Pine View Care Homes Ltd T/A

PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018

PINE VIEW CARE HOME – DEALING WITH DEMENTIA

What is Dementia

Dementia is a term used to describe various different brain disorders. There are over 100 different types of Dementia the most common being Alzheimer’s disease, vascular dementia and dementia with lewy bodies. Symptoms of dementia include loss of memory, confusion and problems with speech and understanding. All types of dementia are progressive. This means that the structure and chemistry of the brain become increasingly damaged over time. The person’s ability to remember, understand, communicate and reason gradually decline. How quickly a dementia progress depends on the individual. Each person is unique and experiences dementia in their own way.

1 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018 UNDERSTANDING AND RESPECTING When caring for a person with dementia you must ensure that they are always treated with respect and dignity. They are a unique and valuable human being. A person with dementia whose mental abilities are declining is likely to be vulnerable and in need of reassurance and support It is important that everyone around them do everything they can to help them to retain their sense of identity and their feelings of self-worth. All staff must remember  Each person with dementia is a unique individual with their own very different experiences of life, their own needs and feelings and their likes and dislikes  Although there are symptoms of dementia which are common to everyone each person will be affected by their dementia in a different way.  Everyone reacts to the experience of dementia in their own way.

When caring for a person with dementia you will need to take account of their abilities, interests and preferences. They need to be aware that these may change as the dementia progresses. They should be prepared to react in a flexible and sensitive way.

THE LIFE STORY OF THE PERSON The more background information you can obtain, as well as their present situation, the better it will be. This information will make it easier to see the person as a whole person rather than simply someone with dementia. Care workers will then be able to give support and feel more confident about finding topics of conversation or suggesting activities that the person may enjoy. Care workers must always remember that  Dementia is nothing to be ashamed of. It’s no one’s fault.  Dementia may cause the person to behave in ways that others find irritating or upsetting but this is not deliberate.  A person with dementia may often remember the distant past than the recent past and the present. They are often happy to talk about their memories. But remember past memories may be upsetting and painful.

OUR NAMES ARE IMPORTANT Our sense of who we are is closely connected to the name or names that we are known by. It is important that care workers and others address the person with dementia in a way that they recognize and prefer. Some people may be happy for anybody to call them by their first names others may prefer younger people who do not know them to use courtesy titles such as Mr. or Mrs.

TREATING THE PERSON AS AN ADULT It is important that all care workers treat the person as an adult and with courtesy, however advanced their dementia. Try to imagine how you would like to be spoken to if you were in their position. Care workers must  Be kind and reassuring without talking down to the person as though they were a child.  Never talk across them or over their heads as if they were not there  Do not talk about the person with other people while the person is present always include them in the conversation  Avoid scolding or criticizing the person  All these things will attack the fragile sense of self-worth of the person  Look at the meaning behind the words even if on the surface they do not seem to make much sense. The person is almost certainly trying to communicate with you about how they feel.

FOCUS ON THE REMAINING ABILITIES Avoid situations in which the person is bound to fail as this can be humiliating. Look for tasks they can still manage and activities they can enjoy.  Give them plenty of encouragement. Let them do things at their pace and in their own way.  Do things with the person, rather than for them, so that they can preserve some independence  Break activities down into small steps so that they feel a sense of achievement even if they can manage part of a task.

RESPECTING PRIVACY Try to make sure that the person’s right to privacy is respected.

2 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018  Care workers must always knock on their bedroom door before entering  If the person needs help with intimate personal activities such as washing or using the toilet, this should be done in a sensitive way. Make sure the door of the bathroom or the toilet is kept closed if others are around.

OFFERING CHOICE It is important that the person is informed and whenever possible consulted about matters which concern them. They should be given every opportunity to make appropriate choices.  Even if you are unsure how much the person can understand always explain what you are doing and why. You may then be able to judge their reaction from their expression and body language  Although too many choices can be confusing you can continue to promote choice by phrasing questions that only need a ‘yes’ or ‘no’ answer such as ‘would you like to wear your blue jumper today’ rather than ‘which jumper would you like to wear today’.

