Alzheimer’s Australia 14th National Conference Brisbane

This week we are attending the Alzheimer’s Australia 14th National Conference in Brisbane. The theme this year is “Take a different view” of this condition that will affect an increasing number of older Australians in the years ahead.

Bernie McCarthy is presenting a workshop on “Sexuality and dementia: What are your needs“, a concurrent paper on “Pre-employment screening: Pre-employment screening: Predicting person-centredness in care staff” and a poster on “Successful e-learning in palliative care for rural and remote aged care homes“.

The keynote speaker this year is Prof. Steven Sabat, a psychologist whose books (The Experience of Alzheimers Disease: Life Through a Tangled Veil (Blackwell, 2001), and in his co-edited book, Dementia: Mind, Meaning, and the Person (Oxford University Press, 2006)) have opened up the subjective experience of the person with dementia and helped us consider how the person experiences dementia. We are looking forward to listening to him speak.

Also keynote is Prof. Raymond Tallis whose career as a clinician and scientist has explored human consciousness, and what it is to be a human being. His over 200 publications include textbooks: The Clinical Neurology of Old Age (Wiley, 1988) and Brocklehurst’s Textbook of Geriatric Medicine and Gerontology (Harcourt Brace, co-edited with Howard Fillitt, 6th edition, 2003.

If you are attending this years conference please call in and say hello at our exhibition booth No. 20 where we will be selling Bernie McCarthy’s new book “Hearing the person with dementia: Person centred approaches to communication for families and caregivers”.

We look forward to seeing you at the Brisbane Convention and Exhibition Centre.

Palliative Care – an electronic learning package

We are about to launch a new electronic CD-based multimedia learning package.

This Australian government funded project is led by Flinders University with whom we have engaged to design a tool to support rural aged care homes to provide best practice palliative care for people living with dementia.

Palliative Care is usually associated with people who have cancer or other terminal illnesses and most often involves providing nursing care and other supports at home. When it comes to dementia however, it is important to note that dementia is also a terminal illness that limits a person’s life both in length of years and in quality of life.

Palliative care for people with dementia then is provided over the course of their illness with a focus on ensuring comfort, involving family and supporting the person for a pain-free end of life.

Comfort is not only physical. Comfort is also psychological comfort of being in familiar surroundings accompanied by people who make you feel good about yourself and who ensure you can interact with them in a successful respectful way that brings you out of yourself and encourages you to flourish rather than just vegetate till the end.

Our CD-based learning package will be trialled in 6 aged care homes in South Australia and Victoria over the next 12 months. Topics covered in this multimedia package include:
What is palliative care?
What is dementia?
Person-centred care
Communication with people with dementia, with families and during decision making
Supporting people with dementia in their culture, spirituality and relationships
End of life
Grief and loss
Care for staff

This is an exciting venture for us. We will keep you updated about progress.

You are attachment figures

Goodbye GrandpaAttachment has been studied with children and more recently with adults. However, it is only now being considered in relation to the relationship between caregivers and people living with dementia.

Whether you are a paid or unpaid caregiver for someone living with dementia you have an effect on the person, emotionally, psychologically. Because of the cognitive changes that cause such loss of confidence and increased confusion, the person with dementia often feels emotionally upset, lost, confused, angry, abandoned, forgotten. So they are more likely to sense themselves they way they did when they were younger, much younger – like 3-8 years old. They are not children but they can feel like they used to and this is where attachment comes in.

You know yourself how easy it is to be thrown back into younger emotional territory by the actions of other people or your own actions that cause you to feel the way you used to when you were younger. Its much the same for the person with dementia.

So you become their attachment figure in this emotional landscape. You are important from an emotional point of view because you become a provider of safety and security, predictability. They rely on you, look to you for guidance about what to do next, where to go, how to feel.

I some ways you are a “mother” or “father” figure to the person.

In a future blog I will talk about the ways in which disturbed behaviour can be understood as attachment behaviour.

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Enriching care planning

This book is a ‘must have’ for your dementia library. It provides a profiled approach to care planning that is holistic and inclusive of the person. It values the life story, the physical, the personality, the roles in life, the social dimension. This inclusive approach results in an enriched care planning process and improved outcomes for the person. Enjoy reading it and enjoy putting it into practice. It comes from the UK but is just as relevant in other settings.

Making dementia services better

Person-centred care has needed this book. Dawn Brooker, the former head of the Bradford Dementia Group and now head of the Association of Dementia Studies at University of Worcester, UK, has given us a simple yet profound model of person-centred care for people living with dementia.

