Dementia Care Course

Home based Dementia Care course contents syllabus

Dementia Care Course Syllabus

Welcome

  • This module examines the different types of dementia:
    • Symptoms
    • Percentage? (how many of those with dementia have this type?)
    • Cause
    • Typical age of onset
    • Diagnosis (what is involved – mini mental state examinations, MRI, physical examinations.)
    • What to look out for. What may challenge you?
    • Prognosis (outcomes)
  • The different types of dementia:
    • Alzheimer’s
    • Vascular dementia
    • Dementia with Lewy bodies
    • Fronto-temporal dementia
    • Other (Korsakoff’s, CJD, HIV etc. Brief references to Parkinson’s and Huntingdon’s)
  • The module also introduces the concept of memory, dividing it into ‘working memory’ and long-term ‘rote’ memory. What may be lost and what may be retained.

Personalising Care for People with Dementia

    • What is personalisation, and how does it work in practice?
    • How can personalisation help those with dementia?
    • How can you make it work?
    • Getting to know the person supported.
    • Writing a case history, with the additional help of relatives, and filing it for all staff. Name the person prefers to be called, age, relatives (constructing a family tree), relationship history, employment history with names of companies etc, medical history, favourite things, hobbies, food preferences, style preferences, etc.
    • Visual personalisation – collecting and displaying photographs, where and how. Videos.
    • Aural personalisation – music preferences, CDs etc
    • Personalising with a visual timetable
    • Personalising activities inside and outside the care home, including grooming, medical/physical care, and mobility.

Providing Dignity and Respect

  • Dignity and respect are the two guiding principles in caring for vulnerable people.
    • What does dignity mean? How can we preserve it?
    • What does respect mean? How can you show respect to the person you're supporting?
    • Choice – does it matter to someone who has a seriously impaired memory? Where to offer choice, and how.
    • Personal care, bathing and washing – preserving dignity, and treating someone respectfully.
    • Handling. What are safe and respectful ways of handling someone?
    • Addressing the patient. How do you enhance their dignity and show respect in your verbal and body-language communication?
    • Facilitating. How can you facilitate someone with respect, to allow them to keep their dignity?

Difficulties associated with dementia

  • There are several known difficulties associated with dementia. How can you prevent them or help the patient?
    What? Why? How to help
    Disorientation Memory problems, moving from own home. Visual, signs, arrows, verbal prompts, photographs
    Visual impariment etc etc
    Malnutrition
    Hoarding
    Aggression
    Wandering
    'Sundowning' (pacing)
    Feeding difficulties
    Balance problems

Medications used for dementia

  • Medications are an important part of caring for the elderly with dementia. Those with dementia may have other medical problems, such as diabetes or hypertension, and medication may have been prescribed for them.
  • The mishandling of medications is the biggest single reason why care and nursing homes fail inspections. The rules that must be followed.
    • Storing medications in a secure place
    • Storing medications in accordance with manufacturers’ instructions
    • Providing each person with their own medication chart, and marking any supply of medication on it
    • Giving pain relief, or other over-the-counter medication, only in consultation with management, and in accordance with the GP's instructions
    • Handling ‘Controlled drugs’ according to the GP's instruction and a Home Office Licence
    • Disposing of unused medication safely.
    • Having more than one member of staff handling the allocation of medicines.
    • Giving medications strictly on time and in accordance with instructions.
  • Why only trained staff should handle medication. In some residential care homes there are nursing staff who can allocate all medication.
  • Administering eye, nose and ear drops, applying creams, overseeing asthma inhalations and ensuring that medication is swallowed.
  • What medications are used specifically for dementia?
    • Aricept/Donepezil.
    • Anti-psychotics: Quietiapine (Seroquel) etc
    • Who they are suitable for.
    • Why they are given.
    • How to give them.
  • Joint training between health and social care staff on issues like medication.

