Dementia

Understand the work of the team 3. 1 Team work is essential for the school curriculum to be taught across the school starting with the head teacher down to the TA. Another benefit of teamwork is that the teacher can divide the work out between the members of the team. This enables the individuals to concentrate on their specific duties that will contribute to the teacher’s lesson plan. This gets the job done faster.

Communication / sharing ideas become an important aspect of teamwork, so the whole team can see the class progress steadily to its goals. 3. 2 The class teacher’s purpose and objective is for the running of their class and making sure that the national curriculum is delivered and delegate duties to the TAs that are in their class. The TA; s role is to support the teacher in delivering the national curriculum do the tasks set out and deliver feed back 3. 3 My role in the class is to help the class teacher. On a Monday I go to Mrs. , s class and get the children get ready for forest school in a safe manner when the class are ready we sing the forest school song then go in to forest school out the other side and around the running track looking at all the interesting things like plants etc then when we are around the track we play 123 where are you in which the class go away and hide and we shout 123 where are you and they respond with 123 we are over here and then we go and find then the kids love this game , when we get back in to forest school the kids had some paint brushes an were encouraged to write some simple words with wet mud on decorators backing paper or on any think that wanted to write on within reason once the activities were over we packed up spades and buckets rakes and the rest of the stuff and put them safely away and get the washed and changed ready for dinner In the afternoon session anther teacher comes in to the class and my role was then to take groups of 4 kids and do phonics with them this consisted of the class teacher giving me recourses which were A4 pieces of laminated paper letters on and I would sound out a letter and they would have to find that letter, anther activity was another piece of A4 laminated paper with pictures on they would have a letter on the top and the kids would have to find the items on the paper starting with that letter normally 4 items , then we play I spy I would 4 items on the table sound out the word and ask them which item they thought it would be after that it was time to get them ready for home. 3. 4 When working in a team I always respect my colleges and opines if I don’t respect their opines how can I expect them to listen to me, almost all my colleagues have a lot more experience than myself and would be able to offer me good advice in situations I have had no experience of.

Normally, Alzheimer disease occurs after 60 old ages old. The chance increases as one gets older. This is a familial disease. The hazard one will acquire Alzheimer additions after 70 old ages old.

Survey shows that people over 65 old ages old that have Alzheimer are 10 % higher and Alzhiemr ‘s patients of over 85 have 50 % . Now, the numbers of Americans who have Alzheimer ‘s disease are more than 4.5 million. The numbers are predicted to raise to 13.2 million by 2050. Approximately 350,000 new instances of Alzheimer ‘s disease are diagnosed each twelvemonth and 59,000 victims dice. So far, there is no intervention for Alzheimer disease. However, I think that by utilizing drugs, we can forestall the symptoms from acquiring worse for a scope of clip. In this study, I would wish to discourse about this solution.

In Alzheimer ‘s disease, there is a deficit of acetylcholine, the encephalon chemical involved in memory and acquisition. For many old ages, physicians have prescribed a drug called tacrine that elevates degrees of acetylcholine by barricading the activity of acetylcholine, the enzyme that breaks down it. -Better Nutrition

In my sentiment, by the utilizing of cholinesterase inhibitors, the actions of the enzyme cholinesterase to interrupt down acetylcholine are impeded and become normal. Hence, the nervus cells in the encephalon have more acetylcholine.

As a consequence of this, new memories may go easier to organize. However, cholinesterase inhibitors do non change by reversal back the loss and destroy of acetylcholine in the encephalon. So, this medical specialty merely helps to forestall the symptoms from acquiring worse but does non forestall the patterned advance of the disease.

Cholinesterase inhibitors are used to handle mild to chair Alzheimer. One grounds of this is four types of cholinesterase inhibitors are available get downing mid-2000. The drugs that are used are donepezil, rivastigmine, galantamine, and tacrine.

However, merely tacrine (Razadyne – antecedently called Reminyl) are used by most doctors as tacrine has more unwanted side effects than the donepezil hydrochloride rivastigmine and galantamine. By the manner, merely rivastigmine and galantamine are merely approved by the FDA for mild to chair Alzheimer ‘s disease, while donepezil is approved for mild, moderate, and terrible Alzheimer ‘s disease.

Memantine

Besides, I think that another drug that could be used to handle Alzheimer’s patients is memantine. Memantine is believed to be able to modulate glutamate, an of import encephalon chemical. This drug’s chief consequence is to detain patterned advance of some of the symptoms of moderate to severe Alzheimer Disease (AD).

Memantine, an NMDA receptor adversary, Plants on the glutamatergic system. It does this by barricading NMDA glutamate receptors and therefore suppress overstimulation by glutamate. It decreases the consequence of extra glutamate activate nervus cells. It can barricade consequence of extra glutamate and reconstruct back physiological signal transmittal. As a consequence, signal sensing is stabilized and signal sensing is enabled. Excess glutamate has bad effects on the encephalon as it, Masks signal transmittal. Prevented sensing of signal in NMDA receptor Deteriorate nervus cells.

Death of encephalon cells, and therefore Alzheimer’s. Although memantine is non proven to decelerate down patterned advance in Alzheimer disease, nevertheless the symptoms of Alzheimer do lessening. Studies show that patients with Alzheimer who take memantine can care for themselves better than patients on sugar pills (placebos). With the intervention of memantine, patients can transport out normal activities a little longer than the patients without the intervention of memantine. For case, with the medicine, memantine may assist a patient with terrible Alzheimer comb the hair themselves, brash their dentitions and bath themselves for several months. This decreases the load for both the health professional and patients. In my sentiment, as NMDA adversary and cholinesterase inhibitors work really otherwise, they can be combined to be used together.

Effectiveness

Survey shows that when the ChEIs was given to th3 patients, the period of looking for NH admittance delayed (HR: 0.37, 95 % CI 0.27 to 0.49) compared with those who ne’er used cognitive foils while with the add-on of memantine the consequence is significantly augmented (HR: 0.29, 95 % CI 0.11 to 0.72) (memantine+ChEI V ChEI entirely). ChEIs entirely, or in combination with memantine had no important association on clip to decease.

