Carers Guide to Dementia

    Carers Guide to Dementia 

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 Facts & Figures 

Dementia is a disease of the brain which is progressive and degenerative in nature.  It is characterised by alterations in reasoning, memory, comprehension, problem-solving, or attention.  It is a disease which is seen more in older people but is not a part of the normal ageing process . 750,000 people are living with dimentia in the UK at present.  This figure is expected to double over the next 30 years. 25% of hospital bed are occupied by an individual over the age of 65 with dementia . 

 

 This resource will help you to: 

• Recall the different stages of dementia and recognise where your loved one is within this model.
• Differentiate between the ‘normal’ aging process and the typical signs and symptoms of dementia.
• Recognize other conditions that may co-exist alongside dementia.
• Identify strategies and techniques that enable you to help your loved one in optimizing their independence and quality of life.
• Identify dementia services and resources that would be appropriate for different stages of dementia.
• Relate the information in this resource to their individual circumstances.
  

 Recognition 

How to recognise early dementia

It is understandable to find yourself concerned about the possibiliy of dementia as a loved one ages. However, there are some aspects of the usual aging process that may be confused for signs of dementia. Table 1 below sets out some of the early signs of dementia and compares them to normal aging.

It is worth noting that half of all cases of dementia are thought to be due to Alzheimers disease while one tenth are due to stroke. In some cases it may be due to another disease (e.g. Huntington's) or from a head injury.

Mild Cognitive Impairment is the term used to describe people who experience some memory problems but do not actually have dementia.

People with dementia may suffer from depression and/or behavioural problems. They may often become annoyed easily or act aggressively towards a family member or friend.
 

Types of Dementia

There are many types of dementia. Although this site cannot provide a full description of each n you can follow the link below for more details.

•Dementia with Alzheimers disease: the most common form of dementia. Loss of nerve tissue along with changes in the chemistry and structure of the brain lead to the death of brain cells.
•Vascular dementia: most common after a stroke or a series of small strokes. The blood supply and therefore oxygen supply to the brain is compromised and brain cells die. The person may start forget or have trouble planning ahead. This can occur alongside balance problems.
•Dementia with Lewy Bodies: caused by the degneration of brain tissue following the formation of tiny spherical structures in nerve cells. They will move more slowly and often fall more often.
•Korsakoff's Syndrome: not strictly speaking a dementia. Heavy drinking over a long period leads to brain cell death and memory is often affected.
•Fronto-temporal dementia: as damage is focused in the front part of the brain personality and behaviour may be more affected than memory in the early stages.
•Creutzfeldt-Jakobs Disease: infectious agents (prions) attack the central nervous system and go on to cause brain cell death.
•HIV related cognitive impairment: some people with HIV and AIDS may experience cognitive impairment late on in their disease.
•Rarer Types of Dementia: people with motor neurone disease; multiple sclerosis; Huntington's Disease; and Parkinson's Disease may be at inceased risk of developing dementia.
•Mixed Dementia: i.e. Alzheimers and vascular dementia. The person may present with  a mixture of symptoms.

For more informtaion and fact sheets on the different types of dementia visit this site: http://alzheimers.org.uk/site/scripts/documents.php?categoryID=200362

 What to expect 

 

It can be a difficult time when a loved one is suffering memory problems or diagnosed with dementia. This page will provide a guide to the different stages of dementia and what you may experience caring for someone in each stage.

The three stages of dementia

 File:Three Main Stage of Dementia.pdf
In those aged over 65 it is thought that 1 in 3 women will fall while 1 in 5 men will fall. This risk is elevated even more if the person is also suffering from Dementia. (O'Loughlin et al 1993). As dementia is a non-modifiable risk it is important that the fear of falling does not lead to a cycle of inactivity. If this occurs it is important to break the vicious cycle of inactivity by improving things such as the person's mobility, independence and ultimately confidence. The aim is to reduce the fear and associated loss of function.

Some symptoms may appear earlier or later than indicated on this table and the stages may overlap. The progression through the stages is highly individual. The process of progression for each person will depend on many factors including the type of dementia, age of onset, the presence of other illnesses, the level of support and care available.

http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=dementia_symptoms#stages

 What physiotherapy can offer 

Physiotherapists use physical approaches to restore 'physical, psychological and social well-being, taking account of variations in health status'. [1]

Physiotherapy plays a key role in promoting and maintaining mobility for individuals with dementia. Physiotherapy interventions can improve the quality of life for your loved ones living with dementia and reduce the burden of care. For a leaflet on dementia and physiotherapy follow this link:

http://www.csp.org.uk/professional-union/practice/evidence-base/physiotherapy-works/physiotherapy-works-dementia-care

Exercise prevents and reduces the risk of developing cardiovascular disease as well as other chronic conditions such as diabetes and osteoporosis [2]   General physical exercise can improve walking, mobility, flexibility, balance and prevent new falls in individuals living with dementia. It is also shown to enhance mood and improve cognitive function. [3]
 

What Physiotherapy can offer
 

Physiotherapy for people with dementia can increase mobility and reduce the risk of falls. The aim of physiotherapy is to increase the persons mobility, lower their risk of falls by doing prevention exercises. Mobility can be increased with balance, stretching and strengthening exercises and the use of walking aids. A physiotherapist will assess how your loved one performs activities such as; walking, going up and down the stairs, getting out of a chair and getting in and out of bed. Physiotherapy can also assist in reducing the burden of care by educating carers to encourage independence in people with dementia.

