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DEM 201 DEMENTIA Awareness by Gaël Romanet

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DEMENTIA Awareness

by Gaël Romanet

... doing this dementia awareness was very exciting! and will help me in my

work place to have a better understanding about my dementia residents...



Level 2 Diploma in Health and Social Care Unit DEM 201

Tutor Name: Akua Quao

Thursday 12th

September 2013 Release Date: 21/07/2013 03:33

Assignment task – DEM 201 Dementia awareness

In your work role: Introduction In your work role in health and social care you will be required to have knowledge of what dementia is, the different forms of dementia and how others can have an impact on the individual with dementia. Others like care workers, colleagues, managers, social worker, occupational therapist, GP, speech and language therapist, physiotherapist, pharmacist, nurse, psychologist, admiral nurses, independent mental capacity advocate, community psychiatric nurse, dementia care advisors, advocate and support groups.



Task ①

• Explain what is meant by the term ‘dementia’

• Describe the key functions of the brain that are affected by dementia

• Explains why depression, delirium and age-related memory impairment may be mistaken

for dementia

Task ②

• Outlines the medical model of dementia

• Outlines the social model of dementia

• Explain why dementia should be viewed as a disability

Task ③

• Lists the common causes of dementia

• Describes the likely signs and symptoms of the most common causes of dementia

• Outlines the risk factors for the most common causes of dementia

• Identifies prevalence rates for different types of dementia

Task ④

• Describe how two different individuals may experience living with dementia depending on

age, type of dementia, and level of ability and disability

• Outlines the impact that the attitudes and behaviours of others may have on an individual

with dementia

Assignment task – DEM 201 Answers

Reference for Assignment task – DEM 201 Dementia awareness

The Essentials Workbook1 Person First... dementia second by Bupa



Task ①

• Explain what is meant by the term ‘dementia’

With my own words, dementia is the less of everything you know.

Dementia are the signs and symptoms caused as a result of specific diseases such as

Alzheimer’s or a stroke that involve the damaging of brain cells; as the brain cells die the

person with a dementia will lose their ability to do things they are used to doing as different

parts of the brain are damaged.

Dementia affects both older and younger people and the decline in the person will get worse

as more brain cells are damaged or die.



Different types of dementia There are many different types of dementia. Some are more common than others.

The most common type of dementia is Alzheimer’s disease, followed by vascular

dementia, dementia with Lewy bodies and fronto-temporal dementia.

More about Alzheimer’s disease: http://www.alz.uci.edu/alzheimers-disease/alzheimers-

disease-overview/

Sometimes people may be diagnosed as having a ‘mixed pathology’ this means they have

more than one type of dementia; usually Alzheimer’s disease with vascular dementia.

There are also what are called ‘secondary’ dementias that are treatable and often reversible.

These are caused by health problems that affect how the brain works, such as

hypothyroidism, vitamin B12 deficiency and diabetes.



• Describe the key functions of the brain that are affected by dementia

The main areas of the brain that are affected by dementia in terms of causing difficulties with

their functions are:

1) Frontal Lobe – this is the part of the brain that controls behaviour, movement, personality

and the interpretation of what is around us

2) Parietal Lobe – this is the part of the brain that controls the language we use, special

awareness and recognition of places, objects and people

3) Occipital Lobe – this is the part of the brain that controls eyesight and our ability to see

4) Temporal Lobe – this is the part of the brain that controls our speech, hearing and memory

How our brain works

Our brain is responsible for controlling everything we do from basic functions such as our

heart beating and breathing, to feeling emotions, speaking, remembering and doing. Your

brain is made up of billions of cells. Each cell sends messages to many other cells.

Most of the cells in the brain are called neurons. Neurons communicate with each other

by passing an electrical signal down their arms (or axons) which in turn leads to a release

of chemical at the fingertips.



At the end of the arm they pass across a gap (called a synapse) by shooting out special

chemicals (called neurotransmitters) into the arm of another neuron.

Different neurons produce different chemicals – some names of neurotransmitters you may

have heard of are dopamine and serotonin. The next neuron then sends the message on to

more neurons. In this way the message is passed around the brain.

Messages are passed from the brain into and out of the body through the brain stem which

joins onto the spinal cord.

