Dementia Flashcards
What 4 things are ALL people worried about later in life?
Cancer
Dementia
Heart disease
Stroke
What are the Gray Panthers?
Group in the US confronting ageism and other social justice issues
What are the Grey Panthers?
Walking group in the UK
What are elderly people most worried about later in life?
Dementia
What is dementia?
deterioration in intellectual function and social behaviour that presents in a variety of ways
does not affect the brain uniformly
Is dementia a disease its own right?
No
ICD10 5 main features of dementia
syndrome due to disease of brain
chronic and progressive
disturbance of multiple higher cortical functions
consciousness not clouded
accompanied by deterioration in emotional control, social behaviour or motivation
What is the most common form of dementia?
Alzheimers (65%)
What is the second most common form of dementia?
Vascular dementia (17%)
What are the three bands of severity of dementia? Why are there 3 bands?
Mild
Moderate
Severe
People require different treatment
What is mild dementia?
cognitive decline limits functional activities but independent living is possible
What is moderate dementia?
seriously inhibited functional activity. Familiar material retained but independent living not possible
What is severe dementia?
complete inability to retain new info. Assistance required for all daily living activities. Very limited communication
How many people in the UK have dementia?
around 850,000
How many people under 65 have dementia?
40,000
Are women or men more likely to get dementia? why?
Women
Greater life expectancy = more likely to get dementia
What can cause an increased risk of dementia?
Parkinson’s
Down’s Syndrome and other learning disabilities
What are the projections for dementia?
Prevalence in the older age groups will increase
Who founded the enriched model of dementia?
Kitwood
What is the enriched model of dementia?
A person centred approach to dementia, providing it as equation
Dementia=NI+H+B+P+SP
NI - neurological impairment H - health & physical fitness B - biography, life history P - personality SP - social psychology
What are the components of the enriched model of dementia?
Dementia=NI+H+B+P+SP
NI - neurological impairment H - health & physical fitness B - biography, life history P - personality SP - social psychology
Why is the enriched model of dementia important?
It appreciates that everyone with dementia is different and will require different treatments
How are views of dementia changing?
From disease to disability CT to care plans "us and them" to "all of us" Living death to living well Problem behaviours to communications
social model of disability is important here
Why is it different to know when people have dementia?
Onset is often very subtle and only recognised after diagnosis
Symptoms are under reported
Lack of self awareness
Gradual loss of self or ‘personhood’
What is personhood?
“A status that is bestowed on one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust”. (Kitwood)
Give some symptoms and signs of dementia
Struggling to remember recent events Struggling to follow TV and conversation Forgetting names of people/objects Repeating yourself Losing track of what you're saying Problems with thinking and reasoning Feeling anxious/depressed/angry about forgetfulness Other people comment on your forgetfulness Confused in familiar environments Decline in talking/reading/writing
What is the well pathway for dementia by NHS England?
Preventing well Diagnosing well Supporting well Living well Dying well
What two types of drugs can be used to treat dementia?
acetylcholinesterase inhibitors
NMDA receptor antagonists (glutamate)
How do acetylcholinesterase inhibitors treat dementia? Give some examples
May temporarily improve memory for mild to moderate Alzheimer’s disease
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)
What type of dementia do NMDA receptor antagonists (glutamate) treat? Give an example
Moderately severe to severe Alzheimer’s
Memanitne (Ebixa)
What other drugs are used in dementia?
What is the issue with this?
Drugs for other problems e.g. depression, restlessness, aggression, behaviour problems
Misuse in care homes - long term use of psychiatric drugs
What is the Banerjee report (2009)?
Looks into drugs for psychological and behavioural problems and dementia in care homes
Why are the issues with antipsychotics in dementia?
Class effects, not limited to one particular drug
Side effects are increased in elderly people (falls, stroke, CVD)
Drugs aren’t licensed for the treatment of agitation
How many people in nursing homes with dementia are on antipsychotics?
20-30%
How much of the costs of dementia falls to the family?
2/3
What are the different state/family obligations to care of dementia across Europe?
Legal obligation to provide care
Only adult children are legally obligated to provide care
Mandatory health insurance
State care is provided if the individual cannot afford it
What are the state/family obligations to care for dementia in the UK?
No legal requirement for the family OR the state to provide care beyond the NHS
If individual has resources to pay for care, they will be used if family does not provide costs (e.g. sell house)
What are the positive aspects of care-giving?
Reciprocity and mutual affection (returning partners past care)
Companionship
Job satisfaction
Sense of duty (.. in sickness and in health, vows)
Which model has changed dementia care and how?
Social model of disability - person centred care (perspective of the person with dementia)
Dementia friendly communities (dementia friends)
