The purpose of this study is to address to family members or family carers for older people with dementia a range of perspectives, as understanding perspective of those affected. For the purpose of giving them an idea of knowing the early signs and symptoms of dementia and the suggested care by the experienced staff involved in this study. To know and identify the problems of the person having dementia, and as carers, to know how to respond to these problem. Thus, the older people would meet their needs and will be looked after.
The definition of dementia is fairly simple. Dementia is a group of diseases that cause a permanent decline of person’s ability to think, reason and manage his own life. Dementia is caused by biological processes within the brain that damage brain cells.
They cause a person to have impaired memory, forgetfulness and an inability to retain new information. To lose the ability to speak and be understood by others and the ability to understand written or spoken language. To lose the ability to plan, make good judgements and carry out multi-step tasks. To lose the ability to process and understand visual information.
These losses mean that a person with dementia cannot manage his own day-to-day and personal care.
The implications for a person with this diagnosis and her family can be staggering.
Dementia, regardless of its cause, is a progressive condition. It is distressing and frightening illness for individual and heartbreaking for family members. The course of the illness may be gradual and sometimes subtle, as in classically seen in Alzheimer’s disease. It may be abrupt and can be characterised by sudden episodes of deterioration as the case of Vascular Dementia, also known as multi infarct dementia. In Lewy Body Dementia, the course of the illness maybe punctuated by episodes of confusion, hallucinations, and delusions and in fronto temporal dementia by insidious personality or behavioural changes.
Today there are more than thousands of people with dementia here in Ireland. If this current demographic trends to continue, this number is likely to rise substantially in the coming years. In the older population, dementia is the most frequent reason for long term care. Because most form of dementia cannot be cured, the aim of this treatment is to delay the disease progression And to maintain functioning and quality of life.
The purpose of this research is to conduct a study to understand the perspective of those affected is crucial prior to the development of care people with dementia and the impact on all those affected, for example, the person with dementia,carers and family members.
To understand the manifestation application in day to day life.
DEMENTIA AS A DISEASE
Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded by deterioration in emotional control, social behaviour, or motivation. The syndrome occurs in Alzheimer’s disease, in cerebrovascular disease, and in other conditions primarily or secondarily affecting the brain.
There are a number of different reasons – some neurological and others environmental – why people with dementia may exhibit challenging behaviours. Some behaviours, for example, are caused by a chemical imbalance in the brain and may be directly related to the dementia but others may be precipitated by a myriad of psychosocial and environmental factors such as room temperature (too hot or too cold), the person’s fatigue or malaise, he or she being in pain, bored or frightened being surrounded by unfamiliar faces. Agitation, aggression, wandering and repeated questioning, for example, may be an expression of unmet need. The big paradox in dementia care is that people with dementia need much time.
If you have dementia, or you are looking after someone who does, you will experience a range of practical issues. People with dementia can feel vulnerable as their condition progresses and they increasingly rely on other people to do things for them. It is important that people who have dementia feel reassured and supported, while retaining some level of independence. Although some symptoms are common to many people with dementia, each person’s experience of the disease will be different.
When a person with dementia finds that their mental abilities are declining, they’re likely to feel anxious, stressed and scared. They may be aware of their increasing clumsiness and inability to remember things, and this can be very frustrating and upsetting for them. If you are looking after someone with dementia, you can help them feel more secure by creating a regular daily routine in a relaxed environment where they’re encouraged and not criticised. Involving the person you look after in everyday tasks may make them feel useful and improve their sense of self-worth. They could help with the shopping, laying the table or sweeping leaves in the garden, for example. As the illness progresses, these tasks may become harder for them to manage independently, and you may need to give them more support. How can we be help to people with dementia?
Offer support sensitively and try not to be critical of their attempts. It can be very important for them to feel that they’re still useful. In the early stages of dementia, memory aids can be used around the house to help the person remember where things are. For example, you could put pictures on cupboard doors of what’s inside, such as cups and saucers. This may help to trigger their memory and enable them to retain their independence a little longer. Keeping up hobbies and interests when someone has dementia
Many people with dementia will still enjoy their hobbies or interests. For example, if they like cooking, they may be able to help make a meal. Going for a walk or gardening can provide exercise and fresh air. Or they may prefer listening to music or playing a board game. Caring for a pet cat or dog can bring a lot of pleasure to some people.
