Managing Clients with Dementia

In your time as a carer, you will have worked with multiple dementia patients. Because so many of your patients suffer from Dementia, it is important to keep your knowledge up-to-date.

The Basics:

What is Dementia:

Dementia is an umbrella term that describes a range of neurological disorders. No experience of dementia is identical, but common symptoms include memory loss, difficulties with thinking and language, and a declining ability to carry out everyday activities. Dementia currently affects almost one million people in the UK.

Dementia is a progressive illness, meaning that symptoms will worsen over time. Depending on the type of dementia, a person’s mental functions may decline steadily (as with Alzheimer’s disease) or more rapidly. In cases of vascular dementia, individuals often experience ‘stepped deterioration’, characterised long periods where symptoms remain the same, followed by short periods where symptoms suddenly worsen.

Diagnosis

Any client who shows a sudden or significant change should be referred to their GP or local health worker immediately. Dementia can affect people of any age, but is most common in those over 65. Despite this, many people remain undiagnosed until other problems arise.

Getting diagnosed can be a lengthy process. Often, the early symptoms of dementia are dismissed as a part of getting older. Dementia may also be mistaken for other illnesses and conditions such as infection, sensory problems, delirium or depression, due to common symptoms like confusion and incomprehension. However, as a client passes through the various stages of dementia, their symptoms will become increasingly apparent. A screening will be able to confirm the form of dementia your client is suffering from. Over time, your client’s condition may change significantly, and they will require more care and support as their symptoms worsen.

Patience, compassion and a good understanding of dementia can significantly improve your clients’ quality of life.

Two Common Types of Dementia

Alzheimer’s Disease

Typically, Alzheimer’s disease causes a steady decline in cognitive function, and progresses in three stages: mild (early stage), moderate (middle-stage) and severe (late-stage). Although Alzheimer’s affects people in very different ways, each stage usually has at least some of the following symptoms:

In the early stage, individuals may

• forget things like recent events
• repeat themselves
• have difficulty concentrating
• easily become confused
• have a lack of motivation

In the middle stage, individuals may

• Get lost while out
• Experience hallucinations and have problems understanding their environment
• Do odd things without realising
• Create risks through forgetfulness (such as forgetting to lock doors, or leaving the cooker unattended)

In the late stage, symptoms become more severe, and left unmanaged, can seriously affect a person’s quality of life. At this stage, individuals may

• Have difficulty eating or swallowing
• Struggle to communicate
• Lose their mobility
• Become incontinent

For more information about managing Alzheimer’s, visit:

• www.nhs.uk/conditions/alzheimers-disease/
• www.alzheimers.org.uk
• www.alzheimers.org.uk/about-dementia/types-dementia/what-dementia
• www.dementiauk.org/understanding-dementia/about-dementia
• www.dementiafriends.org.uk

Vascular Dementia

Vascular dementia is common in those who have suffered a stroke (or mini-strokes), and is caused by a reduced blood supply to the brain, which leads to the death of brain cells. The severity of symptoms depends on where in the brain the damage has taken place. The location of the damage largely determines an individual’s ability to function, and what capacities they may lose. 

For those with vascular dementia, deterioration can be unpredictable, and often depends on the frequency of Transient Ischaemic Attacks (TIAs), the mini-strokes which cause symptoms to suddenly worsen.

Symptoms of vascular dementia include:

• Difficulty concentrating
• Forgetfulness
• Loss of reasoning abilities
• Visual and perception problems
• Deterioration of physical strength or ability

For more about managing vascular dementia, visit:

• www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia
• www.stroke.org.uk 
• www.nhs.uk/conditions/transient-ischaemic-attack-tia/

Supporting clients with dementia

Though caring for clients with dementia can be challenging, it can also be an immensely rewarding experience, allowing you to develop a range of skills and build a strong relationship with your client. Always treat those suffering from dementia with dignity and respect: they are still the same person, just facing new challenges—challenges which can be managed with your support.

