Dementia

The word ‘dementia’ describes a set of symptoms that may include problems with memory, thinking or reasoning, these three elements are known as cognition. Changes to cognition are often small to start with but for someone with dementia they have become severe enough to affect daily life. Dementia is not only about memory loss. It can also affect the way you speak, think, feel and behave.

Not every change in cognition is due to dementia, particularly if the change is sudden. It is important that other, reversible, causes are treated before pursuing a dementia diagnosis.

However most care homes will encounter residents with some level of dementia. Although dementia is not an inevitable part of ageing, it does increase in prevalence with age. People with a learning disability are more likely to develop young onset dementia. It is important therefore that care home staff feel confident in caring for residents living with this condition.

Staying well / Prevention

For residents with diagnosed dementia or where a diagnosis is being sought/considered, it is important to help them live as well as possible with the condition.

Promote ongoing engagement in meaningful activities and hobbies that engage the mind.
Encourage ongoing friendships, family visits and other social interaction
Support residents to look after their physical health – eating well, staying hydrated, and regular movement to prevent deconditioning and reduce vascular risk
Ensure medication is reviewed and reduced where appropriate to reduce unhelpful side effects
Gather information on their life history so that you have a better understanding of what is important to each person and what motivates them day to day

All care should be personalised to respond to the individual resident’s needs and preferences, including support to access activities that are relevant to their interests. More information on non-pharmacological approaches to dementia care can be found in this workbook

Home environment

The home environment is important for supporting residents with dementia and reducing confusion. Key things to consider include

Good quality lighting, that you can change at different points in the day to reflect the time
Controlling noise, including having quiet spaces available if someone becomes overwhelmed
Safe access to outdoors
Using visual clues to aid navigation – for example cupboards with glass doors, pictures on doors or photos that the individual will recognise as theirs
Use of colour to make important things more obvious (eg toilet) and places they should not go more hidden (eg cleaning cupboard)
Promote consistency in how things are managed day to day

You can use this checklist to assess the environment in your home and identify any helpful changes.

Staff knowledge and skills

To support residents with dementia all staff should be trained in:

General awareness of dementia, for example through the social care institute for excellence (SCIE) e-learning Dementia - SCIE or e-learning for Healthcare (e-lfh) dementia module eLearning on dementia awareness.
Good communication skills
Mental capacity, deprivation of liberty and associated legislation, for example through e-lfh Mental Capacity Act programme NHSE elfh Hub
Staff may need specific training in non-pharmacological approaches to dementia care.

Identification of concerns

It is important to be aware of the early signs of dementia. These may appear gradually over a period of months or may be more sudden.

Ask yourself if this person

has become more forgetful, for example asking the same question multiple times
is more confused than they used to be
has changed moods, for example becoming more depressed
is more agitated, especially by changes to their normal routine
has increased difficulty making decisions

Ask relatives ‘are they [the resident] more confused than usual?’

If you are concerned that someone is developing dementia or has a worsening in cognition it is important for the resident’s health to seek timely help and not delay medical assessment. If there has been a very sudden deterioration in cognition that may be due to other causes consider contacting Urgent Community Response or the resident’s GP for assessment and response.

The first point of contact for concerns about the onset of dementia or a worsening in a resident’s dementia is their GP. The GP will first rule out other causes of the resident’s changing health and will usually take a blood test as part of their assessment. It is important that other conditions are treated before a diagnosis of dementia is considered.

Escalation and Response

Where appropriate the resident’s GP will make a referral for a formal assessment and diagnosis with Coventry and Warwickshire Partnership Trust (CWPT) Adults and Older Adults Mental Health Services | Coventry and Warwickshire Partnership NHS Trust. For care home residents the DiADeM tool may be used to support the diagnosis: DiADeM

Most residents with dementia can be looked after with good personalised and dementia friendly care. Residents with a recent diagnosis may receive post diagnostic support from the memory assessment service or local admiral nurse service where available.

However if needed further advice and support can be accessed through Dementia UK helpline, staffed by specialist admiral nurses on 0800 888 6678, or email helpline@dementiauk.org. Advice is also available through the Alzheimer’s society Dementia Support Line

Managing behaviours that challenge

Some residents with dementia may exhibit behaviours that are more difficult to manage. Examples of these include:

Repeatedly asking to go home
Shouting loudly
Hitting out during personal care

It is helpful to consider if there is anything that causing the resident to be distressed and that could be managed, for example are they in pain or has something changed in their environment that they find distressing. It is important to understand what the resident is trying to communicate through their behaviour and how they might be feeling in that moment.

Although some people may be helped with medication, many residents with dementia are better supported through other approaches. Non-pharmacological approaches should always be considered before medication due to the risks they can pose. More information on managing challenging behaviours can be found in the non pharmacological approaches to dementia workbook.

Support for staff and families

Caring for a person with dementia can be challenging. It is important to look after the welfare of staff and also support the families of the resident.

You can support your staff by

Enabling them to step away for a moment when needed
Encouraging understanding of what is driving behaviours that challenge so they do not take it personally
Helping your team to be there for each other and share the load
Sharing information on support available outside the workplace e.g. from dementia charities

More information can be found in the non pharmacological approaches to dementia workbook – time out section.

Useful information for families can be found on the Living Well with Dementia website: Carer and family support – Living Well With Dementia

Useful links

Local resources

Staff training and awareness

Dementia charities

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