The effects of dementia on the brain In dementia the ability of neurons to transmit messages to each other is affected. This can be

because neurons die and so no longer transmit messages or because the neuron has problems

producing the chemicals it needs to get across the gap to stimulate the next neuron.

Example:

Imagine the message being passed around the brain is like a person (Billy) who is in a car

driving from home to work. Each street Billy drives down represents an axon.



Unfortunately today the traffic lights on the main road are not working properly. The traffic is

very slow because the lights keep sticking on red. For a person living with dementia the

neurons may not work properly and as a result transmit the messages more slowly, as they

struggle to produce the chemicals they need, to pass the message onto the next neuron.

The journey is made worse by a fallen tree which has blocked another road, which has now

been closed. Billy has to follow a diversion to take him around the closed road.

Where a neuron dies the message has to take a diversion around it via other neurons, which

takes longer than the more direct route.

Eventually Billy gets to work. However, it has taken him a lot longer than normal and he is

feeling tired and stressed out. A person living with dementia may have this kind of journey to

work many times every day as they cope with living with a brain that has many faulty traffic

lights and diversions. It is not surprising they may become tired and feel stressed by this

experience.



Which parts of the brain do what? Each part of our brain is responsible for different things that we do. Dementia causes the

brain to not work properly. This affects a person’s ability to do things which most of us take

for granted.

The following diagram shows the different parts of the brain and their role.

Living with dementia: the effects of damage to the brain When different structures of the brain stop working properly, this can cause impairments to

be experienced.



Frontal lobe: Repetitive actions, poor concentration, reduced ability to plan and to prioritise

or sequence events.

Examples:

A person may struggle with:

- putting on clothes in the right order so they may put their underwear on over their

outer clothing

- being able to focus on one task for any length of time

- being able to start activities or conversations with others

Loss of care and concern for others, impulsive behaviour, rudeness and rule breaking, openly

sexual behaviour and aggression

Examples:

A person may:

- swear or say cruel or rude things

- touch themselves or others in a sexual manner

- hit out or shout at others unexpectedly or in a way that is not in proportion to the

situation they are in

- find relationships with others break down and they may become socially isolated or

that others avoid them

Parietal lobe: Difficulties with skilled actions such as using cutlery or getting dressed,

problems scanning the environment and picking out people or objects, poor awareness of

body position, problems with reading, writing, numbers or visual neglect (not being able to

see part of the world around them).

Examples:

A person may:

- have problems finding the door, toilet or a chair when entering or leaving a room



- have problems with standing up, sitting down or moving around, and have a tendency

to fall or trip (and then become afraid of falling)

- be unable to read or write or comprehend numbers

- only be able to pay attention to half of their world so they may only eat half of a plate

of food or only shave one side of their face

Occipital lobe: Visual blind spots, problems with seeing things such as the edges of objects

or the shape of objects, problems seeing or telling colours apart, problems seeing movement

and problems with seeing and judging depth.

Examples:

A person may:

- see places within their vision but are unable to see objects or people within them

- have difficulties picking out objects or seeing the edges of tables, chairs and this may

cause them to miss the table when putting down a cup or the chair when going to sit

down

- have problems seeing or picking out objects against a background of a similar colour

or tone eg white toilet seat against a white toilet and white flooring

- have problems sitting down, going up or down stairs or moving between rooms where

there is a change in floor colour or texture as this can be seen to be a change in depth

- see patterned carpets as being ‘alive’ with creatures or misinterpret patterns as objects

to pick up

Temporal lobe: Problems with language such as word finding and understanding other

people, problems recognising objects, people and places and memory loss.

Examples:



A person may:

- be unable to find the right word when talking

- have difficulty understanding other people, particularly when speech is fast or

contains long and complex instructions

- not be able to recognise what particular objects are for eg a knife or a fork

- no longer recognise who people are, including close relatives and friends

- forget recent and also past events

Brain stem: Problems with basic life support functions such as swallowing and breathing.

Examples:

A person may:

- have problems eating and swallowing solid foods and require a pureed diet

- have problems drinking and require thickened liquids to drink

- have problems with choking, as food and drink may be inhaled due to the brain not

being able to regulate properly between swallowing and breathing

- develop secondary health problems such as pneumonia caused by bacteria growing in

the lungs, due to inhaled liquids



Cerebellum: Problems with balance, movement and walking.

