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You, me & dementia

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by

Gill Smith

on 15 February 2014

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Transcript of You, me & dementia

You, me & dementia
De
me
ntia

Dementia: signs and symptoms

Biomedical model
Focusing on the neurological changes that occur within the brain and resulting symptoms
Dangers of biomedical model dominance
Who are you?
3 words
You wanted to know...
Survey monkey results:
psst...there's something we want you to know...
“It’s about having that belief that the person is in there still….”
Jane McKeown, nurse

“….and finding out what is the key to unlocking them”
Claire Craig, occupational therapist

Alzheimer's Disease
Vascular Dementia
3 words
It's our time
You and me
What is it?
Most common form of dementia
Caused by the development of plaques of amyloid protein (sclerotic plaques) in brain tissue and twisted fibres of a protein called
tau
(otherwise know as neuro-fibrillary tangles)
Gradual in onset, progressing in stages
What is the impact on the person?
Neural damage impacts on:
Memory
Language skills
Perceptual abilities
Global deterioration of skills
Dementia with Lewy bodies
What is it?
Caused by presence of abnormal structures (spherical deposits of protein) within nerve cells of the brain
These are called Lewy bodies, after the doctor who discovered them
They disrupt message transmission in the brain
Often under-diagnosed, mistaken for other conditions such as Parkinson's disease

What is the impact on the person?
Particularly noted for wide fluctuations in performance
Some symptoms in common with Alzheimer's disease
Hallucinations
Spatial disorientation
Impaired memory
Problems with alertness and attention
Depression
Motor difficulties
Behaviour changes

What is it?
Sometimes referred to as ‘multi-infarct’ dementia
Sudden onset caused by small strokes or cerebral bleeds

Stepped deterioration of cognitive functioning as more strokes occur
Some symptoms in common with Alzheimer's disease
Difficulty planning and sequencing
Poor concentration
Poor communication
Some physical symptoms of stroke
such as paralysis or limb weakness
Depression and anxiety

What is the impact on the person?
Person-centred model
person with DEMENTIA
PERSON with dementia
3 main areas...
Dementia is an umbrella term describing a set of symptoms which can include memory loss, mood changes, and problems communicating & reasoning (Alzheimer's Society 2012)
Types of dementia
Functional impact
Viewing dementia as a disease with defined stages of progression and different stages such as the sensory or reflex stages
Assessed via cognitive assessments such as the Mini Mental Exam
Treating the disease with drugs - medicating people for challenging behaviour
Incurable, no recovery
Danger of forgetting about the person when formulating care plans and working with family and carers
Danger of assuming from the literature that the medical view is correct, that deterioration is inevitable
Danger of reducing the person to a set of symptoms:
- Deskilling people

- Ignoring people's strengths amassed over the years that they can draw on to self-manage
BUT.....
It's just
one
model to support understanding...
...It's just
one
model to support understanding
People with dementia can still demonstrate capacity for understanding, have discovered new skills and experienced blossoming of creativity
Cognitive impact:
forgetting names or places can impact relationships or carrying out everyday activities or routines such as taking a bus journey to a doctor's appointment
Emotional impact:
feeling nervous, fearful, upset, & frustrated with memory loss
Physical impact:
motor difficulties may limit ability to engage in household tasks or activities outside of the home.
Adaptation may be possible but the effort of performing tasks "normally" may be fatiguing
Impact on identity:
Does it take away "you"?
Difficulty communicating, expressing self & maintaining roles
Social impact:
any of the above may lead to withdrawal and isolation
Loss and change
Each person experiences the condition differently
"Some people will score low on cognitive tests and but will still function well as people, whereas others whose cognitive impairment is less severe will fare less well"
Jackie Pool in Creek 2002 pg. 383
"Stereotypes of people with Alzheimer's will be changing. The voices of people with dementia will be mainstreamed and the capabilities of people with Alzheimer's and related dementia can be wonderful contributions to the Alzheimer's community and to our communities in general"
Christine Bryden
Emphasis on individual - viewing neurological changes in context of person, their life, history & socio-cultural environment
"Personhood is a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being"

Kitwood 1992
"We, the people of this action group, don't want to be seen as suffering from dementia, that is a term we really do not like. We are living with it and getting on with it with laughter and love, and that makes a difference. We are being heard and our opinions valued."

Agnes Houston, SDWG
Full transcript