Caring for people with dementia
Dementia is very common. A quarter of general hospital in-patients have cognitive impairment, dementia or dementia complicated by delirium. Almost all healthcare professionals who look after adults will encounter patients with these problems, we all need the knowledge and skills to care for them.
Much of the care provided for people with dementia is good, but too often, their experiences result in dissatisfaction or complaints.
Beliefs and attitudes
Our own attitudes, knowledge and beliefs about dementia can affect the way we provide care. Try this survey and try to answer the questions honestly, your results are totally private and will not be recorded or shared with anyone else.
You can print or save a copy of this survey if you like and return to it once you have completed these learning resources.
Dementia and cognitive loss
Dementia is a brain condition that affects memory, thinking and daily function. There are different types of dementia including: Alzheimer’s disease, and Vascular, Lewy body and Frontal-temporal dementia. These have differing features, but mostly the similarities are more important than the differences.
Dementia is characterised by progressive loss of memory plus changes in at least one other area of cognitive function, including aphasia, agnosia, apraxia or executive function. This leads to impairments in judgement, thinking, planning, reasoning and the processing of information.
Communication – Introduction
People with dementia and those who care for them can experience difficulties communicating and interacting with each other. For people with dementia their ability to communicate usually worsens as the disease progresses. The hospital experience can be especially distressing because the noisy, busy and confusing environment may make the person with dementia’s symptoms worse and hinder communication. However, it is important that we do everything we can to communicate effectively with people with dementia and include them in decision making.
Means, Reasons and Opportunities
There are some important aspects of communication to consider:
- Without a MEANS of communication you cannot express yourself
- Without a REASON there is no purpose in communicating
- Without OPPORTUNITIES there can’t be any communication
Opportunities implies that there is someone to communicate with, that the person is included and allowed to take part in the conversation. We also need a shared language, desire to communicate, and an appropriate time and place.
Some people with dementia find it difficult to conceptualise or communicate pain or discomfort. If a patient is agitated or distressed consider hidden causes such as pain, thirst, constipation, urinary retention or needing the toilet. Actively look for conditions likely to be painful such as a wound or arthritis. If present, see if additional analgesia reduces the agitation.
People with dementia can have problems communicating, however it is important that we do everything we can to give patients the best opportunities to communicate. Communication should not be limited to information gathering and understanding needs, but be aimed at emotional closeness and respect as well. Working together as a team and involving family and carers will help everyone understand the best way to communicate with the person with dementia.
Care for people with dementia
Every person with dementia is an individual with differing backgrounds and needs. Their presentation will be influenced by many factors including their neurological impairment, their physical and mental health, their personality, their life history, relationships and the social environment where they are cared for. All these elements must be understood and taken into account. Some of these are fixed, some can be changed, especially the social environment, but also some other aspects of health. Due to their neurological impairment, people with dementia need extra help in forming and maintaining relationships, and will not always give much back in return.
Where the treatment of a person with dementia does not take account of all the factors influencing presentation, they are more likely to experience distress, suffer complications or inappropriate treatments or decisions, resulting in unnecessary disability and extended hospital stays. Much of the agitated and aggressive behaviour seen on wards is the patient’s response
To individualise care we must assess thoroughly. This means gathering information from as many different sources as possible. Information is needed from the patient, their family, paid and unpaid carers, the GP, community nurses, community groups and anyone else who can provide information. Formal assessments such as cognitive tests, CT scans, blood results and clinical assessments made by the multidisciplinary team will also provide information. This list is not exhaustive.
By getting information from as many places as you can, you build up a picture of the patient’s condition. Taking information from just one source can be misleading.
It may sound obvious, but we should adapt how we approach patients and what we suggest for them, according to their individual problems, values, preferences and circumstances.
However, it is all too easy to presume that all people with dementia are the same, to stigmatise their condition and disregard or overlook their retained abilities. Care planning needs to reflect patients’ strengths and needs and be reviewed regularly.
Details of the patient’s life history and preferences will need to be sought from family carers. Personal profile documents such as the ‘This is Me’ document are useful to capture this information.
When caring for patients with dementia it is important to treat each patient as an individual with differing backgrounds, problems, abilities and needs. Their behaviour will be influenced by many factors including their neurological impairment, their physical and mental health, their personality, life history and the social environment where they are cared.
It is important that the person with dementia is valued, that their care is individualised, that when caring for the patient you try and understand the perspective of the person with dementia and that you strive to create a positive social environment. That is what is meant by seeing the person, and making them the centre of the care we offer.
|RLO: Person Centred Care||This RLO looks at what person-centred dementia care is and using filming of healthcare professionals caring for people with dementia, shows how person-centred care can be applied on a hospital ward.|
|RLO: Caring for people with dementia in the general hospital||Dementia is very common. A quarter of general hospital in-patients have cognitive impairment, Dementia or dementia complicated by delirium. Almost all healthcare professionals who look after adults will encounter patients with these problems, we all need the knowledge and skills to care for them.|
|Website: Alzheimer’s Society||Alzheimer’s Society is a membership organisation, which works to improve the quality of life of people affected by dementia in England, Wales and Northern Ireland.|