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Calling all GPs – Case Study at The Ness Care Group in Teignmouth

This week I have been working with a family in The Ness,Teignmouth dementia day-care centre, who have just emerged from a tough week which was precipitated by 1 hasty decision. It has prompted me to write this blog, in the hope that a junior GP or doctor, who has yet to come across dementia in the community, reads this and doesn’t make the same mistake.

Memory Loss – Causation and Effects on the Family

Tim (all names have been changed) is a 75 year old man who is physically fit but over the last few months he had been showing signs and symptoms of memory loss. His family had no previous experience of dementia but referred him to his GP who confirmed their concerns and placed him on the waiting list to be assessed by the memory clinic. Meanwhile as an avid cyclist Tim continued cycling and in early December he fell (unwitnessed) off his bike and hit his head badly. He was taken to hospital and confirmed he had concussion and a bleed on the head. There was also suggestion that he may have had a seizure or a TIA as he had no other injuries from the bike accident other than the head injury. He was in hospital a couple of days and appeared to recover well and was discharged home.

After the fall his confusion, and memory loss seemed to get worse but no further brain scans or dementia referral could be taken for 3 months so that the medical team could rule out any connection with the concussion. His family had no understanding of dementia and how to communicate or support someone with brain injury. In an effort to ensure Tim’s safety they locked away his bicycle and his car and tried to keep him safe in doors. Tim found this very frustrating, he couldn’t understand why he couldn’t be independent and make his own adult decisions about his life – like cycling & driving. Understandably this caused frustration and some eruptions of anger. At this point they called me and I listened to all that had occurred and agreed to meet Tim and the family to provide them with some dementia support.

Unprepared and Unexpected – Neglect of Proper Dementia Care

The GP had been aware of the situation throughout this time. However, before I could visit in early January there was an incident in which Tim asked to go cycling and access the garage. His family refused and he became increasingly angry, more family arrived and the situation escalated; they called the GP for advice. The GP, over the phone without seeing Tim, told the family to take him to A&E possibly suspecting further brain injury, although there had been no further organic injury, falls or bruising.

It was this decision that then precipitated a catalogue of issues and a horrendous week for Tim and his family. The principle lesson from this case study is to try and avoid the need to send someone with suspected dementia (or brain injury) to A&E. That decision has to be taken very cautiously and only after a face-to-face consultation allowing the medical professional to weigh up all the factors.

In this incident Tim went to A&E after almost 4 hours of waiting, he didn’t understand why he was there and became angry and tried to leave, family stopped him and health professionals gave him a sedative agreeing he needed to be kept in hospital. Tim was placed on a trolley in A&E and his wife left as it was midnight. Unsurprisingly, Tim then got up and walked out at 2am in the morning, the hospital realised his absence too late and the police were called. The police picked him up on the streets of Exeter and he was brought back into hospital and IV drip started and more sedation administered.

Supervision and the Importance of Understanding when Caring for Elderly with Dementia

The next day started fine with Tim appearing to recognise where he was and accepting he needed to stay on the ward. He had a blood test. However, he soon got frustrated and once again didn’t understand why he wasn’t being listened to, why he couldn’t choose to leave, why they were treating him as a prisoner. Once again he became angry, difficult to handle and the team again had to sedate Tim. The poor man was in his mental context acting completely rationally, angry that people weren’t listening and allowing him to head home. The situation was not only highly stressful for the family, and for Tim but very damaging for Tim’s mental health.

The hospital, however, was now in a difficult situation as they didn’t feel he was safe at home without a package of care (even though he had been at home completely fine up to this point). They couldn’t organise that package of care and Tim was blocking a bed. They hadn’t ended up doing anything for Tim other than to give him some fluids and keep him sedated.

Thankfully the need for the bed overcame the decision to keep him in while waiting for a package of care and 4 or 5 days after that fateful decision to go to A&E Tim arrived back home.

Reflection – Patient’s Perspective and Care for Elderly with Dementia

At the core of this case study is learning empathic good communication with individuals living with memory loss. In the context of Tim’s experience and outlook he had acted completely fairly, he was frustrated because, as an independent adult, other people were stopping him from making choices and living his life. We would all be frustrated if stopped from going to work, from going outside, from using our bike or meeting friends. If you start to see it from Tim’s perspective then you can start to communicate in a way that de-escalates the situation. If the GP who advised an A&E admission had had access to a dementia expert or had teaching around de-escalation and communication with those living with memory loss then the family would have been shown how to de-escalate the situation and help Tim to live fully and independently in the context of his brain injury.

