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Dementia awareness for surgeries - Wiltshire

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Dementia awareness for surgeries - powerpoint presentation by Dr Nicola Decker,

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Dementia awareness for surgeries - Wiltshire

  1. 1. Dementia Produced by Wessex LMCs in partnership with: Wessex AHSN Dr Nicola Decker, GP Alzheimer’s Society
  2. 2. Contents: Why are we here? Understanding Dementia The Brain Symptoms – four main dementias Case Studies Models Visual problems Communication Further Resources Questions
  3. 3. This is designed as an interactive session to use in general practice to increase the understanding of a condition that affects many of your patients and has a significant impact on their family.
  4. 4. Becoming a……… Dementia Friendly Practice
  5. 5. Figures • 1 in 14 people over 65 have dementia. • 1 in 6 people aged 80 and over have dementia. • 850,000 people live with dementia in the UK today. • 15,000 (approx) people living with dementia in Wilts
  6. 6. Facts • Two thirds of people with dementia are women • At end of life, one third of people will have dementia • Dementia is most common in older people but younger people (under 65) can get it too. 40-64 years: 1 in 1,400 65-69 years: 1 in 100 70-79 years: 1 in 25 80+ years: 1 in 6
  7. 7. What is Dementia?
  8. 8. 1. Alzheimer’s Disease 2. Vascular Dementia 3. Dementia with Lewy Bodies 4. Fronto-Temporal Dementias (inc Pick’s disease) Creutzfeldt-Jakob Disease Korsakoffs Syndrome PCA – Posterior Cortical Atrophy
  9. 9. The occipital lobe dementia in this part of the brain leads to PCA or Posterior Cortical Atrophy. This affects the visual processing – recognition of colours/shapes, faces and ability to read. 1. Frontal Lobe controller: damage to the frontal lobes can lead to the individuals no longer being aware of what actions seen by others are inappropriate 2. The non-dominant parietal lobe Our 3D ‘centre’. Makes objects being viewed look 3D. It also helps our understanding of space – to locate objects, e.g. when picking something up. 3. The dominant parietal lobe Our body sense: knowing our left from our right, sensing where a limb is, putting things together into a structure such as reading and calculation 4. The temporal lobe: damage to this area of the brain causes the individual to have problems with short term memory and over time the term memories may also fade as the damage increases further into the deeper regions of the brain 5. The occipital lobe Dementia in this part of the brain leads to PCA or Posterior Cortical Atrophy. This affects the visual processing, so recognition of colours/shapes, faces and ability to read.
  10. 10. Alzheimer’s disease • Most common cause of dementia • A physical disease affecting the brain
  11. 11. Alzheimer’s disease • Most common cause of dementia • A physical disease affecting the brain • Protein ‘plaques’ and ‘tangles’ develop in the structure of the brain, leading to the death of brain cells ) often in the temporal lobe). • It also leads to a shortage of some important chemicals in the brain. • Over time more parts of the brain are damaged and the symptoms become more severe.
  12. 12. Symptoms of Alzheimer’s disease People with Alzheimer’s disease may • Become confused and frequently forget names, appointments and recent events. • Experience mood swings, feel sad or angry, or scared and frustrated. • Become more withdrawn, due to either a loss of confidence or to communication problems. • Have difficulty carrying out everyday activities – checking their change at the shops or how to work the TV remote.
  13. 13. Vascular Dementia • The second most common form of dementia. • Caused by problems in the supply of blood to the brain due to damage to the vascular system (the network of blood vessels). • Damage to the vascular system could be caused by strokes, high blood pressure, heart problems, high cholesterol and diabetes.
  14. 14. Symptoms of Vascular Dementia People with vascular dementia may experience • Problems concentrating and communicating. • Depression accompanying the dementia. • Physical weakness or paralysis. • Memory problems. • A ‘stepped’ progression with symptoms remaining at a constant level and then suddenly deteriorating. • Seizures. • Periods of acute confusion.
  15. 15. Dementia with Lewy bodies • Around ten per cent of cases of dementia. • Lewy bodies are tiny, spherical protein deposits found in nerve cells. • They disrupt the brain’s normal functioning, interrupting the action of important chemical messengers.
  16. 16. Symptoms of Dementia with Lewy bodies • May have problems with: attention and alertness, spatial disorientation, planning ahead co-ordinating mental activities. • Memory is often affected less than in Alzheimers • May develop symptoms of Parkinson’s disease: Slowness, shuffling gait limb tremor, muscle stiffness, loss of facial expression change in voice strength • May experience detailed and convincing visual hallucinations. • May have fluctuating abilities daily or even hourly. • May fall asleep easily by day yet have restless disturbed nights. • May faint, fall or have ‘funny turns’.
  17. 17. Symptoms of Fronto-Temporal Dementia • Poor judgement • Loss of empathy • Socially inappropriate behaviour • Lack of inhibition • Repetitive compulsive behaviour • Inability to concentrate or plan • Frequent, abrupt mood changes • Speech difficulties • Problems with balance or movement • Memory loss
  18. 18. Case Studies
  19. 19. “Aggressive” Behaviour • May be verbally abusive • Physically, hitting, kicking, pinching and lashing out This may be caused by: • Feeling frightened or humiliated • Feeling frustrated about their lack of understanding or communication problems • Dementia may have eroded their judgement and control • Loss of inhibitions and decreased awareness of appropriate behaviour
