Dementia Behaviour Management Advisory Services · Helping Australians with dementia, and their...

Helping Australians with dementia, and their carers

Supporting workers • Advice • Information • Referral

Dementia Behaviour Management Advisory Services

front banner final


NT DBMAS- Aboriginal & Torres Strait Islander Cultural Considerations for BPSD Best Practice

Management Project• Indigenous Australians As a percentage of the total

populationBased on Place of Usual Residence, 2006Northern Territory (State) by Statistical Subdivision

• And Australia

Partner logo here

© Commonwealth of Australia & PSMA Australia 2007

Viewed at www.censusdata.abs.gov.au/ABSNavigation/prenav/viewdata on 21/8/08


Our projects purpose was: To develop guidelines for Dementia Behaviour Management Advisory Service Providers, relevant to working with Indigenous Australians living outside the major urban regions of Australia.

Partner logo here

Mt. Liebig North West ofAlice Springs,Haasts Bluff

Aboriginal Land Trust

Approx. 200 people


How we did this during 2007/08:Project Officer : behavioural advisor for NT DBMAS team

Consultants: Cultural Advisors, Psychogeriatricians, Geriatricians

Focus Groups: NT, WA, Torres Strait: with community key person for contact & feedbackCreated guide: distributed for use by DBMAS providers Dec 08

Partner logo here


Consultants:

Professor Tony Broe: NSWProfessor Leon Flicker: WA

Dr. Jill Pettigrew: NTDr. Sahandra Mahajani: NT

Dr. Dina LoGuidice: VicMs. Venessa Curnow:

Mr. Cyril Oliver:


Focus GroupsBorroloola – NT Top end (May/Aug)Mt. Liebig – NT Central (April/Aug)Thursday Island – Torres Strait (Oct)

Reference Groups: WA (June/July)Kununurra, Warmun, Derby, Wyndham

Group meetings, interviews with individuals, (paid carers & family carers), cultural advisors

- using consistent questionnaire to gather information

Partner logo here


Partner logo here

Australian Aboriginal Language Map:www.decs.sa.gov.au/corporate/pages/default/aboriginalaustralia/

viewed 19 Nov 2007

Mt. Liebig

Derby

Warmun- Turkey Creek

Wyndham Thursday Island

Borroloola

KatherineKununurra


Questionnaire used: Questions for focus groups: Date______Where___________• 1.What do you understand by the word, dementia? _________________________________• ____________________________________________________________________________• What do you think causes dementia?: __________________________________________• What word/s do you use to describe dementia: ___________________________________• 2.If someone in your family/ community develops symptoms of dementia (acting strangely), where do you

go for help? ___________________________________________________• 3.What are some problems for the family / community when someone develops symptoms of dementia that

change the way they do things? _______________________________________________________________________________________________

• 4.What are the cultural considerations that people who are going to help you from outside the community need to know? ______________________________________________________________________________________________________________________________________________________________________________________________

• 5.Is language a barrier to you getting the help you need? Yes No• 6.How can we communicate the best way? (pictures/talk/through AHW’s/through family) etc.

_____________________________________________________________________• 7.How can we gather the information needed to help the family manage the acting strangely associated with

dementia that is causing the problem? (Life History, when the behaviours happen, why they happen, what you do about them, who to speak to) _________________________________________________________________________________________________________________________________________________

• Who filled in form:___________________________________________


Partner logo here

“Strong mind and strong spirit, sharing and caring together”

Cherylene Nocketta

Warmun WA Sept 2007


Focus Groups – Opportunities & Challenges• When making first contact about the project

requests came for education & information about dementia;this enabled introduction of the project and partnershipbuilding for future DBMAS support with local aged care & health services.

• When attending communities needed to ensure not interfering with core service delivery of remote aged care programs –staffing shortages, community events.


Major cultural considerations across all groups around dementia care were related to:

• Kinship – relationships of family and position in community, obligation• Attachment to land – physically & spiritually • Language – communication, identifying • Relevance of time – need for relationship building, hear right story• Importance of cultural ceremony• Cultural perceptions of causative factors eg. Beliefs in curses, sorcery• Spiritual beliefs eg. natural transition of spirit going back to country

Noting that there are Specific cultural issues unique to individual language and community groups who are differentiated by historical geographical land affiliations (traditional land or sea) and history of the area with local traditions.


What does this mean when helping manage BPSD in remote A&TSI settings?

• There are already well established Best Practice models for BPSDmanagement – related to an individuals – life history– carers perceptions of behaviours, – carers/persons knowledge & understanding of dementia, – environment (sensory and physical)– psychosocial and medical management (Figure 2:DBMAS App 1 Op Guidelines)

- this does not change when working with A&TSI people, but needs to be viewed in a cultural & geographical context.


Case study – example of using guideNT DBMAS visited East Arnhem ACAT( Gove/Nhulunbuy) to introduce service and provide education on the use of the KICA( Kimberley Indigenous Cognitive Assessment)

Discussion re old lady with high risk behaviours, concerns for re safety and Carer burden due to change in behaviours. Concerns about how to meet the family, community and cultural needs to keep this lady on country.Lady is from a remote community: Numbulwar approx ½ hour flight from Gove/Nhulunbuy ( hour flight from Darwinto Gove) or approx. 5 hour drive from Katherinein dry season only. (~8 hour drive to Darwin- good day)Respite services provided by Anglicare from Gove- closest residential aged care facility 2 respite beds in Gove Hospital or Darwin (by plane) Had never seen Geriatrician or had formal dementia diagnosis.