Therapies known to be of help in dementia

    • Reminiscence therapy – what is it? Why does it work? (retention of long-term memory - see Module 1). Evidence level – high. Ways in which it can be used in practice, both formal and informal, passive and active
    • Music therapy. What is it? What is involved? Evidence level?
    • Aromatherapy. What is it? What is involved? Evidence level? It is unlikely to be the aromas that work, as the sense of smell is generally lost first in most dementias (so the aroma evidence is low), but evidence for massage and touch is high.
    • Pet therapies. What is it? What is involved? The evidence level is high for improving mood and cooperation etc etc
    • Social interaction therapies. What is it? What is involved? The evidence level high for some forms of dementia. Reminiscence therapy, for instance, has a much higher success rate when it’s done in a group.
    • Psycho-education of care workers. What is it? What is involved? The evidence level very high in helping manage dementia symptoms in those they supported.
    • Complementary therapies. What are they? What is involved? Evidence level?
    • Other therapies.

Mental Capacity and Other Legal Issues

  • This module looks at what is meant by ‘Mental Capacity’ as it can affect whether the person with dementia is capable of making decisions.
  • Who makes the decision on mental capacity? Role of the psychiatrist, the psychologist, and the specially qualified mental health social worker.
  • Section 2 (s2), of the mental Health Act. The decision to section someone is difficult, as even in late stage dementia there are lucid moments.
    • The Mental Capacity Act 2005: who can take decisions in which situations, and how they should go about this. The need to comply with the MCA when making decisions or acting for that person.
    • Decisions that are life-changing events or more every day matters. Relevant to adults of any age, regardless of when they lost capacity.
    • The right of every adult to make their own decisions. Assume that the person has capacity to make them unless proved otherwise.
    • Giving all practicable help to someone before anyone treats them as not being able to make their own decisions.
    • Just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision.
    • The need to take decisions in their ‘best interests’.
    • Ensuring the least restriction of their basic rights and freedoms.
  • Under the Mental Capacity Act can the patient make a particular decision? Four things they need to be able to do.:
  • The presumption that people you provide care or treatment for have capacity to make decisions for themselves.
  • The obligation to consult an Attorney under a Lasting Power of Attorney (LPA), a Deputy appointed by the Court, or a named person.
    • What is an LPA?
    • What legal position does a relative with LPA or EPA have in regard to decision-making?
    • What are ‘best interests’?
    • Getting a second opinion
    • What is the Independent Mental Capacity Advocate Service?
    • How are social care workers protected by the Mental Capacity Act?
    • What does the Mental Capacity Act say about restraint?
    • What is Deprivation of Liberty?
    • What are advance decisions?
    • What is the Data Protection Act 1998? How does it affect you?
    • How do you ensure that people know you have made a decision for a person you support in their best interests?

Assistive Technology and Telecare

  • What is assistive technology and telecare?
  • How can it work for you and the person you support?
    • Alarm systems – gas left on, smoke alarms, flood alarms, bogus caller alarms, and door-opening alarms
    • Personal alarms, and tracking systems for lights and movement
    • Movement-activated alarms for bedside rug, to warn when resident moves in the night
    • Incontinence alarms
    • Monitoring health systems.
    • The use of CCTV in care homes – why is it a hotly-argued subject?
    • Abuse in care homes and relatives’ use of hidden cameras.
    • What is beneficial, and what can be the problem with some of these systems?

Adapting the Environment

  • Where we are caring for people with dementia, we need to ‘modify the environment around the person’ to ease any challenging situations.
  • What is included in ‘the environment’? Everything around the person, including other people – like care workers!
  • How do we modify the environment to defuse any short or long-term problems?
    • The importance of empathy
    • The use of Functional Behaviour Analysis and ABC
    • Considering first the possible physical causes for behaviour: illness, cold or heat, pain, a need to use the toilet, fatigue, etc
    • Using simple visual communication systems
    • The importance of colleagues and consultation
    • The crucial importance of ongoing record-keeping and monitoring

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