be over a million people with dementia by 2025. • Two thirds of people with dementia are women. • 60,000 deaths a year are directly attributable to dementia. • The financial cost of dementia to the UK is over £17 billion a year. • 64% of people living in care homes have a form of dementia. • Two thirds of people with dementia live in the community while one
third live in a care home.
www.alzheimers.org.uk
The prevalence of dementia
Age
40 – 65
65 -70
70 – 80
80 plus
Crawford & Walker (2005 p 72)
Prevalence
1 in 1,000
1 in 50
1 in 20
1 in 5
Living well with dementia;The National Dementia Strategy
DOH 2009A five year plan backed with £150 million over the first two years
Has three main aims;1. Ensure better knowledge about dementia & remove the stigma; for professionals &
public;
• people currently wait up to three years before reporting symptoms of dementia to their doctor;
• 70% of carers report being unaware of the symptoms of dementia before diagnosis;
• 64% of carers report being in denial about their relative having the illness;
• 58% of carers believe the symptoms to be just part of ageing;
• only 31% of GPs believe they have received sufficient basic and post-qualification training to diagnose and manage dementia
( DOH 2009:26)
Aim 2. Ensure early diagnosis, support & treatment for people with dementia, their family & carers
Positive about prevention in dementia – what’s good for your heart is good for your head
• The current evidence base suggests that up to 50% of dementia cases may have a vascular component (ie vascular dementia or mixed dementia). This holds out the possibility of preventing or minimising dementia by means of promoting better cerebrovascular health.
• Current health promotion messages on diet and lifestyle and actions such as health checks are therefore likely to have a positive effect.
(DOH 2009:24)
Aim 2 contd- Ensure early diagnosis, support & treatment for people with dementia, their family & carers
• early provision of support at home can decrease institutionalisation by 22%
• even in complex cases, where the control group is served by a highly skilled mental health team, case management can reduce admission to care homes by 6%;
• older people’s mental health services can help with behavioural disturbance, hallucinations and depression in dementia, reducing the need for institutional care
Aim 3 - Develop services to meet changing needs
• Appointment of dementia advisors• Development of carers groups & innovative
services ( ‘dementia cafes, dementia choirs,• Improve ‘Community personal support
services’• Emphasise the benefits of personalisation for
people with dementia ( individual budgets)• Provision of respite care & ‘Intermediate care’
The concept of ‘personhood’
• To be counted as a person, and so have ‘personhood’, some people think an individual should have qualities like insight, rationality and memory.
• Discuss!(Killick J & Allan K
2001:17)
Malignant social psychologyKitwood T (1997)
• Disempowerment: Not letting someone do what they are capable of doing.
• Treachery: Tricking someone into taking medication by hiding it in food
• Infantilization: Talking to them like a baby
• Intimidation: Making someone frightened
• Labelling: Using their diagnosis as the main way of understanding their behaviour
• Stigmatizing: treating someone as an outcast
• Outpacing: Talking, giving information, and providing choices too quickly, so the person can’t keep up.
Malignant social psychology
• Invalidation: Not taking the persons feelings seriously
• Ignoring: Talking over their head, not including them
• Withholding: Not giving the attention they need
• Disruption: Breaking into a persons conversation or activity rudely, stopping them carrying on with whatever they were doing.
• Mockery: Making fun of people
• Disparagement: Saying critical things about someone, which will damage their self esteem.
• Imposition: Forcing someone to do something, not giving choices.
ReferencesCrawford K & Walker J (2005) Social work with older people, Exeter,
Learning MattersDepartment of Health (2001) National Service Framework for older
peopleDepartment of Health (2009) ‘Living well with dementia’ the National
Dementia StrategyKeady, J., & Nolan, M( 1995) Assessing coping responses in the early
stages of dementia, British Journal of Nursing, 4, 309-14Killick J & Allan K (2001) Communication and the care of people with
dementia, Buckingham, Open University pressKitwood T, (1997) ‘Dementia reconsidered; the person comes first’,
Buckingham, Open University press