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- 1. © Dementia Care Matters 2009 =
- 2. Feeling at home in yourself
- 4. A person A place A thing that helps you feel at home in yourself !
- 6. Your well being is sustained by your relationship to people, places & things.
- 7. Behavioural and Psychological Symptoms of Dementia • Screaming • Restlessness • Physical Aggression • Agitation • Wandering • Anti-social behaviours • Cursing • Shadowing • Anxiety • Depression • Withdrawal • Hallucinations • Delusions • Psychosis
- 8. We rely on these relationships to keep our stress (arousal) at a comfortable levels and avoid escalated negative emotions (affect). “Affect Regulation” These relationships shape how we feel
- 9. Think of a time in your life when you felt stressed. Discuss in pairs How did you know you were stressed? What do you do when you are stressed? Who/What helped? Feeling Stressed!
- 10. Hot Sweaty Palpitations Racing mind Restless Muscle Tense Shallow Breathing indigestion Head ache Shout Swear Cry Restless Reactive Shutdown Withdraw Controlling Worrying Obsessive Hyper Sensitive Irritable Aggressive Accusative Argumentative Agitated Paranoid Eat Clean Take dog for a walk Smoke Drink Go for a walk Take time out Have a bath Tidy the house Solve the problem Seek help Call a friend Watch TV Listen to Music Go shopping Work Exercise, Meditate Angry Anxious Panicked Fearful Rage Tearful
- 11. Think of a time in your life when you felt bored. Discuss in pairs How did you know you were bored? What do you do when you are bored? Who/what helped? Feeling Bored!
- 12. Tired Lethargic Heavy Low Slow Absent minded Numb Depressed Frustrated Irritable Sad Despair Loss Worthless Empty Grief Shame Wandering Sleepy Disengaged Listless Distracted Restless Wander Agitated Irritable Day dreamy Attention Seeking Withdrawn Repetitive Complain Moany ANYTHING! Read Watch TV Tidy Clean Call a friend Sort Go shopping Emails Texts Computer game Sudoku Ironing Listen to radio
- 13. Self regulation - helps to keep our stress at a comfortable levels (arousal) and avoid escalated negative emotions (affect). Our coping strategies help us feel at home in ourselves
- 14. Self Regulation To stay in our comfort zone we need the following abilities – • To know and manage our feelings and emotions • To reflect and respond adaptively to situations • To communicate our feelings and needs effectively • To make use of these abilities in relationships These processes require “Neural Integration” i.e. different parts of the brain working with each other in the service of self regulation. (D.Siegal) The capacity for self regulation is undermined by the neuropathology of a dementia!
- 15. Hot Sweaty Palpitations Racing mind Restless Muscle Tense Shallow Breathing indigestion Head ache Shout Swear Cry Restless Reactive Shutdown Withdraw Controlling Worrying Obsessive Hyper Sensitive Irritable Aggressive Accusative Argumentative Agitated Paranoid Angry Anxious Panicked Fearful Rage Tearful
- 17. Loss of capacity to self regulate = Vulnerable to traumatic stress + heightened negative emotion Hyper or hypo arousal leads to intense negative emotions
- 18. Symptoms of Traumatic Stress Ref. L. Cozolino, S. Porges
- 19. Feeling.. Peaceful belonging capable comfortable present happy free confident able settled calm content safe secure depends more on the quality of our relationships
- 20. Relationships Opportunities for “interactive regulation”
- 21. Comfort – calming/soothing, people, places and things … Occupation –Stimulating/enlivening, people, places and things … Relationships with people places and things need to meet our attachment needs
- 22. Consider - the people the places the things that help you feel at home in yourself? What is it about them that helps you feel at home?
- 23. 1. A Dementia 2. Culture of Care changes your relationships to people, places and things.
- 24. People Language Behavior Body Language
- 26. Nothing – no thing! Touch things in scheduled activities NO – THING !