If the person you care for was very sociable and outgoing, or if they have a large family, they may really enjoy visits from one or two family members or friends. But remember that they may struggle to keep up with conversations if they have a lot of visitors at the same time. Maintaining good health and nutrition in someone with dementia
It’s important that the person you care for healthy foods and gets some exercise. The longer they stay fit and healthy, the better their quality of life will be. If the person you care for doesn’t eat enough or eats unhealthy food, they can become susceptible to other illnesses. People with dementia can become more confused if they get ill.
Common problems for people with dementia include:
not recognising foods
forgetting what food they like
refusing or spitting out food
resisting being fed
asking for strange food combination
How can we help?
Involve the person you care for. For example, if you feed them, you could put the cutlery in their hand and help guide it to their mouth. You could also involve them in preparing food if they are able to.Try to stay calm. If you feel stressed at mealtimes, the person you care for will probably be stressed too. Make sure you have plenty of time for meals so you can deal with any problems that arise. Try to accommodate behaviour changes. It’s likely that the person you care for will change their eating patterns and habits over time. Being aware of this and trying to be flexible will make mealtimes less stressful for both of you.
People with incontinence
Incontinence can be difficult to deal with and can be very upsetting for the person you care for. It’s common for people with dementia to experience incontinence.
A person with dementia may also simply forget to go to the toilet, or may forget where the toilet is. They may also have lost the ability to tell when they need the toilet. It’s important to be understanding, retain a sense of humour and remember that it’s not their fault. You may also want to try the following:
Put a sign on the toilet door, such as a photo of the toilet Keep the toilet door open
Make sure that the person you care for can access it easily make sure they can remove their clothes – some people with dementia can struggle with buttons and zips Look out for signs that they may need to go to the toilet, such as fidgeting and standing up and down.
Helping someone with dementia with their personal hygiene
People with dementia can become anxious about certain aspects of personal hygiene and may need help with washing. For example, they may be scared of falling when getting out of the bath, or they may become disorientated in the shower. The person may not want to be left alone or they may resist washing because they find the lack of privacy undignified and embarrassing, at which it is no longer safe to leave the person alone, and never leave the person alone in the bathroom.
a).Coaching the person through each step of bathing, ex.: by asking him or her to hold a washcloth or shampoo bottle. Avoid asking the person to do a task that is too difficult.
• Ask what time of day and what routine is best for bathing given the person’s choices and previous routines.
• Consider whether a person may be afraid of water or have a depth perception impairment that may make entering a bathtub frightening.
• Respect the person’s dignity by providing a towel to cover his or her body throughout the process.
• Consider the frequency of bathing. It may not be necessary for individuals to bathe every day.
• Be gentle. A person’s skin may be very sensitive. Avoid scrubbing, and pat dry instead of rubbing.
A hand-held shower may help to wash hard to reach areas.
• Wash the most sensitive areas last, including the head, face and perineal area.
• Washing the person’s hair may be the most
People with dementia often experience disturbed sleep. They may wake up during the night or be restless. These problems may get worse as the illness progresses. People with dementia may also have painful illnesses such as arthritis that cause, or contribute to, sleep problems. Some medication can cause sleepiness during the day and interfere with sleep at night. Sleeping pills can be used with care in people with dementia. However, ‘sleep hygiene’ measures are best for people with dementia – for example, no naps during the day, regular bedtimes and avoiding alcohol or caffeine at night.
• Others do not feel dressing up is important and this choice should be equally respected. Attempt to gather this information from family if the person with dementia is unable to
• Simplify clothing choices for the person according
to his or her ability to choose.
• Give the person short, simple instructions while
handing them an item such as “Put on your shirt.”
Sometimes just handing the person an item of
clothing (without saying anything) will facilitate
• Choose comfortable, simple clothing that easy to put on and take off. Consider cardigans, or other clothing that buttons in the front, rather than pullovers. Substitute snaps or zippers for buttons. Keep in mind that if you alter a familiar routine or method, the person with dementia may have difficulty learning something new, so try to follow the same routine and use familiar fasteners for as long as possible.
• Make sure the person has comfortable, sturdy non-slip shoe
EATING AND DRINKING
• Dementia may lead to changes in eating or drinking (e.g. eating more or less) because those affected by it may not be able to prepare meals, remember to eat or drink, remember when they last ate, know or be able to say that they are hungry or thirsty, or smell and taste in the same way they did before. • A person with dementia may not be able to initiate the task of eating, but if a spoon is placed in his or her hand, he or she may begin to eat. • It may become more difficult for the person with dementia to swallow foods and liquids safely as dementia progresses. • A person with dementia may refuse to eat or drink because of physical or emotional conditions at the end of life. . Help the person eat and drink what he or she likes, and provide food that meets dietary needs to promote health and safety. • Help to make mealtimes pleasant and enjoyable; involve family when the person and family are amenable.
