CHCAGE005

PROVIDE SUPPORT TO PEOPLE LIVING WITH DEMENTIA

LEARNER RESOURCE

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T A B L E O F C O N T E N T S

TABLE OF CONTENTS ………………………………………………………………………………………………………………………. 2

UNIT INTRODUCTION ……………………………………………………………………………………………………………………… 6

ABOUT THIS RESOURCE …………………………………………………………………………………………………………………….. 6 ABOUT ASSESSMENT ………………………………………………………………………………………………………………………… 7

ELEMENTS AND PERFORMANCE CRITERIA …………………………………………………………………………………………. 9

PERFORMANCE EVIDENCE AND KNOWLEDGE EVIDENCE ……………………………………………………………………. 11

PERFORMANCE EVIDENCE ……………………………………………………………………………………………………………………… 11 KNOWLEDGE EVIDENCE ………………………………………………………………………………………………………………………… 11

ASSESSMENT CONDITIONS ……………………………………………………………………………………………………………. 13

PRE-REQUISITES …………………………………………………………………………………………………………………………… 13

TOPIC 1 – PREPARE TO PROVIDE SUPPORT TO THOSE AFFECTED BY DEMENTIA …………………………………….. 14

WHAT IS DEMENTIA? ………………………………………………………………………………………………………………………….. 14 WHAT IS THE DIFFERENCE BETWEEN DEMENTIA AND ALZHEIMER’S DISEASE? ………………………………………………………….. 15 EARLY SIGNS OF DEMENTIA ……………………………………………………………………………………………………………………. 17 SYMPTOMS AND STAGES OF DEMENTIA ……………………………………………………………………………………………………… 19 FIRST-STAGE …………………………………………………………………………………………………………………………………….. 19 SECOND-STAGE …………………………………………………………………………………………………………………………………. 21 THIRD-STAGE ……………………………………………………………………………………………………………………………………. 23 FOURTH-STAGE …………………………………………………………………………………………………………………………………. 24

APPLY PERSON-CENTRED CARE APPROACHES TO ALL INTERACTIONS WITH THE PERSON LIVING WITH

DEMENTIA ………………………………………………………………………………………………………………………………….. 25

WHAT IS PERSON-CENTRED PRACTICE? ………………………………………………………………………………………………………. 25 Why is person-centred practice important? …………………………………………………………………………………… 25

LANGUAGE AND PERSON CENTRED CARE ……………………………………………………………………………………………………. 26

INTERPRET INDIVIDUALISED PLAN AND FAMILIARISE SELF WITH THE SPECIFIC NEEDS AND WANTS OF THE

PERSON LIVING WITH DEMENTIA AND IDENTIFY AND ADDRESS PERSON’S NEEDS FOR A STABLE AND

FAMILIAR ENVIRONMENT ……………………………………………………………………………………………………………… 27

TREATMENT AND CARE …………………………………………………………………………………………………………………………. 27 RISK FACTORS AND PREVENTION………………………………………………………………………………………………………………. 28 SOCIAL AND ECONOMIC IMPACTS …………………………………………………………………………………………………………….. 28 LIVING WITH DEMENTIA ……………………………………………………………………………………………………………………….. 28 WHAT IS THE EXPERIENCE OF DEMENTIA? …………………………………………………………………………………………………… 28

RECOGNISE SIGNS CONSISTENT WITH FINANCIAL, PHYSICAL OR EMOTIONAL ABUSE OR NEGLECT OF THE

PERSON AND REPORT TO AN APPROPRIATE PERSON ………………………………………………………………………… 31

DOMESTIC VIOLENCE …………………………………………………………………………………………………………………………… 32 NEGLECT …………………………………………………………………………………………………………………………………………. 32 PHYSICAL ABUSE ………………………………………………………………………………………………………………………………… 33 RESTRAINTS AND RESTRICTED PRACTICES …………………………………………………………………………………………………….. 33 SEXUAL ASSAULT ………………………………………………………………………………………………………………………………… 34 EMOTIONAL ABUSE …………………………………………………………………………………………………………………………….. 35 FINANCIAL ABUSE ……………………………………………………………………………………………………………………………….. 35 SYSTEMIC ABUSE ………………………………………………………………………………………………………………………………… 36 RECOGNISING SIGNS THAT MAY BE INDICATORS OF ABUSE …………………………………………………………………. 36