Social and economic Deductions

Numbers vary between surveies but dementedness costs worldwide have been calculated around $ 160A billion, while costs of Alzheimer in the United States may be $ 100A billion each twelvemonth. One of the economic deductions that I have brush is that Alzheimer disease is the most dearly-won disease which their cost is besides high-rising. In my position, with the addition of ageing of society, the cost besides increases. I can split the cost related to this disease into few phases that are direct costs in medical signifier, like nursing place attention, or direct non-medical costs, twenty-four hours attention and nonmedical costs like lost of productiveness of both patients and health professional. I genuinely believe that the life cost becomes highly high when health professional ‘s lost earning due to long term daily care given. This is shown when the disease becomes worse when advancements, which the patients need longer clip to be cared for and higher cost for nursing-care is needed.

Behavioral alteration

As people with Alzheimer frequently develop memory job at the early phase, I think that they have trouble in retrieving late learned facts, activities and unable to construe new information. Sing the personality, they become apathy, less self-generated and tend to insulate themselves.

So, I believe that with the patterned advance of the disease, troubles in acquisition and memory addition. They are unable to comprehend or hold troubles with linguistic communication, have jobs in abstract thought and in other rational maps. At this phase their older memory is non really much affected but has troubles in new memory. The individual begins to hold job when working measures, with understanding the transition and be aftering their day-to-day activities. Turning to their behaviour, they may go aggressive, dying and leery. They tend to misinterpret what they see or what they hear. In my sentiment, this can take to misconstruing of both the patients and care-giver.

Benefits

“The research workers report that the test consequences indicate cholinesterase inhibitors led to a statistically important decrease in behavioural and psychological symptoms such as aggression, rolling or paranoia when utilizing the same dose as administered for bettering cognitive damage.”

I believe pharmaceutical used as a method of intervention do hold benefits. The drugs can forestall the symptoms from come oning within a limited clip and supply patients with comfort and self-respect. Besides, as the symptoms are prevented from acquiring worse within a scope of clip, the patient can be independent for a longer period of clip. This can diminish the care-giving load every bit good as the lovingness cost. Cholinesterase inhibitors are used for mild to chair AD. It helps the symptoms from worsen and command some behavioural features.

Hazard

The most common side effects from taking cholinesterase inhibitors (ChEIs) are nausea, purging and increased frequence of intestine motions. These are due to cholinergic extra. Among the users, 10-20 % of mild and terrible patient will treat those side-effects.

For the secondary side-effects, they are muscle spasms, bosom rate is decreased. Besides, it besides decreases one ‘s appetency and weight and increased stomachic acid production in some patients.

However, Between 75 % and 90 % of patients will digest curative doses of ChEIs. Figure 6 shows the hazards of taking cholinesterase inhibitors. In my sentiment, the hazards of cholinesterase inhibitors are non life endangering. They may be take the incommodiousness to the patient. This is because of the increasing of acetylcholine in the encephalon. Hence, I think that patients should take cholinesterase inhibitors to as the benefits compensate the hazards. Besides, memantine causes hallucinations, confusion, giddiness, concern and weariness.

In add-on, it can do irregularity, back hurting, addition in blood force per unit area, purging, trouble in take a breathing and coughing. The side effects are normally minor and do non necessitate medical intervention. However, if you have hallucinations, allergic reaction, or trouble in external respiration, you should travel in front for physician. For mild Alzheimer ‘s patients, they frequently feel that the drugs are gross outing and unneeded. This cause the symptoms become worse and they finally labeled as centrist or terrible patients. In my sentiment, the health professionals and patients have to recognize the hazards of memantine before and during taking it for the better intervention for Alzheimer ‘s patients.

Alternate solutions

Psychosocial intercession is a room designed for centripetal integrating therapy, which is an emotion-oriented psychosocial intercession for dementedness ‘s patients. Psychosocial intercessions can be classified into. Behavioural intercessions which tend to place and cut down the ancestors and consequence of job behavior. Behavioural intercession is non helpful in cut downing rolling but can assist in incontinency. Emotion-oriented intercessions which include reminiscence therapy (RT) that involved treatment of past experience separately or in a group, with the aid of exposure, music or sound recordings and their yesteryear ‘s familiar points. This therapy is found to be helpful in knowledge and temper. Proof therapy that based on credence of world and personal truth of past experience to assist to better in dementedness while centripetal integrating is exercising that will assist in stimulation. Supportive psychotherapeutics which is helpful in assisting mildly impaired Alzheimer patients to set their unwellness.

Centripetal integrating (snoezelen) and simulated presence therapy (SPT) which used the method recording and playing the sound and voice of closed relation to the Alzheimer patients.

Cognition-oriented which included:

• Reality orientation which asks the patients to show the information about their topographic point, milieus, relations or household.
• Cognitive retraining ( decrease of cognitive shortages ) which improved the impaired ability by exerting their head. From this intervention, cognitive abilities have been improved.
• Stimulation-oriented attacks which consists of art, music and pet therapies, exercising, and any other sorts of recreational activities. This sort of intervention has most betterment in the facet of behavior, temper, and, to a lesser extent, map.

Surgery in cistron therapy

“The scientists stress that their work is still at a really early phase. So far they have merely worked on a little figure of patients, and the trials have been designed to happen out whether the technique is safe, instead than effectual. However, the early indicants suggest that it might assist to decelerate the promotion of disease. “

Besides from drugs, Alzheimer can now be treated by surgery. This surgery is done by surgically implanted modified tissue into the encephalon of Alzheimer patients and is known as cistron therapy protocol for Alzheimer ‘s disease. The surgery is done on a 60-year-old Caucasic adult female in the early phases of Alzheimer ‘s disease and she recovered good.

This surgery usage human cistron therapy to handle Alzheimer. It prevents cell loss in Alzheimer by presenting a natural brain-survival molecule known as nervus growing factor (NGF) to the deceasing cells in the encephalon.

