Working with Adults;
Dementia
Ian Mathews
Senior Lecturer in Social Work
What is (senile) dementia?
‘Dementia’ is an umbrella term ~ there are over ? different types of
dementia
NB the power of language;
Senile dementia
Alzheimer’s (disease)
Cognitive impairment
• Dementia with Lewy body
• Multi infarct dementia/Vascular disease
• Alcohol related dementia (Korsakoff’s syndrome)
• Huntington’s disease
• Creutzfeldt-Jakob Disease (CJD) ~bovine spongiform
encephalopathy (BSE), a form of prion disease affecting cattle.
Some of the characteristics of
dementia
• Memory impairment;
particularly short term memory
loss
• Language impairment
• Disorientation in time & space
( ‘wandering’)
• Changes in personality
• Mood changes
• Self neglect
• Disinhibited behaviour Eg
uncharacteristic sexual or
aggressive behaviour
• The ability to ‘reason’ or to
plan ahead
NSF for older people, DOH 2001
• How can you diagnose
dementia?
• What are the causes of
dementia?
• How can you treat dementia?
Keady & Nolan (1995) stage model
of dementia
Slipping; minor lapses in memory & behaviour
Suspecting; people & those around them suspect that
something is wrong
Covering up; conscious & deliberate attempts to
compensate for loss of function
Revealing; difficulties shared with those closest tot eh
individual
Confirming; acknowledgement, followed by diagnosis
Maximising; strategies devised to maximise functioning
Disorganisation; cognitive & physical difficulties become
increasingly apparent
Decline; needs increase & residential care may be required
Death;
The incidence of dementia
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There are currently 700,000 people with dementia in the UK.
There are currently 15,000 younger people with dementia in the UK.
There will be over a million people with dementia by 2025.
Two thirds of people with dementia are women.
60,000 deaths a year are directly attributable to dementia.
The financial cost of dementia to the UK is over £17 billion a year.
64% of people living in care homes have a form of dementia.
Two thirds of people with dementia live in the community while one
third live in a care home.
www.alzheimers.org.uk
The prevalence of dementia
Age
40 – 65
Prevalence
1 in 1,000
65 -70
1 in 50
70 – 80
1 in 20
80 plus
1 in 5
Crawford & Walker (2005 p 72)
Living well with dementia;
The National Dementia Strategy
DOH 2009
A five year plan backed with £150 million over the first two years
Has three main aims;
1.
Ensure better knowledge about dementia & remove the stigma; for professionals &
public;
• people currently wait up to three years before reporting symptoms
of dementia to their doctor;
• 70% of carers report being unaware of the symptoms of dementia
before diagnosis;
• 64% of carers report being in denial about their relative having the
illness;
• 58% of carers believe the symptoms to be just part of ageing;
• only 31% of GPs believe they have received sufficient basic and
post-qualification training to diagnose and manage dementia
( DOH 2009:26)
Aim 2. Ensure early diagnosis, support & treatment for
people with dementia, their family & carers
Positive about prevention in dementia – what’s good
for your heart is good for your head
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The current evidence base suggests that up to 50% of
dementia cases may have a vascular component (ie
vascular dementia or mixed dementia). This holds out
the possibility of preventing or minimising dementia by
means of promoting better cerebrovascular health.
Current health promotion messages on diet and
lifestyle and actions such as health checks are
therefore likely to have a positive effect.
(DOH 2009:24)
Aim 2 contd- Ensure early diagnosis, support & treatment
for people with dementia, their family & carers
• early provision of support at home can decrease
institutionalisation by 22%
• even in complex cases, where the control group
is served by a highly skilled mental health team,
case management can reduce admission to care
homes by 6%;
• older people’s mental health services can help
with behavioural disturbance, hallucinations and
depression in dementia, reducing the need for
institutional care
Aim 3 - Develop services to meet changing needs
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Appointment of dementia advisors
Development of carers groups & innovative
services ( ‘dementia cafes, dementia choirs,
Improve ‘Community personal support
services’
Emphasise the benefits of personalisation for
people with dementia ( individual budgets)
Provision of respite care & ‘Intermediate care’
The concept of ‘personhood’
• To be counted as a
person, and so have
‘personhood’, some
people think an
individual should
have qualities like
insight, rationality and
memory.
• Discuss!
(Killick J & Allan K
2001:17)
Malignant social psychology
Kitwood T (1997)
• Disempowerment: Not
letting someone do
what they are capable
of doing.
• Treachery: Tricking
someone into taking
medication by hiding it
in food
• Infantilization: Talking to
them like a baby
• Intimidation: Making
someone frightened
• Labelling: Using their
diagnosis as the main
way of understanding
their behaviour
• Stigmatizing: treating
someone as an outcast
• Outpacing: Talking,
giving information, and
providing choices too
quickly, so the person
can’t keep up.
Malignant social psychology
• Invalidation: Not taking
the persons feelings
seriously
• Ignoring: Talking over
their head, not including
them
• Withholding: Not giving
the attention they need
• Disruption: Breaking into
a persons conversation
or activity rudely, stopping
them carrying on with
whatever they were
doing.
• Mockery: Making fun of
people
• Disparagement: Saying
critical things about
someone, which will
damage their self
esteem.
• Imposition: Forcing
someone to do
something, not giving
choices.
References
Crawford K & Walker J (2005) Social work with older people, Exeter,
Learning Matters
Department of Health (2001) National Service Framework for older
people
Department of Health (2009) ‘Living well with dementia’ the National
Dementia Strategy
Keady, J., & Nolan, M( 1995) Assessing coping responses in the early
stages of dementia, British Journal of Nursing, 4, 309-14
Killick J & Allan K (2001) Communication and the care of people with
dementia, Buckingham, Open University press
Kitwood T, (1997) ‘Dementia reconsidered; the person comes first’,
Buckingham, Open University press