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TOPIC 2 – USE APPROPRIATE COMMUNICATION STRATEGIES …………………………………………………………….. 39

USE VERBAL AND NON-VERBAL COMMUNICATION STRATEGIES TO MAXIMISE ENGAGEMENT OF THE PERSON

WITH DEMENTIA ………………………………………………………………………………………………………………………….. 39

THE GOOD NEWS ……………………………………………………………………………………………………………………………….. 39 BE A GOOD LISTENER …………………………………………………………………………………………………………………………… 40 INTUITION ……………………………………………………………………………………………………………………………………….. 40 THE EFFECTS OF DEMENTIA ON COMMUNICATION ………………………………………………………………………………………….. 41 THE COMMUNICATIVE NEEDS OF PEOPLE LIVING WITH DEMENTIA ……………………………………………………………………….. 41

GAIN COOPERATION AND PROVIDE REASSURANCE AS APPROPRIATE BY USING REALITY ORIENTATION …… 43

UNREALISTIC BELIEF IN DEMENTIA CLIENTS ………………………………………………………………………………………………….. 43 WHAT ARE THEY? ………………………………………………………………………………………………………………………………. 43 VALIDATE THE PERSONS ‘S BELIEF …………………………………………………………………………………………………………….. 44 TREATMENT ……………………………………………………………………………………………………………………………………… 45 SUPPORT FOR FAMILIES AND CARERS …………………………………………………………………………………………………………. 46

USE A RANGE OF VALIDATION STRATEGIES TO RELIEVE DISTRESS AND AGITATION IN THE PERSON …………. 47

WHAT IS AGITATED BEHAVIOUR? …………………………………………………………………………………………………………….. 47 WHAT CAUSES THESE BEHAVIOURS? …………………………………………………………………………………………………………. 47 UNDERSTANDING THE BEHAVIOURS ………………………………………………………………………………………………………….. 47 FREQUENT CAUSES OF AGITATED BEHAVIOURS ………………………………………………………………………………………………. 48

TOPIC 3 – PROVIDE ACTIVITIES FOR MAINTENANCE OF DIGNITY, SKILLS AND HEALTH ……………………………. 51

ORGANISE ACTIVITIES WHICH AIM TO MAINTAIN INDEPENDENCE, USING FAMILIAR ROUTINES AND EXISTING

SKILLS ………………………………………………………………………………………………………………………………………… 51

CREATING OPPORTUNITIES FOR PERSONAL ENJOYMENT ……………………………………………………………………………………. 51

ORGANISE ACTIVITIES THAT ARE APPROPRIATE TO THE INDIVIDUAL, REFLECTING THEIR CULTURAL LIKES AND

DISLIKES, IN ORDER TO BRING BACK PLEASURABLE MEMORIES ………………………………………………………….. 53

DAILY LIVING AND PAST SOCIAL ROLES ……………………………………………………………………………………………………….. 53 CREATING A LIFE STORY ………………………………………………………………………………………………………………………… 53 MEANINGFUL AND PURPOSEFUL DAILY LIVING ………………………………………………………………………………………………. 54 INTIMACY AND SEXUAL ISSUES ………………………………………………………………………………………………………………… 55 INTIMACY AND SEXUALITY ……………………………………………………………………………………………………………………… 55 HOW ARE INTIMACY AND SEXUALITY AFFECTED BY DEMENTIA? …………………………………………………………………………… 55 CHANGED SEXUAL BEHAVIOURS ………………………………………………………………………………………………………………. 55 INCREASED SEXUAL DEMANDS …………………………………………………………………………………………………………………. 56 DIMINISHING SEXUAL INTEREST ……………………………………………………………………………………………………………….. 56 LOSS OF INHIBITIONS …………………………………………………………………………………………………………………………… 56 MANAGING INAPPROPRIATE SEXUAL BEHAVIOURS …………………………………………………………………………………………. 56 INCONTINENCE ………………………………………………………………………………………………………………………………….. 57 WHERE TO BEGIN ……………………………………………………………………………………………………………………………….. 57 CHANGES IN A PERSON’S ABILITY ……………………………………………………………………………………………………………… 57 DRESSING ………………………………………………………………………………………………………………………………………… 58 PHYSICAL OR MEDICAL CAUSES ………………………………………………………………………………………………………………… 58 FORGETTING HOW TO DRESS ………………………………………………………………………………………………………………….. 58 PROBLEMS WITH THE ENVIRONMENT ………………………………………………………………………………………………………… 59 LACK OF PRIVACY ……………………………………………………………………………………………………………………………….. 59 PROBLEMS MAKING DECISIONS ABOUT WHAT TO WEAR …………………………………………………………………………………… 60