EXPRESSING FEELINGS Dementia affects the thinking and reasoning part of the brain. It does not mean that the person no longer has feelings. A person with dementia will probably be sad or upset at times. Care workers must understand how the person feels and should offer support rather the ignore them and ‘jolly’ them along. In the earlier stages the person may want to talk about their anxieties and problems they are experiencing. It is important that care workers do not put these problems aside but listen to them and act accordingly.

FEELING VALUED The person with dementia needs to feel respected and valued for what they are now and for who they were in the past. Care workers must always be  Flexible and tolerant / make time to listen and have a chat / show affection as appropriate UNUSUAL BEHAVIOUR Each person with dementia is an individual with different needs. Much of their behaviour is an attempt to communicate what they want or how they are feeling. Once we understand the reasons why someone is behaving in a particular way, it is easier to find ways of coping. If the person is unable to tell you how they are feeling try a number of approaches. Ask for advice from seniors or management or other care workers before you become to stressed. Always remember that the person you are caring for is not being deliberately difficult. Ask yourself too whether the behaviour is really a problem. Make sure that you have support for yourself and breaks when you need them.

REPETITIVE QUESTIONING A person with dementia may ask the same question over and over again probably they do not remember asking the question or the answer you gave because of their short-term memory loss. Feelings of insecurity or anxiety about their ability to cope may also play a part in a person’s repetitive questioning. Try to put yourself in their position and imagine how they might be feeling.  Try to be tactful when answering. Don’t say ‘ I’ve already told you ‘ as this will increase feelings of anxiety. Try to get the person to find the answer for themselves. For example  Q ‘ is it lunchtime’ A ‘ have a look at the clock’  Q ‘ do we need more milk’ A ‘ why don’t you look in the fridge’  Try to distract the person with an activity if appropriate if you cannot contain your reaction; make an excuse to leave for a while.

REPETITIVE PHRASES OR MOVEMENT Sometimes people with dementia repeat the same phrase or movement several times.

3 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018  This may be due to some kind of discomfort. Check that the person is not too hot or too cold, hungry, thirsty or constipated. Contact the GP if there is any possibility that they are ill, in pain or if medication is affecting them.  They may be finding the surrounding too noisy or too stressful.  They may be bored and trying to stimulate themselves. Encourage an activity. Some people find stroking a pet, going for a walk or listening to music, for example is very enjoyable.  It may be the person’s way of soothing themselves. We all have different ways of comforting ourselves.  It may be due to the damage in the brain. Simply offer as much reassurance as you can.

REPETITIVE BEHAVIOUR You may find the person seems to be constantly doing the same things such as packing and unpacking the same bag or rearranging the chairs in a room.  This behaviour may relate to a former activity or occupation such as traveling, organizing an office or entertaining friends. You may be able to work out what this activity might be. This may help you understand what the person is feeling and trying to do, and may also serve as a basic conversation.  The person may be bored and need more activity to stimulate them.

TRAILING AND CHECKING We know that, for many people, the experience of living with dementia makes them feel extremely insecure and anxious. A person with dementia may therefore constantly follow you or call out to check where you are. Memory and confusion about time means that a few moments may seem like hours with a person with dementia and they may only feel safe if you are nearby. This behaviour can be very difficult to cope with.  Try not to speak sharply. If you do it will only increase the persona anxiety.  Provide something absorbing for the person to do if you are busy with something else – perhaps a pet or a familiar cuddly toy or doll.  It may be reassuring for the person to hear you hum or sing. Or, if you are in another room, perhaps put the radio on.

SHOUTING AND SCREAMING The person may continually call out for someone or shout the same word, scream or wail over and over again. There are several possible reasons for this behaviour.  They may be in pain or ill or they may be experiencing hallucinating, Any of these possibilities seem likely, consult the GP / Manager  They may be lonely or distressed.  They may be anxious about their failing memory. ‘try to reassure and distract them. If they are calling out for someone from their past, talking to them about the past may be helpful.  They may be bored. Everyone needs to be occupied, including people with dementia. Listening to music together or giving the person a gentle massage are some of the things that people have found helpful.  There may be too much noise and bustle. They may need a quiet environment.  It may be the result of brain damage due to dementia.