  20. 20. Bookshelf model Memory without dementia Memories like books on a bookshelf Stored over time Most recent on top
  21. 21. Feedback from focus groups Clarity about roles A priority approach for carers Consistency in every practice Accessible information Training for staff We didn’t know where she was from, or what she did He got lost - this happened a few weeks after the doctor said he was fine I find it difficult to ask people for help. We just carry on - they don’t offer, but then I don’t demand The nurse turned to me and said, “Is she compos mentis?” I was angry, and upset The GPs can be quite patronising - they talk to him as though he doesn’t understand anything Some staff can be aggressive towards him - they seem to think they have nothing to learn It’s just places to go and people to be with we need The GP tests him every year, and that’s really helpful.” “The GP said that they wouldn’t have time We can’t always see the same GP – it’s frustrating when you have to go over it all again and again The toilets do need to be clearly marked – sometimes you need them in a hurry Living with it or suffering it? Well, you’ve got to do both, haven’t you?” (Carer) There was this flurry of activity, and lots of information just after the diagnosis, but then nothing - it felt as if we were just left to get on with it
  22. 22. Small Changes…… Big Differences….. 1.Make sure all health-care staff know whether a patient has dementia before they are seen 2.Remember! People living with dementia may need a longer appointment 3.Don’t let people with dementia fall out of the system if they don’t keep appointments (NB If someone without a dementia diagnosis repeatedly forgets to attend appointments, it may be a sign that they should be screened) 4.If possible, send appointment reminders to both patient and carer
  23. 23. Small Changes…… Big Differences….. 5. Where appropriate, include family carers in decision making 6. Ensure family members have copies of relevant documents – letters, monitoring equipment, appointments, changes to medication etc 7. Continuity of care is very important to the person with dementia – it is better to be seen by the same health-care professional on each visit
  24. 24. Visual Difficulties • Hallucinations: an experience of something that is not really there. They can occur for all the senses, though visual hallucinations are the most common. • Visual Misperception: when the individual mistakes something for something else.
  25. 25. This mirror at the bathroom entrance has caused residents to leave, thinking it was occupied although they were seeing their own reflections.
  26. 26. A lady says there is a mouse in the bin
  27. 27. This carpet in a Dementia unit was mistaken for a pond with goldfish and lilies
  28. 28. The lift looks a corridor to somewhere
  29. 29. Does this floor look slippery, wet or confusing?
  30. 30. Communication • Before you speak • When you speak • What to say • Listening • Body Language and Physical Contact
  31. 31. Perceptions of what life is like for people with dementia… • 58% thought quality of life was fairly bad or very bad • 52% thought that care provided was fairly bad or very bad • 61% thought inclusion in communities was fairly bad or very bad YouGov survey 2011
  32. 32. People with dementia feel that their community could help by: • Better understanding of dementia and less social stigma • More public awareness of the condition • More local activities and opportunities to socialise • More tolerance and patience from others • More community spirit Source: Alzheimer’s Society Dementia 2012 Report
  33. 33. NHS Commitment to raising awareness • Awareness – understanding symptoms, recognising signs, challenging behaviour. • Knowledge of the condition – types of dementia, differences between dementia, delirium, depression etc. • Communications, listening skills and supporting people with dementia. • Person centered care – sign posting to advice and guidance, medication, ethics, impact on families.
  34. 34. Risk factors for developing dementia • Age • Lack of physical exercise • Obesity • Mental activities in mid life • Diabetic • Current Smoking • Excess alcohol • Genetics • Learning disabilities
  35. 35. Modifiable Risk Factors
  36. 36. Diagnosis – the earlier the better Only 1/3 of people with dementia have a proper diagnosis. Early diagnosis means that: • There is more time to plan ahead and support self management • The carer is able to cope for longer • The need for placement of the patient away from their home is delayed
  37. 37. Support for Carers and Family • Registering as a carer with GP • Carers assessment • Memory advisors and support teams • Carers’ Leads • Alzheimer’s Society • Adult /social care services
  38. 38. What can we do? • Become “dementia friends” • (see ’Video about dementia friends’ if access to the internet is available) • Support national campaigns • Become a ‘Dementia Friendly Practice’
  39. 39. Our role as a dementia friendly practice • Maximise health and well-being and help people to remain independent • Improve patient and carer experience • Improve teamwork • Improve clinical consultations – better prescribing & improved referrals • Improved care planning for the future • Improved quality of life for our patients • Know & be able to sign post patients to available services
  40. 40. Where can you find more information? • www.alzheimers.org.uk • www.dementia.org.uk. • www.dementiafriends.org.uk • www.scie.org.uk (e-learning)
  41. 41. So………… What do we want to do as a practice?

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