ENSURE THE SAFETY AND COMFORT OF THE PERSON BALANCED WITH AUTONOMY AND RISK TAKING ……. 61

SAFETY …………………………………………………………………………………………………………………………………………… 61 WALKING AND WANDERING …………………………………………………………………………………………………………………… 62

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PARTICIPATING IN MEANINGFUL ACTIVITIES …………………………………………………………………………………………………. 63 ACTIVITIES CAN BE AN IMPORTANT WAY OF HELPING A PERSON WITH DEMENTIA TO RETAIN THEIR

INDEPENDENCE. …………………………………………………………………………………………………………………………….. 64 ACTIVITY SELECTION …………………………………………………………………………………………………………………………….. 66

ACCESS INFORMATION ABOUT THE PERSON’S REMINISCENCES AND ROUTINES WITH FAMILY AND CARERS 69

HOW DO I MANAGE OUR COMMUNICATION NEEDS? ………………………………………………………………………………………. 69 HOW DO I MANAGE THEIR EATING AND NUTRITION NEEDS? ………………………………………………………………………………. 70 HOW DO I MANAGE THEIR HYGIENE NEEDS? ………………………………………………………………………………………………… 71 HOW DO I MANAGE THEIR CONTINENCE NEEDS? …………………………………………………………………………………………… 71 HOW DO I MANAGE THEIR SLEEPING HABITS? ………………………………………………………………………………………………. 72 HOW DO I MANAGE MEMORY LOSS? …………………………………………………………………………………………………………. 73 HOW DO I MANAGE IF THEY ARE CONFUSED? ……………………………………………………………………………………………….. 74 HOW DO I MANAGE IF THEY ARE AGGRESSIVE? ……………………………………………………………………………………………… 74

PROVIDE SUPPORT AND GUIDANCE TO FAMILY, CARERS AND/OR SIGNIFICANT OTHERS WHERE

APPROPRIATE ……………………………………………………………………………………………………………………………… 76

CARERS OF PEOPLE WITH DEMENTIA ARE NOT ALONE ………………………………………………………………………………………. 76 MANAGING STRESS AS CARERS ………………………………………………………………………………………………………………… 76 ASKING FOR HELP ……………………………………………………………………………………………………………………………….. 77 COMMUNICATING WITH FRIENDS AND RELATIVES ………………………………………………………………………………………….. 77

TOPIC 4 – IMPLEMENT STRATEGIES WHICH MINIMISE THE IMPACT OF BEHAVIOURS OF CONCERN ………….. 79

IDENTIFY BEHAVIOURS OF CONCERN AND POTENTIAL TRIGGERS ………………………………………………………… 79

SLEEPING PROBLEMS …………………………………………………………………………………………………………………………… 79 HOARDING ………………………………………………………………………………………………………………………………………. 80 REPETITIVE BEHAVIOUR ………………………………………………………………………………………………………………………… 80 WANDERING …………………………………………………………………………………………………………………………………….. 80 SUNDOWNING ………………………………………………………………………………………………………………………………….. 81 IDENTIFY POTENTIAL TRIGGERS ………………………………………………………………………………………………………………… 81 MEDICAL CAUSES OF SLEEPING PROBLEMS IN DEMENTIA ………………………………………………………………………………….. 81 ENVIRONMENTAL CAUSES OF SLEEPING PROBLEMS IN DEMENTIA ………………………………………………………………………… 82 OTHER CAUSES OF SLEEPING PROBLEMS IN DEMENTIA …………………………………………………………………………………….. 82 CAUSES OF WANDERING ……………………………………………………………………………………………………………………….. 82