How did we provide a DBMAS service to meet Cultural Considerations of this case.

– DBMAS Liaised with local ACAT,

Spoke to remote aged care service- listened toconcerns offered advice re safety, locks, gates for her home: considering implications of past cultural lifestyle(freely walked as she chose, lived off the land successfully) position in the community as a traditional elder, the harshness of the environment, carer burden and reported behaviours. Spoke to remote clinic staff – re medical concerns, gave advice re possible deliriums.Immediate risk identified and arranged transport (plane) to Darwin for respite, to allow for further dementia screen and full assessment.Respite to reduce carer burden.


BehaviourBPSD

Person Physical & sensory environment

Care environment

Carer characteristics

Wandering • 66 yr old.•Non drinker•Smoked as young woman•Phx head trauma•Seen by Geriatrician whilst on respite-Dementia diagnosed multiple aetiology

•Remote Indigenous community~800 people•Free to walk around community night and day. •Fence around house but gate not shut. House condemned.•Beach approx 500m away from home, Salt water crocodiles inhabit beach area.•Bushland to back of house area, roaming dingoes and buffalo

•Receiving CACP service-• Meals 2x day breakfast, lunch•ADL’s when able to find lady•Some social activities•Known by all in community•Local health clinic. Not seen by GP for some time

•Elderly man –chronic diseases himself•well respected community member –minister of local Christian church. •wife (amputee from fire accident) was clients sister.•Also cared for up to 6 other children•Other community members showed no practical applications to assist.


Assessed her in respite, liaising with Darwin ACAT and Geriatrician for assessment.

Arranged to visit community to allay fearsand ensure all options considered.Family/community very unsure she wasbeing cared for ‘proper way’- took photos and video (after permission gained for this from family) and visitedcommunity for reassurance re her emotional state and to show where she was living- some family had never been to Darwin.

Gave education to family, clinic and aged care service on community about dementia - via poster, AIMHI resources, ‘yarning’- used Aged Care coordinator as liaison (vouched for us) and his workers who acted as interpreters and link


Observed cultural issues: had to leave early due to death and sorry business. Consulted in front yard, stayed in car or stayed in ‘respite’ centre as advised by locals.

Liaised between RACS & community for history gathering (lifestyle programming), financial support.

Took photos of community, land, family with permission for client to look at while in RACS.

Purchased painting from community: family member painted and ensured permission to give her. No avoidance relationship needing to be observed.


Community appeared happy when we left, but were they convinced it was ok for her to stay off land?- needed to allow time for further family discussion and decision making.Adult Guardianship DBMAS continued to support both community and RACS during respite and into permanent placement When main Carer visited Darwin for medical reasons. DBMAS arranged for him to visit his sister-in-law at RACS.At this visit further personalized information was offered as trust was continuing to be built.


Also offered assistance to the Darwin RACS to give appropriate cultural care:

assist with access to culture/language educationresource provision (music/art), videos appropriate activities.culturally appropriate dress access and linkages to community


Major cultural considerations utilized in this case study:

• Kinship – relationships of family and position in community, obligation• Attachment to land – physically & spiritually • Language – communication, identifying • Relevance of time – need for relationship building, hear right story• Importance of cultural ceremony• Cultural perceptions of causative factors eg. Beliefs in curses, sorcery• Spiritual beliefs eg. natural transition of spirit going back to country

*Specific cultural issues unique to individual


Flow on opportunity has been to work with ACAT and remote Aged Care Service/clinics to increase awareness of memory loss and changed behaviours.

Therefore may help to avoid late stage diagnosis with BPSD’s and allow assistance on community.

NT DBMAS wants to acknowledge the traditional owners of the area of Numbulwarr for allowing us to be involved with the care for this client by visiting her home country and meeting with family there.


How t o help

Old People with Dementia Acting Differently

THINGS TO CHECK

Physical Are they sick? Medicines changedForgetting things more

Activity: Are they sitting down more?Walking moreNot sleepingNot doing what they used to

Communication: Are they repeating storiesTalking wrong way Not understanding

Environment: Are they getting lost? House changedNoise / light differentBig mob people or missing family

THINGS TO DO

See Doctor at clinic

Help them do what they used to do cultural way

Listen, don’t argue, take time, distract

Keep things their way

A&TSI cultural considerations for BPSD management- think of the person’s own•Life History: past outdoor lifestyle, cultural ceremony, communal living•Kinship / family structure: avoidance relationships, correct decision maker•Language: use interpreters- get right story•Strong attachment to land both spiritually and physically•Cultural perceptions of what causes BPSD’s and sickness •Spiritual beliefs•Build trust – take time to hear story

For more information andhelp call

DBMAS Dementia Behaviour Management Advisory Service

1800699799

Background Artwork by Cherylene Nocketta – Warmun 2007

Created by NT DBMAS 2009

Dementia Behaviour Management Advisory Services · Helping Australians with dementia, and their...

Documents

Transcript of Dementia Behaviour Management Advisory Services · Helping Australians with dementia, and their...