A one off presentation aimed at those people who work in the home care industry. Trying to make it easier to understand what dementia is and remind themselves that it is the PERSON who matters

1. Informing on Dementia and Person
Centred Care Practice
Paul Tobin-O'Brien 2013

2. 
Created and presented by
 Paul Tobin-O’Brien
 BSoc.Sc. Dip HE (nursing studies), RGN
 Associate Tutor Comfort Keepers (training)
Ireland
Paul Tobin-O'Brien 2013

3. “ME”
There are still many things I can do like, walking, smiling, crying, laughing,
speaking my way. I am here and I hear you speak, I have not yet gone
My mind might be slowly ebbing away but deep down I know I am still Mary. You
see the changes in me I do not. I have not yet gone
I know the time will come when I will not remember your name but please remind
me even if only for a few seconds I can say it back to you. I have not yet gone
When words fail me I strike out. I do not mean to hurt you. I still have feelings but
these feelings I cannot put into words. I have not yet gone
Actions speak louder than words. Your help keeps me going. I have not yet gone
Where have you gone? I know not where. When I call you, you do not answer
Where am I? I am not sure but in my world I feel secure. I have not yet gone
I love your smile, your name is gone. I know your face and feel at peace. I have
not yet gone
(Margaret Mackinlay)
Paul Tobin-OBrien 2013

4. 
Dementia is an umbrella term used to
describe diseases that cause the loss of nerve
cells in the human brain. These impact on the
ability of a Person with dementia to function
as they would normally do in their daily lives.
Paul Tobin-OBrien 2013

5. 
“Dementia is the decline in memory and other
cognitive functions in comparison with the
patient’s previous level of function as determined
by a history of decline in performance and by
abnormalities noted from clinical examination
and neuropsychological tests. A diagnosis of
dementia cannot be made when consciousness is
impaired or when other clinical abnormalities
prevent adequate evaluation of mental state.
Dementia is a diagnosis based on behaviour and
cannot be determined by brain scan, EEG or other
laboratory instruments, although specific causes
of dementia may be identified by these
means”(McKhann in Kitwood (2002) p21)
Paul Tobin-OBrien 2013

6. 
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5% of all persons over 65 years of age have
some form of dementia
85years and older age group this rises to 20%
conservative estimate suggests that over
30,000 people in Ireland have dementia.
2020 this figure could be as high as 50,000.
Paul Tobin-OBrien 2013

7. 
“The basic cause of dementia is damage to
the nerve cells in the brain” (Graham. N.,
Warner. J. Alzheimer’s Disease and other
Dementias, BMA)
Paul Tobin-OBrien 2013

8. 
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Alzheimer’s disease
Vascular Dementia
Lewy body dementia
Frontotemporal Dementia
These are the most common of hundreds of
forms/types of Dementia
Paul Tobin-OBrien 2013

9. 
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Memory loss (short term )
Behaviour changes
Depression
Confusion
Complex thinking (decision making)
Ability to care for themselves
Uninhibited behaviour
Paul Tobin-OBrien 2013

10. 
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Most common of the dementias
Slightly more common in women that in men
Affects over 26 million people worldwide
Over 90% of people with Alzheimer’s are over
70 years of age
Slow start with very mild symptoms initially
Memory often affected first
Smooth progression often over many years
People often live 10 years or more after
diagnosis
Paul Tobin-OBrien 2013

11. 
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Second most common cause of dementia
Slightly more common in men that in women
Poor blood supply to the brain
Often has a sudden start and gets worse in
steps
Paul Tobin-OBrien 2013

12. 
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Third most common cause of dementia
More common in men
Fluctuating confusion(often with spells where
they seem normal especially early on)
Features include symptoms of Parkinson’s
disease and visual hallucinations
Risk of falls and poor mobility
Paul Tobin-OBrien 2013

13. 
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About 1 in 50 people with dementia have
Frontotemporal dementia
tend to be younger usually around 50 years
behaviour includes aggression, lack of
concentration, and loss of speech (finding
right words).
Memory is affected late in the progress of the
disease, and may appear normal in the early
stages.
Some forms of this dementia are genetically
inherited.
Paul Tobin-OBrien 2013

14. Depression
 Underactive thyroid gland
 Parkinson’s disease
 Acute confusion (delirium)
 Some vitamin deficiencies (e.g. vitamin B12)
 Some infections (e.g. Syphilis)
 Rarely brain tumour
(Graham. N. p30)
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Paul Tobin-OBrien 2013

