What is Dementia?

Dementia. For a term, so widely used, it is surprising how little the general population actually knows about it. What is Dementia? What causes it? Can it be prevented? Can Dementia be cured? 

These questions often surround the subject of Dementia, but for good reason. 

Research and knowledge of the condition are still relatively in its infancy; however, it is these very questions that must be understood and answered in order for caregivers of people living with the condition to be able to provide the correct and appropriate support. 

Dementia is a general term used to describe a decline in mental ability to the extent that daily life is interfered with. The word describes a set of symptoms that include memory loss, difficulties thinking, problem-solving and communication. 

What Causes Dementia?

Dementia is caused by damage to the cells in the brain, More specifically the ability of the cells to communicate with one another.

This can be due to diseases such as Alzheimer’s disease; which is the most common type of Dementia. Or Dementia can be caused by damage to the brain due to a stroke, this is known as vascular dementia, which is the second most common form of dementia. 

The early symptoms of these types of dementia can vary, but as time progresses and more of the cells lose their ability to communicate, the symptoms tend to become similar. It is during these later stages that a person will require more support with their everyday life. 

However, most people, in the right environment can live well with Dementia for many years after their initial diagnosis. With the right environment and support, people living with dementia can lead a comfortable and content life. 

It is crucially important that caregivers have experience and training in providing suitable support and care for people living with dementia. 

Research Driven Care 

It is not enough for support staff to rely solely on their own personal experiences with dementia to provide good care, no matter how extensive it may be.

Over the last few years, there have been many various studies and clinical trials that attempt to understand the condition better.

Whilst some of these have yielded inconclusive results; there have also been some very helpful studies with clear results that indicate techniques that are successful in improving the lives of people with dementia. 

At Halwill Manor we strive to incorporate these techniques into the delivery of our care.

Throughout these pages, you will find citations to pieces of research that have had a direct influence on how we approach dementia care at Halwill Manor. 

Early signs of Dementia

In the early stages of somebody diagnosed with dementia, people may experience behaviour and personality changes. 

It is these changes that can be the most challenging and distressing effect of the disease. 

Close friends and family will often find these changes the most difficult, simply because these new behaviours that are being exhibited can be completely out of character for the person.

In these situations, caregivers and loved ones need to adopt a slightly different perspective of the person and develop an empathetic approach to interacting with them. 

At times a person living with dementia may behave in a way that seems wrong to us, however, we must understand that in their minds they are doing something perfectly normal.

So by us trying to stop them, it naturally causes frustration and distress to them. Instead, we need to work with them, reassure them, and distract them if necessary. 

In the early stages, people may experience behaviour and personality changes such as 

• Irritability 
• Anxiety 
• Depression 
• Aggression and anger 
• Agitation 
• Emotional distress 
• Physical and verbal outbursts 
• Restlessness pacing 
• Hallucination 
• Sleep issues 

In order for these symptoms to be mitigated, it is important that the person living with dementia resides in an environment that minimises triggering situations and also has positive interactions with people who understand the condition. 

Managing Dementia Symptoms

There are many approaches that need to be adopted in order to avoid these triggering situations. Personal comfort is a big factor in reducing anxiety and distress. 

A well trained and experienced Caregiver will understand trigger points, so when someone with dementia is becoming unsettled, the caregiver will investigate any:

• Underlying pain 
• Hunger or thirst
• Constipation
• Fatigue
• Infections
• Skin irritations

If these small irritations are present, they can amalgamate to cause a distressing feeling for somebody who is unable to express their emotions clearly, therefore it is vital for caregivers and support workers to be well trained and experienced in spotting these situations.

Imagine for a moment, being physically impaired whilst lacking the ability to communicate – but having a really itchy item of clothing irritating you all day! That would cause me great frustration, I can assure you of that!  

So in these situations, close friends, family, and caregivers must avoid being confrontational. 

The point is, there is usually an underlying reason for every behaviour. 

Treatment 

Although everyone should be treated differently, there are a few fundamentals that can be helpful to adopt when a person is exhibiting.

