Elderly residents evacuated in Victoria

This week has seen more flooding in Australia as a quarter of the area of Victoria is under water. 245 residents of aged care facilities have been evacuated to safety as towns such as Rochester in central Victoria was inundated by floodwaters.

For those residents with dementia this was a difficult and confusing experience. For staff whose own homes were threatened it was also a difficult and stressful experience.

Can you tell us what happened to you? Do you have relatives in the flooded areas.

Queensland and Victoria now continue the cleanup of sodden homes and businesses.

Our thoughts are with you all.

Can anyone fix dementia care?

Have a look at this video of Sir Gerry Robinson made by the BBC. He is a business man who specialises in turning around businesses from failure to success. He looks at what can be done in dementia care in two homes in the UK.

What he finds makes you want to throw your head back and wail in frustration and sadness.

Yet, he finds some signs of hope. The BBC series is broken up into several 15 minute pieces in these video clips telling the story of his journey.

This video is the first of several I will link to in a series of posts over next few days. This will be well worth your time just to see what is being done and what can be done.

Let me know what you think. What is happening in your place? What grabs your attention?

Family input – worth its weight in gold

I have had the pleasure of listening to family members talk about their experiences of having a relative in aged care. It has been inspiring and concerning. Today was the concerning bit.

I listened today to a son talk about visiting his mother and watching a staff member ignore an old lady nearby who was in obvious distress in her fallout chair and calling out for help. He saw the same staff member walk passed twice and not offer help. He became concerned for his own mother. While she can look after her own needs now, what will happen if she becomes more incapacitated and is unable to protect her own interests. He is worried now. And rightly.

It is a small thing seemingly but it shows a lack of compassion and empathy from the staff member. I had watched earlier in the day and saw the same person doing the same thing so I knew he was right in his observation. What concerns me is that apart from the distress caused to the lady in the chair, his trust in the care offered by the facility has now been damaged and he has moved closer to making a complaint. The next time is happens he might not be so patient.

Staff, please be careful of your actions. Visitors note what you do and don’t do. They see your care and lack of it.  You may be busy but not so busy you become an uncaring robot. Always be aware of the feelings of the person you are caring for. How do they feel right now. The noise they are making has a reason. Look beyond the noise and ask yourself how they are feeling and what it means that they are calling out for help.

Behaviour is communication

Behaviour is a form of communication. As Richard Ward suggests: “Irrespective of the severity or nature of impairment, a person with dementia will seek out and establish a means of self-expression and thereby make every effort to maintain a relationship with the world they inhabit”.

This relationship attempt may be in the form of repeated questions to you, clinging, or it may be to other people in their environment in the form of physical intimacy. This can be concerning for others but it is a legitimate and reasonable thing for the person to do. However, as with all behaviour it must be safe for others. If this is not the case and is imposed on others people then it must be managed in a skillful way so that everyone is maintained in a positive emotional state.

A useful book that can help to put sexual behaviour in a sensible light in aged care is this one by Barbara Sherman: Sex, Intimacy and Aged Care

What are the people in your care doing that is their way of communicating their inner experience to you? What are they saying to you?

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Families in aged care

Families affect the wellbeing of the people you care for. Some are easy to have involved and others are difficult. Every one of them is doing the very best they can and in the only way they know how, to be involved in the care of their older relative.

Think about your family for a moment. It is the place where you attached to your mother and father and learned the ways of relationship and behaviour in society. How to function and feel, how to solve problems and make your way in the world. You also probably learned how to avoid some feelings. Its all part of your own attachment history with your caregivers.

Now come back to the families you have in your work. The older person is the attachment figure or caregiver for the younger people who visit them, their adult children. And you are now an attachment figure for the older person. How the wheel turns.

Some families do not cope well with being replaced by professional caregivers. They feel angry and guilty at the same time. They think they should still be the primary person to provide care for their mother or father. Some parents have instilled this guilty thinking into their children so they are caught. Others find themselves doing it naturally.

