INTRODUCTIONIn this assignment, the author will endeavour to define what Dementia is; describe what the Physiological and Psychological changes that occur for the older person with Dementia; explore the Individuals Needs in relation to the condition; describe the Role of the Carer and the Multidisciplinary Team in assisting the Individual with Dementia, what Practices need to be Implemented and what Care Settings are available; state the Current Approaches towards Developing Quality Services for people with Dementia.The Methodology the author will use will be independent research via the internet and tutors notes.WHAT IS DEMENTIA? THE PHYSIOLOGICAL AND PSYCHOLOGICAL CHANGES THAT OCCUR FOR THE OLDER PERSON WITH DEMENTIADEMENTIA:Dementia is adisease marked by a gradual loss of cognitive functioning such as memorycapacity which can also incorporate losses/impairment of language, attention,orientation, emotional, motor (fine and gross skills), social functioning andspatial skills.It is a progressive, degenerative and permanent neurological disease that eventually leaves the individual dependent; dementia is caused by different diseases that damage the nerve cells in the brain; the experience is not the same for every individual. The diseases affect the parts of the brain which are normally used for learning, memory and language. There are three stages of dementia: In the Early stages, individuals display difficulties in judgement, problem solving, decision making, orienting to time and space, personality changes, including, becoming agitated, irritable, manic episodes and depression where the individual can suddenly burst into tears for no apparent reason.The middle stage can be characterised with the individual unable to remember names, loss of short term memory, be agitated, anxious, have obsessive behaviour, being delusional and will require assistance with their ADLs.In the late stage individuals will typically lose the ability to communicate, mobilise, be doubly incontinent, are unresponsive to most stimuli and have extended sleeping patterns. At this stage, the individual is 100% dependent on the carer for their ADLs.Dementia can affect younger people as well and this is called younger or early onset dementia. There are over 100 types of dementia, the most common being Alzheimer Disease, Vascular Dementia and Lewy Body Dementia. Alzheimer Disease:Alzheimer Disease accounts for between 50-70% of people with dementia. The symptoms develop slowly, usually over a period of several years. In the early stages, is difficult to differentiate the mild forgetfulness to the normal aging process; individuals have difficulty in making new memories for recent events; have difficulty working out problems, finding the right words, making decisions, finding their way to familiar places and judging distance. What is happening in the brain: with Alzheimer Disease is that there is a build-up of plaques and tangles in the brain that the author will elaborate on in the physiological changes.Vascular Dementia:Vascular Dementia occurs following a series of mini-strokes or TIAs (Trans Ischemic Attacks), it is the second most common type of dementia. It can occur on a gradual basis, like Alzheimer, over a period of several years. The symptoms are very similar to Alzheimer and other forms of dementia: difficulty with communication, memory loss, and being disorientated. However, with Vascular Dementia, individuals have difficulties with concentrating, planning and they can experience short periods of deep confusion.What is happening in the brain: of an individual with Vascular Dementia is that thereduction in blood supply to the brain is reduced due to either blockages ornarrowing of the blood vessels resulting in the brain cells being damaged. Lewy Body Disease:Lewy Body Diseasesufferers have a marked difference in how they walk, they shuffle and have atendency to fall, symptoms very similar to individuals with ParkinsonsDisease; they can experience periods of being severely confused; havehallucinations, hearing or seeing things that are not really there; sleeppatterns and swallowing may be affected, individuals sleep easily during theday, however, then have a very disturbed nights sleep.With Lewy bodydisease, movements may be affected so people might shuffle as they walk, and bemore prone to falls. Some of the symptoms are similar to those who haveParkinsons disease. People with Lewy body disease may experience periods ofsevere confusion. They can have hallucinations, seeing or hearing things thatarent really there. Swallowing and sleep patterns can also be affected; peoplecan fall asleep easily during