SUMMARY OF THE DISABILITY/CHRONIC ILLNESS YOU HAVE CHOSEN TO EXPLORE CHOSEN AREA
A) BRIEF INTRODUCTION
Dementia is syndrome which covers a spectrum of degenerative disorders. It manifests as a progressive decline in functioning that affects cognitive skills, personally and behaviour. It has a profound impact on individuals, families and communities, posing significant challenges to quality of life. It is not a curable disease, but it can improve with treatment. The number of people with dementia across the world increases every year as our global population ages, it is fast becoming known as the public health concern of the 21st century
It is an acquired brain injury. It is also a hidden disability and an intellectual disability. It is an acquired brain injury because it occurs when parts of the brain used for learning, memory, decision making, and language are damaged or diseased. It is a hidden disability because it could affect parts of the brain beneath the cortex which just tends to show changes in the speed of thinking and ability to start activities, they don’t necessarily forget things or have language problems. It is intellectual because if it affects cerebral cortex, the outer layer of the brain, this plays a critical role in memory and language.
There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer’s and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behaviour associated with each type. Doctors can determine that a person has dementia with a high level of certainty. But it’s harder to determine the exact type of dementia because the symptoms and brain changes of different dementias can overlap.
The causes of dementia include degenerative neurological disease which include Alzheimer’s disease, Parkinson’s disease, Huntington’s disease and some types of multiple sclerosis. These diseases get worse over time. Vascular disorders are disorders that affect the blood circulation in your brain. Traumatic brain injuries caused by car accidents, falls, concussions, etc. Infections of the central nervous system. These include meningitis, HIV, and Creutzfeldt-Jakob disease. Long-time alcohol or drug use
B) ICF DIAGRAM
The International Classification of Functioning, Disability and Health, known more commonly as ICF, is a classification of health and health-related areas. The ICF conceptualises a person’s level of functioning as a dynamic interaction between her or his health conditions, environmental factors, and personal factors. ICF is the WHO framework for measuring health and disability at both individual and population levels.
The ICF diagram below illustrates a person with Dementia
COMPREHENSIVE DESCRIPTION OF WHAT YOUR ROLE AND RESPONSIBILITY WOULD BE WHEN CARRYING OUT CARE ROUTINES AND OTHER SUPPORTS WITH A CLIENT WHO HAS THIS DISABILITY/CHRONIC CONDITION
GIVE EXAMPLES OF THE TYPE OF CARE AND SUPPORT YOU WOULD PROVIDE IN RELATION TO 5 ADL
Showering – A routine has been created in relation to showering Paul who is a Dementia patient, it is usually around 7pm daily; this is to help him relax and sleep well at night. About 6.30pm, I will mention to him that he would be having his shower in the next 30minutes, this helps him to prepare his mind and work his brain around any fear of water or anxiety that might want to come up. His wife will be getting his pyjamas and underwear ready while I check if the hot water is running, if the room temperature is warm and get the bathroom items in place. At 7pm, I would offer him a choice of bath or shower and whatever he decides is what I do. This is to make him realise he has control of himself and not being forced to do things. I start by letting him wash his face himself to support his independence and promote his physical and cognitive co-ordination. I work my way through other parts of the body that he can not reach himself in the subtlest manner, with light music at the background so it is like a spa like treatment and this helps him to relax. I wrap him with large towel afterwards to keep him warm before heading off to the room. I was talk him through the shower time, so he knows what is next and seek his consent; this makes him respond well and get through the shower time without much stress. His wife is always around in the house which is a kind of support for me knowing that she is always there to help me but if she is not available a member of the family would be there to support. For health and safety, a shower chair is in the bathroom in case he gets too weak to stand, he can easily sit on that to reduce the risk of him falling.
When it is feeding time, we set the table in the normal format as it is always done. Mealtimes are usually with at least one member of the family mainly his wife. We would invite him to the table telling him of the choices of food available and if he would like to pick from any. Most of the time he usually says he doesn’t mind whatever he is given so we ensure he gets balanced diet meals in the most attractive way possible. He is still able to feed himself, so the cutleries are placed within his reach to easy accessibility. During mealtimes, he might ask what food he is eating, and we just tell him what it is and ask him if he likes it and enjoys it; he would normally say yes but we ask all the time to be sure. There was a day he was served rice and curry sauce, but he said he thought he would get mashed potatoes and steak, we asked if he would prefer that, so we could make it for him, but he said he was fine with the rice and curry sauce. We do normally give him what food he wants but he is generally not a fussy eater. Sometimes when he is weak and cannot eat by himself myself or any member of the family would help him. He loves to drink water during meal but gets a cup of tea immediately after meal to use his medication. He then leaves the dining table and goes to the lobby to relax himself and watch the television although he dozes off sometimes when he is sitting on the couch.
