Management Of Behavioural Problems In Dementia
At some point the person with dementia will develop challenging behaviours towards those around them. This is termed behavioural and psychological symptoms of dementia . Symptoms tend to be grouped into four categories: hyperactivity , psychosis , problems with mood , and instinctual .31 Dealing with BPSD is complex and has consistently been a difficult issue for GPs to manage.32,33 National guidance has dictated that non-drug approaches are used first, but this can often be difficult to achieve due to a lack of specialist interventional services on a background of persistent family concerns around safety of the individual while waiting for the intervention.34
Gp Mythbuster : Caring For People With Dementia
- Organisations we regulate
When we inspect GP practices, we look at how key population groups are cared for. One such group is people with poor mental health, including people with dementia.
In 2013/14, we carried out a thematic review of the care people living with dementia receive when moving between care homes and acute hospitals. The Cracks in the Pathway review found variation in the quality of care received. It recognised that improvements were needed to extend far beyond institutional boundaries. This was to make sure everyone living with dementia received good care.
Health and social care has developed further to include holistic models of care. These are based on health and social needs.
They emphasise the importance of:
- proactive care planning
- living well for longer and
- collaborative working between health and social care providers.
In the social model approach to dementia care, the focus is placed on the persons cognitive needs. It concentrates on their remaining abilities and skills. Activity is centred on stimulating the mind.
The medical model of dementia focuses on the brain diseases which can cause dementia. It studies neurological and chemical changes in the brain itself. This has led to development of drug interventions. It may one day mean that dementia can be prevented or even cured.
Important considerations when caring for someone living with dementia are:
- early diagnosis
- care planning and
- living well.
Case Study: No More Mammograms
I had the privilege of serving as guardian to a wonderful lady I loved to pieces. At the point she had advanced disease progression, it no longer made sense for her to have mammograms, even though she had a history of breast cancer.
Her perception of having labs drawn was she was being punished. She jerked away, yelling, Ow! as she slapped at the lab tech. I had no reason to believe a mammogram would go any better.
Additionally, I had to think about what would happen if a mammogram came back with a spot. Would I say yes to a biopsy? What if that came back bad?
Would I say yes to surgery, knowing anesthesia would exacerbate her dementia symptoms? What about post-op recovery? Would I say yes to her going to rehab, knowing an unfamiliar environment would further aggravate her symptoms?
What if she needed chemo and/or radiation? Would I say yes to that, knowing shed not understand why an IV was hooked up and try to pull it out?
Thats what I mean by beginning with the end in mind. Before you say yes to testing, think about what youd do if the results dont come back the way you want.
On the flip side, good news is great. But how would going through the diagnostics add to your parent or partners quality of life? What would it change?
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What Information Will The Gp Record
The GP may take the contact details of a carer, family member or friend of the person with dementia. This person will be a key contact and the person with dementia may allow the doctor to share relevant medical information with them.
For more information, see Can the GP share information with carers?
Treatment For Other Medical Conditions
If you have health issues that are not related to dementia, you should continue to get treatment for them. If any new problems develop, you should be able to start new treatment.
Your dementia care plan should link to any other care plans for other conditions.
Your care plan should look at how you can stay as healthy as possible. Your care coordinator will help make sure your physical and mental health is monitored. They will make sure you get advice on how to stay as healthy as possible.
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Getting A Needs Assessment
If you find you need help to manage everyday tasks like washing, dressing or cooking, it’s advisable to get a needs assessment from the social services department of your local council.
Ideally, this assessment should take place face to face. It’s a good idea to have a relative or friend with you if you’re not confident explaining your situation. They can also take notes for you.
If the needs assessment identifies you need help such as a carer to help with personal care , meals delivered to your home , or a personal alarm, you will then have a financial assessment to see how much you’ll contribute to the cost of your care.
Read more about NHS continuing healthcare.
How Can I Support Someone As Their Dementia Progresses
In the later-stages of dementia the person may become increasingly dependent on others for their care.
They may have severe memory loss at this stage and fail to recognise those close to them. They may lose weight , lose their ability to walk, become incontinent, and behave in unusual ways.
Not everyone will show all these signs, and some people may show them earlier on in the illness.
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Get A Carer’s Assessment
If you care for someone, you can have an assessment to see what might help make your life easier. This is called a carer’s assessment.
A carer’s assessment might recommend things like:
- someone to take over caring so you can take a break
- training in how to lift safely
- help with housework and shopping
- putting you in touch with local support groups so you have people to talk to
A carer’s assessment is free and anyone over 18 can ask for one.