Falling is accidentally coming into contact with the ground or another surface, like a table. Falls may occur with or without injury and often result from a loss of balance. • People with dementia have a greater risk of falling because they can have problems seeing, thinking, moving, and balancing. • The cause of falls can be related to the person’s abilities or home environment. • Personal risks include: history of falls, depression, vision problems, muscle weakness, fear of falling, multiple medications, being tired, blood pressure problems, incontinence, and being unable to move or having difficulty with movement.
Environmental risks can include:
•Confusing environment and clutter
•Lack of stable furniture or handrails
•Surfaces (e.g. floor, stairs, or ground) that are uneven, slippery or have glare •Poor lighting, especially at night
• Weather conditions that may result in slippery surfaces, or heat exhaustion •Rugs and door mats
Encourage safety and maintain a person’s ability to move within a living space by decreasing the risk of falls and related injuries. Encourage daily exercise to increase or maintain physical strength.
Wandering describes the behavior of people with dementia who move about in ways that may appear pointless but often have purpose. Wandering, like all behavioral symptoms of dementia, happens for understandable reasons. It may occur as a result of an unmet need for social interaction or friendship, a noisy environment, pain or distress, boredom or other causes.
Wandering is not necessarily a behavior that must be stopped. Wandering can help a person remain physically fit and in a better mood. It can help a person sleep better at night. Wandering can be dangerous when a person leaves home alone or goes into unsafe areas. Physical problems, such as injuries, health risks agitation, or death Wandering may happen because of many things that the person with dementia cannot express, including:
• A need for food, fluids, exercise or the toilet
• Pain, a need to urinate, constipation, infection or medication effects • A need for security or friendship
• Depression, anxiety, delusions or hallucinations
HOW CAN WE BE OF HELP
Help a person move about safely and independently and understand the difference between safe and unsafe wandering.
• Determine each person’s need and ability to move about • Wandering patterns, such as time of day it happens, events or places that cause it •Other needs such as hunger, the need to go to the bathroom, or boredom • Mental abilities, especially safety awareness and being impulsive by asking the person where is he/she at the moment, what is he/she doing in that place. •Vision and hearing, make sure he wears his hearing aid if applicable or eyeglasses. •Ability to move, do they need an aid for mobility like frame or stick. •Emotional conditions that may relate to wandering, such as anxiety or depression, or maybe substitute for another activity. •Environmental hazards such as poor lighting, throw rugs and uneven floors make sure all the surroundings are clear from having an injury. •The person’s footwear and clothing is safe for them, not too tight and not too loose or not too slippery.
This studies conducted to date does provide sufficient evidence of care or less costly care with effectiveness for any of the interventions or suggestions made of how can we be of help by knowing early signs and symptoms of dementia and that the carers would be more familiar with these if they have older people at home or relative.
Most of this research studies and feed back from the participants, a nursing staff and a health care assistant, the implementations or help suggestions have a very positive effects in regards of the care for people with dementia.
Therefore, we believe that most of the complex needs of the people with dementia and their family carers can be met by primary care services as well as community care services. However these services need to be individualized, comprehensive, accessible, flexible and delivered by competent well trained care provider. When we say community care, GP’s are the first point of contact for the individual and family members worried about the signs and symptoms of dementia.
We believe that the sooner we identify the problem the sooner we respond to it thus preventing major problems could occur.
Inevitably, some people with dementia would be unbearable for the family members, so some people might end up attending acute care or A&E care, or being admitted as in patients to these hospitals. Dementia care hence being implemented by professional and well trained nursing staff or health care assistant. Thus, dementia care is being met in acute setting with extra cost.
Or some might end up that the family members could not cope up at home and they are already burdened so older people are being handed over to the care of nursing homes
Therefore, the development of a more positive view of older people and old age and the broadening of the view of older life to encompass more than the health needs and the development of the view of responsiveness to needs is the best way forward to look after the elderly.
In terms of the care for people for dementia, greater levels of resources are needed to augment the availability, accessibility and usefulness of person centred dementia specific services that support the abilities of people with dementia.
Specific health and social care are needed or must be revised to counter dementia.
Families and carers must be involved in regards of planning and development of dementia.
Books, ForestKnolls, CA
Feil, Naomi. 1933. The Validation Breakthrough, Simple techniques for Communicating with People with dementia.
Planning Guide with Dementia care at home: A reference Tool for Managing Care.
Elements of Nursing 1985.