It is done by roll uping little sample of patients ain skin cells and infixing an stray NGF cistrons (of course happening proteins found in the encephalons of all vertebrate animate beings) from nervous system. The genetically engineered cells were cultured for three months. As they underwent mitosis, they produced big measures of NGF. After corroborating the cistrons has no harmful contaminations, it was implant into the patients ‘ encephalon.

Although it can non wholly cures the disease, but it is hoped to protect and even reconstruct certain encephalon cells and relieve some symptoms, such as short-run memory loss, for a longer period or may be few old ages. This intervention targets a group of cells located deep in a encephalon ‘s country known as cholinergic system which map as back uping memory and cognitive map as it is the devolution of this system which leads to Alzheimer ‘s. By forestalling inordinate loss of this type of cells, Alzheimer ‘s disease can be improved.

The difference between alcohol dementia and dementia is that alcohol dementia is a form of dementia caused by a long term use of alcohol and excessively drinking to the point where the individual suffers from memory loss due to neurological damage to the brain. With dementia there is the person does not suffer from alcohol abuse. Alcohol dementia can cause very serious brain complications and ten percent of patients diagnosed with alcohol dementia have a history of extended alcohol abuse.

People that suffer from dementia also suffer from memory loss but not due to abuse of alcohol or other drugs. With dementia you have a serious loss of your cognitive ability, this is also like the old age illness known as Alzheimer’s disease. These symptoms result from a brain injury in the past, or a progressive injury or even if you are suffering from a disease in the body. It is found that people that are diagnosed with cancer are soon later diagnosed with dementia as time passes.

Long term consequences from both of these illnesses are very severe. Patients suffer from memory loss, attention p decreasing, speaking in incomplete sentences, and also problem solving is altered drastically. Suffering from dementia reduces the ability to learn, reason with others. What might be the worst about this illness is that people can end up forgetting who their family members are. There is also loss of patterns of thoughts, feelings and activities.

In the later stages of the condition, affected individuals may be disoriented in time. People suffering from dementia might not know what day of the week it is or what year. This is very severe dementia of course. At the moment, scientists have not found a cure or even a treatment to slow down the process of dementia. It may be something majority of human beings go through and old age must play a factor with the memory loss.

Title: A 3000 words essay critically reviewing a service user’s journey through their experience of care In this essay I will critically evaluate a resident by the name of Tom Journey with dementia. He suffers from Alzheimer’s dementia and lives in sheltered housing. I will explore issues surrounding nutrition intake, wandering, communication, incontinence and the environment that affect the client, family and staff. I will then look at the assessment process, care planning, implementing and evaluation.

I will explore patient safety, intervention and the processes that managers and professionals have to undertake when managing . These interventions and approaches adopted are vital when planning person centred care. In addition, due to the policy of confidentiality I would not mention the name of the organisation and persons involved. The essay will end with a conclusion and a summary. According to Mathers and Leanardi (2000), “Dementia is a syndrome caused by a range of illnesses and currently many are incurable, and cause progressive, irreversible brain damage.

They include Alzheimer’s disease (the most common cause), vascular disease, frontal lobe dementia and Lewy Body disease. Symptoms of dementia can include memory loss, difficulties with language, judgement, insight and failure to recognise people, disorientation, mood changes, hallucinations, delusions, and the gradual loss of ability to perform all tasks of daily living”,( Mathers and Leanardi, 2000). Mace and Rabin (1999) highlighted that, “the word dementia originated from two Latin words which mean “away and mind”. This can indicate a loss of memory inability to function effectively, which can result in mental confusion”.

Jack is a seventy year old man with dementia. He lives in sheltered housing. He has four children two sons and two daughters. He was moved from his home into sheltered accommodation after the death of his wife Mary. His condition deteriorated very rapidly and he needed extra support to live at home safely. The family was unable to adequately provide for Jack’s needs, so they decided to re-house him. The family brought Jack with them to view the flat before he was moved in. This allowed Jack the opportunity to meet the staff and get familiar with the new environment. He was brought in by is son and daughter, but his son stayed with him in the guest room for a few days to get him settled and feel comfortable. Jack was showing early signs of dementia as his communication was not clear at times and often his speech was muddled. Furthermore, his memory was poor at first as he kept asking for his wife repeatedly for examples, ” where am I”, “whose house is this”, and “why am I here”. Also his nutrition was an issue as he was not eating his meals and often said he was not hungry or he would eat later. He would sometimes say take it away and feed the pigeon.

Food would turn up in various places like bins, in drawers and even in his bed. Mace and Rabins (1999) mentioned that eating alone can contribute to or worsen their confusion. Incontinence was also a big concern for staff as he was constantly wet and soiled with faeces. He would choose places not suitable to use for toileting, removing his protective clothing. He was also hiding dirty soiled clothes in inappropriate places. Moreover, getting his personal care done was a big task as he was not cooperative. Beatie et al, (2005) stated that people with dementia do not know that they are not being cooperative with certain basic tasks.

This could be related to my client as I observed these issues on many occasions. All these conditions have been highlighted by (Kitwood, 1997). With regard to incontinence, Parker (2000) supported that because of the dying of the brain cells, a person like Jack will not be able to independently identify the message the brain is conveying about the bowel. This problem was identified with Jack. Jack, as supported by Parker (2000) should be encouraged to use the toilet before and after consuming meals and drinks and should also have a regular pad change.

Parker 2000 also cited that when any person in a state like that of Jack is constipated or having sluggish bowel movement, they should be offered medication like suppositories and if this does not work they should be supported by observation. When dealing with Jack who does not have mental capacity it is important to observe his actions. When he is in need of toileting he can exhibit the following actions which are non verbal such as pulling down or removing pants, or opening his fly. These actions are likely to suggest that he wants to use the toilet.

Mace and Rabins (1999) argued that it can be very difficult for practitioners to achieve appropriate assessments when they are dealing with persons who are living in an independent setting. My assessment highlighted many problems such as personal care, poor memory, poor nutrition intake, urinary incontinence, poor communication and wandering about all the time. However, this was more pronounced in the evenings. Morris and Morris (2010), Kitwood, (1997) and Algage (2006), have highlighted this problem to be “sundown syndrome”.

