Care of People with Dementia in the Acute Hospital Setting

CARE OF PEOPLE WITH DEMENTIA IN THE ACUTE HOSPITAL SETTING

What is dementia?

Dementia is the generic term covering a number of brain related illnesses some of which are:

· Alzheimer’s disease (causes more than half of dementia cases)

· Vascular dementia(second most common)

· Lewy body dementia

· Alcohol related dementia (includes Korsakoff’s syndrome)

· Younger onset Dementia

· Frontal lobe and Pick’s disease.

These illnesses cause the brain cells to die off more rapidly than is normal. How the illness affects someone will depend on which area is damaged. It is a progressive illness for which no cure has been found, brain cells cannot regrow.

Many recognisable features:

Short term memory loss

This is one of the most common type of memory loss, where people sometimes cannot remember things from one hour or minute to the next. They may ask the same question repeatedly as they cannot remember asking the question in the first place. They may be unable to remember what they have just eaten, cannot remember where they are, where the toilet is. This is caused by damage to the temporal lobes of the brain, which are responsible for short term memory.

Long term memory

The person may have no recollection of something that happened a moment ago yet can talk at great length about things that happened as far back as childhood. The long term memory usually lasts longer than the short term memory and may not be affected until the later stages of the illness.

Memory is not only about remembering events, it is also about being able to remember how to do things for yourself. Remembering the need to get up in the morning, get washed and dressed, to eat and drink, stay warm or cool and got to the toilet. It is about everyday tasks, it forms an important aspect of your identity, your role within the family. It your likes, dislikes, your attitudes. This is what makes us individual which in turn makes dementia an individual experience.

Communication

People with dementia gradually lose the ability to communicate. As these abilities are lost, behaviour may replace conventional means of communication. People with dementia can become withdrawn or respond angrily and seem to have no get ‘up and go’. They may lack insight into their abilities, believing that they are fine and that they are still able to do most of the things they could do before having dementia.

How can we communicate?

· Be calm and patient

· Face the person, speak clearly and slowly

· Make sure that you have their attention by gently touching their arm and saying their name

· Use short, simple sentences and say exactly what you mean

· Try to get one idea across at a time

· Allow plenty of time for the person to take in what is being said and to reply

· Try not to embarrass them by correcting them

· Use questions which can be answered simply

· Try not ask questions which test their memory, eg ‘who am I? or ‘what did you do yesterday?’

· Use facial expressions and hand gestures to make yourself understood

· A smile, touch or gesture can be just as important in getting the message across and showing that you care. Sometimes just holding the persons hand when you talk can be reassuring.

· In advanced stages of dementia even when a person is bedbound and not responding to speech, communication is essential to quality of life.

Eating and drinking

Someone with dementia may:

· Not be very interested in eating or may be the opposite and eat continually

· Be confused as to whether they have just eaten or not

· Lose their table manners and become messy in their eating habits

· Have difficulty using cutlery or recognising what is in front of them

· Difficulty in eating due to ill fitting denture

· Use a person-centred approach action plan which will help to reduce risks i.e. use of MUST tool. This is the NHS Fife recognised food, fluid and nutrition assessment form.

How can we assist with eating and drinking?

· Dementia should not be a barrier to making menu choices

· Allow plenty of time for meals

· Advise the person which meal is being served and what it is

· Avoid jumping straight in and assisting someone unless it is necessary as this de-skills the person

· Ensure utensils are suitable for the individual

· Ensure they have enough to drink

Medication

· People with dementia will need to be reminded what to take, how much and when

· They should be supervised to ensure medication is taken and not left under their pillow or popped into their handbag

· Time to explain what the medicine is for

Personal care

· Encourage the person to take pride in their appearance and personal care

· Ensure they have a choice in their clothes

· Pay attention to their dental and nail care

Behaviour- Stress and Distress

Some of the behaviour that people with dementia exhibit can be hard to understand or for us to know how to respond to. Remember it is the illness causing the person to display behaviour that we find odd or embarrassing. Try not to over react, explain what is happening to other people so that they can understand. Try to deal with the situation in a calm manner.

Ask yourself:

· Is the behaviour really a problem? If so why?

· Who is it a problem for?

· How did the behaviour start?

· Could the person be in pain?

· What was the person like before?

· If an incident took place, did something or someone trigger it?

· What happened afterwards?

· How did the problem be resolved?

· Who did you inform?

By breaking down behaviour, you can begin to know what to do about it should it happen again.

Constantly moving around

A person with dementia may often be unable to just sit in a chair all day but may want to move around. People may move around for many different reasons, they may need the toilet, simply be bored, they have a need to exercise or trying to find their way home. Is it really a problem or just a problem for you? Trying to keep the person in one place may create behavioural problems e.g. agitation. Always ensure they are in a safe and secure environment. The noise level as well as the general hustle and bustle of the hospital environment and coping with the symptoms of dementia can be frightening and disorientating. It is important that where possible people with dementia have an established routine and familiar staff. They should not be moved from place to place unless there is a good clinical reason for doing so and which outweighs the distress and disorientation that any moves may cause.

Pain management

Pain is often under-recognised and under treated in older people. Assessing pain is a skilled and complex task, and carrying out an effective pain assessment becomes more difficult during the later stages of dementia. The awareness, attitudes and knowledge of staff are important factors in how pain is treated. Emotions and behaviour associated with

Uncontrolled pain may fear frustration, anxiety, depression, sleeplessness, helplessness, restless and aggression. These should not go unreported.

Dementia can be harrowing experience not just for the person but also for close family and friends. Working effectively with people who have dementia requires patience and understanding. Someone with dementia should not be rushed and will often need one to one support. They should always be consulted and involved in any decision affecting their own welfare.

Every member of staff has a duty to care. Families, friends and carers should be seen as partners in care who can assist with helping someone to eat, to accompany the person with dementia for consultations, hospital visits, and tests. Staff recognise that patients with dementia may have difficult in remembering key things about themselves so it is important to use the getting to know me document.

Reference

www.alzscot.org.uk