Kirsten Halse spring 2005 Caring for people suffering from dementia Class 3A 2005.
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Transcript of Kirsten Halse spring 2005 Caring for people suffering from dementia Class 3A 2005.
Kirsten Halse spring 2005
Caring for people suffering from dementia
Class 3A 2005
Kirsten Halse spring 2005
Definisjon off dementia
Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is a disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. Consciousness is not clouded. Impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour or motivation. (Warner et al 2002 p. 90)
Kirsten Halse spring 2005
Definition of dementia
Dementia come from the Latin word demens. It means: without mind.
Alzheimer's disease has been given the name after the doctor who first described the illness in 1910. His name was Alzheimer.
(Burns in Jacoby & Oppenheimer 2002 p. 501)
Kirsten Halse spring 2005
Who is the person suffering from dementia
Kirsten Halse spring 2005
Who is the person suffering from dementia
Kirsten Halse spring 2005
Who is the person suffering from dementia
Kirsten Halse spring 2005
Who is the person suffering from dementia
Kirsten Halse spring 2005
Who is the person suffering from dementia
Kirsten Halse spring 2005
Who is the person suffering from dementia
Kirsten Halse spring 2005
Who is the person suffering from dementia
Kirsten Halse spring 2005
History
1920 Born
1930 Economic bad times, unemployment
1940 Second world war, In her twenties, married.First child born
1950 Building up the country after the war The next two children born
1960 Cars, telephone and Television more common for everybody
1970 Women start working, welfare society growing Start working part time in a store. Grandchildren.
1980 Heart attach, diabetes, hypertension
1990 Computer. Mobil telephone Retired, husband dies
1995 First symptoms of dementia
Kirsten Halse spring 2005
What happens
First there is the gradually advancing failure of mental powers such as memory. Reasoning and comprehension. Much here can be attributed directly to the brain being less efficient; its function has declined and usually there is degeneration in its actual structure.
Kirsten Halse spring 2005
What happens
Second there are changes in the social-psychological environment – in patterns of relationship and interaction. Those changes can be part of the disease or they can occur because of the responses the person gets from the surroundings. (Kitwood 1997 p. 20)
Kirsten Halse spring 2005
Symptoms or characteristic features of the disease dementia.
Cognitive impairment- Decline in memory
Short-time memoryLong-term memory, e.g. semantic memory,
episodic-memory, procedural memory.– Abstract memory
Recognise, identifyRecall, call back to mind
– The memory for making plans
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Cognitive Impairment - continued
Decline in comprehensionDecline in the ability to orientates
oneself in relation to time, person and place.
Decline in the ability to learnDeficit in language, anomia, aphasia
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Cognitive Impairment - continued
ApraxiaAgnosisDecline in the function of the will, the
ability to decide for something and do it.All those different impairment results in
a decline in the ability to care for oneself in the daily life. Reduced ADL.
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Psychological impairment
Tendency to isolate oneself, to withdraw from people
The interest in ones surroundings falls, less interested in other people and things
The person can become apathetic psychological unstable, more irritated Decline in judgment
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Psychological impairment
Depression Anxiety Aggression towards other people –
catastrophic reactions Personality characteristics are maintained or
exaggerated in some persons and may otherwise be altered in others
Forgetting of feelings connected to incident
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BPSD
90% of all patients suffering from dementia will have some kind of BPSD symptoms
BPSD = Behavioural and Physical Symptoms of Dementia
These symptoms can both be of psychological and behaviour character
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BPSD
Delusions Misidentification
syndrome Hallucinations Depression, mood
changes Anxiety Unrestrained behaviour Physical and verbal
restlessness Aggression, treats or
violence
Call out, cry out Wandering Sleep disturbance Wandering (20%) Excessive motor activity,
restless, purposeless activity
Collecting things Conspicuous eating and
sexual behaviour (Thomas and O‘Brien inJacoby and Opperheimer
p. 512- 518, Matteson et..al 1997 p. 297-298
Kirsten Halse spring 2005
Anxiety
Associated with dementia. Anxiety reactions can be manifested in various ways;
somatic complaints, rigidity in thinking and behaviour, insomnia, fatigue, hostility, restlessness, pacing, fantasizing, confusion, increased dependency. (Eliopoulos 2005 p.454)
Patients without speech often shows their anxiety in behaviour pattern, sometimes as physical aggression.
