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Philosophy of Care

Tuesday, 05 Feb 2019
For someone who has learning disabilities and dementia, it is important to establish a philosophy of care to reduces the levels of stress within that person, as well as those surrounding them. Here at LDCareTraining.org we have provided three key points to aid mindfulness for those with learning disabilities and dementia. These are a) producing a life story book and making a special fun box, b) thinking ahead and being prepared, and finally c) following routine and creating a calming environment. Within this post I will elaborate on how training can successful achieve these important points of care.



Life Story Book and Special Fun Box
The making of a life story book, which is essentially a photo album, with dates and captions creates a life story for a person living with dementia. Living with dementia can mean that ones field of vision and clarity of vision becomes more limited and so, eventually, they may only see what is directly in front of them. When this happens, then sizing up photos and captions will really help the person to see them more clearly. With rollback memory it is important to include all phases of a person’s life, correctly dated, which can further help loved ones and carers in understanding the person’s history and where they are in their roll back memory (see previous blog entry for more about Roll Back Memory). A box full of fun special objects, which can be handled, from a person’s past can be extremely comforting too. Suggestions for this box could be a Teddy Bear, Building Blocks, Books, Soft Ball as an example, they should be things they know and recognise.

Thinking Ahead and Being Prepared
Knowing a person well enough to recognise situations in which they may become stressed, is hugely important. This encompasses what thinking ahead and being prepared is, as essentially it is helping create a calm frame of mind. If you know the person has certain triggers, you are able to plan ahead to avoid them. For example, it is important to celebrate what someone with dementia or learning disabilities can do, so they feel included and failure free. Allowing them to carry out tasks, regardless of how well they may or may not be able to achieve them. See our free video on this on the website.



Routine
Understanding a person’s routine and habits is vital in establishing a philosophy of care. Never assume! A dementia workbook for staff can record likes, dislikes and situations likely to provoke stress. By providing clear and simple choices helps to achieve a calm environment, and not arguing with the person is crucial. In certain situations, you should ask yourself ‘does it really matter?’; enjoy their rollback memory, validate the experience and be with them in their world. By meeting their changing needs, you will help to reduce anxiety, and ultimately create a safe, secure, happy and enriching environment in which to live.


It is important to remember to go with the flow, forget targets and don’t stress or confront the person, in order to provide the best care possible. Keep communication simple and changes to a minimum, whilst continually planning the needs of their present and future. Be proactive and prepared and together we help them live fulfilled lives filled with meaning.
Posted by Anna White

How to Spot Dementia

Friday, 07 Dec 2018

How to Spot Dementia


This is one of the most commonly asked questions on our website.

So congrats for coming to learn!


If you have watched our third video, How to Spot Dementia, the 3 key learnings below will be at the forefront of your mind. In this blog we will unravel these 3 key learnings and help shine some light on how to spot dementia.


3 keys of learning

  • Baseline Assessment - have one done at the peak of cognitive skills
  • Engage your local service to have a health check – to rule out all other possibilities
  • Get some of the reading and DVD materials listed to help you


As always if anything we have covered has raised concerns for you or your loved ones, you are not alone. There are many charities set up to help. We have listed some below:


https://www.dementiauk.org/

https://www.downs-syndrome.org.uk

https://www.alzheimersresearchuk.org/

https://www.alzheimers.org.uk/

https://www.ageuk.org.uk/

https://www.youngdementiauk.org/


Early stage dementia

It is critical that there is no immediate assumption that a change in behaviour has been caused by dementia. For this reason, it is vital to first rule out all other possibilities. This said, the following changes in a person could be signs of early dementia.


  • Subtle changes in behaviour and mood
  • Night time waking
  • Loss of interest in favourite hobby
  • Performance at day placements deteriorate
  • Problems with 3D vision
  • Problems with memory for recent events
  • Ability to learn new information is affected
  • Language and word finding problems
  • Decline in social, community and daily living skills
  • Disorientation or challenging behaviour
  • Difficulties with steps, stairs, and kerbs due to depth perception problems. (Depth perception is common in dementia. You may have noticed a loved on raising their leg as though to step when there is no step in front of them. This is because changes of colour can be misunderstood as a change in depth.)


If you have noticed any of these changes in someone you are caring for please phone your local care team to make an appointment for a Baseline Assessment. Your local care team will be able to organise the Baseline assessment which will lead to a definitive diagnosis. The assessment will be made up of a variety of puzzles, games and questions, in order to measure cognitive skills.