Sometimes Dementia takes its course on him and he does forget to brush or remember why it is important to do so. I usually remind him when he wakes up as that is how it has been built into his routine, but he sometimes asks why he should. I tell him that oral hygiene is as important as every other one he does to keep his teeth healthy and prevent the tooth loss and infection. Since he still has the use of his hands, I support him to do the brushing himself to promote his independence by putting all necessary items within his reach. To start the procedure, I show him his toothbrush then remind him, it is time to brush his teeth. I ask him to hold his brush, put the tooth paste on it and do the brushing, I do not leave him on his own but talk him through the brushing procedure. This he does most morning when he wakes up but there was a morning when he said he wishes to do it but he does not feel strong enough to brush his teeth by himself, so I helped him brush his teeth and he was happy with it. There was a time he complained on pain in his mouth, asked him if he was comfortable to have it checked by the dentist and he said yes so an appointment was booked for him but the dentist didn’t see any major cause of it as he said he noticed he has good oral care so told him that it looked like an inflammation and taking pain relief would help and it did. The dentist put him on periodic check and we make conscious effort to keep those appointment which has been going on well for some time now.
Now he is still able to go to the toilet by himself most times, although he uses day and night pad in case of accidents because his walking is becoming slow and might not make it to the toilet in good time. When dressing him up, he sometimes refuses the pad but after an explanation that it is to prevent him from accidents he agrees to use them. There is a commode is his room with TOILET boldly written on it place in his bedroom to save him the trip to the toilet in the night, but he sometimes ignores it and still goes to the toilet down the halfway in the night. When I ask him why he didn’t use the commode in his bedroom he would say because that is not the toilet. He always has pad on because people with Dementia sometimes have loss of bowel control or forget where the bathroom is located so to retain his sense of dignity we would always have the pad on him. In addition to this I would always ensure that he puts on easy-to-pull down track bottoms to reduce the feeling of embarrassment having to call someone when he needs to use the bathroom. One morning about 4am when I went to check him and noticed that his bed was wet, I quietly woke him up that he needs to change the pad, he was a little worried but I supported him by telling that anyone can have an accident and he need to change the sheets to prevent him from getting cold then he cooperated with him and he responded to every words that I spoke to him to help me change the pad and he went back to sleep almost immediately.
After he has been diagnosed with Dementia, he has been placed on specific medications by the GP that he must use daily. Even though I have undergone Medicine Administration course extra care has to be taken to ensure that he gets the required amount of medicine at the right time. He has them in the blister pack and I would put them in the medicine cup to show him his medication for the period. Sometimes he would refuse to take them then I would leave him for another 20 minutes again then try him highlighting the importance of the medicine and why he should take a regular course to keep him at a good state of mind and health. He would usually at this time use them when I try again. If he refuses after the second time I would get another family member to try in another form, then he would take them at that time too. His medications are helpful as they keep in calm and relaxed. I check regularly the stock of his medicines and when they are running out I inform his wife then she picks the prescription from the GP, drop into the pharmacy and anyone of us can pick up when it is ready. There was a day the wife forgot to give him his night medication, this made him not to sleep for the whole night; not even for 5minutes so from that day an alarm was set for 8pm to take his night medication and this has worked well ever since, and he has not had any disturbed night for a while now.
PRINCIPLES YOU FOLLOW WHEN WANTING TO COMMUNICATE EFFECTIVELY WITH THE PERSON WITH THE DISABILITY
a) WHAT IS EFFECTIVE COMMUNICATION
Effective communication is listening without judging or having pre-determined mind, it is understanding the intention and the emotion is conveying of information. It is conveying message in a way that the message is being understood and if it is not understood, ask question to clarify to know what the person said and is trying to pass across. Effective communication can not occur if there is no active listening where the party does not interrupt but shows interest in understanding what the message is. It also involves non-verbal communication, reading the posture and looking into the other person’s eyes to get both spoken and unspoken words of the message. Effective communication is important in every aspect of our lives for example school, work, home and between partners. With the person with Dementia you need to stay as calm as possible while communicating with them, speaking in clear and concise language so that they can understand what you are saying and when they talk and one doesn’t seem to understand you can paraphrase to see if you clearly understand them and acknowledge it to the person when you have understood their messages.
b) OUTLINE WHAT IS MEANT BY THE THERAPEUTIC RELATIONSHIP
The therapeutic relationship refers to the relationship between a healthcare professional and a client. It is how a therapist and a client hope to engage with each other, and effect beneficial change in the client. (Wikipedia 2019).
