More than 342,800 Australians are currently living with dementia – a figure that is expected to rise to 400,000 within ten years, according to Alzheimer's Australia. If there is no medical breakthrough, this number is expected to reach 900,000 by 2050.
Demand for specialist dementia care is increasing, and knowing how to adapt to provide it can be difficult. We take a look at what you need in order to provide proficient and comfortable dementia care.
Creating a dementia-enabling environment
A particular environment is incredibly influential on a person’s mood or state of wellness, particularly in the case of people with dementia. A homely environment should be strived for, rather than a health care one, as should individualised, personal care.
Accommodation should also be designed with a feeling of independence in mind. This would mean smaller areas that residents are able to go to avoid crowded or busy places.
Safety features installed into the premises should be discrete, while the floor level should be considered depending on the stage of dementia. For example, if they are physically able and/or enjoy wandering around the home, they should be located on the ground floor so that they don’t need to navigate the stairs. However if they are less physically-able and/or prefer quieter areas, they may prefer smaller communal rooms near to their personal rooms.
There should also be locks on exterior doors so that residents will be unable to leave the home unattended and into harm’s way. Tripping hazards should also be minimalized as much as possible, meaning no floor lamps or coffee tables.
Various places in the care home should be uniquely patterned with differing colour systems to make it easier for residents to find rooms and move around themselves.
An area for activities and different types of therapy, for example pets should also be provided by the care home as well as an easily-accessible garden.
Needs and abilities of people with dementia
Dementia is a general term for those with physical changes to the brain, leading to deterioration in a person’s memory and other mental abilities which will interfere with daily aspects of their life.
Alzheimer’s disease accounts for 70% of people with dementia, making it the most common form. It can either be sporadic (affecting adults usually over the age of 65) or familial (rare hereditary early onset dementia). Other types include vascular, frontotemporal, Parkinson’s, DLB, Huntington’s, Creutzfeld-Jakob disease, Korsakoff’s syndrome and mixed dementia.
Each of these types of dementia have varying symptoms, which emphasises the need to make sure that care for each patient is individualised. The individual’s interests and likes should be taken into account, rather than focusing purely on their symptoms.
If every patient were treated through the most common symptoms of dementia, care would not be adequate. For example, not all dementia is simply about a loss of short-term memory; frontotemporal dementia will often consist of progressive non-fluent aphasia and may involve confusing the meanings of words. This can also trigger certain behaviours that they may not have had prior to dementia, for example a lost interest in people and increase in repetitive behaviours.
Vascular dementia, on the other hand, is caused by reduced blood flow to the brain. Common cognitive symptoms include a loss in visuospatial skills (difficulty in seeing things in three dimensions) and problems in following a series of steps, and more.
Despite the fact that dementia is considered mental health, there are also many effects on physical health.
People with dementia will over time lose the ability to wash, walk, dress and feed themselves. They will also find it increasingly difficult to communicate, which can be scary and distressing for them. People with dementia are also reluctant and resistant to change, meaning that the transition from their own home or a family home is often challenging. Therefore creating the right environment that addresses their needs and abilities is incredibly important.
There are a variety of care practices that you need to consider when looking after dementia residents. Both social working and nursing staff should be available at all times in the care home to provide the right amount of support.
Upon considering what amounts to ‘good care’, Alzheimer’s Australia believes that it comprises of several aspects: culturally appropriate care; involvement of relatives and friends; effective pain management; using minimal restraint; and access to specialist supports.
Access to specialist support is particularly important in dementia care as it will attain the best quality of life for those living with the condition. Advice from health professionals such as speech pathologists, dieticians, physiotherapists, psychologists or occupational therapists will allow more specialised, personal care.
Knowing how to effectively communicate with dementia residents can appear rather difficult in the onset, however there are several things that you and your staff should think about when interacting with them.
Gain their attention through minimalizing other distractions like a loud radio or TV. Familiar greetings can also help those who have a difficulty in remembering faces. Maintaining eye contact can help them focus, though you should be at their eye level as it can be intimidating for someone to look over them.
Clear, calm speech that is short and simple should be optimised when talking to those with dementia, as well as an avoidance of complicated or interrogative questions. Patience is needed as well as careful listening and noting their body language. And, most importantly, don’t speak to them as though they were a child; they are an adult, and they don’t need to be patronised.
Alzheimer’s Society also suggest other helpful advice for nurses and other healthcare professionals: dealing with challenging and unpredictable behaviour; orientation; eating and drinking; washing and bathing; incontinence; moving and walking about.
The Australian Aged Care Quality Agency is the independent accreditation body which assesses care homes’ performance against a set of legislated Accreditation Standards. In order to receive Australian Government subsidiaries, it is a requirement for residential care homes to be accredited.
Main elements of the accreditation process are as follows:
• self-assessment of the home against the Accreditation Standards
• submission of an application for re-accreditation (with or without the self-assessment)
• assessment by a team of registered aged care quality assessors at a site audit
• a decision about the home’s accreditation by a decision-maker (not part of the assessment team)
• issue of an accreditation certificate
• publication of the decision on this website
• unannounced visits to monitor homes’ on-going performance
The Quality of Care Principles 2014 further ‘specify the care and services that an approved provider of residential care is to provide, set out the Accreditation Standards that must be met by a residential care service to achieve accreditation, specify the care and services that an approved provider of home care is to provide, and set out the Home Care Standards that a home care provider is expected to meet as a part of quality review.’
Part 2.9 of the principles are particularly important to care homes providing care for dementia patients:
‘Individual attention and support to care recipients with cognitive impairment (for example, dementia and behavioural disorders), including individual therapy activities and specific programs designed and carried out to prevent or manage a particular condition or behaviour and to enhance the quality of life and care for such care recipients and ongoing support (including specific encouragement) to motivate or enable such care recipients to take part in general activities of the residential care service.’
Providing care that specifically caters to residents with dementia can really increase their quality of life and put their family at ease, knowing that you are offering the best environment for their relative.
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