Examples:

A person may:

- have problems co-ordinating movements (ataxia) and with precision or accurate

timing of movements

- have problems with loss of balance and may experience falls

- have problems walking and gait

- experience tremors or weakness of muscles

- have problems with speech due to loss of muscle control

Living with dementia: how much does the person know? In the beginning people living with

dementia may have self-awareness and so know that they need support, but that is when they

need us least. As dementia progressively worsens, people usually lose insight and so they no

longer know they have dementia and hence do not know they have become dependent on

others. As a result when a person living with dementia needs us most they may not be aware

that they need us at all. Consequently, they can easily misunderstand the actions of others

especially during times of intimate care.

• Explains why depression, delirium and age-related memory impairment may be mistaken

for dementia

Depression can sometimes be mistaken for dementia because with dementia a person’s

behaviour and feeling of well-being can change and cause the person to appear withdrawn

and this for example might be mistaken for depression.

However, if the person is depressed then it could be the depression not the dementia causing

them ill-being.

Delirium for example can be brought on as a result of an infection and this might be mistaken

with dementia because for example the person could become confused and suffer with

memory loss, which are also signs and symptoms of dementia.

It is very similar for age-related memory impairment; if someone becomes forgetful they

might think or others might think they have dementia because a lot of people associate

dementia with old age and memory loss but younger people can be affected too.



Depression and delirium Depression is when someone has feelings of low mood which go on for a while. It is quite

common and can happen to anyone at any time.

Depression can range from mild low mood to serious “clinical depression” where people may

feel suicidal. Some of the symptoms of depression can be similar to those of dementia such as

irritability, social withdrawal, forgetfulness, poor appetite and sleep and problems making

decisions.

Depression is treatable with anti-depressant medication or “talking treatments” such as

therapy.

Depression can occur alongside dementia, but is often not diagnosed. It is possible to treat

people living with dementia for depression.

Delirium is an “acute confusional state” or a temporary, short term state of confusion. It can

be identified by sudden onset (the confusion occurs very quickly), perceptual problems

(problems making sense of the information coming in through the senses – sight, hearing etc),

altered sleeping patterns and may be accompanied by hallucinations (seeing or hearing things

that are not there) and delusions (believing things that are not true).

It is caused by something going on outside the brain such as an infection (chest infection,

Urinary Tract Infection (UTI)), or the effects of drugs (some drugs such as pain killers or

sedatives can build up in the system and cause delirium), poisons or dehydration.

Delirium is temporary and treatable.



Task ②

• Outlines the medical model of dementia

In the medical model of dementia the dementia itself is the focus rather than the person and it

is seen as something that has to be treated and managed.

• Outlines the social model of dementia

In the social model of dementia it is the reverse of the medical model because the person not

the dementia is the focus and what the person needs, their feelings and wishes is the main

focus rather than the dementia.

• Explain why dementia should be viewed as a disability

If social care workers viewed dementia as a disability then they will be accepting that

dementia is a disability as it progresses it carries on disabling the brain and its functions; for

example someone might become more confused or forgetful.

Thinking of dementia as a disability makes social care workers think about how they can

change things round and adapt their ways of working to meet the person’s needs and to let

them live their lives how they want to; for example if a person with a dementia is difficult to

understand when they are speaking it might be better to communicate with them using signs,

pictures or writing things down.

What is a disability? Definition of disability under the Equality Act 2010

You’re disabled under the Equality Act 2010 if you have a physical or mental impairment

that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily

activities.

What ‘Substantial’ and ‘Long-term’ mean

- ‘Substantial’ is more than minor or trivial - eg it takes much longer than it usually

would to complete a daily task like getting dressed

- ‘Long-term’ means 12 months or more - eg a breathing condition that develops as a

result of a lung infection

Progressive conditions

A progressive condition is a condition that gets worse over time. People with progressive

conditions can be classed as disabled.

However, you automatically meet the disability definition under the Equality Act 2010 from

the day you’re diagnosed with HIV infection, cancer or multiple sclerosis.