According to Leblance (2011) he described this as onset of confusion that occurs in late afternoon and night time. Algage (2006) further stated that wandering is a way of communicating in a non verbal form by using action to correspond with others. Moreover Beatie et al, (2005) argued that patients with dementia may not be able to read signs. For example factors like the environment may cause them to be distressed and might put them at risk, (Hodgkinson et al, 2007). Some residents like Jack may have limited communication ability to verbalise what they want to do, so they just show action as a way of communicating.

For example, the sign posts, symbols and photographic pictures might not appeal to them because of their limited ability to focus on details, (Hodgkinson et al, 2007). Beatie et al, (2005) and Fox and Wilson (2007) have highlighted that living in a sheltered housing environment can be a lonely experience for many patients and this can make them feel isolated. More so, Beatie et al, (2005) mentioned that these factors might cause a patient to wander because if they feel lonely and anxious for a long period of time. They might want to find something to engage in.

A person with dementia might find it difficult to sit down. For example in my observations I feel that Jack was living in a community where he had friends and family to socialise with and moving to a new place was somehow upsetting for him. Likewise changes might have caused Jack’s more loss of memory and this could be another reason why he failed to adjust to his new surrounding as cited in Mace and Rabins (1999). Moreover, in this sheltered housing there are no facilities like shops and recreational facilities as it is in a secluded area.

Knockers (2000) mentioned about daily living activities that could have been useful to a patient with dementia like Jack. In my opinion, this would have given Jack the opportunity to engage with other residents. This would have been a great way of socialising, chatting, enjoyment and given him a purpose in life and most of all engaging his time and stop him from wondering so frequently. According to Cheston and Bender (1999) and Innes et al, (2000) the DCM (Dementia Care Mapping) is a precise framework that is important to assess patients with dementia.

The DCM (Dementia Care Mapping) is an observational tool which is used in a professional setting. This tool could have been useful to Jack if he was living in suitable housing that meets his needs (Kitwood 1997, Shels 2007 and Fox and Wilson, 2000), Mace and Rabins (1999) mention that MME (Mini Mental Examination) also known as the “mini mental” is one of the tools that are used to screen an individual’s mental ability at the onset of dementia. This tool is also known as the performance tool that allows five minutes to perform a set of precise tasks.

This entails a maximum score of thirty answers to questions given. “Some of the questions are, do you know what day it is, date, month and the time, do you know what country you live, and the town. Can you spell the word “world” backwards, can you write a sentence”. Likewise, In Jack’s case he was assessed using this tool to get a precise answer to see what he can independently do for himself. In addition, Fox and Wilson (2007) argued that the assessment processes should be compiled into a feedback statement. This information should be given at the beginning and end of the assessment.

Chester and Bender (2000) mentioned that feedback should be given in both oral and written statement. This is necessary for the patient and their family to adjust and come to terms with their illness, and deal with their emotions. According to Carmody and Forester (2003) the main areas of care planning are assessment, planning, evaluation, implementation and evaluation. Care plans are legal documents which should be reviewed on a regular basis for accuracy. Jack’s care plan contains some important information such as his name, date of birth, address and all information recorded was signed and dated.

Likewise, May et al (2003) mentioned that a care plan should be compiled and put together the persons needs and deeds. Jack’s care plan was fully supported and some of the information included was his life history, lifestyle, health, personality, and preferences, present and future wishes. Jack’s capacity, cognitive ability and the stages he was at present were documented. Jack’s care plan contains three columns. The left column was to record Jack’s needs, the middle column gives precise information for cares to comply with, whilst the right column is to record information, sign, date and reviews (May et al, 2003).

May et al, (2003) proposed that the enriched care planning was developed from the enriched model of dementia by (Kitwood, 1997). Jack care plan consists of five core areas which are reviewing, profiling, implementation, identifying needs and documenting needs. Jack care plan was fully supported by the carers. In Jack’s case his care plan was reviewed with the social worker, general practitioner, occupational therapist, dietician, warden, care manager and family and myself who is his key worker. This set out clear instructions for staff on how to personalise care for Jack.

This includes, monitoring and assessing changes in his toileting, nutritional intake, communication, health and wandering. Four main calls were put in place for his main meals and regular checks to stop him from feeling lonely. Jack care plan was reviewed and implementation of safety devices was put in action to keep Jack safe. This involves the implementing of sensory aids and equipment that will help to keep him safe at all times and especially during the nights. This included a bed sensor and door activator that goes off when he gets out of bed and when he leaves his flat.

This equipment was most useful during the nights. Reflective lighting was also put into place. It would come on at a certain time in the evening. The door bell flashing light let him know when someone was entering his flat. Picture coding colour was put on his fridge door and bedroom door to remind him where to go and what to do. Jacks’ family were in complete denial about his condition and they would often get very upset with him. They thought that their dad was trying to get back at them for moving him. One daughter was constantly fussing over him and telling him off.

This made it quite difficult for staff and management to get the assessment process started. The other barrier was the staff members that were not able to support Jack’s family appropriately, as they were not trained adequately in dementia care. Jack’s condition deteriorated rapidly and staff was finding it quite difficult to cope with his demanding and stressful behaviour. Jack was given tablets to keep him calm, however, this medication in my observation was too strong for him and often he would sleep for long periods of time.

Staff would have to wake him up for meals and before he finished his meals he would be fast asleep. In work places which are independent based, these facilities are not designed to accommodate people with certain forms of dementia and for this reason it took a longer time for Jack’s needs to be reassessed. Jack’s needs were finally met and then he was admitted to a dementia unit where he was housed, (Carmody and Foster, 2003, Jacques and Jackson, 2000). These factors can become a barrier for professional when implementing care for people living with dementia, (Jacques and Jackson, 2000).

In Jack’s case he could have benefitted from the evaluation tool to stimulate communication between staff and himself. This would have prompted his alertness and encouraged communication at meal times as observed by Shiels (2007). With reference to evaluation this process is necessary to get a direct result of Jack’s illness. This will establish how far his condition has deteriorated and the extent of his impairment and functioning. Moreover, this will identify other health problems, so that the necessary treatment and planning can be put in place to address his needs, (Mace and Rabin 1999).