What Support Will A Gp Give After A Diagnosis
GPs are an important source of support for people diagnosed with dementia, and their carers. Their doctor can help them to manage the condition, and to live well after a diagnosis of dementia.
Following a diagnosis, the GP should make sure that the person understands what this means, and talk with them about what to do next. They may also tell the person where they can get further information, and share any local sources of support.
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How To Take Care Of A Person With Dementia
Learning how to take care of a person with dementia can be a trial-and-error process. Every person with dementia and every caregiver is unique, and so is their relationship. However, the following general tips may be useful in helping people with dementia remain physically healthy and connected to the world.
General Practice Should Be Placed At The Centre Of Dementia Care
Dr Eugene Tang and Professor Louise Robinson discuss the latest recommendations for diagnosing and treating dementia patients, and how GPs can provide support
Read this article to learn more about:
- current trends in the prevalence of dementia
- benefits of a timely diagnosis at an early stage of the disease
- the different methods of managing dementia.
Dementia describes the clinical syndrome where a person’s difficulties in language, behaviour, and memory lead to problems for them with managing day-to-day activities. In the early stages of dementia, the person may have difficulty in remembering recent events and as the disease progresses, a wide range of other symptoms such as disorientation, confusion, worsening memory, and behavioural changes can emerge. Progression of these symptoms then leads to further disability, interfering with daily function and social or professional interactions, which can, therefore, affect not only the person with dementia but also their families and society as a whole.
|Adapted from Alzheimer’s Society Dementia UK: update 2014. Available at: www.alzheimers.org.uk/dementiaukReproduced with permission|
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When Nothing Works
In desperation, Joeys family hired me. Theyd been trying to get him diagnosed for three years, but couldnt convince him to go to the doctor. The arguments had become unbearable.
The wife reasoned with Joey. The son used logic. The daughter painted a happy picture of how great it is to go to the doctor. The adult grandkids used emotional appeals.
They told Joey he needed to go for his own good. They told Joey something wasnt right and needed to be checked out. That it wouldnt be as bad as he feared. They told him they loved him and begged him to do it for them. Joey wouldnt budge.
I got him to go to the doctor on my first try. And he loved me not just after the appointment, but the whole time I worked with him. What magic did I weave with Joey?
How You Can Help
Let the person help with everyday tasks, such as:
These can lead to increased confusion and make the symptoms of dementia worse.
Common food-related problems include:
- forgetting what food and drink they like
- refusing or spitting out food
- asking for strange food combinations
These behaviours can be due to a range of reasons, such as confusion, pain in the mouth caused by sore gums or ill-fitting dentures, or difficulty swallowing.
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What Causes Dementia To Progress So Quickly
Dementia symptoms are typically mild at first and progress over time to moderate and then severe, over several years. The speed as which dementia progresses varies between individuals, but some factors can cause dementia to progress more quickly. These include the persons age, the type of dementia, and other long term health problems. Dementia tends to progress more slowly in people over 65 compared to younger people below 65.
Get Your Parent/partner Ready
However long it takes you to get ready, double that number and tack on an extra 15 minutes. Throw on an extra 15 for unforeseen circumstances. Now youre in the ballpark.
Rather than being left to their own devices, most people need cueing and reminders to successfully get through the morning routine. For a detailed example sequence on how to do that, see Potty Talk: Successfully Navigating The Bathroom.
Moderate And Severe Cognitive Impairment
The different types of dementia share many more similar symptoms in the later stages of disease than they do in the early stages. As dementia progresses, a patients confusion and memory loss increase, sleep patterns are disrupted and most activities of daily living become risky or impossible to manage independently. At this stage, personality changes are more apparent and patients can become easily agitated and have unfounded suspicions. They may also no longer be able to recognise family members or their own reflection.
Interacting with patients who can be aggressive as a result of their dementia is challenging it can help to maintain eye contact and an open body posture, while keeping movements slow and smooth to show that you do not pose a threat to them. These aggressive behaviours are an attempt by the patient to communicate, so pharmacists and other healthcare professionals should ask questions that show interest and help to determine what need is being communicated.
Keep Your Mind And Body Healthy
Staying active has proven health benefits and may help ease dementia symptoms.
Being physically active, eating a healthy diet, getting enough sleep, and spending time with family and friends offer proven benefits. They may also help slow the symptoms of Alzheimers disease and related dementias.