CONTRIBUTE TO TEAM DISCUSSIONS ON SUPPORT PLANNING AND REVIEW AND TAKE ACTION TO MINIMISE

THE LIKELIHOOD OF AND REDUCE THE IMPACT OF BEHAVIOURS ON THE PERSON AND OTHERS ……………… 84

SAFETY INSIDE THE HOME FOR PEOPLE WITH DEMENTIA …………………………………………………………………………………… 84 SAFETY OUTSIDE THE HOME FOR PEOPLE WITH DEMENTIA ………………………………………………………………………………… 86 INDEPENDENCE AIDS FOR THE PERSON WITH DEMENTIA …………………………………………………………………………………… 86 CHANGES TO THE ENVIRONMENT FOR PEOPLE WITH DEMENTIA ………………………………………………………………………….. 87

EVALUATE IMPLEMENTED STRATEGIES WITH SUPPORT PLANNING TEAM TO ENSURE EFFECTIVENESS IN

MINIMISING BEHAVIOURS …………………………………………………………………………………………………………….. 89

TOPIC 5 – COMPLETE DOCUMENTATION …………………………………………………………………………………………. 90

COMPLY WITH THE ORGANISATION’S REPORTING REQUIREMENTS, INCLUDING REPORTING OBSERVATIONS

TO SUPERVISOR …………………………………………………………………………………………………………………………… 90

COMPLETE, MAINTAIN AND STORE DOCUMENTATION ACCORDING TO ORGANISATION POLICY AND

PROTOCOLS ………………………………………………………………………………………………………………………………… 91

COMPLETE DOCUMENTATION …………………………………………………………………………………………………………. 91 MAINTAIN DOCUMENTATION …………………………………………………………………………………………………………. 92 STORE INFORMATION …………………………………………………………………………………………………………………………… 92

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TOPIC 6 – IMPLEMENT SELF CARE STRATEGIES …………………………………………………………………………………. 93

MONITOR OWN STRESS LEVEL IN RELATION TO WORKING WITH PEOPLE WITH DEMENTIA …………………….. 93

USE APPROPRIATE SELF CARE STRATEGIES AND SEEK SUPPORT IF REQUIRED ……………………………………….. 95

SUMMARY ………………………………………………………………………………………………………………………………….. 96

REFERENCES ………………………………………………………………………………………………………………………………… 97

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U N I T I N T R O D U C T I O N

This resource covers the unit CHCAGE005 Provide support to people living with dementia.

This unit describes the skills and knowledge required to provide person-centred care and support to people living with dementia. It involves following and contributing to an established individual plan.

This unit applies to workers in a residential or community context, including family homes. Work performed requires some discretion and judgement and may be carried out under regular direct or indirect supervision.

The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand standards and industry codes of practice.

ABOUT THIS RESOURCE

This resource brings together information to develop your knowledge about this unit. The information is designed to reflect the requirements of the unit and uses headings to makes it easier to follow.

Read through this resource to develop your knowledge in preparation for your assessment. You will be required to complete the assessment tools that are included in your program. At the back of the resource are a list of references you may find useful to review.

As a student it is important to extend your learning and to search out text books, internet sites, talk to people at work and read newspaper articles and journals which can provide additional learning material.

Your trainer may include additional information and provide activities. Slide presentations and assessments in class to support your learning.

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ABOUT ASSESSMENT

Throughout your training we are committed to your learning by providing a training and assessment framework that ensures the knowledge gained through training is translated into practical on the job improvements.

You are going to be assessed for:

 Your skills and knowledge using written and observation activities that apply

to your workplace.

 Your ability to apply your learning.

 Your ability to recognise common principles and actively use these on the job.

You will receive an overall result of Competent or Not Yet Competent for the assessment of this unit. The assessment is a competency based assessment, which has no pass or fail. You are either competent or not yet competent. Not Yet Competent means that you still are in the process of understanding and acquiring the skills and knowledge required to be marked competent. The assessment process is made up of a number of assessment methods. You are required to achieve a satisfactory result in each of these to be deemed competent overall.

