Transcript Presentation Headline

Person Centred Dementia Care
Dr. Phil Anderson
Consultant Clinical Psychologist
Traditional approach to dementia care
• Focus of research has been on understanding the disease
process in terms of neurological/cognitive changes
• Better understand of different types of dementia and how
these progress in relation to cognitive functioning and
changes to brain structures
• Development of medications that can have positive effects
on cognitive functioning
Traditional approach to dementia care
• Problematic in that all behaviours are understood as
symptoms of the disease and treated with medication
(BPSD)
• Over-use of antipsychotic medication in people with
dementia to manage ‘Challenging behaviours’ (Sube
Banerjee, 2009)
 Of 180,000 people with dementia treated with an antipsychotic only 36,000 likely to derive any benefit
1,600 additional cerebrovascular events
1,800 additional deaths
A person centred approach to care
Disease model looses sight of individual factors and the
complex social and physical environments people live in
90% of catastrophic behaviours in people with dementia
are induced by carers and the environment (Brawley, 1997)
• Not all people with dementia display challenging
behaviours
• People who display challenging behaviours do not display
them all the time
A person centred approach to care
• Person first, dementia second
• Look at person and situation specific factors to understand
behaviours that challenge us
• Challenging behaviours can be avoided if we step out of
our world and understand the reality of the person with
dementia
Two laws of dementia (Buijssen, 2005)
Law of disturbed encoding – in the early stages, disruption
to the transfer of information from short-term to long-term
memory.
Two laws of dementia (Buijssen, 2005)
Law of roll back memory – initially most recent memories
are affected. As disease progresses, memories from further
and further back disappear. Eventually, even childhood
memories are erased.
Roll back memory
Roll back memory
Consider the whole person
• Cognitive abilities
• Mental Health
• Physical health
• Environment
• Life history (Work and family roles, relationships, skills and
abilities, important events)
Environment
Adapting the environment for people with dementia
Perceptual problems – shiny floors/patterned floors
Colour contrast
Clear signs
Labelling cupboards
Noise/distraction
Familiar objects taking into account role back memory
Person centred approach to care
Knowing the person’s history, life experiences and
important relationships
• Does the person like to socialise or do they prefer privacy
• What music do they/did they like to listen to
• What hobbies, interests/skills do they have
• What are their preferred routines
• Do they have a history of difficult relationships
Person centred approach to care
What would you want people to know about you
• What makes you most annoyed
• What do you enjoy
Understanding challenging behaviours
Behaviour as communication of unmet need (CohenMansfield, 2000)
Joan’s story
We often know very little about the person other than
diagnosis and behaviours
What more would you like to know about Joan?
Recent History
Professionals and family have tried
to protect Reg from facts about
dementia because of his illnesses
Personal History
Very independent woman who brought the
children up her self while Reg worked
Previously worked in a care home and did shift
work
An anxious person
Cognition
Memory impairment – ST memory poor
and long term getting worse
Visuospatial difficulties
Relationships
Likes to socialise
Very close family
Hobbies, likes and dislikes
Enjoys knitting and cross roads
Loved her cat who died 10 years ago
Mood
History of anxiety
Can get low if stressed
Joan’s story
Physical - are medical conditions being managed, is
Joan in any pain? – medication side effects? Could these
be affecting sleep patterns? Sleep Hygiene?
Environment – adequate lighting and signs around the
house to help orient Joan? Lose rugs? Colour contrasts?
Skills and abilities - could Joan get out of the house to
socialise with support? Can she still knit? Crossroads?
Joan’s story
Cognitive functioning - Does Reg understand what is
happening to his wife in terms of her cognitive functioning,
roll-back memory, attention and concentration,
visuospatial abilities?
Roll-back memory – does Joan think that she is working
shifts? Is she getting up to let the cat in?
How does Reg respond to his wife when she insists on
doing something certain way – does he give Joan choices,
does he challenge her roll-back memory?
Could Reg work on a life story book with Joan to help their
relationship and share with others?
Joan’s story
How did Reg help Joan to relax and manage anxieties
previously
Supporting carers
•Early diagnosis helps people to understand what is
happening and to make adaptations to the environment and
their interactions
•Education about dementia - understanding how dementia
affects their loved one in terms of thoughts, feelings and
behaviours
•Need to focus on the person and emphasise what people
can still do, not what they have lost
Supporting carers
Need to let carers know that their loved ones can continue
to have a good quality of life
Need to support carers in adjusting to changing
relationship with their loved one
Learning to go with how their loved one is now
Supporting carers
Getting the support of people going through similar
problems
Having a break from the caring role
Putting together a life story book with their loved on
Understanding that challenging their loved one will only
make the situation worse – go with the flow
Section Title
Celebrating what the person can do
Allowing people to do things even if they are not doing
them ‘right’
Support people in making choices
Don’t argue or contradict
Ask your self ‘does it matter’
Enjoy the roll back memory – take a journey into their
world – validate their experience to reduce anxiety
Supporting carers
Social isolation
Anger, frustration
Guilt
Exhaustion
Loss