the day but then have disrupted sleep at night. Whats happening in the brain: of an individual with Lewy Body Disease is that there areclumps of protein that have built up over time in the brain. The proteindeposits interfere with the nerve cell connections and result in changes inthinking, alertness, behaviour and movement. The Physiological Changes that occur for the Older Person with Dementia:The aging processaffects everyone, changes including grey hair due to lack of pigmentation, wrinklesdue to lack of collagen, loss of hearing and sight, tooth loss resulting inwearing dentures. However, in addition to these changes an individual withdementia, particularly with Alzheimer disease will have the followingphysiological changes: they develop Neurotic Plaques and NeurofibrillaryTangles in their brain. The Plaques andTangles were discovered through autopsy. The NeuroticPlaques are commonly found in the brains of elderly people but appear inexcessive numbers in the cortex of an individual with Alzheimer disease. Thecortex is surrounded by deteriorating neurons that produce acetylcholine andneurotransmitter that is essential for processing and controlling responses tothe input from the rest of the central nervous system: emotion, voluntarymovement, planning and execution of behaviour, memory, intellect, writing andspeech. The Hippocampus is part of the Limbic system in the brain. It plays avital role in in retrieval and encoding of information. In Alzheimer disease,damage to the hippocampus produces global retrograde amnesia, which renders theindividual unable to retain newly learned information.The NeurofibrillaryTangles are twisted remains of a protein which is essential for maintaining theproper cell structure. It is unknown whether the tangles and plaques are thecause of Alzheimer disease or if they are part of the results of the disorder.The Psychological Changes that occur for the Older Person with Dementia:Loss ofintellectual and memory function are common symptoms in the older person,however, an individual with dementia also have changes in mood and behaviour. Around90% of individuals with Dementia will develop psychological and behavioural andemotional Psychological and emotionalimpact of dementiaThe impact that dementia has on a person is not limited to the practical effects of the condition. The person still experiences feelings, thoughts and responses just as a person without dementia does. However, living with dementia will affect these. It is important to recognise and respond to the persons emotional needs and responses.An individualsreaction to diagnosis:A Diagnosis ofDementia has a major effect on an individual and their family. Their reactioncould include: shock, anger, fear, disbelief and grief. It can also be a senseof relief. Individuals can struggle a lot with their emotions; may be afraidabout their future, really scared about being forgetful and confused. Reallyupset about the impact of their Dementia will have on their family and friends.Symptoms thatinclude:Mooddisturbance, e.g. depressionRepetitivebehaviour, e.g. clapping hands, calling outSocialinappropriateness, e.g. stripping off clothes, masturbationAgitation,e.g. fidgeting, pacingWandering,e.g. aimlesslySleepdisturbance, e.g. thinking day is night and vica versaPsychosis,e.g. hallucinations or delusionsPhysicalaggression, e.g. hitting out, kickingAn individual withAlzheimer Disease may have changes in their behaviour in the early evening orlate afternoon. Doctors refer it to a syndrome called Sun Downing Syndrome.Individuals often look for their Mum or Dad to bring them home. The fadinglight often appears to be the trigger. Their symptoms usually get worse as thenight progresses and normally improve by morning.Symptoms of sundowning include: Restlessness, Agitation either anxious or upset, Irritability,Confusion, Disorientation and being Suspicious.There is anothersyndrome, Magpie Syndrome, whereby, the individual will take items from otherresidents and stockpile them in their room, usually in their wardrobe. Theitems they take vary, could be anything from hair brushes to cigarette butts.EXPLORE THE PERSONS NEEDS IN RELATION TO THE CONDITIONAn individual withDementia is a Valuable and Unique human being. They face challenges due tochanges in how they think, communicate, remember and to do every day things. Individuals withDementia need for their loved ones and carers to Understand Dementia, We have to have the ability to step into theirworld as they do not have the ability to step into ours! Loved ones and carersneed to understand that the individual is not going to get better; individualsneed