All of your assessment and training is provided as a positive learning tool. Your assessor will guide your learning and provide feedback on your responses to the assessment. For valid and reliable assessment of this unit, a range of assessment methods will be used to assess practical skills and knowledge.

Your assessment may be conducted through a combination of the following methods:

 Written Activity

 Case Study

 Observation

 Questions

 Third Party Report

The assessment tool for this unit should be completed within the specified time period following the delivery of the unit. If you feel you are not yet ready for assessment, discuss this with your trainer and assessor.

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To be successful in this unit you will need to relate your learning to your workplace. You may be required to demonstrate your skills and be observed by your assessor in your workplace environment. Some units provide for a simulated work environment and your trainer and assessor will outline the requirements in these instances.

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E L E M E N T S A N D P E R F O R M A NC E C R I T E R I A

1. Prepare to provide support to those affected by dementia

1.1 Apply person-centred care approaches to all interactions with the person living with dementia

1.2 Interpret individualised plan and familiarise self with the specific needs and wants of the person living with dementia

1.3 Identify and address person’s needs for a stable and familiar environment

1.4 Recognise signs consistent with financial, physical or emotional abuse or neglect of the person and report to an appropriate person

2. Use appropriate communication strategies

2.1 Use verbal and non-verbal communication strategies to maximise engagement of the person with dementia

2.2 Gain cooperation and provide reassurance as appropriate by using reality orientation

2.3 Use a range of validation strategies to relieve distress and agitation in the person

3. Provide activities for maintenance of dignity, skills and health

3.1 Organise activities which aim to maintain independence, using familiar routines and existing skills

3.2 Organise activities that are appropriate to the individual, reflecting their cultural likes and dislikes, in order to bring back pleasurable memories

3.3 Ensure the safety and comfort of the person balanced with autonomy and risk taking

3.4 Access information about the person’s reminiscences and routines with family and carers

3.5 Provide support and guidance to family, carers and/or significant others where appropriate

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4. Implement strategies which minimise the impact of behaviours of concern

4.1 Identify behaviours of concern and potential triggers

4.2 Contribute to team discussions on support planning and review

4.3 Take action to minimise the likelihood of and reduce the impact of behaviours on the person and others

4.4 Evaluate implemented strategies with support planning team to ensure effectiveness in minimising behaviours

5. Complete documentation 5.1 Comply with the organisation’s reporting requirements, including reporting observations to supervisor

5.2 Complete, maintain and store documentation according to organisation policy and protocols

6. Implement self-care strategies

6.1 Monitor own stress level in relation to working with people with dementia

6.2 Use appropriate self-care strategies and seek support if required

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P E R F O R M A N C E E V I D E N C E A N D K N O W L E D G E E V I D E N C E

This describes the essential knowledge and skills and their level required for this unit.

PERFORMANCE EVIDENCE

The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has:

 Provided support to 2 different people living with dementia:

 Using a person-centred approach to support

 Using appropriate communication strategies

 Assisting in implementing a range of suitable activities that meet the person’s

needs

KNOWLEDGE EVIDENCE

The candidate must be able to demonstrate essential knowledge required to effectively complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the work role. This includes knowledge of:

 Up to date research on dementia and the different manifestations of

dementia, including:

o Alzheimer’s disease

o Vascular dementia or multi-infarct dementia

o Lewy bodies

o Excessive alcohol intake or korsakov syndrome

o Fronto temporal lobar degeneration (FLTD) including pick’s disease

o Huntington’s disease

o Parkinson’s disease

o Younger onset dementia

 Dementia as a progressive neurological condition, including pathological

features:

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o Amyloid plaques

o Neurofibrillary tangles

o Loss of connection between cells and cell death

 Common indicators and symptoms of dementia

 Behaviours of concern, needs driven behaviour model and de-escalation

procedures

 Progression of dementia and potential impact on the person with dementia,

their family and significant others, including:

o Depression

o Loss and grieving

o Anger

o Despair

o Social embarrassment a family member might feel

o Isolation

o Financial burden on the family

o Social devaluation

 Principles of person-centred approach to support

 Relevant activities which enhance self-esteem and pleasure in the person’s

life, minimise boredom, and distract from or eliminate behavioural and

psychological symptoms of dementia

 Competency and image enhancement as a means of addressing devaluation

 Verbal and non-verbal communication strategies including:

o Reality orientation

o Reminders of the day, the time, relationships, occasions

o Reassuring words, phrases and body language

o Validation

o Empathy

o Acceptance of the person’s reality

o Acknowledgement

o Allowing expressions of distress

o Providing verbal and physical reassurance

o Frequent reminiscence to connect with person

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A S S E S S M E N T C O N D I T I O N S

