What can be done, or what resources can be obtained, to improve the dementia care of residents in care homes or general hospital settings?

Introduction

Due to concerns about the increase in the prevalence of dementia within an aging population and the difficulties of knowing how best to support dementia sufferers in general care settings; it was decided to investigate what could be learnt and easily introduced to improve the experience for both patients, residents and staff without going to any great expense.

Visits and Literature Search

Due to support from The Atkinson Morley and Amandus Club Neuroscience through the Florence Nightingale Foundation, it was possible to make visits to the Salford University based Dementia Centre, a community resource centre for the elderly specialising in dementia, to a new EMI unit and to complete my degree. Increasing awareness of the problems experienced and increased knowledge of how to adjust environments is having a huge impact on the experience of dementia sufferers and consequently, their carers’ and loved ones too.

From the Literature search, certain types of activity have also been shown to help delay dementia (Verghese, 2003, 2010) or to reduce some of its more disruptive symptoms.

Method of investigation

Using a Multi – research approach with flexible design: Firstly an evaluation was done to look at the uptake of existingactivities available in a dual registered nursing and residential home. This looked at the types of activities and at how many people participated in them. The results and implications are then discussed.

A questionnaire was then used with colleagues in other nearby homes to ascertain how effective they felt additional resources might be or what experience they already had of them. A pilot qualitative type study was then set up to review some relatively inexpensive new resources to see how they made a difference to the lives of patients, visitors or staff. A structured observation list and numerical assigning of an effectiveness rating score applied by the same researcher, to reduce bias, was used to observe and monitor the effects of the resource with a small sample of appropriate residents. Relatives were invited to share their experiences as well.

Findings

From both the literature search and the review of participation in a variety of activities offered in a mixed nursing and residential setting, it can be seen that it is important to include a good variety of activities. There should be a mix of musical, craft, physical, social, faith and cognitive type activities. These help give variety and meaning to the day as well as promoting physical activity, helping to maintain or reignite social skills, and the use of cognitive function. Increased cognitive function has been shown to help delay the onset or severity of dementia symptoms as well as improving the well-being of individuals and in reducing symptoms of disruptive behaviour and depression (Han et al, 2010). They can thus also reduce the need for pharmacological management of symptoms.

Some newly obtained resources are also looked at. A series of books (Bate, 2006-2013) especially designed with dementia challenges in mind was shown to be helpful in a variety of situations which are discussed and evaluated. See also the appendix for full details.

Recommendations

When or where a dedicated activity co-ordinator is not available, it is important that others caring for elderly, infirm individuals ensure that different activities are still available in order to maintain a sense of well-being, to promote physical and mental health and to minimise any effects of dementia.

Appropriate multi use resources are available and should be chosen carefully for maximum potential and ease of use. It is important to remember that those suffering with dementia, particularly in the early stages, may be increasingly frustrated at their reduced abilities, especially if others belittle them or complain about their distracting behaviour. It is important to set an example and to include these residents in ways they feel comfortable wherever possible.

All staff should obtain dementia training. The Alzheimer’s Society initiative `Dementia Friends’ is doing a great job of increasing awareness amongst the general public. This should be encouraged and facilitated further, and staff too should be encouraged to get involved.

Individualised care plans should show an awareness of the presence and degree of any dementia with assessments (such as Folstein et al, 1975) and adjustments made as appropriate.

Conclusion

As well as increasing training opportunities and inviting family members of residents to also participate in dementia training, the care plans need to reflect specific requirements of individuals. Activities should be varied and accessible by any resident who wishes to participate and support given to do this. It is suggested that the Pictures to Share series of books (Bate, 2006-13) should be available in any setting where elderly with dementia reside or spend a lot of time as this resource can be used at any time to promote communication, to improve feelings of security and familiarity and thus to improve settling and well-being,

Other resources are available. Books of suggested activities such as `Keeping Busy .., ‘ by Dowling (1995) improve ideas. Reading a biography like `The Little girl in the radiator’ (Slevin, 2012) can increase understanding. Crossword puzzles, jigsaws and computer games can be useful for cognitive exercises and packages are discussed (Sunghee et al, 2014) where sets of slide shows are combined with soothing music and suitable computer games. Too many hours can be spent just sitting in their rooms or watching television on their own and that does not promote well-being, social contact, exercise or feelings of self-worth. When individuals are busy, they tend to be happier. They can be taught new activities, get involved in a music or singing class, assist with gardening, take a walk outside, do some cooking or craft, pick the balls for Bingo, be allowed to do some `dusting’, help to set the tables or many other familiar activities. We just need to remember the individual and tailor activities and care accordingly.