Know your stuff

By gaining a good understanding of dementia, you will be able to provide your client with positive, focused support, tailored to their personal needs. By focussing on your client’s individual needs, you can significantly improve their quality of life. It will also allow you to rediscover activities and experiences your client once enjoyed and even experiment with new ones, such as arts and crafts, music, films or walking.

Managing difficult behaviour

Always minimise background noise when speaking to a client with dementia. By reducing environmental distractions, you will help your client to focus, and reduce the likelihood of stress, confusion or upset. Try to use positive facial expressions, simple hand gestures and maintain eye contact, to make communication as clear as possible.

Receiving poor care, being ignored, or being treated like a child can cause dementia sufferers significant distress, and may cause them to react by

• Shouting or screaming
• Calling for help
• Lashing out
• Wandering
• Experiencing episodes of anxiety
• Becoming withdrawn

For more information on supporting clients with dementia, visit:

• www.ageuk.org.uk/information-advice/care/helping-a-loved-one/caring-dementia/
• https://www.caregiver.org/caregivers-guide-understanding-dementia-behaviors
• www.unforgettable.org/blog/i-care-for-someone-with-dementia-what-now/

Managing very challenging behaviours

Some types of dementia can give rise to other more challenging behaviours, which may put the client and those around them at risk of harm.

Some forms of challenging behaviour can be disturbing or even dangerous. If you think you are at risk of harm, leave the situation as quickly as possible. This will help prevent the situation from escalating, and reduce the immediate risk of harm to you and your client.

When dealing with challenging behaviours, remember that your client is a vulnerable person. Respond to the situation calmly and report any instances of challenging behaviour to their GP or an Occupational Therapist (OT), who will be able to arrange an assessment for your client. As part of this screening, a team will determine whether it is in your client’s best interests to be referred to their local mental health services under the Mental Health Act 2005. These services may see it fit to bring in a specialist team to support your client on a 24-hour basis.

Forms of challenging behaviour include:

• Hitting, kicking or biting
• Aggressive manner
• Shouting, swearing or verbal insults
• Wandering
• Repetitive questioning
• Inappropriate sexual expression or behaviour
• Self-harming
• Hoarding
• Urinating in inappropriate places
• Collecting or smearing faeces
• Non-compliance with care (refusing medication, washing, eating)

Medication

Some of these symptoms and behaviours can be alleviated with medication, though it is important to fully understand the potential side effects of any substance before administering. Some side effects can be serious, and may change the care needs of your client. These medications may only be taken if prescribed by a health professional.

Medications include:

• Anti-psychotics (e.g. haloperidol, risperidone)
• Sedatives/benzodiazepines (e.g. diazepam)
• Anti-depressants (e.g. citalopram)
• Anti-convulsants (e.g. sodium valproate)
• Anti-dementia drugs (e.g. donepezil)

Setting up the home

There is a range of ways your client’s home can be adapted to ensure their safety and improve their wellbeing and independence. 

You might consider:

• Sensory aids
• A commode
• Using picture cards on doors and cupboards
• Writing down simple instructions on cupboards, doors, and fridges
• Surrounding the client with reminders of their life (photographs, objects etc.)
• Getting a professional to disconnect the cooker/oven
• Installing a pre-programmed telephone
• Installing sensory alarms (if they are prone to wandering)
• Bringing in specialised carers

More can be found on home adaptations here:

• www.dementia.co.uk/products/bed-leaving-sensor-mat-alarm-mat
• www.completecareshop.co.uk/household-aids/night-lights-and-safety-lights
• www.healthandcare.co.uk/blog/top-10-dementia-wandering-products
• https://alert-it.co.uk

Should your client need further specialist care, you may wish to consult the following:

• Speech and language therapist
• Occupational therapist
• Audiologist
• Social worker
• Dementia nurse
• Advocacy service
• Dementia support services
• Dietician
• Specialised carer