What isn’t counted as a disability

Some conditions aren’t covered by the disability definition. These include addiction to non–

prescribed drugs or alcohol.

Reference about disability:

https://www.gov.uk/definition-of-disability-under-equality-act-2010

Equalities Act 2010 Diagram

More about "disability dementia" under the Equalities Act 2010

http://www.dementiapartnerships.org.uk/workforce/learning-pathway/step-2/11-legislation/



Remind: What is Inclusion?

Inclusion

Quote: What you can do, I can do it too, my disability does not stop me.

What is inclusion ?

Inclusion means the action or state of including or of being included within a group or

structure.

Inclusion is ensuring that all people with health needs can become valued and responsible

citizens and take part in mainstream activities alongside people who do not need to use health

services.

Health is a state of complete physical, mental and social well-being and not merely the

absence of disease or infirmity. (World Health Organisation, 1948)

No sector of society should be excluded from access to health benefits.

Group which have been excluded include substance abusers, alcohol abusers, travellers and

people with mental health needs.



Remind: What is Equality?

Equality

Equality means treating everyone in the same way.

What is equality ?

Equality means the state of being equal, in status, rights, and opportunities.

Equality is ensuring individuals or groups of individuals are treated fairly and equally and no

less favourably, specific to their needs, including areas of race, gender, disability, religion or

belief, sexual orientation and age.

Promoting equality should remove discrimination in all of the aforementioned areas.

Bullying, harassment or victimisation are also considered as equality and diversity issues.



Remind: What is Discrimination?

Discrimination

Quote about discrimination: “Sometimes, I feel discriminated against, but it

does not make me angry. It merely astonishes me. How can any deny

themselves the pleasure of my company? It’s beyond me.”

What is discrimination ?

The definition of discrimination is the act of prejudice against a person because they have a

certain set of characteristics.

Discrimination is to treat a person less favourably than another person is, or would be, treated

in the same or similar circumstances.

Discrimination is treating someone differently because of some ascribed difference. Usually

negative.

Discrimination is to treat people unequally, some favoured more than others - is often an

expression of prejudice.

Discrimination can take many forms but in many countries around the world there are laws

prohibiting any form of discrimination.

Discrimination can be on the grounds of sex and sexual orientation, race, disability, mental

health, age, ethnic background, religion, gender and gender reassignment, learning ability,

life style and outlook. This is not acceptable.

Discrimination can be based on the assumptions people make about other eg people with

mental health issues are dangerous.



Remind: What is Diversity?

Diversity

Quote: It takes all sorts to make a world.

What is diversity ?

Diversity means difference. The fact or quality of being diverse. People's differences can be

many and varied.

People are different in the way they look, dress, behave, believe and worship; where they

work; how they live; age, gender, Sexual orientation, Marital status, Politics, Religion,



Disability, Socio-economic differences, Family structure, Health, Values, Race, Culture,

National origin, Ethnic group - yet also have many similarities.

In a diverse society people need to tolerate and value differences in people so that we can

continue to be individuals.

Diversity allows people to contribute to society.

The more people are economically active, the more successful is the economy and this then

benefits everyone.

Diversity is about valuing difference.

It does not mean that everyone should be treated in the same way as different people have

differing needs.

Everyone should be treated with equal respect.

A successfully diverse workforce is one that contains people at all levels who have a range of

different characteristics and who have been recruited on the basis of their abilities and

competence to do the job.

Task ③

• Lists the common causes of dementia

The common cause of dementia are Alzheimer’s Disease, Vascular Dementia, Dementia with

Lewy Bodies, and Fronto-temporal Dementia

• Describes the likely signs and symptoms of the most common causes of dementia

The likely signs and symptoms of the most common causes of Alzheimer’s Disease are

difficulties with remembering, using language to speak becomes more difficult, thinking and

making decisions becomes harder as the person becomes more confused.

The likely signs and symptoms of the most common causes of Vascular Dementia are

difficulties with speaking and using the right language, the person’s balance and co

ordination can be affected as well as memory loss.

The likely signs and symptoms of the most common causes of Dementia with Lewy

Bodies are the physical symptoms include can cause the person’s movements to slow down

and can make them more likely to have trips and falls.

There will be memory loss, difficulties with using language and making decisions.