The aim is to work out the unmet need that lies behind the behaviour

We believe that non-drug approaches should always be tried first. 

The first step to achieving this is to understand a person’s life history, hobbies preferences and routines. Essentially the aim is to understand what the person used to be like and how they used to behave before their diagnosis. 

Put yourself in the shoes of somebody living with dementia for again for a moment.

First imagine by nature you are a motivated and busy person, someone that has always had control over their life choices and is always achieving tasks and get things done. 

Now imagine that some of your fundamental senses have been stripped away.

Remove your ability to think clearly and rationalise.

Remove your ability to vocalise and communicate properly. 

Lose your motor skills and impair your vision and hearing slightly.

Then disrupt your short-term memory. 

Even though the senses and abilities have been removed, on a cognitive level part of your brain is still functioning in terms of trying to achieve your normal tasks, except now you are unable to complete these tasks in the way you used to.

What does this result in? Naturally, it results in frustration, anxiety and restlessness. 

These are common and classic traits of people living with dementia. 

So, with this in mind if you have people around you who are trying to support you in achieving your goals, trying to reassure you, ultimately helping you in your actions; opposed to trying to stop you. Then you will adopt a less anxious and frustrated mental state. 

By providing people with activities and engagement that are suitable to them and their previous life history and preferences, a more comfortable lifestyle can be had. To learn more about Activities at Halwill Manor click HERE. 

Environment 

for people living with dementia and residing in a care setting, it is extremely important that the environment is conducive to a relaxed and comfortable mental state. 

Research has shown the importance of an environment with a sense of home. (Source A three perspective study of the sense of home of nursing home residents: the views of residents, care professionals and relatives – BMC GeriatricsBMC series – 2016) 

 “People’s bedrooms were very personalised with things that were meaningful for each person, family photographs, items of furniture and pictures. The registered manager said how one person had been involved in choosing the colour of their room.” (2017 CQC Report) 

Sometimes it can be said that the mind of a person with dementia regresses back to earlier years. When we cast our minds back to our sense of home in earlier years, the memories will be of a homely environment.

Very few of us would have grown up in a clinical environment as a child. 

Halwill Manor utilises the Sterling University dementia design audit tool as part of the ongoing development of the physical environment.  

Choice 

Wherever possible it is hugely important to give people with dementia a choice about their care and support.  

“It is important to remember that people with dementia are often able to make decisions about their care and support” (NICE Guidelines – Dementia: independence and well-being.) 

Giving people choice in their care and support, helps them retain their independence. 

Below are some examples of choices that can and should be presented to people. 

• In terms of the environment, it is a good idea to give people the choice of their decoration furniture layout, colour schemes etc. 
• It is imperative that people are given a choice of menu and a choice of where to eat 
• People need to be given a choice in terms of activities 
• Choice of sleeping and waking up times. 
• A choice of clothes 
• Choice of colour schemes, and design of bedrooms. 

Independence and Control

The ability to have control over one’s decisions is an important factor in dementia support.

If appropriate, we encourage residents to have small houseplants to take care of themselves.

There has been some interesting research that demonstrates a positive outcome in people living with dementia are able to care for houseplants 

Plants – The effects of choice and enhanced personal responsibility for the aged (Langer and Rodin 1976)

Key Workers 

Any good care home will have a structure that incorporates key workers into the staffing team. The importance of key workers cannot be understated. 

It is usually a key worker or activities coordinator that will obtain the life history of people living in the home.

As mentioned earlier the life history forms the basis for our dementia support.

Each person living in the home will be allocated to a particular key work, key workers become a go–to person for a resident living in the home.

Key workers also will develop a deep understanding of the person’s preferences likes and dislikes. It is the key worker’s responsibility to make sure nothing falls by the wayside.

A support environment that utilises personal experiences, as well as ongoing research and training will provide the most fulfilling environment. 

All of these aspects of dementia support need to be knitted together to form a strong blanket of support around people living with dementia.