1.1 Describe a range of causes of dementia syndrome
Dementia is a term describing a wide range of symptoms associated with the decline of the memory, or other cognitive or sensorial skills that reduce a person’s ability to perform day by day activities. This term refers to Alzheimer disease, Vascular dementia, Dementia with Lewy bodies, Parkinson’s disease, Creutzfeldt-Jakobs disease, Huntington’s disease in the same time. What causes this range of diseases varies from bad connections between synapses, bad vascularisation of the brain, abnormal aggregations of proteins in the cortex, degeneration of the nerve cell that produces dopamine, bad distribution of the proteins in the brain, build-up of fluids in the brain or a mixture between them.
1.2 Describe the types of memory impairment commonly by individuals with dementia.
Alzheimer’s disease is the most common type of dementia and is accounted for 60-0% of the cases. The symptoms are: difficulty remembering recent events or names, apathy, depression, communication impairment, poor judgment, disorientation, confusion, behaviour changes, difficulty speaking and swallowing. Vascular dementia is common to 10% of the cases and involves symptoms like: ability to make decisions, plans or organise, confusion, disorientation, speech or understanding impairment, vision loss. Dementia with Lewy bodies is manifested by memory loss and thinking problems same like the people with Alzheimer but in the early stages they have sleep disturbances, visual hallucinations and muscle rigidity. Parkinson’s disease is having as symptoms problems with movement, memory loss, difficulty to speak or to swallow. Creutzfeld-Jakobs has rapidly fatal disorder that impairs memory and coordination and causes behaviour changes. Huntington’s disease include abnormal involuntary movements, severe decline in thinking and reasoning, mood changes.
1.3 Explain the way that individuals process information with reference to the abilities and limitations of individuals with dementia.
Processing information is a complex process that involves the brain and the sensors in the same time. Informations are coming to our brain through the sensors we have: sight, hearing, touch, taste, etc. After the information is received is passed to our brain and here is processed in three major stages: encoding, storage and retrieval, in order for them to become memories.
They are three major types of memory that our brain is using when is processing information: sensory memory (sensory information from the environment is stored for a very brief period of time), short-term memory (also known as active memory, is the information we are currently aware of or thinking about) and the long-term memory (refers to the continuing storage of information, is outside of our awareness but can be recalled when is needed).
People with dementia have this chain of processes broken and here occur the problems they are facing in the day by day life. Usual the information stored in the long-term memory cannot be recalled and when his sensors are telling him he needs something (hunger, thirst, temperature changes, etc) he cannot get the thing he wants to fulfil his need. So the individual starts to have behaviour changes becoming anxious, unsettled, confused, etc.
If in the same time with retrieving the information from the brain, another impairment is manifesting the problem becomes more complex. If someone is hungry and cannot remember how to get to the kitchen, or how to prepare his food and in the same time he cannot express himself, because he cannot talk, the frustration and anxiety is more intense.
1.4 Explain how other factors can cause changes in an individual’s condition that may not be attributable to dementia.
A stroke can affect the person’s wellbeing by adding almost the same symptoms in the behaviour like dementia and can be confusing when this occurs.
1.5 Explain why the abilities and needs of an individual with dementia may fluctuate.
2.1 Describe the impact of early diagnosis and follow up to diagnosis
2.2 Explain the importance of recording possible signs or symptoms of dementia in an individual in line with agreed ways of working.
Any small detail of behavioural change or medical change can lead to a better understanding of the evolution of a patient. Early signs of dementia can be confused with normal behaviour of a normal person but the rate of occurrence and the time that the person is behaving abnormal can lead to a clear diagnostic even for the very early stages. If a person is forgetting his glasses somewhere is normal but if this happens most of the time when is considered to be a routine behaviour this can be one of the signs that his cognitive function is affected by something. Difficulty to find words to express himself when is no other sign of being tired or under medication is another clue that the dementia can occur to this person is short time.
If all the small details of abnormal behaviour are recorded regular they can be a good proof that the person’s condition is deteriorating slowly. They can lead to a pattern and they can even predict how fast the person’s condition will evolve in time.