This model is the VIPS model of person-centred care. We all know that a VIP is a Very Important Person. Brooker uses this popular acronym to describe the four core elements to a well-rounded understanding of person-centred care.

V = Value. Each person has value regardless of disability

I = Individualised. Care must be shaped to the particular needs and preferences of each person

P = Perspective. The person has a unique perspective on their life, feelings, ants and needs and this must be respected

S = Social. We are social beings who thrive in relationships of respect and understanding.

Brooker explores the practical implications of this model for care homes and for people providing care in their own home. However the focus is mostly towards care homes and professional caregivers.a model that is intuitively useful for explaining what person-centred care actually means in practice to caregivers who may think person-centred is what you do after you have your work done and have a little extra time to be kind and thoughtful. No, person-centred care is integral to everything you do. Its how you do what you do.

She then sets out a benchmarking process with detailed markers (24: Six for each of the four elements of the VIPS mode to help care homes to judge how they are progressing toward a more person-centred environment This is a valuable addition to the literature of benchmarking in aged care and brings person-centred markers into focus for those making decisions about the quality of care and the organisational supports that person-centred care needs if it is to take root in any organisation.

I highly recommend this book as a must have for the serious about person-centred approaches to the care of people with dementia

Validation – the key to healthy relationships

Validation theory has been around for a few decades now thanks to the work of Naomi Feil who is featured in the YouTube video in this post among many others.

Check out her work with Mrs Wilson. The transformation of this withdrawn lady is remarkable.

Validation is the respectful acceptance of the emotional and thought reality of each person. We engage in validation when we understand someone else and communicate that understanding successfully to them so they say, “Yep that’s it. That’s how it feels for me!” This is how we need to relate in our relationships at home with those we love, with our colleagues at work, with the people we care for at work, and especially with the people in our care who are unable to communicate their reality in words. We rely on our empathy and compassion to understand their reality. Sometimes its guess work but each time we try we come a little closer to understanding and so being able to respond and provide exactly what they need from us to be OK, to feel wellbeing.

Enjoy the videos of Naomi Feil.

Assistive technology for people with dementia

Around the world there is an increasing focus on finding ways to support people with AD and others dementias to live in their homes and enjoy their lives for as long as they can.

Recent developments include using movement monitoring equipment that we have in our own homes to enable people with dementia to remain safe. These sensors  can also help researchers understand the pattern of movements that are characteristic of each person and then look for changes in regular movement patterns that may predict illness conditions such as heart attacks.

GPS technology has also been combined with GSM mobile phone technology to enable people who are lost to be found quickly. This is major step forward in providing an unobtrusive and secure environment of security for the person with dementia. Boundary alerts can enable people living at home or in residential care to be found quickly, avoiding the distressing experience of being confused and alone in a strange environment for the person with dementia.

Computers in homes are being used to help people stay in touch with relatives via skype and touchscreen icon photos of the people they want to talk to. They are also being programmed with games and other forms of cognitive stimulation to support the person’s cognitive function.

This is only a small taste of the use of the technology that is available in experimental form and in some cases practically available today.

Exercise, memory and dementia

Exercise is good for you and it helps to put off the effects of dementia if you’ve got it.

A neat study presented to day at the International Conference on Alzheimer’s Disease in Hawaii compared the effects of doing Tai Chi, Slow or Fast Walking and Social interaction. They found that there was no improvement on cognition for the Slow Walking group But there was an increase in cognition for all other groups and biggest improvement was for the Tai Chi group. Next were the Fast Walkers.

They also measured brain volume and found that after 8 months Tai Chi increased brain volume most out of all groups with Fast walkers next.

This is an important result as it shows just how an activity like Tai Chi which uses both physical movement and thinking, memory for patterns, concentration and visualising to complete a complex series of movements is better than simple exercise that does not require cognitive effort.

What does this mean for middle aged and older people? Engage in something that is going to exercise your brain as well as your body. The aerobic exercise is good but the mind-body task of Tai Chi is much better.

The increase in brain volume is another support for the plasticity of the brain – the brain can grow new connections, and build new growth to support new challenges. That’s the way we learn and our brain can do it.

New book contract – Hearing the person with dementia

I have just signed a contract to write a book on communication with people living with dementia with Jessica Kingsley Publishers in the UK. The book is almost finished and will likely be out in 2011.

It will have a person-centred focus on valuing the person in your communication and attending to those small and meaningful signs that tell us what the person means when they no longer have words at their disposal. It will also address teh practicalities of communicating in times of difficulty, when stress is high between you and the other person both in residential and in community home care situations.

I will give you notice when it is launched.