- Exercise. You dont have to join a gym or spend a lot of money. Even light housework, gardening, and walking around the neighborhood can have benefits. Experts recommend both aerobic exercise and strength training . Learn more about exercise and physical activity.
- Eat right. A healthy diet is proven to influence heart health, which relates to brain health. Learn more about healthy eating.
- Sleep well. Lack of sleep and poor-quality sleep are linked to memory problems. Try to get 7 to 8 hours per night.
- Be mindful. One way to help manage stress and reduce anxiety and depression is a technique called mindfulness. Mindfulness is being aware of whats happening in the present, both inside and outside of your body. This web page and handout offer overviews of mindfulness in daily living.
- Stay social. People with dementia who live alone dont manage daily activities as well when they feel lonely. Join a support group, chat with someone regularly, or volunteer at a local school or community organization. For example, you could read to children at the library. For more ideas, visit Participating in Activities You Enjoy.
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How To Diagnose Alzheimers Vs Dementia
Alzheimers is a progressive and fatal brain disorder. Dementia is not a specific disease, but an umbrella term that defines a syndrome and used to refer to a specific group of symptoms related to a decline in mental ability. Alzheimers is one of the most common causes of dementia. Both Alzheimers and dementia are diagnosed using a variety of different assessments and tests, including a physical exam, lab tests, cognitive and neuropsychological tests, and an analysis of changes in behavior.
Dementia Help And Support
For further help and support with understanding dementia, try one of the following resources:
- Alzheimers: information about dementia and Alzheimer’s disease.
- Dementia uk: a charity providing Admiral Nurses for families affected by dementia.
- Dementia friends: learn more about what it is like to live with dementia.
Different Care Professionals You Will Meet
You will see professionals in a range of places, including hospitals and your home. Some will be NHS health professionals, including doctors and nurses. Others will be ‘allied health professionals, such as dentists.
You might also receive help from social care professionals. These are usually arranged through your local council.
A Named Person To Support You
Your care plan should give you the name of the person who will coordinate all the different support you should get. This named person will be your care coordinator. They will be the main point of contact for you and anyone who is helping to support you. A care coordinator is also sometimes called a care navigator.
Your care coordinator can help you understand what help is available.
Your care coordinator should:
- make sure your health is monitored
- look at your care plan with you at least once a year to make sure you are getting support
- make sure you know about the help you can get
- work with your family or friends to make sure you are getting the help you need
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Make Everyday Tasks Easier
This “memory bench” is used by a person living with dementia to organize the things she needs for each day.
Many people with early-stage dementia continue to manage their everyday activities. But its important to look ahead to a time when performing daily tasks will be harder. The sooner you adopt new strategies to help you cope with changes, the more time you will have to adjust to them. Here are some tips:
For more suggestions on living independently, see Aging in Place: Growing Older at Home.
Providing Psychological And Emotional Support
Another area where psychologists can intervene when someone has received a diagnosis of a neurodegenerative disorder is their emotional and mental well-being.
Like any diagnosis, dementia can create confusion, sadness, anxiety, and other disturbing emotions both in the diagnosed individual and in their family members.
They might experience an initial reaction of shock, followed by DENIAL and GRIEF.
These emotional states can be challenging to overcome, as individuals and their families are still adjusting to the new circumstances of their life.
In this respect, psychologists can provide strategies to manage THESE emotions.
And help those involved in the life of the person with dementia find useful coping strategies for challenging moments.
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Living Well With Dementia
Remember that people diagnosed with dementia are not completely helpless.
Dementia progression is usually fairly gradual. Live one day at a time and cope with things as they come.
Involve the person with the diagnosis as much as possible in future plans for their care.
Plan as many things in advance as possible when it comes to future care so that later on, family members will be able to follow their loved ones plan.
Set up the environment for success.
Design the space where the individual with dementia lives to enable him or her to function well. For example, the caregiver might use a piece of paper to draw an outline for a place setting so their loved one can set the table, or label shelves so they can put groceries away on their own.
Use memory tools.
Just like when vision starts to decline and people wear glasses to read, those with dementia use memory tools like alarms and to-do lists to remember things like birthdays, doctor appointments and to take their medicine.
Emphasize remaining strengths.
It is possible for a person with mild or moderate dementia to continue to learn using remaining learning and memory systems. Try to facilitate daily successes by:
- Providing visual and verbal cues for everyday activities.
- Simplifying tasks and routines.
- Breaking larger tasks into small steps.
- Identifying and engaging in activities that are pleasant and meaningful to the person with dementia.
This article was reprinted with permission by the American Psychological Association .