15. Paul Tobin-OBrien 2013

16. 
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Group of drugs known as cholinesterase
inhibitors, there are three drugs in this group
currently in use
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)
Paul Tobin-OBrien 2013

17.  These
drugs do not stop the
disease from progressing or
make people completely better.
Paul Tobin-OBrien 2013

18. Very Common
Common
Less Common
Apathy
Agitation
Crying
Dis-inhibition
Mannerisms
Aggression
Verbal or physical
Wandering,
restlessness
Eating problems
Sleeping problems
Depression
Anxiety
Repeated questions
(repeated actions)
Delusions
Screaming
Sexual problems
Hallucinations
Paul Tobin-OBrien 2013

19. 
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Validation: A communication therapy.
Reality orientation
Reminiscence:
Music therapy
Aromatherapy:
Diversion
Paul Tobin-O'Brien 2013

20. 
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Assess,
Plan
Implement
Evaluate
Record
all changes that occur in the condition of the
Person with dementia.
Paul Tobin-O'Brien 2013

21. Person
With
Dementia
Is at the centre of the care you are providing.
Learn about the Person
Paul Tobin-O'Brien 2013

22. 
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Environment
Safety
Forgetfulness
Interpersonal Communications
Avoid confrontation
Paul Tobin-O'Brien 2013

23. 
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Take deep breaths before reacting to an episode,
stepping back to allow the patient or family
member space. If the patient is extremely agitated,
you may need to exit the room for a few minutes
until he/she has calmed down.
Remain calm and do not argue with the patient. Try
to reassure him/her or distract her from the issue
at hand.
Offer aid to the patient without appearing to take
over the situation. Direct him in small steps, using
simple words and allowing them plenty of time to
perform the needed action. Offer praise and
encouragement.
Paul Tobin-O'Brien 2013

24. 
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Reduce any demands that are unnecessarily placed upon
the patient, rearranging his/her day into a more stressfree routine that he/she will be better able to cope with.
If the patient becomes physically violent, move away from
him/her and leave the area; do not attempt to restrain
him/her unless it is absolutely necessary for his own
safety. Seek the aid of an additional helper, if possible.
Analyse, with the patient, what triggers the episodes and
try to minimise these types of situations in the future.
Paul Tobin-O'Brien 2013

25. 
Mrs A was a very well respected lady in her local community. She was a
founder member of meals on wheels and supported other services for
older people in her area. She was regarded as a refined and well-spoken
person, well dressed and mannerly. She had been living alone for a
number of years since her husband had passed on. She had no children
and no known relatives in the area. In her late 70’s she developed
Dementia and as it progressed she began to lose her independence.
Neighbours and friends began to notice that she was becoming
dishevelled and had been seen wandering outside her house at odd
times of the night and very early in the morning. Previous colleagues
decided that some sort of intervention was required and put in place an
informal system of care for her. These interventions included some of
her friends visiting her and helping to take care of her appearance by
providing personal care such as bathing, dressing and grooming. As her
condition progressed it was found that she began to swear at anyone
who was trying to help her and became very aggressive. This behaviour
led to fewer and fewer friends and former colleagues becoming available
to attend to her. They decided to get in some professional help and
arranged for a home care company to provide care for Mrs A in her
Paul Tobin-O'Brien 2013

26. 1.
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Dementia is a normal consequence of ageing
If you get dementia, nothing can be done about it
Alzheimer’s disease is a common cause of
dementia
Memory problems are just part of getting old
Most people with dementia live in the developing
world
Alzheimer’s disease usually runs in families
There are Drugs available to treat dementia
The best way to treat dementia is the bio-medical
method
The person is lost who has dementia
Dementia is curable
Paul Tobin-O'Brien 2013

27. Questions
Paul Tobin-O'Brien 2013
?

28. 
Dementia is not part of the Ageing Process
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Who is the behaviour challenging to?
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Without a comprehensive history to create a
personal care profile an intervention to
alleviate behaviours that challenge may never
be found
Treat each person with dementia as unique.
Paul Tobin-O'Brien 2013

29. 
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There is no one treatment or intervention that
works for everyone
Effective communication is essential to
ensure that all care that is given to the Person
is continuous and effective. This includes
communication with the person, with
colleagues, family members and other
members of the multidisciplinary team.
Paul Tobin-O'Brien 2013