The case study highlighted how much we need more Ness teaching and we need more Ness knowledge around this disease so that families and health professionals feel confident in dealing with acute situations and caring for the elderly with dementia.

If you have a loved one with dementia and are looking for dementia support near you, then get in touch with us by giving us a call on 01626 774799, or email us on [email protected].

4 tips on running activities at Home for those with Mild to Moderate Dementia – A few ideas from Active Minds Dementia Leads

“What activities should I do with my husband/wife/parent when we are at home?”

This is a common question and one of the most common searches on google (please have a look at my short video for more information). However, it is also not that simple to answer, we will be doing a series on this subject looking at all aspects of running activities for people living with dementia, and those looking for dementia support services.

However, in this article we are starting not by searching for specific activities but rather I think it is more helpful for those looking for dementia support services, to understand WHY you are running an activity and HOW to choose the right one for your loved one. I offer 4 simple tips when choosing and running an activity for someone you care for (it should be noted this article is for family not professional carers who should approach activities in a different way).

Tip number 1 – It is harder for a loved one to run an activity

It is important to be aware that it is far harder for someone close to the person living with dementia to run an activity that it is for a stranger.

The husband will find it harder to encourage his wife to try out making Easter decorations than his granddaughter and the granddaughter will find it harder than the neighbour and the neighbour harder than a paid professional. From an early age, we are taught social politeness and social niceties; we will be grumpy and disruptive to those we love and know most and most polite and agreeable to those we know least.

If you are struggling to run an activity with a loved one and would like some support for dementia near you, get in touch with us 01626 774 799.

Tip number 2 – It is the action not the result that is most important.

I cannot emphasise this enough!

Most of us can be fixated on the outcome of the task rather than the simple pleasure of sitting with/near someone and laughing/talking as you just do. Someone living with dementia may no longer be able to paint a picture, fix a plug, plant a flower or make a bird box, but sitting with the materials and working together on something, using your hands and letting conversation wash over you both brings huge pleasure and mental stimulation. This can provide some respite for the dementia patient and the carer.. The result may well be a ball of mush or a stack of sticks.

Equally if you are doing a crossword, a quiz, playing boggle or dominoes the correct answer is not the point. The answer to the quiz is irrelevant but the question might take you down a line of questions, memories and laughter which brings great pleasure.

Tip number 3 – Everything can become a therapeutic fun activity!

Respite for dementia patients is something both a loved one and those living with dementia will be looking for, and a therapeutic, fun activity can be just that.

An activity in dementia does not need to be a craft or a quiz or a game, instead change the way you see every common action. The stimulation and benefit comes from doing an action together, communicating and learning. The person living with dementia needs to feel useful, to feel needed and to be stimulated. With this in mind loading the dishwasher, sweeping the drive, sorting buttons, un-knotting the knitting are all therapeutic activities.

Even better though they offer a sense of self-worth, you have done something that has helped your daughter/son/wife/friend, providing some respite from the disease for the dementia patient.

Remember tip 2, the end result is not important; the dishwasher doesn’t need to be loaded correctly or the leaves piled neatly; it is the social action that is important, not the outcome!

Tip number 4 – It is incredibly important to offer both mental stimulation and social stimulation to someone diagnosed with any form of memory impairment.

It is the single most important thing you can do for someone living with memory loss. There is now undisputed research to show that our brains shrink or become further impaired if under stimulated or isolated. Our brains are social muscles that learn new pathways, improve mood and maintain function through social stimulation. The temptation is to reduce social contact and to rely on your own ability to entertain and stimulate your husband/wife/parent..

However, going back to tip number 1, it is harder to stimulate your loved one alone, families need to engage a wide variety of people, groups and activities to enable/empower the person living with memory loss. The support services at our dementia daycare centre can provide respite to dementia patients and you and your loved ones as carers, if independent care becomes too challenging. Certainly do fun activities together at home but also get out and meet people, engage with neighbours, meet new friends.

One way to meet new people would be at our dementia day care hub, or give us a call on 01626 774799.

Keep an eye out for more

I hope the above few tips have given you some thoughts on why we should do activities with a person living with memory loss and that the activity itself is not that important. Rather it is the shared action and the social connection that comes from that. That said our next blog will be on more specific activities provided by The Ness dementia daycare centre in Teignmouth.

If you are looking for a dementia support service near you, give us a call on 01626 774799 to discover how we might be able to help.

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