LAUGHING AND CRYING The person may laugh or cry uncontrollably for no apparent reason.  This may be associated with hallucinations or delusions (seeing other people or things that are not there, or believing things that are not there)  This may be due to the effects of brain damage. It is more common among people who have vascular dementia. It does not necessarily mean that the person is very sad or very happy. They may respond to reassurance.

4 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018 LACK OF INHIBITION The person may behave in a way that others find embarrassing due to their falling memory and general confusion. Try to react calmly.  Undressing or appearing naked in public may simply indicate that the person has forgotten when and where it is appropriate to remove their clothes. Take them somewhere private and check whether they are hot or uncomfortable or whether they want to use the toilet. Lifting a skirt or fiddling with flies may indicate that the person wishes to use the toilet.  If a person starts to stroke their genitals in public, discourage this tactfully and try to distract their attention, if such behavior is frequent and persistent consult the GP.  If the person behaves rudely – for example, by insulting people or swearing or spitting – do not attempt to argue or correct them. Try to distract their attention. You can explain to others that the behavior is due to their dementia and is not directed at them personally.

PACING There may be a number of reasons why a person with dementia may pace up and down a room.  They may be hungry or thirsty or constipated, in pain or may want to use the toilet and be unable to tell you this. Always check on these kinds of possibilities.  They may feel ill or they may be suffering the side affects of certain medicines. If you suspect that this may be the case, contact the GP  They may be bored. Or may not be using up all their energy, Try to find then appropriate activities or enjoyable forms of exercise.  They may be upset by noisy surroundings and may stop walking up and down if they find a quiet place to sit.  They may be angry, distressed or anxious. Try to find out how they are feeling and show that you understand. However in some cases pacing may be due to changes that have taken place in the person’s brain. Try to distract them, however if you are unable to stop the pacing  Try to find somewhere they can walk in safety without disturbing the other residents.  Encourage the person to choose comfortable clothes and supportive shoes.  Check their feet regularly for redness, swelling or blisters which may need attention and if required contact the GP or community nurse.  Try to persuade the person to rest from time to time by offering a drink, snacks or an activity.

FIDGETING A person with dementia may fidget constantly. They may be uncomfortable, upset, bored or need more exercise. The fidgeting may be associated with the damage to the person’s brain.  Check whether the person is too hot, too cold, hungry, thirsty or whether they want to use the toilet for example  If they seem upset try to find the reason and reassure them.  Try to distract their their attention with an interesting activity or involve them in some form of exercise.  Give them something to occupy their hands such as a soft toy, or provide a rummage box with interesting objects inside.

HIDING AND LOSING The person may deliberately hide objects to keep them safe and then forget where they are or indeed that they have hidden them at all.  The wish to hide articles may be partly due to feelings of insecurity and desire to hold on to the little that they may still have. Try to reassure the person, however impatient you may feel.  Do not leave important documents lying around and make sure you have a spare set of keys if they are likely to lock things away.  Try to find out the persons hiding places so that you can tactfully get them to find ‘missing’ articles Some people may hide food, perhaps intending to eat it later, if this is the case you may need to check ‘hiding places’ regularly, and discreetly dispose of any perishable items.

5 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018 SUSPICION People with dementia sometimes become suspicious. They may worry that others are taking advantage of them or intend to harm them in some way. For example, when they mislay an abject they may accuse someone else of stealing from them, or they may imagine a friendly resident is plotting against them. Such ideas may be to do with their falling memory or their inability to recognize people they know, and partly due to the need we all feel to make sense out of everything around us.  Although such attitudes can be difficult to deal with, try to avoid arguing. State calmly what you know to be true and reassure or distract  Explain to other residents who are in contact with the person that any accusations are caused by the dementia and should not be takes seriously  However you should not automatically dismiss the persons suspicion there is always possibility that they may be true. So always investigate the matter and report to seniors/manager

COMMUNICATION

People with dementia should be encouraged to communicate whichever way seems appropriate. This will enable them to preserve their own sense of identity and improve their quality of life. Communication consists of much more than verbal language. Non-verbal communication is particularly significant for people with dementia and it is very important to be aware of this. We are all familiar with saying action speak louder then words. This is particularly true of people who are losing their language skills. Much of the behaviour which causes problems for carers is actually the attempt by the person with dementia to communicate.