Hallucinations, double vision and problems with balance are also common.



The likely signs and symptoms of the most common causes of Fronto-temporal

Dementia are difficulties with language, behaviour and feelings. The person might have

mood swings and variable and inappropriate behaviour.

How do different types of dementia affect the brain and the person? The parts of the brain affected by dementia can vary depending on the type of dementia a

person has.

Alzheimer’s disease – the damage is usually global, so all parts of the brain may be affected.

The disease process tends to work from the outside of the brain downwards and inwards.

The cerebellum and then the brain stem are the last areas to be affected.

Example:

A person with Alzheimer’s disease may notice a number of abilities slowly and gradually

beginning to decline. They may start to forget things, have problems finding the right word,

or in remembering people’s names and may start to become lost when they go out shopping.

Vascular dementia – the damage can be anywhere in the brain because it is caused by an

accumulation of small or large strokes. A stroke can be caused by a small block (clot) or a

break in the artery. Either of these can stop blood flowing to a particular part of the brain.

This causes that part of the brain to die because its blood and oxygen supply is cut off.

Someone with vascular dementia may not appear to have dementia at all except in one aspect

of their functioning. People who have vascular dementia usually experience sudden or step

changes in abilities because they experience another stroke.

Example:

A person with vascular dementia may have no problems with language, memory, planning or

judgement. They may however find that writing becomes increasingly difficult or impossible,

as do other skilled actions. This would suggest damage to the parietal lobe.



Dementia with Lewy bodies – the damage to the brain tends to be within the frontal, parietal

and occipital lobes.

Example:

A person living with dementia with Lewy bodies may find their memory is largely unaffected

by their dementia. However, they may experience regular hallucinations (they see or hear

things that are not really present), have disturbed night sleep and daytime drowsiness,

problems with talking and balance and find undertaking activities that require planning or

sequencing of events, such as getting dressed and finding their way around, even in familiar

places, becomes increasingly difficult.

Fronto-temporal dementia – the damage is largely to the frontal and temporal lobes. As the

condition progresses damage can spread throughout the brain and it appears more like

Alzheimer’s disease.

Example:

A person with fronto-temporal dementia will experience changes in personality and

behaviours, such that they may seem rude or engage in socially inappropriate behaviours and

seem to lose control of themselves, or alternatively develop rigid routines and rituals. The

changes in a person’s behaviour are due to the damage within the brain and are not controlled

by the person. They may also have problems with language such as finding the right word or

maintaining a conversation. As their condition progresses problems become more general.

The problems dementia causes Dementia causes people to experience a range of different problems. These include:

Memory problems – this includes forgetting things, getting lost, not being able to remember

people/faces or people’s names etc.



Communication problems – these can include problems finding the right words to use,

problems with reading and writing and difficulties understanding what other people are

saying.

Difficulties processing information – this can include what they see or hear, abilities to

understand what other people are saying or doing, difficulties thinking, planning or carrying

out actions. This can particularly be a problem is information is being received at a fast pace

or if there is lots of it.

Changes to how people feel – having dementia can make people feel more emotional, for

example anxious or angry as they face the difficulties of adjusting living with dementia.



Difficulties socially – this can include finding social situations difficult, tiring or just too

noisy and confusing to participate in.

Other people living with dementia may behave in socially unacceptable ways eg saving or

doing things such as swearing or exhibiting inappropriate sexual behaviours.

Space and time awareness – people may forget the day, date and even the year. Awareness

of their own body and the space around them can also be affected. This can mean people have

difficulties sitting down or moving around. They may not recognise where they are as being

familiar and may want to leave because it feels so strange.

• Outlines the risk factors for the most common causes of dementia

The risk factors include having other family members with this condition means in terms of

the genes that there is more chance of developing dementia. If you are at a high risk of high

blood pressure which can cause a stroke then this will be another risk factor.

Also, smoking, lack of exercise and eating food high in cholesterol can lead to an increase in

risk of having a stroke. If you have a medical condition such as Huntington’s disease as

dementia occurs in most cases.



