dementia-leafletTitle: dementia-leaflet.pdf Created Date: 20190708083721Z
Dementia Behaviour Management Advisory Services -...
Transcript of Dementia Behaviour Management Advisory Services -...
Helping Australians with dementia, and their carers
DBMAS Target Group
Severe and persistent
Behavioural and
Psychological
Symptoms of
Dementia
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Brain StemControls heart rate
and rate of breathing
Temporal LobeHearing
Memory of hearing and Vision
Broca’s
AreaMotor
control of
speech
Frontal LobeMotor control of voluntary muscles
Personality
Concentration, organization
Problem solving
Motor StripSensory Strip
Parietal LobeSensory areas of touch,
pain, temperature.
Understanding speech,
language.
Express thoughts
Wernicke’s AreaInterpreting speech
Occipital
LobeVisual recognition
Focus the eye
CerebellumBalance
Coordinating
muscle movement
Helping Australians with dementia, and their carers
Cross Section
Normal Brain
Cross Section
Brain with
Alzheimer’s Disease
- enlarged ventricles
Normal Neurone
Abnormal Neurones
Inside are neurofibres
in paired helix
MMSE deficits:
•Relies on literacy
•Education
•Cultural background
•Emphasis on orientation
•Poor sensitivity for frontal lobe deficits
Imprecise or inaccurate language translation
Limitations of the MMSE
MCMMSE
• 6 items
• 12 domains (Memory, Learning, Praxis,
Judgment, Planning, Attention, Gnosis,
Language, Visuo-spatial/Construction,
Perseveration, Initiation, Orientation)
• 10 mins
MCMMSE12 domains:
Memory, Learning,
Praxis, Judgment,
Planning, Attention,
Gnosis, Language,
Visuo-spatial
Construction,
Perseveration,
Initiation, Orientation
Africa
Middle East
Central/Sth America
Asia
Europe
U.S.A. United Kingdom
Australia
Country of Birth
of Pilot Participants
50%
English
speaking
Helping Australians with dementia, and their carers
Item/Domain
Matching
1. 4 Item Grocery List
2. Identify Body Parts
3. Hand/Fist Alternating
4. Cube Drawing
5. Crossing the Road
6. Animal Naming
2. (R) Parietal / Frontal Lobes:
Memory, Praxis, Judgement, Planning, Attention, Gnosis, Language, Visuo-spacial construction, Perseveration, Initiation, Orientation
1. Frontal / Temporal Lobes:
Memory, learning, attention, Language,perseveration
3. Parietal Lobes:
Learning, Praxis, Judgement, Planning, Attention, Visuo-spacial construction, Perseveration, Initiation,
4. Frontal / (R) parietal Lobes:
Learning, Praxis, Planning, Attention, , Visuo-spacial construction, Perseveration, Initiation,
6. (L) Parietal / Frontal medial Lobes
Memory, Judgement, Attention, Gnosis, Language, Perseveration, Initiation,
5. Frontal Lobe:
Memory, Judgement, Planning, Attention, Gnosis, Language, Visuo-spacial,construction, Perseveration, Initiation, Orientation
12 DOMAINS 6 ITEMS MANAGEMENT
STRATEGIES
COMMENTS &
SUGGESTIONS
Item1 4 item grocery list Item 2 Identify Body Parts Item 3 Hand/Fist Alternating Item 4 Cube Drawing Item 5 Crossing the Road Item 6 Animal Naming
1.
Research project!
Helping Australians with dementia, and their carers
Part of an Holistic Assessment
• The Behaviour Response Flow Chart
• Describe the behaviour
• A: antecedents
• Is the behaviour consistent with the type of
dementia?
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How to implement the Toolkit
• Conduct the RUDAS test
• Review ‘Problems” to see which match with the
description of the person’s behaviour.
• Review the ‘Suggested Strategies”
• Choose which ones apply to this event or
circumstance
• Personalize them, then add to the care plan
•German woman
•Living alone and in squalor
•Self care deficit
•Risk taking behaviour:
Lighting fires in house
History of disinhibition
Allowing unknown males into her home
Taking explicit photos
•75 years old
•Bizarre ‘eccentric’ behaviour
•Family conflict
•Unaware of true nature of situation
•No history of psychiatric illness
•No diagnosis of dementia
Zilla’s Story
2001: ACAT and Neuropsychology assessments
Fronto-temporal dementia, services refused;
nil further contact with health services until…
2003: ACAT assessment initiated by family
MMSE 28/30, services refused
shortly followed by…
2003: Hospital admission confusion and agitation;
one month later…
Hospital admission confusion & UTI.