LANGUAGE SKILLS An early sign of language being affected by dementia is that the person becomes unable to find the right words – particularly the names of objects and their use. For example a toothbrush- the person with dementia will not know what it is or how to use this. As the dementia progresses they will be less able to start a conversation, the carer may have to become accustomed to taking the initiative. Try to avoid asking direct questions – a person with dementia may become frustrated if they cannot find the answer. In the earlier stages of dementia the person may be able to express these feelings, but later on they may respond with general irritation or even aggression. Most of our ordinary social conversations is based on asking questions, So carers will have to overcome this. There may be a time when the person can hardly communicate in language at all. People quite often confuse the generations, mistaking wife for mother, or son for husband. However the reason for this lies in the memory loss which is one of the most striking symptoms of dementia. People with dementia may be trying to interpret a world which no longer makes sense to them because their brain is feeding them incorrect information. The difficulties which arise are the result of misinterpretations both by the person with dementia and by the carer of what the other person is trying to communicate. Carers must always if caught up in this kind of situation seek help and advice from seniors/management.

TIPS TO HELP WITH COMMUNICATION Listening  Always try to listen carefully to what the person is saying and encourage them. At all costs, do not patronize them. Most of us react badly to being treated as if we were small children- and people with dementia are not different in this respect.  If the person has difficulty in finding the right word, or in finishing the sentence, ask them to explain in a different way, use the knowledge that you have about the person to interpret what you think they may may be trying to say. Always check back with them to see if you are right.

6 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018 Gaining attention  Try to catch and hold the attention of the person before you start to communicate.  Try to position yourself so that they can see you clearly  Make eye contact. This will help them to focus on you.  Try to minimize competing noises, such as radio or TV or the conversation of other people. Body Language  Try to remain calm and still while you are speaking.  A person with dementia will read your body language. Agitated movements or a tense expression o your face may upset them and make communication more difficult.  Try to find ways to relax so that you body language communicates calmness and confidence.  You may pick up clues about the way the other person is feeling from their body language, even if words fail them. The expression on their faces and the way they hold themselves and move can give clear signs about how they are feeling. Speaking  Speak clearly and calmly. Try not to speak sharply or raise your voice. This will distress the person, even if they are unable to follow sense of the words.  Use simple short sentences  The person will need longer than they used to in order to process the information – so allow enough time. Try not to hurry them. If you do they will feel that you are putting them under pressure, even if that is not the carers intention.  Try to avoid asking direct questions. But if you have to ask the question one at a time and phrase them in a way that allows for a ‘yes’ or ‘no’ answer  People with dementia find it hard to make choices and are likely to become confused and frustrated if they are asked to do so.  If the person does not understand what you are saying don’t keep repeating the same words. Try using a different format Encourage spontaneity  Humour can help bring you together and is a good safety net. Laughing together about misunderstandings and mistakes can help.  If the person is feeling sad they have a right to express these feelings. All you can do is show them that you care. Showing respect  Never speak down to the person or treat them as a child, even if they understand very little and never allow other carers to do so either.  Try to include the person in conversations with others. Including the person in social groups preserves their fragile sense and protects them from the feelings of exclusion and isolation which can be overwhelming. Remind yourself again that everyone reacts badly to being patronized  It is also important not to converse across the person with dementia as if they were not present. People with a variety of disabilities complain at being treated in this way, but it is a particular hazard for people with dementia. If you are getting little response from the person it can be tempting to do this, but it can cause great irritation, frustration and sadness WHOSE REALITY Fact and fantasy can become confused as dementia progresses, Try not to respond with a flat contradiction to a statement that you know to be untrue. Thus if the person says ‘ I must leave now – mother is waiting for me’ you may reply ‘ your mother used to wait for you, didn’t she’. At all costs avoid making the person with dementia feel foolish in front of you.

