Specific Needs of the Older Person with Dementia

Introduction

In this project I am going to explain what dementia is, explore the physiological and psychological changes that occur for the older person with dementia and their needs in relation to this condition. I am also going to cover the role of the carer and multidisciplinary team in assisting the person with dementia focussing on practices that need to be implemented, care settings that are available and state what current approaches should be undertaken towards developing quality services for people with dementia.

I am going to research this topic using the available material on the Internet, newspaper and healthcare articles, books, class notes and my own experience in the healthcare setting.

Main Body

The task of this assignment is to write a project exploring the issues for the person who suffers with the chronic illness Dementia. The project is going to cover the following topics:

1. What is dementia?

The definition of dementia in global terms states that it is an umbrella term describing a variety of progressive in nature (Health Information and Quality Authority, 2009) symptoms including problems with memory, reasoning, understanding, learning and speech, that are caused by the impact of this disease on the brain and will impair the functioning of the person in their daily living activities over the period of six months or more (Chapman et al, 2001). The Dictionary of Nursing, Churchill Livingstone’s 1^st Edition, 2002, defines dementia as “irreversible deterioration of mental functioning resulting from organic brain disease”. Dementia is a social issue and the majority of people affected by this condition (63%) live at home and are part of a community. Over 4,000 Irish people are diagnosed with dementia each year and people of any age can be diagnosed with it (1 in 10 people under 65). According to The Alzheimer Society of Ireland, there are currently 55,000 people living with this condition in Ireland and this figure is going to more than double over to reach 113,000 cases in 2036. There are over 400 types of dementia. With many different conditions causing dementia, though their effects would be similar, they are not identical, because each one would tend to affect different parts of the brain. The most common forms are: Alzheimer’s disease, Vascular dementia, Lewy body disease, Frontotemporal dementia, Wernicke-Korsakoff’s Syndrome (alcohol related dementia).

What are the physiological and psychological changes that occur for the older person with Dementia?

The damage caused to the brain might affect the ability to perform everyday tasks, language, thinking, problem solving, perception and memory. Dementia can influence psychological and behavioural changes, like depression, anxiety, agitation, hallucinations and delusions, wandering, aggression or social inappropriateness due to loss of inhibition. Clients, who have been diagnosed with dementia, are very likely to experience a variety of emotions, including loss, anger, shock, fear, grief, disbelief or even relief that they finally know their diagnosis and can plan ahead. They might find it very hard to understand what might be happening in the moments of confusion and forgetfulness, feel insecure and fearful about their own future and that of their family or focus on their relationships and activities that make them happy by revaluating their lives. People with dementia go through the ageing process just like everyone else, their body slows down, perhaps at a different pace due to the impact their illness has on it. The physiological changes in their body will manifest in the cardiovascular system (heart working harder to pump blood through stiffening vessels and arteries), skeletal system with muscles losing flexibility and endurance, bones becoming brittle and weak, which would affect mobility (scoliosis, osteoporosis), digestive system (constipation), urinary system (incontinence), the impairment of sensory organs: loss of hearing, vision, sense of smell, oral issues and the integumentary system, which is skin, losing its elasticity, moisture etc. Some of the physical changes affecting a client with dementia are extreme memory loss, the inability to express using words, loss of mobility, difficulties with swallowing, incontinence, skin problems, prone to infections etc.   

2. Explore the persons needs in relation to the condition

The needs and behaviour of people with dementia might change as the condition progresses but in general, those affected by it have the same needs like everyone affected by the ageing process. It is also important to understand that those changes may not be their fault. They get the same illnesses but might have problems communicating them to their carer so it is very important to look out for signs (e.g. changes in behaviour, facial movements, refusal to move). Client’s needs must be assessed on individual bases and a holistic care approach must be introduced. A need is a desire or requirement and refer to those basic things that people must have in order to survive. Food, water, shelter, sleep, clothes etc. would be the examples of the physiological needs as per Abraham Maslow’s Hierarchy of Needs. Other categories involve safety, love, esteem and self-actualisation.  A person with dementia will at some stage experience changes in their communication, nutrition and eating, hygiene, continence, sleeping, behavioural and cognitive needs.