Kirsten Halse spring 2005
Anxiety
Treatment of patients with dementia, anxiety and delusions are;- environmental - medications
The goal is to reduce both the anxiety and the psychiatric symptoms as delusions and hallucinations
Kirsten Halse spring 2005
Depression
Prevalence of depression:– 15 to 25% in community based elders– 25% in older adults who are residence of long-
term care facilities Depression can occur in the early stage of
dementia as the patient becomes aware of declining intellectual abilities (Eliopoulos 2005 p. 452)
Kirsten Halse spring 2005
Depression - symptoms
Insomnia Fatigue Anorexia, weight loss, Constipation, Guilt, Apathy, remorse Hopelessness, Helplessness
Feeling of being a burden Loss interest in people Physical complaints,
headache, indigestion Altered cognition
The symptoms of depression can mimic those of dementia (Eliopoulos 2005 p.449-453)
Kirsten Halse spring 2005
Delirium - symptoms
The onset of symptoms tends to be rapid
Disturbed intellectual function
Disorientation of time and place
Altered attention span Worsened memory Labile mood Meaningless chatter
Poor judgement Altered level of
consciousness, mild drowsiness
Disturbance in sleep-wake cycles can occur
Physical signs such as slower psychomotor activities
(Eliopoulos 2005 p.442-444)
Kirsten Halse spring 2005
Other symptoms
Neurological symptoms, more primitive reflexes late in Alzheimer's disease
Instability IncontinenceWeight loss (people with Alzheimer's
disease lose weight over 3.5 times the rate of healthy age-matched controls (Thomas & O'Brian in Jacoby & Oppenheimer p. 519).
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Different types of dementia
Alzheimer's disease is the most common cause of dementia in the older adult 60%.
The symptoms of this progressive, degenerative disease develops gradually and progress at different rates among affected individuals.
Kirsten Halse spring 2005
Dependency over the years
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Developmental of the disease
Although staging of the disease can help predict its general course and anticipate plans or care, it must be appreciated that many factors affect the progression of the disease and that there will be individual variations.
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Different types of dementia
In addition to Alzheimer's disease, dementia may be caused by a variety of pathologies.
Vascular dementia 25%.
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Vascular dementia
This form for dementia results from small cerebral infarctions.
Damage to the brain tissues can be diffuse or localised.
The onset is more rapid and the disease progresses more predictably than Alzheimer's disease.
The risk factors are smoking, hypertension, hyperlipidemia, inactivity and a history of stoke or cardiovascular diseases
Kirsten Halse spring 2005
Frontotemporal dementia
The characteristic of this form of dementia is that the frontal lobes of the brain is affected.
Behavioural rather than cognitive abnormalities in the early stages are common.
Rather than poor memory early cognitive changes can include impairment in the abstract thinking, speech and language skills.
Kirsten Halse spring 2005
Other types of dementia
Lewy body dementia Parkisons`s disease Creutzfeldt-Jacobs disease Wernicke encephalopathy
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Other types of dementia
Potentially Reversible causes of Dementia Emotional disorders Metabolic and endocrine disorders Eye and ear dysfunction Nutritional deficiencies Tumor and trauma Infections Arteriosclerotic complications
(Linton &Matteson p293 in Matteson et.al 1997)
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Presence of cognitive impairment
The prevalence rate across Europe are estimated as 4.5% of men and 6.5% of women over 60.
Over 90 years of age the rate are estimated as 32% of men and 35 of women (Warner et al.2002, p. 95)
In Norway there are around 70.000 people with dementia. The number will increase because the amount of elderly people will increase.
Kirsten Halse spring 2005
Alzheimer's disease - Prevalence
Kirsten Halse spring 2005
Treatment
There is none specific treatment for the disease dementia
Treatment focus on: Milieu therapy All diseases must be taken care of Medication
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What do people with dementia need
Comfort Attachment InclusionOccupation IdentityLove (Kitwood1997)
Kirsten Halse spring 2005
What do people with dementia need
(Kitwood1997)
Kirsten Halse spring 2005
What do people suffering from dementia need - identity
To have an identity is to know who one is, in cognition and feelings.
It means having a sense of continuity with the past; a “narrative” to present to others.
It involves creating a kind of consistency across the different roles and context of present life. (Kitwood 1997p. 83)
Kirsten Halse spring 2005
What do people suffering from dementia need - identity
Help the person to remind who his is by using- photographs of the patient and family- personal possessions in the room- dressed like they use to- talk with the patient about his life. Can be done individually and in groups - Reminiscence.
Kirsten Halse spring 2005
What do people suffering from dementia need - inclusion
Everybody has a need for being part of society.
The need for inclusion comes poignantly to the surface in dementia in so-called attention-seeking behaviour. Tendency to cling.
Person with mental impairment are not easily included in everyday life.
Kirsten Halse spring 2005
What do people suffering from dementia need – occupation
The need for occupation is present in people with dementia. It is manifested, for example, when people want to help or take part in activity.
Helps the person to feel part of life and valuable
Kirsten Halse spring 2005
What do people suffering from dementia need - Occupation
Help and support the person in relation to self-care – involving the person.
The person does as many daily activities as his is able to. (Eliopoulos 2005 p 447)
The purpose is to:- promote mastering- make sure the patient do have meaningful day- increase quality of life
Kirsten Halse spring 2005
What do people suffering from dementia need - comfort
The word comfort carries meanings of tenderness, closeness, the soothing of pain and sorrow, the calming of anxiety, the feeling of security.