OTHER DIFFICULTIES Pain, discomfort, illness or the side effects of medication can also make communication more difficult. Check with the GP at once if you suspect this is happening. Problems with sight, hearing or ill-fitting dentures can also hinder communication. Make sure that prescription glasses are correct, that hearing aids are working properly and that denture’s fit well and are comfortable. KEEPING CLOSE Affection can help to keep you close even when conversation becomes difficult. You can communicate your care and affection by the tone of your voice and the touch of your hand. The reassurance you can give by holding the persons hand or putting your

7 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018 hand around them (if that is appropriate) should never be underestimated. Here again we can see that actions speak louder than words.

AGGRESSIVE BEHAVIOUR All carers will find that a person with dementia will sometimes seem to behave in an aggressive way. They may be verbally abusive or threatening, for example, or kick and pinch, or they may lash out violently against people and property. If such behaviour occurs you will feel anxious about the best way to cope. Here are some suggestions.

A person with dementia may react in what appears to be an aggressive way. If they feel frightened or humiliated, or frustrated because they are unable to understand others or make themselves understood. Someone may also become aggressive if his or her judgment and self-control has been eroded by the dementia. They may be no longer be restrained by their inhibitions learned in early childhood and forget how to behave appropriately. Aggressive behaviour sometimes seems to take the form of an over-react. The person may shout or scream or become very agitated as a result of what appears to be a very minor setback or criticism. Any form of aggressive is upsetting but is important to remember that the person is not being aggressive deliberately. They will probably forget the incident very quickly, although the emotion which caused them to behave in this way may persist. You may take longer to forget the incident than they do.

TRIGGERS FOR AGGRESSION If you look carefully at the situations in which the person becomes aggressive and the events that lead up to the outburst, you may be able to identify the trigger and gain some understanding of what might be troubling them. Of course, it is not possible to analyse such a situation until it is over. But, when the heat of the moment has passed, you may be able to think about what happened and why. If there seems to be no pattern to the behaviour and it is becoming very much to manage, seek professional advice. Possible reasons for a person with dementia behaving aggressively include situations in which they:

 Feel frustrated, under pressure or humiliated because they are no longer able to cope with the everyday demands of life. It takes longer for the person with dementia to process information and respond to a situation in words or in actions. It is therefore common for them to feel pressured.  Feel their independence and privacy are threatened because they are forced to accept help with intimate functions such as washing, dressing and going to the toilet. These are areas of life which have been private since childhood. It is not surprising that these become particularly stressful  Feel they are being judged or criticized because they have forgotten something or made a mistake in completing an everyday task.  Feel bewildered or frightened because there is too much noise or too many people around them or there has been a change in familiar routine. All these things can be hard for a person with dementia to manage The person may also react aggressively in situations where they :  Feel anxious or threatened because they are no longer able to recall certain people and certain places. They may be convinced that they are in the wrong place or that a relative is a stranger who must have broken into their home  Feel frightened because of a sudden noise, sharp voices, abrupt movements or a person approaching them without warning from behind  Feel discomfort, pain, boredom or thirst.

PREVENTATIVE MEASURES

8 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018 If you can find out what may be upsetting the person with dementia you may be able to reassure them or you may be able to find ways of making situations less distressing. Try to obtain advice from other carers or from professionals where appropriate.  Reduce demands on the person if they do not seem to be coping, to ensure that there is an unrushed and stress-free routine.  Explain things, wherever possible, calmly and in simple sentences, allowing more time for the person to respond.  Find tactful ways to offer help without seeming to take over. Guide and prompt the person and break down tasks into easily manageable so that they can do as much as possible for themselves.  Try not to criticize. Hide any irritation that you feel. Avoid situations the person is set to fail. Praise any achievements and focus on the things which the person can still rather then those that are no longer possible. IN ADDITION  Watch out for warning signs as anxious or agitated behaviour, restlessness and offer more reassurance, if appropriate  Avoid sharp voices and sudden movements. Too much noise or too many people may add to their confusion.  Avoid confrontation. Try to distract the person’s attention if they seem upset. You might find that it helps if you leave the room for a few moments  Find activities to stimulate the person’s interest. Make sure that the person has enough exercise.  Make sure that the person has regular health checks and consult the GP immediately if they seem to be ill or in discomfort.