Skills must have been demonstrated in an ageing support workplace with the addition of simulations and scenarios where the full range of contexts and situations have not been provided in the workplace. These are situations relating to emergency or unplanned procedures where assessment in these circumstances would be unsafe, impractical or threatens the dignity of the older person.

The following conditions must be met for this unit:

 Use of suitable facilities, equipment and resources, including individualised

plans and any relevant equipment outlined in the plan

 Modelling of industry operating conditions, including scenarios that reflect a

range of dementia support services involving a range of dementia symptoms

and behaviours of concern

Overall, assessment must involve some real interactions with people with dementia, colleagues and families/carers.

Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.

P R E – R E Q U I S I T E S

This unit must be assessed after the following pre-requisite unit:

There are no pre-requisites for this unit.

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T O P I C 1 – P R E P A R E T O P R O V I D E S U P P O R T T O T H O S E A F F E C T E D B Y

D E M E N T I A

Dementia is a major health problem in Australia. It has profound consequences for the health and quality of life of people with the condition, as well as for their families and friends.

Because dementia is generally a progressive condition, its impact increases with the growing severity of the condition. Eventually, people with dementia become dependent on their care providers in most, if not all, areas of daily living (unless they die from another condition first).

WHAT IS DEMENTIA?

Dementia is not a disease, but rather an umbrella term for a variety of symptoms that may accompany or indicate certain diseases or conditions. Today over 60 different conditions are known to cause dementia symptoms

After a dementia diagnosis, the focus is often only on the person’s symptoms and behaviour rather than on his or her needs. It can seem that there is not much that can be done, which makes it very hard to maintain a positive attitude. However, if you shift your focus and energy to the person’s strengths and remaining abilities, it helps you keep a positive attitude and enables you to encourage and inspire improvement, joy, hope, and well-being in those you support.1

1 http://www.dementiacareaustralia.com/index.php?option=com_content&task=view&id=336&Itemid=81

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WHAT IS THE DIFFERENCE BETWEEN DEMENTIA AND ALZHEIMER’S DISEASE?

Dementia is not a disease, but a broad term to cover a group of symptoms; the most common being memory loss. The most common cause of dementia is Alzheimer’s disease, a degenerative disease accounting for between 50 – 70% of all cases. To date, there is no medical cure or preventative for Alzheimer’s. Medical treatments available today can only prolong a stage of dementia for a certain period of time with varying success depending on the product and the individual. It is important to be aware that despite the amazing assessment tools available today, it is still not possible to truly diagnose Alzheimer’s until an autopsy has taken place. Also, in many situations there is no direct link between the person’s neurological changes and the degree of dementia symptoms he or she may experience.

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Below are some examples of curable or reversible conditions:

 Dehydration can cause confusion and increased memory loss – both

symptoms of dementia.

 Constipation

 Infection. e.g. pneumonia, urinary tract infection or even the smallest

infection can cause dementia symptoms.

 Vitamin imbalance. Imbalance or lack of ‘brain vitamins’ such as C, E, B6,

B12 and folate (folic acid) can also cause dementia symptoms. High

homocysteine, levels are associated with an increased risk of cardiovascular

disease, stroke and also Alzheimer’s disease and other dementias. Adequate

intake of vitamin B and folate can help reduce homocysteine levels.

 Pain – can cause dementia symptoms.

 Medication poisoning. This can occur easily in older people because their

bodies are less able to excrete surplus medication, which can build up in the

system and create side effects, such as bewilderment, confusion and amnesia;

all symptoms of dementia.

 Brain tumors – (that can be removed) benign as well as malignant.

 Depression can also cause symptoms similar to dementia, such as decreased

memory and concentration loss; often leading to misdiagnosis.