Assessments for adults with Learning Disabilities will often include:


  • Medical assessment e.g. hearing, sight, blood tests to rule out other conditions
  • Cognitive assessment e.g. orientation, memory, learning, language, visual-spatial skills
  • Adaptive assessment e.g. daily living skills, social and communications skills
  • Behavioural assessment e.g. changes in behaviour, personality, unusual or challenging behaviours
  • Background history: medication, medical history, health, past abilities, risk factors e.g. head injury, family history
  • Psychological/ psychiatric assessment e.g. mental health problems, real life events, bereavement, social and physical environment
  • Need robust baseline assessment of individual’s cognitive and social functioning in early adult life circa age 30. (Excellent documentation by care providers is vital, especially for those with LD who move from home to home. Ensuring an assessment is carried out at the peak of an person’s cognitive skills ensures that there is something to compare with as time progresses.)


As previously discussed, it is important to not jump to an assumption of dementia as many other conditions present like dementia. One such condition being delirium. It is essential the correct process is undertaken to rule out other causes. Here is a range of other conditions that may be causing this change:


  • Differential diagnosis
  • Endocrine or metabolic disturbance
  • Toxicity - combinations of drugs causing the person to seem confused
  • Heart disease
  • Bone fractures
  • Constipation
  • Lack of sleep
  • Dehydration
  • Poor diet
  • Visual and hearing impairments
  • Pain
  • Grief reactions
  • Environmental changes


This can be a worrying time and you may have a lot of unanswered questions. For example; What percentage of people who have LD know they have LD? How many know the word ‘dementia’? What will you tell the person about why you want to do a baseline assessment? What other ways can you introduce issues of aging and dementia?


Diagnosing dementia is all about the small changes. Reach out and ask for help.


If you have any further questions or concerns do not hesitate to get in contact with us or a leading charity. We have also listed below some great books and DVDs which will help you in your journey..


Books and manuals for people with learning disabilities

http://www.bild.org.uk/our-services/books/health-and-well-being/about-my-friend/

For those who live in a care home and need to understand what is happening to their friend
It has lots of pictures


Down's Syndrome and Dementia Workbook for Staff
This is designed to go with each person where ever they move to and each and every person should have one! It has pages for staff to write notes and is really excellent. An invaluable investment.
Pls call DSA on UK Number 0333 1212 300 and they will send you a copy for £15


The Simplicity of Dementia

Buijssen, H. (2005) The Simplicity of Dementia. London: Jessica Kingsley


Contented Dementia
Good general read with loads of coping ideas and real life people examples
http://www.amazon.co.uk/Contented-Dementia-Wraparound-Lifelong-Well-being/dp/0091901804


Disability and Dementia
Diana Kerr
http://www.amazon.co.uk/Understanding-Learning-Disability-Dementia-Interventions/dp/1843104423/ref=pd_bxgy_b_img_b
Also available in Dutch, Chinese and Norwegian


We are here to help so reach out to us and we will do all we can to support you.

Posted by Anna White

What is Roll Back Memory?

Thursday, 25 Oct 2018
To better understand the difficulties that people with dementia experience in relation to their understanding of memory and who they are, what they are doing and how they see others, it is important to understand the ways in which memories are stored and subsequently damaged by dementia. Diana Kerr states "we have two kinds of memory, short-term and long-term memory. New information is stored in our short-term memory for about 20-30 seconds before being transported into our long-term memory.” (Kerr, 2007) When someone develops dementia, however, the ability to retain memories by moving them back into the long-term memory breaks down and eventually memories are unable to be moved into the long-term memory at all. This means from the moment dementia onsets, the amount of information able to be stored reduces.


3 keys of learning will be explored in this blog:


1. Shelf of yearly Diaries and Roll Back Memory

2. Proactive attention to every day details e.g. like hand dryer

3. Mirrors – be aware the person may not recognise themselves


1. Shelf of Diaries


Hubb Buijssens The Simplicity of Dementia (2005)

A great way to better understand the way memory works is to look closely at Buijssens "Shelf of Diaries” illustration. It should be noted that not all diaries roll back. Memories which are revisited time and time again are reinforced and may remain.


2. Proactive attention to every day details e.g. a hand dryer


Imagine a time before the electric hand dryer. If you woke up one day and had only used a towel to dry your hands, you would be very confused by the many different forms which hand dryers come in today. For those with dementia, this is a common problem. Without access to the last 20 years of memories, they know only a world pre-hand dryer. This means when faced with an object that they do not recognise they will likely feel anxious and stressed. It is important to try to avoid stress for people with dementia.