Caring for an elderly parent is not easy so we should be patient and understanding but also careful to maintain healthy boundaries for ourselves and them.

Next Thursday you may wish to come along to the latest public training day we are holding on “Working with families in aged care” at the Assisi Centre, Rosanna, Victoria on Thursday August 5th from 9.30am to 4pm.

Bookings limited by space so book soon on 03 9431 0311

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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

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.

Estrogen and dementia

Estrogen has long been thought to be protective against the effects of dementia. Yet so many more women have dementia than men. Today at the International Conference on Alzheimer’s Disease Dr Walter Rocca of Mayo Clinic Minnesota, reviewed the results of the Mayo Clinic Cohort Study of Oophorectomy and Aging.

I found it startling to hear him say that estrogen may be protective against dementia until older age when it may become toxic to the older woman and make her more vulnerable to the effects of dementia.

His study followed a large cohort of women who had had their ovaries removed prior to menopause (before 50 years) and a group of women who had not had this surgery and who had normal reproductive function into menopause, and followed them up an average of 27 years later. What he found was that those who has their ovaries removed prior to the onset of menopause and who had not had estrogen replacement therapy had a significant increase in their risk of dementia compared to the reference group. It was just as true for removal one ovary as for two.

He was reluctant to say that the removal of the ovaries and subsequent drop in estrogen levels caused the dementia as the link between these two events is not clear.

His group also  found that older age women who had not had their ovaries removed and those who had estrogen therapy 10-15 years after the removal of their ovaries had an increased risk of dementia.

One hypothesis is that the removal of the ovaries also caused a drop in progesterone and testosterone levels, Genetic factors and some lifestyle factors such as smoking and obesity could also be important. However, he was reluctant to come to a firm conclusion just yet. One of his hypotheses is that estrogen is protective in the early years and becomes neurotoxic in later years although he was unable to explain why this would be so.

This study has significant implications for the post-operative treatment choices that are offered to women so that they are given the information about neuroprotectivity and offered the choice of estrogen therapy in a timely way.

The implications for later life are unclear at this stage.

Your lifestyle and dementia

The International Conference on Alzheimer’s Disease in Hawaii opened this morning with a re-affirmation that in addition to the well known genetic risk factors for dementia, lifestyle factors can have a significant effect in contributing to or decreasing your risk of Alzheimer’s Disease (AD).

I will begin by briefly summarising the genetic knowledge in one paragraph (presumptuous I know).

Dr Jonathan Haines of Vanderbilt University Medical Centre gave a comprehensive review of the genetic literature that emphasised just how much has been achieved in the past ten years. APOE is still the most consistent gene that turns up in all the studies that search for markers for AD. A long list of other genes are turning up in studies of particular populations. The message here is that some genetic changes are particular to families or groups of families and may have to be studied in detail to find the small indications of the genetic changes that are missed in larger studies. The genetic risks are only about 50% known so far but the next ten years should show remarkable progress.

Lifestyle factors include diet, exercise, cognitive stimulation and sleep. It has been common knowledge for the past decade or so that most of these are contributors to many disease conditions including cardiovascular disease, high cholesterol and diabetes and obesity. All of these conditions are in turn factors that can make your risk of Alzheimer’s disease worse.

Dr Kristine Yaffe, of University of California at San Francisco spoke of the importance of mid-life high blood pressure in increasing your risk. She also mentioned diabetes in mid to late life as a risk of dementia due to unstable insulin levels affecting the levels of beta amyloid which has been implicated in the onset of Alzheimer’s Disease. Obesity is increasingly common but she also included in her remarks “overwieght“. This condition can be as harmful as obesity even though the Body Mass Index may not be as high. Fat is not an inert substance but can have toxic effects in the body by causing inflammation. Inflammation is harmful to neurological function. Numerous studies have shown that reducing inflammation by improving immune function can stimulate cognitive function and everyday living. Dr Yaffe remarked that combinations of these factors can increase your risk of AD markedly.