Jack had to undertake this evaluation and many tests such as CBC (Complete blood count) which includes a blood chemistry test, checking the liver and kidney for signs of diabetes, vitamin B12 and thyroid level . The VDRL check for syphilis and LP (lumbar puncture) investigates the central nervous system. EEC (electroencephagram) measures the brain activities. CT scans, MRI scans, PET scans, SPECT scans which are all important tests can identify the presence of a stroke. Jack was also given a neuropsychological test or the cortical test where they test his memory for writing and reasoning ability, and coordination (Mace and Rabin 1999).

A psychiatric and psychosocial evaluation was also conducted by way of interviews with Jack’s family and his friend. This was vital to planning and development of care and this was also supported by a family evaluation to assess and to address their emotional, financial and physical needs, (Carmody and Forster 2003). Jack‘s condition has deteriorated even further and he has started leaving the premises through the back door. There is sensory equipment which is now in place in order to monitor his movements.

Jack sometimes presses the button and it raises an alarm with the central control office. The control room staff will then contact the staff on duty to go and attend to Jack and see whether there is anything he needs. In most cases when the staff gets there, Jack will be trying to leave the premises not properly dressed. Examples being dressed in his pyjamas and bed room slippers, wearing a vest without his shirt or wearing his trouser inside out. When the staff try to get Jack to return to his flat he becomes very aggressive, shouting and hitting the staff and refusing to go back.

The police on many occasions are called to search for him. AGASE (2006) indicated that wandering is associated with risk factors of getting lost and falls. As highlighted by Hodgkinson et al ( 2007) “gridlines placed on front door exits, door handles, panic button bars might be an effective way to addresses Jack’s wandering and reduce the risk of escaping”. Carmody and Forster (2003) suggest that a person like Jack can benefit from ADL (Activities of Daily Living) as this will help test his functioning abilities and performance.

With regards to communication and Jack’s outburst Phillips and Penhale (1996) argued that some people with dementia like Jack might have poor memory, limited communication ability with others. Jack is unaware of his aggression towards staff. This is not done intentionally as his brain cells are dying. Jack is unaware that he is causing harm to any one as he is simply trying to communicate. Jack will be trying to say why are these people stopping or preventing me from going to see my friends. In my observation Jack was finding it difficult to say the right word, as he was not able to understand what is being said to him.

Carmody and Forster (2003) Fox and Wilson (2000) highlighted that the person who is undertaking a communication assessment needs to be a good listener and a competently trained professional. This person needs to have experiences of in dealing with different cases of dementia and know the differences between the different types. Fox and Wilson (2000) mentioned that a person with counselling skills might be able to address the needs of a person with dementia more efficiently. In my opinion, these skills are important when working with customers with dementia.

In Jack’s case this would have been more beneficial if staff dealing with him had appropriate counselling skills. They would have been in a position to understand how to communicate with Jack as to achieve effective results. In the long run Jack was finding it more difficult to cope with every day activities. He had suffered a relapse and his condition deteriorated very rapidly and he needed more specialist care. He was not coping well and his health and safety was at risk. Jack needs were reassessed and he was no longer capable to live independently any more.

Management and social worker were in the process of getting him relocated when he suffered a fall. He was taken to hospital and then he was moved into a residential home that cares for people with dementia. In conclusion, the government acknowledges dementia as a growing problem and has put strategies in place to care for people with dementia. To address Jack’s needs appropriately his care should be person centred. Jack was moved to a new home and this might have contributed to his wandering. His new setting was secluded and he had no friends to communicate or socialise with.

This factor could have led to further confusion and made him feel lonely and even depressed. Although Jack was fully supported by the planning, assessment, implementing and evaluation process, his needs were slow to be addressed by the family and this posed as a barrier to Jack getting the care he required. However, the assessment procedure and progress for independent living have to be organised by many professionals. It appears in Jack’s case it was not recognised and dealt with appropriately at times. For example, the process to get a person assessed for dementia in independent housing took a long time.

There were other issues and barriers that Jack faced on his journey, even though the government had put these strategies in place to address the needs of people with dementia. In order to address Jack’s needs and that of other people with dementia the professionals need to adapt a person centred approach. Staff needs to be competently trained in dementia care so that they can support family and friends when a person is diagnosed with dementia. Reference Algase,D. L. (2006) What’s new about wandering? An assessment of recent studies 226 -234 [Available at: www. reo. beds. ac. uk]. (Accessed: 3/10/ 2011). Beatie,E. R. A. Song, J. And LaGore, S. (2005) A comparison of wandering behaviour in nursing homes and assisted living facilities, Research and theory for nursing practice Vol 19 No. 2. 181-196 [Available at: www. breo. beds. ac. uk]. (Accessed: 3/10/2011). Carmody, S. Forster, S. (2003) Nursing older people; a guide to practice in care home. Oxion Radcliff Publishing. Cheston. R. Bender, M. (1999) Understanding dementia: the man with the worried eyes, London. Jessica Kingsley. Fox, M. And Wilson, L. 2000) The centred advocacy for people with dementia, The journal of dementia care Vol 15 No 2. Jacques, A. And Jackson, G. (2000) Understanding dementia, 3rd edn, London, Churchhill Livingston. Hodgkinson, B. Koch, S. Nay R. And Lewis, M. (2007) Managing the wandering behaviour of people in a aged care facility 407-436 [Available at: www. breo. beds. ac. uk]. (Accessed: 3/10/2011). Inness, A. Capstick, A. And Surr, C. (2000)Mapping out framework, The Journal of dementiacare, Vol. 15 Kitwood, T (1997) Dementia reconsidered; The person comes first, Buckingham.

