Reaching out by sdfwerte


									        A challenge to us all

So you have
• an incurable disease
• a terminal disease
• a disease that many people associate
  still with „madness‟

How do you feel?
“If you‟re demented, you‟re wasting
  lives - your family‟s life – and
  you‟re wasting the resources of the
  National Health Service…the real
  person has gone already…and
  nobody wants to be remembered in
  that condition.”

• Societal stigma and consequent lack
  of understanding can get to us all

• Most of our systems give us no time
  to tackle this
Good and effective care for people
must understand the whole person,
his/her history, relationships, beliefs,
physical and mental state -
without that person necessarily
giving this verbally in a coherent
No person with dementia is a passive
victim of the disease, as a biomedical
model would imply, but an active
person seeking to cope with and
manage the disease.
„Challenging‟ behaviour is an attempt
to communicate a need.
We must find out what the need is
and meet it.
Challenges for us:

• Recognising and managing pain
• Understanding different realities
• Understanding the perceptual,
  visual and processing changes
  that come with dementia
They will be different for every person
 and for each one of us, so it will take
       a lot of time and thought.
“Pain is whatever the experiencing
  person says it is, existing whenever
  he says it does.”
     (McAffrey 1968)

 If the only clear indications of pain
 are agitation and distress, a solution
 involves everyone.
Different realities:
• I want to go home.
• Where‟s mother?
• Who is this woman?

 We have to learn to speak the
 language and see with their eyes
Different realities:

• interpreting an attempt at treatment
  as past abuse
• fear making all attempts at help
  appear as threats to self
    Refusal of medication

•   a different person
•   a different time
•   is this unusual so may be temporary?
•   wanting some attention
• Is there a sudden loss of capacity?
      If not, we all have a right to refuse
      medication even if it‟s unwise.
• Is there an Advance Directive?
• Talk with relatives and friends
• May need a „Best Interest‟ meeting
  with those who know the person or
  with an advocate
       Frightening things
  Perception changes and sight loss:
•   narrowing of visual boundaries
    with age
•   changes in processing visual
•   unexplored links between
    cognitive function and poor
If people are scared because they
   cannot see or perceive things
   differently, they may:

•   hit out or kick
•   refuse to move
•   refuse to go to a particular place
•   refuse to bathe
•   be very incommunicative
It all takes time and there‟s no easy
Family and friends will be in an
emotional state – that does not
mean that they won‟t help shed light
on things.
It does mean we may have to do
some work with them as well; also
useful in relationship terms.
Research into working with such
challenges shows that all staff
involved benefit from closer working
and open discussion.

Peer discussion and support is often
the best way to resolve a challenging

“ We want not to be smothered by your
  care, nor isolated by your denial, nor
  cast aside as a victim of your grief
  but we want you to be a care partner
  walking alongside us to meet our
  increasing needs.”
                    Christine Bryden
               Dancing with Dementia
Alzheimer‟s Society
16-18 North Parade
T: 01274 733880

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