Other factors that can be important in the risk profile for AD include depression. This has been around for a while as a risk for dementia but she clarified that mid-life depression untreated may in fact be a prodrome or early phase of AD. This is a startling way to understand mid-life depression. This is of concern because many people do not seek treatment for their low mood which can then build into depression. This is particularly true of males.

Post-traumatic Stress Disorder (PTSD) is a disruptive condition that is now associated with a raised risk of dementia in veterans up to 2.5 times. The common element in this relationship is that the hippocampus (the brain area mostly responsible for memory decreases in size in PTSD. This also happens in AD but it seems that the shrinkage that occurs in PTSD may increase the risk of it developing into AD.

Sleep is the final are covered by Dr Yaffe. Sleep helps to decrease the levels of beta amyloid , the protein that is associated with AD. Sleep is often disturbed in people with AD. The common disturbance of sleep, sleep apnoea may be associated with hypoxia (deprivation of oxygen) that can contribute to brain injury.

So the message is take care of your brain and your body and you will be more likely to live a healthy old age.

How you live makes a difference. The science is pretty strong now. The areas of your life that influence the presence of high blood pressure, diabetes, obesity/overweight, depression and poor sleep are:



Cognitive stimulation

Social engagement

The evidence of other speakers this morning have reinforced the importance of diet. Dr Martha Clare Morris of Rush University Medical Centre, Chicago, reviewed the literature around nutritional factors. These included antioxidants, omega 3 and fish, fats, and Vitamin B12/Folate. You will know from media coverage that when a new discovery is made supporting the use of a particular food to prevent AD, an equally strong study can be quoted to show that this is not so. Dr Morris explained that some of the studies were with subjects who already had adequate dietary levels of these nutritional supplements. Giving them even more showed no effect. The greatest effects have been shown in studies where the subjects have been shown to have inadequate levels of the dietary factor in the first place. Only then does cognitive performance improve or risks decrease. It reaffirmed the importance of the advice that the food supplements we take in such great quantities are really only beneficial when our diets are inadequate in the first place. Eat a healthy balanced diet that is high in antioxidants such as Vitamin E and C, beta carotenes and flavonoidesDHA from fish and other sources and you will maximise your cognitive function and protect your brain into the future.

Exercise, even  every second day is effective in reducing your risk of dementia. The size of the hippocampus (remember this is the brain area for memory!) increases with exercise even after 3 months. Exercise also reduces other dementia risk factors such as high blood pressure, obesity, poor sleep and depression. So get out there and buy a pair of trainers and  shorts and go for it every second day for at least 45 minutes.

Cognitive skills training is the latest thing to become a popular way of fending off the effects of ageing. What is the evidence? Does it stand up? Yes it does. Dr Sherry Willis, of University of Washington, Seattle, looked at Reasoning, Memory and Speed and asked if cognitive skills training made a difference to actual daily living task such as dressing, eating and toileting.

She found that there was a good effect on reasoning ability, speed of performance and for memory function.  For speed she found 86% of people who participated in the cognitive skills training had in improvement in the speed that they could do their tasks while in the control group who had no training only 31% improved. However this improvement does not generalise to other abilities or tasks.

Her study also looked at the effect of a booster session at 1 and 3 years. They found that the booster did  improve the effect of the Cognitive Skills Training for both reasoning and speed but not for memory. Lower functioning subjects improved more than higher functioning people.

Of particular interest was her finding that driving skills improved for the group who had Cognitive Skills Training. This may be an important finding for the safety of elderly road users in helping to maintain their driving skills and so their social independence for longer than is currently the case.

Brain plasticity has been in the news  a lot in recent years as discoveries of just how much brain change we can expect from aging brains changes by the minute. It is extremely heartening to see such evidence for the usefulness of cognitive skills training in fending off the effects of such conditions as dementia and improving functional abilities for longer so that people who have such a condition are enabled to continue to function with success and confidence long into their futures.