Open University Press. Knockers, S. (2007) Capturing the magic of everyday activities, The journal of dementia care. Vol 15 No2 Leblanc, G. J. (2011) staying afloat in a sea of forgetfulness; common sense care giving, Bloomington Xlibris. Parker, T. (2000) Incontinence of faeces: the final frontier? Journal of dementiacare V0L. 8 No2 Phillips, J. and Penhale, B. (1996) Reviewing Care Management for Older People, London. Jessica Kingsley Publishers May, H. Edwards, P. And Brooker , D. (2009) Enriched care planning for people with dementia , London. Jessica Kingsley

In Tim Winton’s collection of short stories, ‘Minimum of Two’, family is a major, recurring theme. Winton displays his interest in exploring the idea of family within each story differently, containing the positive and negative influence that family has on the actions and emotions of the Nilsam family and his alternative protagonists. In ‘Distant Lands’, he deals with the feeling of obligation towards and the traditional expectations of family whilst in ‘The Water Was Dark’ the focus is on a need to separate oneself from negative family completely. Laps’ focuses on how family can help you move on from her past. Winton has a strong belief that family shapes the kind of person one becomes, regardless of whether that is a good, or bad natured person. Within the short story ‘Distant Lands’, although it is portrayed subtly, family plays an important role. We are told of Fat Maz’s parents; her mother, who sits in the family shop for the majority of her day, emitting ‘dull thudding’ sounds from the register and Maz’s father, who is portrayed as a hot headed, intimidating individual.

As Winton goes on to display Maz’s character, which contains attributes the likes of reserved, self-conscious yet quietly ambitious, we are made to create a link between Maz’s persona and her parents, that of which one is silent and dismal and the other unapproachable, and the realization that it was the impact of her family that has built the aspects her character by failing to restore her confidence and paying little to no attention of whether Maz had her own ambitions. This contributes to her overall quietness. The Water Was Dark’ has it’s protagonist, ‘the girl’, who is struggling to escape from the negativity of her mother. The girl lists her mother’s many faults bitterly and her mother’s poor decisions’ impact show heavily as we read in to the girl’s thoughts. The girl has no actual stability that she feels in her life and she is angry at her mother because her mother is to be blamed. She actually says in many a sense that her life would collectively improve if her mother rid herself of the poisonous things in her life, like drinking and being isolated.

Basically, the state of the girl’s family is so ruined that she herself becomes destructive. Despite the lack of encouragement, in ‘Distant Lands’ Maz’s parents actually follow the traditional expectations associated with family. They give Maz a roof over a head and a secure, paying job in a small town. It is not what Maz wants however it is a safe, stable environment and so Maz feels a sense of debt towards her family. ‘Laps’ revolves around Queenie and her family.

Queenie’s daughter Dot provides a great contrast in regards to most of the adolescents Winton writes. She is not only in a secure and stabile lifestyle, but she is content. It could be argued that this is because she is younger than other characters explored by Winton however given that Queenie and Cleve are in a healthy marriage and they openly show their pride, care and love towards their daughter, it is clear that Dot will be provided with a more normal, happy life.

Every Family is different from the other. Certain are functional and certain are falling apart at the seams. The short stories of Minimum of Two explore this through different experiences and circumstances which directly reflect on how the characters are portrayed. Family is a huge aspect of a person’s identity. Throughout the stories, Winton gives us examples of how the support and love of family are required for one to be fully satisfied with life and truly be aware of their identity.

The absence of this supportive, healthy family will most likely outcome in a never-ending negativity for the members within that family. In most instances, the impact of family can either act as a curse that increases one’s isolation and negativity or a blessing that provides a sense of belonging and contentment, not only with the family itself but also with the broader world. Mainly, the stories of Minimum of Two suggest that regardless of being moral or immoral, family shapes oneself.

Identify prevalence rates for different types of dementia. Prevalence shows the number of new cases of dementia in a given time period. The well-established prevalence rates for dementia in the UK are – 40-64 years – 1 in 1400 65-69 years – 1 in 100 70-79 years – 1 in 25 80+ – 1 in 6 It is estimated that by 2021 there will be one million people with dementia in the UK this is expected to rise to over 1. 7 million people with dementia by 2051. A steady rather than dramatic growth is expected over the next 25 years.

The proportions of those with different forms of dementia can be broken down as follows:

• Alzheimer’s disease – 62%
• Vascular dementia – 17%
• Mixed dementia – 10%
• Dementia with Lewy Bodies – 4%
• Fronto-temporal dementia – 2%
• Other dementias – 3%

There are currently nearly 36 million people with dementia in the world, the number of people is expected to double every 20 years, by 2050 it is projected that there will be 115 million people with dementia worldwide, 71 percent of those will live in developing countries.

There are 800,000 people in the UK with a form of dementia in 2012 and 17,000 are under 65, one in 14 people over 65, and one in 6 people over 80 have a form of dementia, the number of people with dementia in different parts of the UK has been estimated by applying new prevalence figures to estimates of the population numbers for 2011 theses are:

• England – 648,898
• Northern Ireland – 18,286
• Wales – 43,614

1 UNDERSTAND KEY LEGISLATION AND AGREED WAYS OF WORKING THAT SUPPORT THE FULFILMENT OF RIGHTS AND CHOICES OF INDIVIDUALS WITH DEMENTIA WHILE MINIMISING RISK OF HARM

1.1 The key legislations are Adult and Incapacity Act 2000, Mental Health Act 2007, Disability Discrimination Act 1995, Safeguarding Vulnerable Groups Act 2006 and the Mental Capacity Act 2005. Human Rights Act. These are all core principals of legislation regarding an individual with dementia.

Policies and procedures and agreed ways of working and safeguarding Individuals is another key factor. All organisations and authorities have a duty of care towards an Individual with dementia, GPs, Social Workers, Health Visitors, Family and Carers. All Individuals with dementia have the rights to make choices. Individuals with dementia should be encouraged to make as many decisions as possible for them; however they must be guided so they stay within the Mental Capacity Act 2005.

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We must assume that the Individual with dementia has capacity unless it has been assumed that they lack the capacity to make choices. We must not think that an Individual is not to be treated as unable to make a decision unless this has been established. An Individual is not to be treated as unable to make a decision because they might not always make a wise decision. If a decision is made under the Mental Capacity Act on behalf of the Individual, the decision must be made for the best interests of the Individual.