Once any of the above existing conditions has been cured, the dementia symptoms are likely to disappear or return to the level they were at before the condition appeared.

Medical research has not yet been able to find any treatment or preventatives for the following conditions:

 Alzheimer’s disease (the most common cause of dementia) is a result of

damage and changes to nerve cells within the brain. These abnormalities are

referred to as amyloid plaques and neurofibrillary tangles which can

ultimately destroy nerve cells.

 Vascular dementia or multi-infarct dementia (the second most common

cause of dementia) and more commonly known as stroke, is a result of the

blood supply to the brain being cut off due to clotting or blood vessels

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bursting in the brain, (aneurism) destroying surrounding tissue and

triggering strokes.

 Lewy Bodies dementia (the third most common cause of dementia) is a

result of a build-up of Lewy bodies – accumulated bits of alpha-synuclein

protein – inside the areas of the brain that control particular aspects of

memory and motor control. The dementia symptoms are characterised by

pronounced fluctuations in the mood with periods of confusion, followed by

greater lucidity, and disturbed visual experiences.

 Excessive alcohol intake or Korsakov Syndrome is associated with

prolonged alcohol use characterised by personality changes and short-term

memory loss.

 Fronto Temporal Lobar Degeneration (FLTD) including Pick’s disease is

caused by a degeneration occurring in one or both of the frontal and temporal

lobes of the brain resulting in significant behaviour and personality changes.

 Other less common causes of dementia include Huntingdon’s and

Parkinson’s diseases.2

EARLY SIGNS OF DEMENTIA

The first signs and changes in a person with dementia may be scarcely noticeable as most often they come on gradually. (Except in cases like multi-infarct dementia, which takes a more step-like decline?) The person or family may initially only notice memory lapses, such as difficulty in remembering dates or finding the right word. The person may use impaired judgement resulting in financial or ill-considered decisions. Behaviour and personality changes may occur too, such as becoming more assertive/more withdrawn, less flexible; showing a loss of interest in things that have mattered previously, becoming absent-minded or repeating the same story or question.

Each person will be affected in his or her own unique way, and also dependent on the type or cause of his or her dementia. It is important to avoid foretelling the future or embracing all the pessimistic possibilities you may hear or read of because such negative predictions may well result in a self-fulfilling prophecy.

2http://www.dementiacareaustralia.com/index.php?option=com_content&task=view&id=336&Itemid=8 1

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The fact that some brain cells die or that there has been a deterioration of brain cells resulting in the onset of dementia does not mean the path ahead has to be all downhill. Some research studies show that there is no correlation between the severity of brain damage and the extent to which a person is generally affected by the dementia process.

Research into the brain also shows that even though some brain cells may die, the brain has the capability to repair itself, creating new networks and pathways to link information stored in cells that are still functioning. There is much excitement in the scientific world about the possibility of nerve regrowth in the brains of people with dementia.

We know through experience that people with dementia have a fabulous ability to develop new strategies and behaviours to compensate for what they have lost. Positive responses to and interpretations of these changes, strategies and behaviours can be a matter of attitude, both in the person and those of their supportive partners or “carers”.

Often, after a dementia diagnosis, focus fixes only on the person’s symptoms and behaviour rather than on his or her needs. With this daunting diagnosis, it can seem that there is not much that can be done and it can be very hard to maintain a positive attitude. However, if we shift our focus and energy to the person’s strengths and remaining abilities, it will help us to keep a positive attitude and influence both the way we care and how the person we support will feel and respond to us.

The first step is to switch our thinking from – dementia as resulting from an irreversible, degenerative disease of the brain without a cure. (A very negative picture); to – dementia resulting from a disability of certain parts of the brain. We need to remember that the rest of the person is still alive, feeling, sensitive and responsive. There are many possibilities to work with to help the individual improve, blossom and grow. By focusing on all that the person can still do, we can help ensure meaningful, positive and fulfilling lives for those we support.

When we open up to possibilities instead of the forecast probabilities, a whole new dimension can develop in relationships between either you and the person who supports you or you and the person you support.3

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Developed by Enhance Your Future Pty Ltd 19 CHCAGE005 Provide support to people living with dementia Version 1.1

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