Research into Dementia Care:
new developments in
rehabilitation and enablement
Eastern region Older People's Network Event...
Gail Mountain
Professor of Occupational Therapy Research
g.a.mountain@shu.ac.uk
Director of the Centre for Health and Soci...
The old view of dementia:
a dread diagnosis
Unfortunately, people with dementia are
sometimes seen as ‘unsuitable for
rehab’…This can arise if dementia is
seen one-si...
Downward Spiral: self-
fulfilling prophecy
Low expectations
by others
denial of opportunity to
participate in meaningful
a...
The new perception: helping
people to live a quality life
with dementia
Listening to the Voices of People
with Dementia
“Being told I had dementia was like a door re-
opening after a difficult t...
New Ideologies and
Professional Practice in
Dementia Care
• Abilities rather than deficits
• Self management in the earlie...
New Ideologies and
Professional Practice in
Dementia Care
• Involvement of the person with dementia at all
times with thei...
This Presentation will
Consider:
• Self management for people with
dementia
• Rehabilitation for people with dementia;
bot...
Rehabilitation within the
Context of Dementia
1. Assessment of function
2. Psychosocial activities
3. Psychotherapeutic mo...
Rehabilitation within the
context of dementia cont.
6. Interventions to improve memory and cognition
7. Self management of...
Rehabilitation for People with
Dementia: changing parameters in
response to assessed need
Self Management
Mild
Impairment
...
Self Management
• In the early stages of the illness following
diagnosis
Mountain (2006), Dementia, The International Jour...
Components of a Programme for People
with early Dementia
• Emotional support
• Pleasure
• Social support
• Managing new ch...
Service Requirements
Must be supported by a whole systems
approach towards service delivery which:-
• promotes early diagn...
Changing perceptions of needs for
rehabilitation…..
• People with dementia are being included
within the remit of intermed...
Compensatory Technologies
Can include:-
• Provision of community equipment/ assistive technology
• Adaptations to existing...
New applications to promote
independence
• Use of mobile phones to prevent getting lost
• Technology tagging to enable oth...
Approaches with people with
Severe Dementia
• Cognitive approaches like quizzes and reality
orientation are redundant in p...
• Tables
• Kitchens, dusters
• “I have enjoyed doing that it makes you feel
like a person”
• Garden sheds, sweeping brushe...
Technologies to promote quality of
life in people with severe
dementia
A relatively new area but one that is developing ra...
Workers need to embrace the new
possibilities presented by
technology
This requires:-
• Involving users and carers in devi...
Design of the built and
outdoor environment
• Interpretation of shared spaces in residential
care – Torrington et al
• Des...
Consistent Requirements
• Involvement of informal carers in all settings:
community and residential care
• Listening to th...
Listen to the Voices of People
with Dementia
“I'm not dying of dementia. I'm living with
dementia.”
“I want to keep going ...
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Research into dementia care: new developments in ...

  1. 1. Research into Dementia Care: new developments in rehabilitation and enablement Eastern region Older People's Network Event Developing Dementia Care Services
  2. 2. Gail Mountain Professor of Occupational Therapy Research g.a.mountain@shu.ac.uk Director of the Centre for Health and Social Care Research www.shu.ac.uk/research/hsc Director of the EQUAL4 SMART Rehabilitation Consortium www.shu.ac.uk/research/hsc/smart Member of Interdem EU Collaboration Timely Psychosocial Interventions for People with Dementia http://interdem.alzheimer-europe.org/
  3. 3. The old view of dementia: a dread diagnosis
  4. 4. Unfortunately, people with dementia are sometimes seen as ‘unsuitable for rehab’…This can arise if dementia is seen one-sidedly as a process of degeneration, or if rehabilitation is seen largely in terms of functional performance or simplistic notions of independence…… Wey, 2002, Journal of Dementia Care 10(3)
  5. 5. Downward Spiral: self- fulfilling prophecy Low expectations by others denial of opportunity to participate in meaningful activities deskilling inability to participate further lowering of expectations more denial to participate in meaningful occupation further deskilling
  6. 6. The new perception: helping people to live a quality life with dementia
  7. 7. Listening to the Voices of People with Dementia “Being told I had dementia was like a door re- opening after a difficult time in my life – new challenges, new opportunities”. “I want people to understand that dementia isn't an end, it's a new beginning where you do things differently. While some things change forever there is a lot you still can do.” James Mckillop
  8. 8. New Ideologies and Professional Practice in Dementia Care • Abilities rather than deficits • Self management in the earlier stages of the illness • Promoting rehabilitative potential at all stages • Quality of life throughout the course of the illness