Support and Reassurance; they need to feel Loved and Secure, this can beachieved by maintaining a familiar environment and having routine as set out inthe care plan; they need to Trust their carer; they need the people around themto do everything in their power to Maintain their feelings of Self-worth and Identity.It is Vital forcarers to understand that Each Individual with Dementia is Unique and havetheir Individual Life Experiences, likes, dislikes, feelings and needs; thatthey will be affected by the condition in a different way and that they need tobe responded to in a Sensitive and Flexible manner.Individuals needto know that their Quality of Life will be Maintained at the Highest Level;they need to be Respected and their Dignity to be Maintained at All times; theyneed to be Communicated with Effectively, they need their carer to adjust howthey are interacted with as appropriate: to be Listened to Patiently, Good eyecontact, Gentle approach, using short sentences with appropriate language.Individuals need for others to Empower them to Maintain their Independence, e.g. offering two choices of clothes to wear, would they like a shower or a wash by the sink; They need to be offered assistance with their ADLs, as appropriate. They need to be Given the Time to Reminisce, as they often remember details in their past fondly and have forgotten something they have had for dinner five mins ago. This will give individuals a feeling of Comfort and Belonging.WHATIS THE ROLE OF THE CARER AND THE MULTIDICIPINARY TEAM IN ASSISTING THE PERSONWITH DEMENTIA AND WHAT PRACTICES NEED TO BE IMPLEMENTED AND WHAT CARE SETTINGSARE AVAILABLE?THE ROLE OF THE CARER IN ASSISTING THE PERSON WITH DEMENTIACaring for someonewith dementia can be both emotionally and physically challenging. Dementiainfluences an individuals behaviour including: being anxious or agitated,wandering, depression, having hallucinations and displaying sociallyinappropriate behaviour such as stripping off and masturbation. COMMUNICATION:The carer will noticechanges, in which the individual with Dementia communicates, for example, onoccasion, they may find it difficult to find a word; comprehend; speakfluently; express emotions; lose the normal way that people interact andinterrupt or may disregard what the carer is saying.As a carer, youshould always remain calm and afford as much time as the individual needs torespond to you and for the individual to understand you; to use simple, shortsentences; help to orientate them, for example, today the author was caring fora resident aged 98 years old and was in a confused. At one stage she mentionedthat her Mum and died last year at the age of 90. The author asked the residenthow old she was and although confused, after a few minutes Oh, nurse that cantbe right! She then said Dont mind me;I must be away with the fairies!; the carer should never be condescending,argue, speak in front of them to other members of staff or anyone bout them asif they werent there; use verbal and non-verbal communication, for example, agentle approach, good eye contact, and touch (holding hand); the carer shouldbe consistent avoid communicating in a noisy environment.NUTRITIONAL NEEDS:For an individual with Dementia, their nutritional needshave to be monitored by the carer. They may forget to eat or drink, havedifficulty in swallowing and chewing. The carer should prompt the individual toeat and drink; only offer one course at a time; offer food that they arefamiliar with; avoid using plates with patterns; offer meals and snacksregularly, maybe 5-6 times a day; encourage fluids.HYGIENE NEEDS:An individual with Dementia may lose interest or simpleforget about maintaining their own personal hygiene.A carer has to bevery Patient with the individual and Encourage them and give them options: tohave a shower or a wash; empower them to do as much as they can by themselvesby gentle prompting to promote their independence; Put out the things they needin order of sequence; routine is important as per care plan for each individual;the carer may to offer assistance with shaving, toileting, offering two choicesof clothing, provide dental care and with personal grooming.CONTINENCE NEEDS:An individual withDementia, due to a decline in their mental functions, may become incontinenceat varying stages. The carer has to manage any incontinence and to protect theindividuals dignity and privacy that could cause them any humiliation. Inorder to manage their continence needs, the carer should: observe the patternswhen the individual empties their bladder and bowel and prompt them at regularintervals to go to the toilet offering assistance