2.3 Explain the process of reporting possible signs of dementia within agreed ways of working
Any possible sign of dementia must be recorded in the Care Plan and must be reported to the person in charge to make sure they are aware of the individual’s change of condition. This will trigger an alert signal and the patient will be closer monitored by every one of the members of the staff to find if the signal was random or does exist a pattern in his behaviour. This will be recorded in Observation Charts and all the information gathered in a specific amount of time will be reported to the GP to seek further advice.
2.4 Describe the possible impact of receiving a diagnosis of dementia on:
– the individual
– their family and friends
The impact of receiving a diagnosis of dementia is huge on the individual and on the people around him as well, because this will involve a new life style for all of them and they need to prepare for the outcome of the diagnostic.
An individual with dementia has to be prepared to seek for help when he is in need, to admit to himself that he needs help and to accept it. For this they need to be carefully advised by professionals to help them to understand that at one moment they will not be able to do most of the common tasks that usually are doing by themselves and to accept the help that others can give him. This diagnosis needs to be taken serious and they need to plan ahead in the future what will happen with them and who will be their legal representative.
The family and friends of someone diagnosed with dementia need to be prepares as well to recognise the symptoms and to know the evolution of the illness in order to be able to help the individual when will be needed and to understand that all the reactions coming from him are the result of the person’s condition.
3.1 Compare a person centred and a non-person centred approach to dementia care.
Person centred care is about caring for the person, rather than the illness. By the time a person with dementia needs care, they’ve been stripped of a lot of their dignity, are surrounded by strangers, and are very confused by the world around them, which can lead to problem behaviour. Person-centred caring is about maintaining the persons dignity. It’s about learning what things the patient responds well to, and treating them like a human being, rather than just an oversized toddler.
A non-person centred approach is about dealing with the illness and treats the individual like an object considering that all the individuals react the same to the same stimulus. This way of dealing with dementia not only that is disrespectful for the person’s dignity but is not helping to slow down the evolution that the condition is having for the individual.
Every person should be treated as an individual. Even they are members of the a group with things in common they still are individuals with separate needs, likes and dislikes.
3.2 Describe a range of different techniques that can be used to meet the fluctuating abilities and needs of the individual with dementia.
People with dementia have their abilities and needs is a continuous change. Sometimes they can feed themselves when other times they cannot figure out how to do it, even if the hunger feeling is present. A good observation by the staff members of his behaviour and recording regular in the Care Plan about all the small changes can help the person to be spotted when is in need and to give him the necessary aid to accomplish the task they need to do (help them eating when needed, help dressing, etc.)
3.3 Describe how the myths and stereotypes related to dementia may affect the individual and their carers.
Around people with dementia are lots of stereotypes, especially in a closed environment like a care home. Supposing that all the individuals need help when dressing or eating and doing the task for them is restricting their independence and can accelerate the decrease of the cognitive and motor skills in a dramatic way. The individual needs to be assessed at the time when is doing something and only when is needed the carer should intervene to help them. This will improve their life and will reduce the risk of making their condition worse. In the same time this helps the carers to be more relaxed in their work and to focus more on the important details which otherwise will be ignored.
3.4 Describe ways in which individuals and carers can be supported to overcome their fears.
One of the fears people with declining memory loss often think of is that they will be vulnerable to abuse either from their family or careers. Ill-treatment of people with dementia can have a lasting effect on them.
People with dementia can display certain behaviour deemed inappropriate and unacceptable, such as shouting, excessive screaming, insultive and inappropriate touching. Such behaviours should be seen as a result of the person’s conditions and handled in an empathetic and polite manner.
Shouting at a dementia patient just because they are screaming can cause further distress and confusing them. Not paying attention to them when they make a request can make them feel like a burden to the system and their careers, thus preventing them from willing to use the service the way they should.
A person with dementia may simply forget to go to the toilet, or may forget where the toilet is. They may also have lost the ability to tell when they need the toilet. Careers blaming them for their incontinences can make them feel sad and ashamed of the situation and themselves. Carers should encourage and reassure them instead of blaming them for anything that goes wrong.
People with dementia should be encouraged to be part of their daily care routine if they can. Just by asking the patient to help hold a towel whilst carer pick other items can make them feel useful and helpful and part of their care. Staff doing everything and not attempting to get help from the person can make the person feel like a burden and useless.
All this fears can be avoided by a better understanding of the evolution of the illness and by a continuous training with the staff.