It involves close and consistent relationship of the healthcare assistant and patient. It builds trust and respect in the relationship that helps to make living better for the patient. This involves creating a safe, non-judgemental and open atmosphere where the patient feels at ease to share their emotions, beliefs and their concerns with their carer without the fear of being judged or ignored. It is important to let the carer know of the productivity of this therapy and to provide appropriate care where necessary. They are to ensure patients of the confidentiality of their information expect there is a suspect of abuse which must be reported to appropriate authority immediately. I can say I have this relationship with Daniel as his face lightens up when I come in and he talks about what has been happening since he got up in the morning. I show interest in his talk, give him attention and address whatever is within my reach to do for him, it could be as little as him wanting to watch a television programme that he could not communicate across properly and that makes him happy
c) DESCRIBE 3 METHODS OF EFFECTIVE COMMUNICATION WITH A PERSON WITH A DISABIILITY
It is important to communicate effective with people with disability as we need to see the Ability in their world and stop limiting the strengths of their ability. We need to support them in the most effective way as we can.
It is easy for people with Dementia to wander away by not remembering where their house is or how to get back home so Dementia bracelets helps to inform anyone about the wearer’s health status but also to alert people, such as rescuers, first-aid staff and medical professionals of the appropriate action to perform when the wearer is involved in an emergency. This is so crucial as we all know that knowledge can save life.
Dementia bracelets with a tracking device are useful if someone goes walkabout”,” says Maher.
Dementia Circle: Funded by The Alzheimer Society in Scotland, this website has reviews from people with dementia and their families who have tested products, they also have helpful information sheets.
AT Dementia: provides information about assistive technology products. The website in based in England but many of suppliers listed deliver to Ireland. The site has lots of information leaflets to help you make decisions about what technology works for you.
d) DISCUSS HOW YOU CAN EMPOWER A PERSON WITH A DISABILITY TO COMMUNICATE
To empower a person with a disability we need to create a safe environment and use person centred approach. Make sure you make them know that you are in support of them and understand them. Engage in active listening when with them, always clarify what you don’t you understand and never make assumptions. Trying to acknowledge their strengths, encouraging them of what they can do which enhances their empowerment. Using Validation therapy to bring the person to their reality, helps them to communicate and builds their self-esteem. Music therapy by playing old and familiar music to unlock their memories and feelings to enhance communication. By reminiscence with a dementia patient which is reviewing past events is a positive activity that brings them pleasure, even though they might not talk it reduces anxiety. Always stay calm, use short and precise sentences and allow plenty of time for you to be understood as a carer.
EFFECTIVE AND APPROPRIATE MEASURES TAKEN TO FOSTER GOOD RELATIONSHIPS WITH PARTNERS WHEN WORKING WITH A PERSON WITH A DISABILITY
a) IDENTIFY PARTNERS
His wife, his children, family and friends. Other carers, day hospital staff, dentist, GP, occupational therapist, bus drivers, other shop users and road walkers.
b) DISCUSS 4 MEASURES THAT COULD FOSTER GOOD RELATIONSHIPS WITH THESE PARTNERS
To foster good relationships with these partners I ensure that I put a note on for the next person coming in to see him of his activities that would help inform them of what my time with him was. Ensure a good and working buddy system where all can be contacted of any changes. Schedule regular meetings to familiarise with partners to be able to know if there are any major changes that needs to be looked in. Always ensure that communication is clear and concise so that the error of mistake is reduced. Be flexible and always consider other partners views and opinions as important also. Find out from other partners what works for the person you are caring for so that there is a form of uniformity with what everyone is doing with the client. People with Dementia also attend the following gatherings listed below to help bring in the expertise in dealing with patients which makes managing them easier.
Alzheimer Cafes provide a warm and welcoming space for people with dementia, their family and friends and social and health care professionals to meet, exchange ideas and learnings.
The Cafe is based on an international model and usually opens monthly in the early evening. Some cafes open during the day, and all provide light refreshments and a mix of education and support.
The cafes provide an informal way to meet others living with dementia and to meet health and social care professionals. Usually an expert speaker is invited each month to talk to the Cafe about a topic of interest, however the cafe is also a space to chat and enjoy a social occasion in a supportive environment.
The Club is a social gathering once a week where people can drop in to chat, access information and support, meet other people as well as to exchange ideas and experiences. The Clubs also plan activities and organise outings and provide an informal, flexible and fun opportunity for people with dementia and their carer or family member to meet others in a supported environment.
Dementia is a disability that cannot be ignored because its occurrence is very alarming. In Ireland there are currently over 41″,000 people living with dementia, and this number is projected to increase to over 100″,000 by 2036. Continuous learning is required when providing Dementia care. Therefore, we work closely with associated organisations to develop on-going training programmes for our carers, enabling us to better support both our clients and carers.
About 5% to 8% of adults over age 65 years gave some form of dementia. This percentage doubles every 5 years after 65. As many as half of people in their 80s have some dementia. The big growth in the numbers of those living into their 80s means dementia is becoming unavoidable and if this trend continues dementia, sadly will become the leading cause of death in a few years. Dementia remains the leading cause of death of women as it is associated with stress which is common among women.
Although there is currently no cure of Dementia but living a healthy lifestyle and late education can help reduce the risk of Dementia.