COPING MEASURES Prevention is the best solution foe aggressive behaviour but it will not always work. If this type of behaviour occurs, don’t blame yourself. Concentrate on handling it as calmly and effectively as possible.

At the time  Try to stay calm and do not enter an argument however upset as your heated response will probably make the situation worse.  Take a deep breath and count to ten before you respond. Reassure the person and try to distract their attention. Leave the room is necessary  Try not to show anxiety as this may increase the person’s agitation.  If the person is physically violent, give them plenty of space. Closing them or trying to restrain them, unless absolutely necessary, can make matters worse. You may need to leave them until you have both calmed down. You may also have to call the seniors or manager for help. Afterwards  Do not try to punish the person by, for example, withdrawing a treat or ignoring them. They are not able to learn from experience and will ably forget the incident very quickly. However they may feel a general sense of unease for some time. Try to behave as normally and reassuringly as possible  If aggressive incidents are frequent or worrying carers must consult professionals such as old-age psychiatrists as they may be able to offer advise and other ways of handling the situation  Generally it is best to avoid treating aggressive behavior with drugs. These can suppress behavior without addressing its cause and may add to confusion.

MAINTAINING SKILLS

A person with dementia is a unique individual. As a carer you will want to do everything you can to preserve their dignity and confidence. Each person experiences dementia in their own way but, using encouragement, a reasonable routine and common- sense measure, you can help them to continue to make the best use of their skills and abilities as their condition changes. Try to encourage the person with dementia to do whatever they can for themselves and only offer as much help as is necessary. If they are struggling with a task, avoid the temptation to take over completely, even though it may seem easier and quicker. If you take over, the person is likely to lose control and cope less well. 9 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018  If you need to offer assistance, try to do things with the person rather then for them. The person will then be more likely to feel involved. .  Always try to focus on what the person can do rather than what the person cannot do.  Try to be patient and allow plenty of time. If you feel yourself becoming irritated , take time out and call another carer. Make sure that the person is safe.  Give plenty of praise and encouragement.

WAYS OF HELPING

The person may find certain tasks increasingly difficult as the dementia progresses, while others may remain much longer. Adjust any care/help you give accordingly so that they can make the best use of the skills they possess. Ways of helping that may be appropriate at different times include  The person may be able to complete a task when it is broken down into sections, even if they can’t complete it. An example of this is getting dressed. Putting the clothes out in order they are put on may make it possible for the person to continue to dress themselves. Achieving one or two steps of the task may give them a sense of achievement.  Give tactful verbal reminders or simple instructions. Try to imagine that you are the person receiving the help and speak in a way that find helpful.  Doing things together , such as folding clothes or drying dishes can be very helpful.  It is very important that the person with dementia does not feel they are being supervised or criticized in any way. The tone of voice can count as criticism as the actual words.  Pointing, demonstrating or guiding an action may sometimes be more helpful than any verbal explanations when the dementia is more advanced for example, the person may be able to brush their own hair if you start gently guiding their hand. FEELING SAFE

 Feeling safe is such a basic human need. A person with dementia is likely to experience this is an unsafe place for much of the time. We can only imagine how frightening it must be to experience the world in this way. This is why the person with dementia may try to keep as close as possible to people they recognize.  The less anxious and stressed the person with dementia feels the more likely they are to be able to use their skills to the best advantage. A relaxed, uncritical atmosphere is therefore very important.  Too many conflicting sounds or too many people can add to confusion. If possible, turn off the radio or the television or, if the person needs to concentrate on something in particular, take then to a quieter place.  A person with dementia is quite likely to be upset or embarrassed by their declining abilities or clumsiness. They will need plenty of reassurance.  Although you need to be tactful and encouraging, sometimes the ideal thing to do when things go wrong is to have a good laugh together.

OCCUPATION

We all need to feel useful and needed. This does not change when someone develops dementia. Carrying out appropriate activities around the home and garden is a way of enabling a person with dementia to feel useful and to practice everyday skills. Suggestions for chores in the home include dusting, drying dishes, and folding laundry and so on. You will know what the person’s past interests were. Look and see whether you can help them to maintain skills related to past interests. If the person enjoyed cooking they may be able to help with a particular dish..  It is more important that the person feels useful then being able to do a task perfectly.