Before a decision can be made on behalf of the Individual we must ask ourselves whether the purpose of the decision can be effectively achieved in a way that would not restrict the Individuals rights and freedom of choice and action. We also have to adhere to the Human Rights Act and code of Practises. The Individual with dementia will have to be risk assessed. The Individual will be encouraged to make their own choices and decisions, if they make an unwise decision they should be offered other options which will help lead them to make a wise decision.

Risk needs to be balanced with Independence and Individuals choices and working within legislations. We should not assume that all Individuals with dementia are vulnerable; this depends entirely on the stages of dementia. We should not restrict the Individuals from having choices and making decisions for themselves. Risk assessments can be very complex as no two assessors will come to the same conclusion regarding the Individual. We have to let the Individual with dementia take a certain amount of risk for themselves, allowing this to happen makes the Individual feel worthy and independent and more at ease with their illness.

If we were to put everything an Individual did down as a risk the Individual would feel worthless, inadequate, and useless and they would feel that they are a burden on their family. We have to weigh up the risk against the danger this is the key. If we were to take away all the choices and decisions and have someone else make these decisions and choices on behalf of the Individual this would have a negative impact on the Individual as they would be having everything took away from them and they wouldn’t feel in control.

A positive impact on allowing the Individual to take risks, the Individual can still do their day to day activities etc, make their own meals, make cups of tea, do their own housework, laundry, take bathes, go for walks. Wherever possible we should eliminate high risks and look at ways to reduce these risks so they become low risks etc, supporting an Individual to make their meal observing them so they don’t hurt themselves, or accompany them on a walk etc.

1.2 People with dementia may have other difficulties too, like loss of hearing, make sure that the hearing aids are working well and that you speak to them in a loud clear voice so they can understand you. The person could also be in pain or discomfort, they could be having side effects from medication which will affect the way they communicate with you. Other problems would be eyesight, make sure they are wearing the correct prescription of glasses.

Dentures are important as well, if the dentures are loose fitting then this will affect the person’s speech and this will be frustrating for them . 3Personal Information comes under the Data Protection Act 1998. We have to make sure personal Information is confidential. We have to know how to handle the personal Information, agreed ways of working, policies and procedures are all legislation frameworks. The Information should be processed fairly and lawfully. The Personal Data should be processed for limited purposes. The information should be adequate, relevant and the information should be for the purpose of whom the information is processed for.

The information should be kept up to date and accurate. The information should not be kept longer than intended for. The Persona Data will be processed in accordance with the rights of data subject under the Act. Measures are in place to avoid the information being lost or unauthorised and unlawfully processed or damaged to. The Personal Information shall not be transferred to another country outside the European Economic Area unless that country ensures an adequate level of protection for the rights and freedoms of data.

Personal Information may be shared with others, consent is needed to do this at all times from the Individual or in the case of an emergency, abuse, or if neglect is suspected. If the Individual is mentally incapable, informed consent should be given by the family or next of kin. Information that is shared with an advocate should be information that is for the Individuals best interest, Exchange of information from one organisation to another should be shared and done securely and access to the information should be controlled.

Personal Information may be shared with carers who have access to the information regarding the service user. The carer will write up her findings when she has visited the service user and they will be on the log sheets in the care plan. When another carer goes to visit the service user they will look at the previous notes the other carer had documented and they will have a better understanding of the service user’s situation and needs. This is one form of information sharing also the carer will access information from the care plan and from the med sheets.

If a service user was to be hospitalised the paramedics may need the care plan and log sheets so they can read up and see if any information documented is relevant to the response of the paramedic. Also if a service user was to go into a care home the care plan and log sheets would be taken in to the home so the relevant members of staff could read the data and have a better understanding of the service user. The Medication sheet would also be in with the care plan; a key factor is getting consent to access information.

BE ABLE TO MAXIMISE THE RIGHTS AND CHOICES OF INDIVIDUALS WITH DEMENTIA

2.1 SEE STANDARDS

2.2 It is very important not to assume that an Individual with dementia cannot make their own decisions. From the time the Individual has been diagnosed the time scale is important as this gives the Individual time and may be capacity or limited capacity to make own choices and decisions. This is the time when the relevant authorities should prompt the Individual and gather as much information about the Individual; this information can come from the Individual, the family, the next of kin.

Information on preferences, choices and decisions and wishes. Information on Individuals life experiences, strengths and abilities, family history, favourite foods, pastimes, hobbies, favourite drinks, dislikes, likes, favourite radio station, favourite tv programmes, routines, clothes the Individual likes to wear and socialising. All the information and choices and preferences will help the Individual and the people supporting the individual prepare for the future. Early diagnosis of an Individual will give the Individual the rights to their freedom and this must be respected.

As dementia advances the risk assessment plan will need to be reviewed and the care plan may need to change to accommodate the changes within the Individual. We should still encourage the Individual to make decisions and choices as much as possible, bearing in mind the risks which come with these decisions and choices. All the choices and decisions should be monitored and recorded. Taking away the rights of an Individual with dementia can be soul destroying, it can be frustrating, the Individual may become depressed, withdrawn, feel isolated, worthless, a burden, emotionally detatched and angry.

Every emotion a normal person feels, the Individual with dementia will feel the same but on a higher scale. Dementia Individuals need to be in an environment of comfort and empowerment. The Individual will respond better to a person centered approach. The Individual needs to feel a sense of belonging and attached, they need to feel included and feel part of a group or physical setting, they need to be occupied and kept busy just as they was in their everyday life before they got the illness. Their environment needs to be created so that the Individual has support and can do the things they have always enjoyed doing.

All Individuals with dementia have their own personal Identity they are all unique so learning about their life stories and experiences can be of benefit to the care they receive as the information learnt can be built into their interactions within their care plan needs.

2.3 SEE STANDARDS.

3 BE ABLE TO INVOLVE CARERS AND OTHERS IN SUPPORTING INDIVIDUALS WITH DEMENTIA

3.1 SEE STANDARDS.

3.2 There can be conflicts and disagreements between carers and Individuals with dementia and also conflicts with family members. When the problem arises we have to address the problem and try and resolve the problem as soon as possible.