- 27. © Dementia Care Matters 2009 =
- 28. © Dementia Care Matters 2009 = Emotionally intelligent staff Responsive to feelings & needs Recognise that every interaction shapes quality of life Look more like friends than people in charge Sit down and hang out Eat with people living with dementia Close, loving and affectionate Understand the difference between care and control
- 29. © Dementia Care Matters 2009
- 30. © Dementia Care Matters 2009 Removal of Them and Us Barriers No more trolleys or uniforms Shaped by the life history of individuals in care People look and feel free Institutional features removed Relaxed ‘go with the flow’ feel No sense of the rigid routines Lots of 30 second connections Lots of 60 second activities Adapted to individual needs/abilities
- 32. Stuff everywhere i.e. “clutter” Relates to individual life history Triggers emotional memories Matched to stages of dementia Half done things to finish off Themed and staged activities Enables people to occupy themselves independently of carers Comfort objects, sensory calming things. Household items and sensory stimulating things
- 33. Group Living Attachment needs Care Tasks Reducing Routine Bound Care Being a Butterfly Change the moment Turn tasks into experiences Spontaneous and go with the flow Go along with different realities Focus on social interaction Use stuff in interactions Stage activities rather than run them Aware of controlling language & behaviours
- 34. People experiencing the early stage of a dementia People experiencing a different reality People experiencing the late stages of a dementia Lots of opportunity for domestic activities Access to domestic and functional household items Small reminiscence groups, themed reminiscence boxes Lots of opportunity for conversation and “banter” during care giving interactions Partnerships in domestic and daily living activities Greater independence in daily living tasks Domestic things/tasks/jobs laying around half done and to be finished Themed and personalised rummage boxes Opportunities for people to live out the past jobs, vocations, roles that may be part of their reality Lots f stuff to hand to rummage through A care team that can role play and go along with different realities to meet underlying emotional needs rather Comfort objects, dolls, stuffed toys to hand Soft and textured fabrics Opportunities for sensory stimulation and soothing at different times of day Sensory items related to individuals life history immediately to hand/within reach A care team that is able to be still, close, affectionate, tactile to meet attachment needs MATCHED CAREGIVING & THE STAGES OF A DEMENTIA
- 35. 10% 5% 70% 10% 5% 0% 10% 20% 30% 40% 50% 60% 70% 80% Positive Social Positive Care Neutral Negative Protective Negative Restrictive Dementia Care Matters Study (c) - 700 Audits Across UK - Average Results Quality of life is determined by quality of relationships with people places and things
- 36. = Dementia Care Matters Butterfly Household Model of Care A therapeutic environment between people, places & things that meets peoples individual attachment needs 42 Accredited Butterfly Care Homes in UK, Ireland, Canada & Australia 15 Butterfly projects UK, Ireland, Canada & Australia
- 37. You’re a person, in a place, with things! What can you do to create a culture of care that helps people with a dementia feel at home?
- 38. “Contact with dementia or other forms of cognitive disability can - and indeed should - take us out of our customary patterns of over busyness, hyper-cognitivism and extreme talkativity into a way of being in which emotion and feeling are given a much larger place …. they are asking us, so to speak, to heal the rift in experience that western culture has engendered, and inviting us to return to aspects of our being that are much older in evolutionary terms: more in tune with the body and its functions, closer to the life of instinct.” Kitwood, T. 1997. Dementia Reconsidered: The Person comes First. Buckingham: Open University Press. Attachment Interactions
- 39. Dementia Care Matters Butterfly Home
- 40. Dementia Care Matters Butterfly Home
- 41. 24 hour visible and available snacks Dementia Care Matters Butterfly Home
- 48. Behavioral & Psychological Symptoms Wandering Listless Disengaged Distracted Despairing Low self esteem Grief Shame Day dreamy Attention Seeking Paranoia Repetitive Moody Switched off Absent minded Depressed Frustrated Anxious Angry Fear Panic Swearing Crying Restlessness Reactivity Shutdown Withdraw Worrying Irritability Aggression Argumentative Agitated Shouting Symptoms of Dementia or traumatic stress? Focus on the individual or the quality of their relationship?