•Strengthening exercises
•Stretching
•Proprioception
•Static and dynamic balance
•Flexibility
•Maintain independence
•Postural management

               Regular change in body position is essential for comfort and prevention of poor posture which may lead to muscle tightness and spasms, decreased movement of joints and pressure sores. (NHS Postural Management Survey 2012)
•Advice and recommendations on aids; 

                 Equipment and adaptations at home will help make life easier for your loved one with dementia and keep them independent or as long as possible
•Falls prevention program; 

                 Created and used along with the home assessment. This will help to reduce the persons risk of falls as well as their fear of falling and keep them safe and independent at home.

Physiotherapy can also help to manage pain. Pain affects cognition, motivation and will affect how the person with dementia responds to any rehabilitation programme. Individuals living with dementia who experience impairments in verbal communication may not be able to easily report pain and are at risk of receiving inadequate medication and treatment of pain. It is important that pain should be assessed before and during interventions to allow rehabilitation. (Marshall 2005)

Physiotherapy plays an essential role in promoting and maintaining mobility for people with dementia, by managing positioning, seating and painful contractions.

Poor balance, known to increase the risk of falls, can be imporoved by physiotherapy-led exercise. Exercise can have a significant and positive impact on behavioural and psychological symptoms of dementia, improving function and mood. This in turn may decrease the need for pharmalogical intervention. (Oddy 2011).

What you can do 

When caring for someone with dementia it is important to help them remain as independent and fit and healthy as possible. They should also continue to enjoy their usual activities. The better they feel the more they can enjoy life.
 

The aim of treatment is to slow down the progression of dementia related impairments and control behavioural symptoms. http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=dementia_treatmemt

 
What you can do

•Let the patient do as much as they can independently    

1.Give the person a role/task; doing the washing up, peeling the vegetables, pairing socks.
2.Do less for them
3.Keep requests meaningful
4.If motivation is an issue, make the tasks functional; walk to the kitchen to get a drink instead of carrying it to them.
5.If the person is wandering around or restless, then think about why this might be hapenning.  Some people walk because they are bored, have excess energy or may be responding to hallucination.

•Plan activities that you can both enjoy

1.If it is realistic to do so, take the person for a walk each day.  It will burn off energy and the fresh air will do you both good.

•Prevention of falls

1.Make sure there is nothing around the house that the person could trip up on.

•Communication:

1.Keep commands simple, one request at a time. 
2.Allow extra time for a response to your question before repeating it.
3.If the individual doesn't appear to understand your request, try rephrasing it.
4.Don't chat whilst the person is trying to perform a task, this will likely be a distraction.
5.Make sure communication problems are not due to visual or hearing impairments. Check that glasses and hearing aids are in good working order.
6.Use names and explanatory phrases where possible, such as "Your son, John."

•Other forms of communication:

1. Touch can be used to assist movement through directional guidance during walking by placing a hand on their shoulder or by taking their hand.
2. Sounds can provide an extra stimulation to encourage normal movement or to trigger an appropriate response to an instruction. Some peoples walking can improve by providing an external rhythm for example counting aloud or by playing music with a rhythm appropriate to the speed of a person’s walk.
3.Visual stimuli can be used to demonstrate instructions. When performing exercises it is more effective to demonstrate the exercise than to give instructions. (Marshall 2005)

Mood is usually affected in individuals coping with dementia. Individuals can often become flustered and distressed and in some cases can become aggressive and depressed. Regular movement will balance their mood help to reduce depression and keep them calm. Activity can help improve sleep pattern which can often be disturbed by dementia. Regular routines can include household activities, exercise classes, resistance training and stretching. http://www.healthcentre.org.uk/physiotherapists/physiotherapist-dementia.html

Behaviour management is one strategy that may be used to decrease depression in people with dementia and can be carried out by either carers or family. It is suggested that the reduction of repetitive verbalisations, management of agression and management of eating behaviours in people with dementia has a positive effect on their behaviour and overall well-being. (SIGN Guidelines 2006).

 Where you can get help 

Use the links below to find your way around this site

Recognition

What to expect

What physiotherapy can do 

What you can do 

Where can you get help

References