as appropriate; watch fornon-verbal cues, for example, being increasingly agitated and pulling onclothes. Then using simple words asking if they would like to go to the toilet;the use of nightlights to enable the individual to find their way to thetoilet; ensure that the toilet is clearly marked, that the bed is at a levelthat they can get in and out of safely; that their clothing is easily pulled upand down; and use continence pads, if necessary and appropriate.SLEEPING HABITS:Individuals withdementia tend to get confused between day and night. The carer should be awarethat this can make it difficult for them to have a normal sleeping pattern. Thecarer should try to engage the individual and encourage them to participate inactivities to prevent them from prolonged napping; ensure the individual hasadequate lighting and draw the curtains especially in winter when it gets darkso early; the carer should try to encourage the individual not to go to bed tooearly and not to deviate from their normal routine.CARE OF THE INDIVIDUAL IF CONFUSED: The carer should not make any changes to theindividuals familiar environment, if possible; remind the individual to taketheir medication; the carer should update the notice board writing the day,weather and what activities are on that particular day; have large clocks andcalendars to help orientate individuals to time and date.THE ROLE OF THE MULTIDICIPLINARY TEAM IN ASSISTING THE PERSON WITH DEMENTIAThe role of theMultidisciplinary team in assisting an individual with Dementia is central toDementia care along the range of detection and diagnosis , whether it is caringfor the individual in their home, residential setting and outpatient clinic orin hospital. The individual with Dementia is the Most Important member of theMDT, and the family and friends are a Critical part of the team and come a veryclose second.There are a numberof healthcare professionals that form the MDT including: the GP,physiotherapist, occupational therapist, dietician, social worker and nursing.All of the disciplines work together to deliver individual client centred careto meet the needs of the individual with Dementia in a holistic manner. GPs are crucial inthe care process as they are usually the first individuals in diagnosingDementia; the public health nurse is also vital as they are most likely tovisit the individual with Dementia, at their most vulnerable, living at home;they provide guidance to the individual and their carer to support servicesthat they value and need; the speech and language therapist works with theindividual to improve their communication; the physiotherapist works with theindividual to achieve their optimal mobility, thereby, promoting theirindependence; the Occupational therapist works with the individual to ensurethey have the correct equipment to enable to them to complete tasks etc.; thenurses and health care assistants follow the care plan and contribute usingIndividualised Centred Care. Eachindividual and discipline is involved in compiling the Individualised CarePlan; should record, report and updates any changes identified. The Care Planis evaluated in a minimum of three months, however, if the individualsspecific needs have dramatically changed, it is evaluated and updated straightaway.The MDT is a vitalelement of a shared approach in the delivery of services to individuals;effective communication between the various disciplines ensures that the bestpossible secondary care is provided seamlessly. There is a national trainingprogramme for all professionals who work with individuals with Dementia both ona primary and secondary level of care in St. James Hospital, Dublin. Here theyhave established an Information and Development Centre in Dementia Services.WHAT PRACTICES NEED TO BE IMPLEMENTED?In Ireland, theeffective management of Dementia requires an action plan to be developedincluding the points of view of all the major stakeholders. The plan highlightshow individual and unique each person with Dementia is; the individual withDementia is placed at centre of the planning process in a Client Centre Caremodel developed by Dr Tom Kitwood (1997), where he looked for a new culture ofDementia. The plan will serve as a model of Best Practice to guide policymakers that are involved in the planning and provision of services and supportthe providers of flexible and local services for individuals with Dementia. The32 HIQA standards need to be implemented in line with the recommendations inthe National Dementia Strategy. Most of the needsof the individual with Dementia and their carers should be acquired at thePrimary and Community level of