• Identifies prevalence rates for different types of dementia

The prevalence rates for dementia in the UK (i.e. how frequent dementia occurs in the

population) as per 2011 figures based on Alzheimer’s Society research:

40-64 years: 1 in 1400

65-69 years: 1 in 100

70-79 years: 1 in 25

80+ years: 1 in 6

The number of people with these different types of dementia can then be broken down into

the following:

Dementia Types: Alzheimer’s Disease Prevalence Rates 62%

Dementia Types: Vascular Dementia Prevalence Rates 17%

Dementia Types: Dementia with Lewy Bodies Prevalence Rates 4%

Dementia Types: Fronto-temporal Dementia Prevalence Rates 2%

Task ④

• Describe how two different individuals may experience living with dementia depending on

age, type of dementia, and level of ability and disability

Joan story:

Joan is 65 years young and has recently been diagnosed with Alzheimer’s.

Joan is fully aware of her diagnosis but apart from having to write things down to remember

she does not see that this will cause her any difficulties and does not think that she needs any

support at the moment. Joan continues about her day-today life as usual and goes out. As

Joan is 65 and her outlook on life is positive she is taking the news well and believes she can

go about her usual business. This is due to her having Alzheimer’s in the early stages as she

has not seen any major decline in her abilities apart from a little to her memory.

Also, Joan is able to continue to go out so again does not feel that having Alzheimer’s is

holding her back.

Helen story:

Helen is 80 years of age and has dementia with Lewy Bodies.

Most mornings she wakes up in pain all over her body and requires support with her personal

care activities now as she is unsteady on her feet and complains of double vision. Helen is

aware of her dementia sometimes and seems low in herself at these moments in time and at

80 years old she keeps on saying that things will not get any better for her now at her stage in

life.



Helen’s experience of living with dementia with Lewy Bodies is very different to Joan’s as

the dementia has affected her ability to do things by herself and she is in pain – being aware

of this means that she feels low in herself at times and cannot see a positive future ahead.

• Outlines the impact that the attitudes and behaviours of others may have on an individual

with dementia

Positive Impacts:

Social care workers encouraging Joan to continue to go out and be independent will maintain

her sense of well-being. A dementia care advisor talking through and providing Joan with

information about Alzheimer’s will retain her sense of being in control of the dementia not

the other way round.

Negative Impacts:

Social care workers getting frustrated with Helen or ignoring her pains will only add to her

ill-being and feeling low. An advocate imposing own views on Helen and not listening to

how she is and ignoring her needs will only add to Helen feeling low.

Summary of dementia awareness The experience of every individual living with dementia is different. This is because: The damage to each individual’s brain will be different. The impact of the dementia itself is always within the context of an individual’s life history, personality, health and the social world around them. Each person makes sense of what they are experiencing through their own previous experiences. This is why it is important to know and see the person first. Even though someone may have dementia, no two people living with dementia nor their experiences of people living with dementia are the same. We can do a lot to support people to face the challenges of living with dementia. We need to work to support the disabilities caused by the damage of their brain in the context of knowing the person and always bear in mind that the person living with dementia may misunderstand and resist our efforts to assist them. This may be because they lack insight and hence are unaware of their dementia and of their dependency on us. Of my own opinion confronted by many years of working with dementia residents, I should find more efficient for the general opinion, to install a special environment between the dementia nursing home and mental unit.



As a fact, some dementia residents can be "terrible" due to difficult dementia conditions, and the staff in normal dementia nursing home can be confronted to difficult situations, and they may not have enough experience and understand of dementia to provide the good cares for this kind of "terrible dementia residents". Also, the structure and design of normal dementia nursing home may not be properly adapted to provide the correct cares for the "terrible dementia residents". It's could be a REAL PROGRESS for the society to provide a "special environment care" between the dementia nursing home and mental unit for the "terrible dementia resident"

...about... A dementia person REALLY believes the words of the other normal persons, and it is

TERRIBLE because you lost control with the reality and you don't know what is true and

who to believe. Who say the truth? I am lost!!!

I observed dementia residents in my work place all believe in JESUS CHRIST. It is nothing

strange because Jesus is the only one who never lies, the only one who speaks the truth!

Tell me? Do you know? What time? Are common questions in my work place, and the best

answer to give to a resident is to say the truth, simply.

Other words after 'Yes' or 'No' are from the bad and are useless for the residents.

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