  9. 9. New Ideologies and Professional Practice in Dementia Care • Involvement of the person with dementia at all times with their carer • Technologies to facilitate self management • Managing the implications of the Mental Capacity Act • Good design of equipment and environments
  10. 10. This Presentation will Consider: • Self management for people with dementia • Rehabilitation for people with dementia; both community living and those in care • The contribution that technologies and good design can make
  11. 11. Rehabilitation within the Context of Dementia 1. Assessment of function 2. Psychosocial activities 3. Psychotherapeutic modalities 4. Sensory stimulation 5. Interventions to improve function, ADL & IADL
  12. 12. Rehabilitation within the context of dementia cont. 6. Interventions to improve memory and cognition 7. Self management of the condition 8. Compensatory technologies 9. Interventions to assist carers to continue caring Mountain, 2004 (in Marshall,M perspectives on rehabilitation and dementia); updated Mountain and Moniz-Cook 2007
  13. 13. Rehabilitation for People with Dementia: changing parameters in response to assessed need Self Management Mild Impairment Moderate Severe EnablingRestorative Physical & cognitive Compensatory
  14. 14. Self Management • In the early stages of the illness following diagnosis Mountain (2006), Dementia, The International Journal • Involving both the person with dementia and their carer • The Expert Patient Programme is currently developing a self management training course for people with early dementia with Gail Mountain which will then be evaluated www.expertpatients.co.uk
  15. 15. Components of a Programme for People with early Dementia • Emotional support • Pleasure • Social support • Managing new challenges • Memory and daily living support • Support to maintain health • Accessing and using available support
  16. 16. Service Requirements Must be supported by a whole systems approach towards service delivery which:- • promotes early diagnosis and improved access to services • improves information provision and knowledge • enables professionals to work within a more flexible, patient centred approach
  17. 17. Changing perceptions of needs for rehabilitation….. • People with dementia are being included within the remit of intermediate care services in many locations • Service innovation is occurring up and down the country • Alzheimer Society “Living with Dementia” Programme www.alzheimers.org.uk
  18. 18. Compensatory Technologies Can include:- • Provision of community equipment/ assistive technology • Adaptations to existing housing • Telecare technologies: community alarms, SMART homes, various devices to prevent accidents etc • SMART Homes Not rehabilitative in themselves: depends upon associated interventions
  19. 19. New applications to promote independence • Use of mobile phones to prevent getting lost • Technology tagging to enable others to locate the person • Technologies to provide reminders and prompts information and assistance
  20. 20. Approaches with people with Severe Dementia • Cognitive approaches like quizzes and reality orientation are redundant in people with severe dementia • The playful practitioner: undertaking enjoyable activities • A skilled person centred approach Perrin and May, 2000
  21. 21. • Tables • Kitchens, dusters • “I have enjoyed doing that it makes you feel like a person” • Garden sheds, sweeping brushes, runner beans • Outside spaces Weaving rehabilitation into the fabric of care
  22. 22. Technologies to promote quality of life in people with severe dementia A relatively new area but one that is developing rapidly • Music player • "Window on the world" • Talking mats www.atdementia.org.uk • Robotic pets
  23. 23. Workers need to embrace the new possibilities presented by technology This requires:- • Involving users and carers in devising and testing new developments – be sure that people want what is being offered • The provision of an appropriate infrastructure for technology provision • “Doing things differently”
  24. 24. Design of the built and outdoor environment • Interpretation of shared spaces in residential care – Torrington et al • Design of extra care housing – Tinker et al • Design of outdoor spaces – Idgo consortium Ward-Thompson et al www.idgo.ac.uk
  25. 25. Consistent Requirements • Involvement of informal carers in all settings: community and residential care • Listening to the views of people with dementia Reid et al, 2001 • Enhanced communication: verbal and non verbal Kitwood, 1993; Allan, 2001 • Person centred care Benson, 2000
  26. 26. Listen to the Voices of People with Dementia “I'm not dying of dementia. I'm living with dementia.” “I want to keep going for as long as I can and when things are difficult I don't want to be left on the shelf or forgotten.”

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