care. This should include providing a flexiblenetwork of services for the individuals with Dementia and their carers. The Autonomyand Dignity of individuals with Dementia can be maintained by developingindividualised care plans facilitated through case management structures.The Day Carecentres are also key for providing care. Individuals at the earlier stage ofDementia, with no behavioural problems are generally managed in general DayCare centres. However, individuals with more severe Dementia who have issueswith wandering need specialised Dementia day care centres at Primary CareLevel. The Alzheimer Society currently provides this service in some parts ofIreland.Respite care bothat home and in nursing homes is of vital importance to carers as there istremendous pressure on them on a daily basis and they need respite care torecharge their batteries. The important element in Primary and Community Careis the flexibility of supply of services following the needs of the individualand their carers being expressed.The majority of individuals with Dementia in Ireland are cared for in residential homes that are generic facilities for older people. However, their needs differ greatly to that of other residents. Training programmes for the MDT should be implemented specific to the care and needs of an individual with Dementia; the training should adapt the Client Centred Approach to their care and delivery service; more investment should be implemented in all residential care facilities for Ireland to catch up with international trends adapting safe, small homely style long term accommodation; Various psychosocial interventions should be implemented, including: validation therapy, reality therapy and reminiscence therapy for individuals with early stage Dementia. It is a vital to implement training in the delivery of these interventions for effective residential care for individuals with Dementia.WHAT ARE THE CARE SETTINGS THAT ARE AVAILABLE?At the early stagesof Dementia, most individuals will benefit by being cared for in their ownhome. The familiar environment, sights and sounds makes the individual feelmore secure. A carer in under a huge amount of stress on a daily basis; theyneed support and relief regularly to promote their health and well-being. A lotof carers turn to family, friends and/or neighbours for a break, however, thereare a variety of formal Respite Care that includes:DayCare centres specifically for Dementia and Alzheimer Disease, allow individualsto socialise in a safe environment, they offer structured programmes andactivities like art and/or music therapy. They also provide transportation andmeals.Thereare home health services both private and HSE that provide HCAs that care forthe individual in their own home, companionship and can help with shopping andhousework.As the diseaseprogresses, many carers consider the option of Assisted Living, and then ResidentialCare for their loved one; as their needs mount, they require twenty four hour care, it becomesalmost impossible for the carers even with intermittent assistance to continuedelivering the care required.Assisted living, in an option for individuals that do not require skilled medical care butdo need assistance with some of their ADLs; The residents either have theirown apartments or share; have the assistance of 24 hour staff; have servicessuch as laundry, transportation and recreational activities provided. A Nursing home is the option that cares consider when their loved one needs skillednursing care, supervision and medical care 24 hours a day. The individual andtheir family will be very involved with the MDT in their care planning anddelivery of care. There are specialised care units that are Dementia specificavailable to individuals, e.g. Lucan Lodge and Kiltipper Woods Nursing Home.The Health care professionals on these units has received specialised trainingin order to care for the individuals needs.The Programme forGovernment (2011-2016) has given a commitment to develop a Dementia Strategy.The key principles are to reinforce and inform the variety of social and healthcare services that can be provided to individuals with Dementia and their lovedones.The HSE willdevelop a local and national Dementia care pathway to clearly signpost anddescribe the optimum way through the system going from the initial symptoms,diagnosis and to the levels of appropriate intervention required in theirjourney.As part of thestrategy, certain material will be made available to GPs: guidance on localand national pathways from investigation to diagnosis; reference material thatis Dementia specific is made available to widen their