We have to take into account the rights and choices of the Individual and balance this with the risk and safeguarding of the Individual. An Individual who has dementia may not want carers to come into their homes; they may not want anybody doing things for them and refuse the help. This can be frustrating for the carer however the carer may talk to the Individual in a subtle way and explain that he or she is not here to take over their lives but just here to help support them when they need help and just here to see that the Individual has had their medications.

The carer will find it useful to read the Individuals notes and care plan and get as much information as possible on the Individual. The carer will have to reassure the Individual and try and gain their trust. The carer may ask the Individual if you could accompany them to the shops or to an appointment etc. The Individual must be allowed to take risks however if the risks look like they are dangerous or appear to be harmful we must explain the reasons to the Individual. If we cannot resolve the problem there and then, we must record the information and report it to the manager of the company supplying the service.

The manager will take the appropriate action with the relevant authorities. The safeguarding of the Individual is paramount and we should never ignore potential high risks or dangers to the Individual, and we must work to policies and procedures and agreed ways of working at all times.

3.3 All organisations and service providers have a system for complaints and procedures these are legal requirements. Everybody has the right to complain about poor quality services, services not being delivered, services that Individuals need but are not being supplied, conflict with carers, service providers.

The Individual will have a document of complaints within their care package. The document should be clear and informative on how to make a complaint. The document will state who the complaint should be made to and timescales for when the complaint will be dealt by. If an Individual with dementia wanted to make a complaint I would support them and if they wanted I would read the document to them and support them in filling out the form. If the Individual with dementia didn’t have full capacity to fill out the form I would liaise with the next of kin, family members or advocates.

I would inform them that the Individual would like to make a complaint and if they would like to help the Individual to fill the form out providing the Individual gave consent. I would explain how the complaints system works and when they would receive a response to the complaint. I would inform my manager that the service user or service user’s family have made a complaint and I would take the complaint in an addressed envelope to my manager as soon as possible. When handling a complaints document with an Individual with dementia I would work within the Mental Capacity Act 2005.

I would explain to the Individual and the next of kin that the document is confidential and that it will be dealt with in a professional manner and that the complainant has nothing to worry about regarding the complaint and explain that it is their right of choice to complain. I would also explain that whilst complaints are being dealt with it makes the service user resolve the problems and also it is of benefit to the organisations in ensuring the problems don’t occur again and that they get it right first time and this will have a positive impact on the organisations.

If a carer wanted to make a complaint about another carer they would follow the same procedure in filling out the document and they would take it to the manager. The manager would explain that in making the complaint it does not jeopardise their employment as they have a right and choice as whether to make a complaint. The manager would work towards resolving the complaint in a professional manner so that the employees can move forward and be happy in their work.

4. BE ABLE TO MAINTAIN THE PRIVACY DIGNITY AND RESPECT OF INDIVIDUALS WITH DEMENTIA WHILST PROMOTING RIGHTS AND CHOICES

From a personal experience of supporting an Individual with dementia to maintain privacy and dignity, I have found that the more I get to know the Individual and them getting to know me the easier it has become for both of us to feel comfortable about maintaining privacy and dignity. Personal care and hygiene is a key factor. We should support the Individual to maintain their personal hygiene and appearance and their living environment to the standards that they want. We should respect their choices and decisions of choice of dress, hairstyle etc.

We should let the Individual with dementia make own choices and decisions. We should not make assumptions about standards of hygiene for Individuals. We should respect cultural factors and take them into consideration when supporting the Individual. Supporting the Individual to have a clean appearance and pleasant environment is good for the Individuals self esteem. Supporting female Individuals with dementia helps them to keep their home nice and clean and helps towards maintaining their dignity and self respect.

Supporting a male Individual with dementia, he may need support with shaving, maybe prompting the Individual to shave will all it will take and the Individual may go to the bathroom and have a shave and this will allow him to maintain his dignity and respect for himself. Supporting an Individual to have good hygiene will also reduce the risk of infection and promote well being. We should ensure that the Individuals personal preferences are respected as well as their choice in how to support them.

Personal hygiene can be of many aspects, washing, bathing, showering, denture care, oral hygiene, foot care, hair care, grooming, nail care, toilet care , continence needs, dressing and undressing, laundry and housekeeping. We should treat every Individual with dementia with respect like we would anybody else. We should provide a person centered approach towards their care, putting the Individual at the centre of care. Communication shows how we respect the Individuals and this will help maintain their dignity and respect.

Privacy is also a key factor for an Individual with dementia; privacy must be respected at all times. We should respect privacy where people have personal relationships and sexual relationships. We should always ask permission and knock before we enter an Individuals personal space. We should get permission before accessing Individuals possessions and documents; we should provide space and privacy for Individuals private conversations. We should make sure the Individual receives their personal mail unopened, we should always pull the door too if the Individual is getting dressed or undressed and doesn’t require support.

We must comply with the Human Rights Act 1998 as this gives the Individual the rights for respect, dignity, privacy and a private family life. Individuals with dementia should receive care and treatment in a dignified manner that does not embarrass them, humiliate them or expose them. Legislation states that the Individual with dementia are to be treated as equal to everybody else. If an Individual with dementia had a toilet accident or was having regular toilet accidents, I would support the Individual by assuring them that it is ok and that it doesn’t matter and that it can be cleaned up.

I would encourage the Individual to go to the bathroom whilst still assuring them. I would close the bathroom door and support the Individual to take off their soiled clothing and prompt the Individual to maybe shower or have a bath or a wash whilst still ensuring them everything is ok, I would encourage the Individual to have a bath in privacy that’s if they didn’t need support with getting in the bath or shower, I would let them wash themselves in privacy and when they had finished I would knock on the door and ask if they were ok and support them to put clean fresh clothes on so they feel fresh and clean again.

If the problem was ongoing I would report the problem to my manager as the Individual may need extra support and may need continence pads or pants, I would also discuss this with the Individual in a subtle way. I would work to policies and procedures and agreed ways of working and adhere to professional boundaries.