MEMORY AIDS

Memory aids and frequent reminders given at the appropriate stage may help the person to practice their skills longer. Common sense measures such as labels on cupboards and drawers, a large calendar, a picture/photo on the bedroom door for example can all help in the early stages of dementia when the person is able to understand the message and to act on it.

10 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018

WASHING AND BATHING. For most adults washing is a personal, private activity. Carers need to show great sensitivity and tact and to respect the dignity of the other person when offering help. A flexible approach often works best. Here are some suggestions.

ENCOURAGE INDEPENDENCE Encourage the person to wash themselves for as long as possible.  We all have our own routines for personal care, particularly when we get up in the morning. It is important to continue with these routines for as long as possible. It is worth taking a little time to analyze which routine works best. Where does the person prefer to get undressed, do they prefer a bath or shower? What toiletries are they used to, What care do they need.  Tactful reminders about steps in the process of personal hygiene are helpful  The person may like to have some assistance from you – for example handing them the soap or towel. You will become aware of their preferences as you are caring for them.

SENSIBLE PRECAUTIONS  Check that the floor is not slippery. Particularly in bathrooms  Make sure that the room is warm before the person undresses. Understand that older people are more sensitive to heat or cold then younger people  Check that water temperature of the bath is not too hot or too cold

GENERAL TIPS WHEN HELPING SOMEONE  Try and make the experience as pleasant and relaxed as possible.  Try to make sure that everything is ready before you start  Use the time to have a general chat as well as to explain what you are doing  Check for any red or sore areas while the person is undressed. Let the Manager / GP and district nurse know if you are concerned about this.  Make sure the person is thoroughly dried .

ANXIETY SURROUNDING PERSONAL HYGIENE Personal care, including washing and bathing, is a common source of anxiety with the person with dementia. This is quite understandable- we have all been used to performing these activities in private since we were small children. Common reasons for anxiety include  The person may be worried by deep water in the bath and need reassuring that the bath water is shallow  Incontinence is an emotive issue. If the person has an ‘accident’ they may be ashamed, and may refuse that it may have happened. They will need reassurance. A matter of fact approach works well, so does humour, The approach you adopt will depend on the nature of your relationship with the person  The person may be embarrassed by your presence. One strategy is to keep one part of their body covered while you help them wash the other part.  On the other hand, they may become anxious if they are left on their own and want you with them all the time. Be sensitive to the persons preferences and try to work out which approach will be the most effective. You may need to adapt your approach from time to time.

A FLEXIBLE APPROACH

Where a person is reluctant to wash you may find that different approaches work at different times, depending on the persons mood and on the severity of their dementia. Whatever happens, try to remain calm and find a solution that does not involve getting into an argument or confrontation.  The person may respond to gentle reminders about using the toilet and washing  A matter of fact approach may work best

11 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018  Sharing a joke about any muddles makes the person feel better  The person may agree to a wash because they are expecting visitors  It may be a question of timing or the way the request is phrased. The person may adamantly refuse to wash when you suggest it but may decide to wash themselves later in the day. This does not mean they are being difficult. It may relate to the damage that has been caused to the nerve pathways in the brain.  If a person appears very confused it may help them if you break the process down into small stages. If the nerve pathways have been damaged the person will not be able to process a lot of information at once. So, for example handing the soap and flannel to wash themselves and then the towel to dry themselves may work.  If bathing or showering causes distress, a strip wash may be sufficient.

EATING

It is important that the person with dementia enjoy their food and that the eat a healthy balanced diet. But for most people as dementia progresses, mealtimes become stressful. Here are some suggestions.

A calm, regular routine is reassuring for a person with dementia. Meals should be relaxed, unhurried occasions. Try to allow plenty of time for eating and ensure there are no distractions. Changes in eating habits often take place as dementia progresses.