Living with dementia:

1. Agree, never argue
2. Divert, never reason
3. Distract, never shame
4. Reassure, never lecture
5. Reminisce, never say “remember”
6. Repeat, never say “I told you”
7. Do what they can do, never say “you can’t”
8. Ask, never demand
9. Encourage, never condescend
10. Reinforce, never force

(Huey, 1996)

3. What is the role of the carer and multidisciplinary team in assisting the person with dementia?

Caring for clients with dementia is rewarding but might be daunting and quite challenging at the same time. Their needs have to be assessed and identified periodically as the illness progresses. People with dementia have crucially impaired intellectual functioning that interferes with their normal activities and relationships and require a significant increase in the need for personal assistant and routine support. A carer for a person with dementia has to be realistic about what they can do for the client and their family, who also need support. The role of the carer is to deliver a person-centred care, which is tailored to the individual client’s needs and also growth- and caring-centred. A carer will provide assistance with the client’s:

• basic physical care needs, like feeding and promoting sufficient hydration
• immediate needs like personal care: washing, dressing, continence management
• needs for emotional support, company, participating in social activities, carrying out hobbies

The multidisciplinary team is a group of skilled healthcare professionals from different medical disciplines, offering effective and efficient dementia care and providing specific services to people with dementia as per their care plan, e.g. nurses can assess the condition and develop a care plan, healthcare assistants can assist with their personal needs, establish routines, engage in reminiscence therapies and communication, a pharmacist, occupational therapist, SALT, geriatrician, nutritionist, social workers etc. 

What practices need to be implemented?

• a stronger focus on understanding the needs of a client affected by dementia
• a holistic person-centred approach
• good listening and communication skills
• empathy
• awareness of the client care plan

What care settings are available?

There are various specialist care units available for people diagnosed with dementia, with trained staff, nurses, healthcare assistants, household and support staff etc. understanding the challenges these people are met with in their daily lives. Depending on the severity of dementia, they can be looked after in their own homes by family member or qualified carers, in care or nursing homes (public, private), day care facilities within their own communities, attend memory clinics, live in a designated dementia village (a pioneering project launched by Minister of Mental Health and Older People, Jim Daly, Irish Examiner, 12 July 2019) etc.  

4. State the current approaches towards developing quality services for people with Dementia

The Irish National Dementia Strategy was launched on the 17^th of December 2014 led by the Department of Health. The aim was to improve the care of people with dementia so they could live well for as long as it could be made possible, allowing them to die with dignity, in comfort, with access to full health and social care services and support, also available to their carers and families. The National Dementia Implementation Programme’s is to promote a better understanding and awareness of the needs of people affected by dementia, their position in the society and the contribution they still make to it, and also how a timely diagnosis and early intervention can be fundamental in long-term objectives and challenges the Irish people would need to face.

The “Dementia Post-diagnostic Grant Scheme” (PDS) led by the HSE’s National Dementia Office, aims to ensure and improve access to supports for people diagnosed with dementia. It facilitates skilled health professionals, like occupational therapists, nurses, psychologists etc. in assisting people with dementia and their families to live well.  

“Guidance on Dementia Care for Designated Centres for Older People” published by HIQA, 01 July 2016, was developed to guide providers of high quality, safe and effective care services for people with dementia. 

HSE & Genio Dementia Programme developed with the support from the Atlantic Philanthropies and HSE, is developing and testing new service models aiming to improve the range and quality of community-based supports for people with dementia.

The Alzheimer Society of Ireland, the leading dementia specific national voluntary organisation, with a network of nursing homes, day care centres, support groups and services etc.

 Conclusion

Dementia is one of the fastest growing health conditions globally with about 1 in 3 people over 65 developing it at some point in their lives. There are about 55,000 people currently affected by dementia in Ireland, with the number to double in the next 20 years. It is not part of getting older, exclusive to old age only or part of the ageing process. It is also more than just a memory loss issue. People diagnosed with dementia can lead independent and active lives providing there are supportive services and strategies put in place. They are encouraged to stay active, take up new hobbies, meet friends and remain part of their community. Care can be provided by family or friends but also in residential long-stay care facilities. Dementia impacts the whole family and not just the person alone. It is still the most feared condition because of the stigma of mental illness surrounding it. Dementia doesn’t affect only those from the Western World, but also China, India and part of Africa. Currently there is no cure for dementia but the research continues with the occasional breakthroughs in the treatment of Alzheimer’s disease. The Irish governments’ 2014 National Dementia Strategy had been a very good starting point in placing more focus on the condition, highlighting issues associated with the availability of resources to provide care and services for people and their families.

Bibliography and references:

• Concepts of Care, A Text Book for Health Care Assistants, LHP SKILLNET EADING HEALTHCARE PROVIDERS 2011, Edited by Mary Power and Imelda Duffy
• CereScan.com/Conditions/Alzheimers
• “Why all I felt was relief when my mother died”, article by Deborah Moggach, Irish Daily Mail, Wednesday July 10, 2019
• “The Carer”, Deborah Moggach, Tinder Press, 2019

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