To comfort another person is to provide a kind of warmth and strength which might enable the person to remain in one piece when his is in danger of falling apart.
In dementia the need for comfort is likely to be especially great when a person is dealing with a sense of loss.
(Kitwood 1997 p. 81)
Kirsten Halse spring 2005
What do people suffering from dementia need - attachment
The need for attachment remains when a person has dementia; it may be as strong as in early childhood.
Life for persons with dementia are overshadowed by new uncertainties and anxieties.
People with dementia are continually finding themselves in situations that they experience as “strange” and that this activates the attachment need. (Kitwood 1997 p. 82)
Kirsten Halse spring 2005
Maintaining Personhood
Maintaining Personhood
When physical needs have been met, this is the central task of dementia care. It involves enabling the exercise of choice, the use of abilities, the expression of feeling, and living in the context of relationship
Kirsten Halse spring 2005
Communication with a person suffering from dementia
Communication can be affected early on in dementia.
A reduced ability to communicate has an impact on relationship as well as on the well-being of the patient and on the early stages of management.
(Pearce in Jacoby & Oppenheimer 2002 p. 584)
Kirsten Halse spring 2005
Communication with person suffering from dementia
To a person in a nursing home the nurse talks about something which is going on now. The person does not answer regarding what the nurse talks about.
Why not ??? – maybe he or she is another place in his life
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Communication with a person suffering from dementia – reality orientation
Reality orientation were designed to help reduce confusion and disorientation in people suffering from dementia
The idea was to orientate people to who they were, where they were and present time.
Reality orientation can be useful
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Communication with a person suffering from dementia - reminiscence
Reminiscence means the use of recall of events of ones life.
This can be done in two ways:- individually- in groups.
Kirsten Halse spring 2005
Communication with people suffering from dementia - reminiscence
Kirsten Halse spring 2005
Communication with people suffering from dementia - reminiscence
Kirsten Halse spring 2005
Communication with a person suffering from dementia - validation
Naomi Feil
Between 1963 and 1980 she developed Validation as a response to her dissatisfaction with traditional methods of working with the disoriented old people.
Kirsten Halse spring 2005
Communication with a person suffering from dementia - validation
To validate is to acknowledge the feeling of the person. To validate is to say that their feelings is true. Denying feelings invalidates the “other”.
A “fantasy” is based on memory and wishful thinking. It is a personal view of the world. It is seeing with the mind's eye and it is an inner realty. (Feil 1989 p. 1-3)
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Communication with a person suffering from dementia - validation
To validate means to accept and appreciate the person the way the person experience the world.
It is important to create assurance for the person by respecting and accepting the persons feelings and experiences.
Kirsten Halse spring 2005
Communication with a person suffering from dementia – validation, general rules
Take part in a retrospective view with the person. Do not contradict the mistaken view of the
person. Allow the person to show his feelings. Respect and appreciate the persons feelings, all
feelings are allowed. Do not ask “why” questions. It can be difficult for
the person to answer and can create anxiety and insecurity.
Kirsten Halse spring 2005
Communication with a person suffering from dementia – general rules
Use a environment which is free of distraction
Improving sensory input, by maximizing both hearing and vision
Use face to face contact or touch when initiating and during conversation
Simplifying the matters to be discussed Presenting the ideas as one idea at a time
Kirsten Halse spring 2005
Communication with a person suffering from dementia – general rules
Orientation to the topic of conservation, written reminders may be helpful.
Assist the person when she get ”stuck”. For example can sentence completion helps.
Reassurance and support can help when the person becomes frustrated.
(Pearce in Jacoby and Opperheimer 2002 p. 584)
Kirsten Halse spring 2005
Communication with person suffering from dementia – use of music
Literature review suggest that music therapy is a useful intervention to help patients deal with a range of behaviour problems. (Lou, M.F. 2001 Scandinavian
Journal of Caring science Vol. 15)
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Communication
In communication with people suffering from dementia is it important to use all the senses in communicating with the person
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Communication
Interaction with person suffering from dementia is not only a question about responding to signals but also to catch the meaning the other person communicate; it involves reflection, hunch, expectation and creativity (Kitwood 1997).
Kirsten Halse spring 2005
Management behavioural disturbance – Risk assessment
In dementia there are risks of harm occurring both to the patient and to others.
Is there a risk of harm? If so, what sort of harm, to whom, and what is the likely
severity? How likely is it to happen? How immediate is the risk and how long will it last? What factors contribute to the risk? How can these factors be modified or managed?
(Pearce in Jacoby and Opperheimer 2002 p. 578)
Kirsten Halse spring 2005
What kind of competence is necessary for the nurse to care for the person suffering from dementia ??
Validation uses empathy to tune into the disoriented old person.
Empathy - walking in the shoes of the “other” – builds trust.
Validation means each person is unique. Workers do not judge (Feil 1989),
For Travelbee empathy is also essential in nursing (Travelbee 1999)