POOR APPETITE There are several reasons why a person with dementia may have a poor appetite and seem uninterested in eating.  In the early stages of dementia some people lose interest in food as they are depressed. Depression is very common and is quite understandable. There are effective drugs for depression treatment and should you suspect this please consult the GP. Once the depression lifts the persons appetite should return.  There may be problems with badly fitted dentures or sore gums. All these thing must be checked as these will make eating uncomfortable.  If a person is not active during the day they might not feel hungry. Physical activity must be encouraged.  In the later stages of dementia the person may not understand that the food in front of them is there to be eaten. Even if they are clearly hungry, This is because the nerve pathways in the brain are so damaged that the message is not getting through. You may have to keep reminding them to eat or even guide the food to their mouth  Chewing and swallowing can be a problem as dementia advances if this is the case the advise of a speech therapist may be sought. One can be contacted through the GP

OVEREATING

12 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018 Sometimes a person with dementia may eat far more food than they recall. This is due to changes in the brain caused by the condition and is often a temporary phase. In some cases, overeating is explained by memory loss a person may completely forget that they have eaten – even if they have done so If a person is eating excessive amounts too will want to try to limit their intake, otherwise they will be in danger of becoming very uncomfortable when eating or may put on a great deal of weight People with dementia often seem to prefer to eat carbohydrates and sweet foods, It may be that their tastes have changed and they find these comforting. However it is important for a person’s health that they have a balanced diet. Sometimes people seem compelled to search out and consume any type of food. You will need to be aware if this is a problem because, apart from over eating, the person may eat or drink unsuitable or even dangerous substances  Put anything, which you do not wish to be consumed out of sight.  Try to distract the persons attention or find a satisfying activity as a substitute for eating  If the person constantly seeks out food, try to provide non-fattening snacks such as fruit or raw vegetables

MAINTAINING INDEPENDENCE It is very important to encourage the person to feed themselves for as long as possible. Table manners may deteriorate because they are forgotten or the problems with co-ordination develop. You will need to be flexible and tolerant.  Try to concentrate on the needs of the person and not the mess. Use common sense measures such as plate guards,.

PROBLEMS WITH EATING Problems with eating are common in dementia, for example the person may refuse to open their mouth, they may not open their mouth unless they are reminded to do so, They may accept food but not swallow t, or they may chew the food and then spit it out. They may resist the person who is trying to feed them and push them away, they may throw food or they may turn their head for example. These reactions may be due to discomfort in the mouth or the damage in the brain. They are not signs that the person is being deliberately difficult. If you have to feed the person, try putting the food into their hand and guide it to their mouth, involving them in the process of eating. Never try to feed the person when they are drowsy or agitated or when they are lying down as there is a danger of choking.

A HEALTHY DIET It is important to encourage the person to eat a balanced diet. They may become more confused or ill if they are lacking certain essential nutrients. If this is the case consult a GP who may prescribe vitamins or other dietary supplements During the later stages some people develop a taste for specific foods. Foods with strong flavours are surprisingly popular at this stage. Constipation is a common problem, especially the later stages of dementia, and can increase confusion. Ensure the person has a fibre-rich diet and drinks plenty of fluids. If constipation becomes a serious problem consult the GP. In the late stages of dementia, weight loss is a normal symptom, If they are very restless and physically agitated they may be using more energy than the calories they are consuming or there may be a medical problem.

TIPS  Elaborate meals are not essential. It is probably better to devote your energy to ensuring that the person eats and enjoys their meal.  You may find that frequent small meals or nutritious snacks are more tempting for a person who is restless or who has a poor appetite.

13 PINE VIEW CARE HOMES LTD T/A Pine view Groby Lodge Silver Birches 418 – 420 Hinckley Road 452 Groby Road 85 Lutterworth Road Leicester Leicester Aylestone, Leicester LE3 0WA LE3 9QB LE2 8PJ OP, DE(4) OP,DE(3) OP, DE Tel : 0116 2855868 Tel : 0116 2871970 Tel : 0116 2832018  The taste of food is affected by dementia. You may need to offer sugar/ salt and pepper which the person did not use before. However you will have to remove them if the person uses them excessively.  Make sure that food and drinks are not too hot – people with dementia may lose the ability to judge temperature.  Encourage the person to drink enough liquid each day. Too little may lead to dehydration which apart from anything else will make the person mare confused.