RUDAS 14/30
discharged home…
Background Discovered
2003:Later referred to IDST:
Wholistic assessment, RUDAS 17/30
The item numbers highlighted
deficits in the cognitive domains of:
•Memory, (1,2,5,6)
•Learning, (1,3,4)
•Initiation, (2,3,4,5,6)
•Perseveration, (1,2,3,4,5,6)
•Judgement, (2,3,5,6)
Demonstrated as:
•Extremely disinhibited,
•significant self care deficits,
•at risk behaviour etc
True Deficits Revealed
1. Provide information, advice and education to
family
2. Increase monitoring of supervision of
environmental situation and activities
3. Provide calendar, memos and visual cues
4. Provide simple prompts and guides for ADLs
5. Attend dementia specific day care
6. Discourage inappropriate visitors to her house
Zilla’s Initial Care Plan R/T Domains
7.Trial of residential respite in female only
facility
8.Intensive Behaviour Monitoring in facility
9. Provide staff advice and education
10. Remove camera and provide
distractions
11. Meditrak electronic locating device
issued
12. Accept permanent placement
13. ACAT referral for ACCR
Background: Zilla’s Story 75 year old woman of German background Living alone and in squalor Reduced ability to self care Bizarre behaviour, labelled as ‘eccentric’ by
health care workers Risk taking behaviour: History of disinhibition Allowing unknown males into her home
for sex Taking explicit photos Lighting fires in house to attract help
Family conflict over mother’s care needs Family and health care workers unaware of
true nature of situation No history of psychiatric illness or
diagnosis of dementia
Assessment Process: Chronology & Results2001 ACAT and Neuropsychology assessments fronto-temporal dementia,
services refused; nil further contact with health services until…..2003 ACAT assessment initiated by family, MMSE 28/30, Zilla refused
services; shortly followed by…..2003 Hospital admission 1. confusion and agitation; one month later
Hospital admission 2. confusion and UTI, assessed by CNC/Psychogeriatrics RUDAS 14/30; stabilized and discharged …..
2003 Referral to Behaviour Management Team: Wholistic assessment, RUDAS 17/30 deficits highlighted in
cognitive domains of memory, learning, initiation, judgement and perseveration (see Figure 1);
disinhibited++, significant self care deficits, at risk, Family conflict over residential placement Dementia specific day centre trial – discontinued due to her
disinhibition Family trial Zilla’s care in their home – discontinued due to her
behaviours impacting on their ability to care Respite/trial of placement in dementia specific female only
residential aged care unit BMT provided intensive behaviour monitoring and modelling of
care strategies aimed at behaviours of concern Facility agreed to permanent placement and Zilla settled but not
without additional BMT nursing and DT input as she was still taking photos and eloping from N/H with fellow resident.
DiscussionThe RUDAS findings highlighted cognitive deficits for Zilla which were not
demonstrated in the MMSE imparted understanding to the family members informed education and counselling allowing the family
to overcome feelings of embarrassment and denial assisted in the creation of a set of guidelines for
informing care
References:Storey, Rowland, Conforti and Dickson. 2002 The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. International Psychogeriatrics, 16:1, 13-31.
ConclusionThe clinician’s experiences using theRUDAS have demonstrated the utilityof the tool in formulating care planswith implications for education aboutthe impact of the dementia diseaseprocess on behaviour, and appropriatelong-term care for older people withdementia.Zilla settled well into residential carewith the stimulus of men and camerasremoved within a supported environment.
Zilla’s Care Plan Provide information, advice and education to family Increase monitoring and supervision of
environmental situation and activities Provide calendar, memos and visual cues Provide simple prompts and guides for ADLs Attend dementia specific day care Discourage inappropriate visitors to her house ACAT referral for ACCR Trial of residential respite in female only facility Intensive behaviour monitoring in facility Provide staff advice and education Remove camera and provide distractions Issue ‘Meditrak’ electronic locating device Permanent placement accepted
HYPOTHESIS: That a set of guidelines for informing care of people with dementia can be developed from the results of the RUDAS TOOL
Helping Australians with dementia, and their carers
References
• Agostinelli B, Demers K, Garrigan D, Waszynski C (1994) Targeted Interventions Use of the Min-Mental State Exam.
Journal of Gerontological Nursing
• Bird M, Llewellyn-Jones R, Smithers H, Korten A. (2002) Psychosocial Approaches to Challenging Behaviour in
Dementia: A controlled trial. Department of Health and Ageing: Canberra.
• Department of Health (2006a) Guidelines for Working with People with Challenging Behaviours in Residential Aged
Care Facilities: Using appropriate interventions and minimising restraint. NSW DoH: Sydney.
• Department of Health and Ageing (2000) Psychogeriatric Care Units Program Operational Guidelines. DoHA:
Canberra.
• Folstein M, Folstein S, McHugh P (1975) Mini-Mental State A practical method for grading cognitive state of patients
for the clinician Journal of Psychiatric Research, 12: 189-198.
• Storey J, Rowland J, Conforti D, Dickson H (2004) The Rowland Universal Dementia Assessment Scale (RUDAS): a
multicultural cognitive assessment scale. Journal of International Psychogeriatrics 16:13-31
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