skills base; informationabout social and health supports that are available within the community.STATE THE CURRENT APPROACHES TOWARDS DEVELOPING QUALITY SERVICES FOR PEOPLE WITH DEMENTIAResearch into theneeds of individuals with Dementia has shown that they require residentialcare as the disease progresses. There is a movement towards caring forindividuals with Dementia from traditional nursing homes to that of them beingcared for in Dementia villages.This ingeniouspioneering notion has come after De Hogeweyk, Holland, developed a cutting edgeelderly care facility in a village setting since 2009. It is located on theoutskirts of Amsterdam where all the residents have Dementia and have thechance to live highly social and almost normal lives.The houses aredesigned to look like houses from different eras from the 1950s to 1970s;residents and their families can also choose different lifestyle modelsincluding Christian, Urban, Indonesian and Artisan.The Dementiavillage currently have 152 residents; is mostly state funded; has its own postoffice, supermarket, town square, garden and theatre. The residents livelonger, eat better, require fewer medications and enjoy a higher standard ofliving than those in the traditional nursing homes.In response to thesuccess of the former, countries worldwide, including Ireland, are beinginspired to follow suit. According to Journal.ie, (2016), Irelands firstpurpose built village is under construction for individuals with Dementia inBruff, Co. Limerick. Care Bright Community, the company behind the developmenthas stated that it will change the face of Dementia Care in Ireland. Although it is on asmaller scale, 18 homes, the village is based on a similar community that DeHogeweyk designed; the village includes a gym, talking sheds, café, beautysalon, sensory garden and an orchard. The carers and/or their loved ones canstay overnight should they wish to do so, making it feel like a home from home.Moving forward, itappears that there will be a shift from the current traditional Nursing homesby developing this New Innovative Approach towards Quality Services forindividuals with Dementia and their families in the future.CONCLUSIONIn this assignment,the author has given an Explanation as to what Dementia is; what thePhysiological and Psychological Changes that occur for the older Individualwith Dementia; Explored the Individuals Needs in relation to the condition; Describedthe Role of the Carer and the Multidisciplinary Team in assisting theIndividual with Dementia, the PracticesNeed to be Implemented and the Care Settings that are available; She alsoDescribed the Current Approaches towards Developing Quality Services for peoplewith Dementia. On completion ofthis assignment, the author has gained a greater insight into Dementia and howthe individual and their loved ones are Key players in the Planning, Implementingand Evaluating as part of the Multidisciplinary Team to ensure the Quality andDelivery of care is of the Highest Standard.WEBOLOGYAlzheimer.ie (2017) Available at: https://www.alzheimer.ie/About-Dementia/What-is-Dementia/Treatments-available.aspx, Accessed: 7th Oct. 2017Mydr.com (2017) Available at: http://www.mydr.com.au/seniors-health/dementia-behavioural-and-psychological-symptoms, Accessed: 7th Oct. 2017My Aged Care (2017) Available at:https://www.myagedcare.gov.au/caring-someone-particular-need/caring-someone-dementia, Accessed: 2nd Oct. 2017Ncaop.ie (2017) Available at: http://www.ncaop.ie/publications/research/reports/54_Action%20Plan%20for%20Dement.pdf, Accessed: 2nd Oct. 2017Mydr.com (2017) Available at: http://www.mydr.com.au/seniors-health/dementia-behavioural-and-psychological-symptoms, Accessed: 3rd Oct. 2017Alzheimeimers.org.uk (2017) Available at: https://www.alzheimers.org.uk/info/20046/help_with_dementia_care/31/understanding_and_supporting_a_person_with_dementia/4, Accessed: 4th Oct. 2017Webmd.com (2017) Available at: https://www.webmd.com/alzheimers/guide/manage-sundowning#1ww.understandtogether.ie/about-dementia/what-is-dementia/diagnosis/, Accessed: 4th Oct.2017myagecare.gov (2017) Available at: https://www.myagedcare.gov.au/caring-someone-particular-need/caring-someone-dementia. Accessed: 3th Oct. 2017health.gov.ie (2017) Available at: http://health.gov.ie/wp-content/uploads/2014/12/30115-National-Dementia-Strategy-Eng.pdf, Accessed: 4rd Oct. 2017thejournal.ie (2016) Available at: http://www.thejournal.ie/dementia-village-bruff-2922387-Aug2016/, Accessed: 5th Oct. 2017)Get Help With Your AssignmentIf you need assistance with writing your assignment, our professional assignment writing service is here to help!Find out more