3. Mirrors – be aware the person may not recognise themselves


Mirrors can also pose a problem for people with dementia. They can lead to people with dementia feeling frightened or confused. "Because of the loss of recent memory, the person no longer sees themselves as the age they are. If they look into a mirror the person they see will not tally with their own self-image, which is of a younger person” (Kerr, 2007) For this reason, people with dementia may wave at a mirror or their own reflection, as they do not recognise it to be themselves. So we begin to understand the hurdles that people with dementia face and how we as their support can help them navigate this world which is partly in the present and partly of memories. When we understand their frame of reference so we are able to assist them live their lives to the full.


References:


Diana Kerr (2007) Understanding Learning Disability and Dementia: Developing Effective

Buijssen, H. (2005) The Simplicity of Dementia. London: Jessica Kingsley Publishers, p.37.

Posted by Anna White

Learning Disability & Dementia Training – An Introduction.

Tuesday, 23 Oct 2018

In recent years there has been an increase in the conversation surrounding dementia. There are a number of possible factors behind this – the millions of baby boomers turning 65 or perhaps the improvement in medicine and care. However, there is a demographic which is often overlooked and underdiscussed – that is people with Learning Disabilities (LD) and in particular those with Down’s Syndrome (DS). Typically in the general population, 1% of people develop dementia in their 60s, which grows to 30% once they reach their 90s. For those with Learning Disabilities and Down’s Syndrome, dementia can make an appearance significantly earlier whilst also affecting an even larger proportion of the demographic. I am a Learning Disabilities and Dementia care trainer. My sister, who has Down’s Syndrome, was recently diagnosed with dementia. I noticed a lack of representation for people like my sister and struggled to find the right resources to provide her with the care and support she needed. This sparked my quest to help others in similar scenarios and so designed a series of 6 educational videos. I consulted with world renowned experts such as the clinical psychologist Dr Karen Dodd and Dementia Consultant Diana Kerr. These videos have been created to provide advice, valuable information and knowledge for looking after people with LD and DS, whether that be care homes and their teams or the families who are looking after their loved ones from home.


Below we have provided a brief overview of each of the six videos and why they may be beneficial for you.


Video One – Introduction

The first video provides you an overview of what’s to come in the 6 step support series. It will explain what it all means as you embark on your trip of discovery to transform care into hope, joy and empowerment. Each video is only 10 – 20 minutes long, making it easier to slip your learning into small pockets of spare time.


Video Two – Roll Back Memory

This episode advises you on how to help your loved ones feel at ease. Briefly explained, Roll Back Memory addresses the way your loved one’s memory will roll back from the present day to days gone past. There are a number of ways you can support them by validating their experience which is explained in more detail in the video.


Video Three – How to Spot Dementia

Have you noticed some subtle changes in mood? Are there pauses whilst searching for a word? This episode sheds light on the symptoms of dementia, even in the earliest of stages.


Video Four – Philosophy of Care

Get ready for some astounding realisations! In Episode Four we demonstrate some effective solutions to revolutionise your understanding of their experience to help provide hope and comfort to their lives.


Video Five – Understanding, Managing and Preventing Pain

In Episode Five we will learn how to distinguish what pain is being presented, with guidance on what to do and how best to help.


Video Six – Environment Management & Tips

Do they seem startled at loud noises? Why is language simplification so important? Is routine necessary? By using some of these simple steps you could transform your loved ones’ quality of life.


Join me and let’s us take this journey together. Email us if you have any questions or if we can help.

Posted by Anna White

Wordpress for all future Blogs

Wednesday, 23 Dec 2015





Hi Everyone

Thank you for your emails and comments.

By popular demand my Blog will now move to Wordpress.

So keep in touch will all the news and updates by subscribing through Wordpress.

Just click on the Wordpress symbol top right of this page!


 
Posted by Anna White

Life Story Book

Monday, 06 Apr 2015

In order to help the person who has dementia a Life Story Book should be made. 

This is because the memory rolls back with time. It ensures that the whole care team can meet the person in the various places of their life.  The images give them a mutual snapshot upon which to connect.

 

A life story book is great fun that everyone can enjoy and be a part of.

 

This is in effect a photo album with lots and lots of photos that catalogues what was or is important to that person in their life.  Remember also that as Dementia progresses so might the clarity of the vision and field of vision reduce for the person concerned.  A person with Learning Disabilities with Dementia may well eventually only be able to see what is directly in front of them.  So where that person may be able to see a photo today which is 6 inches by 4 inches.  You may find they will only later on be able to see something that is the size of a full A4 page - so be ready to upscale the pictures when needed!

 

Remember with roll back memory we need to get photos that are from all phases of the person life and when you are putting this photo album together it might make sense to put it in date order too. A life story book is never finished it should be continually updated and is fun for all to do together.

 

It is also important to add dates and captions, so for example "A day at Blackpool beach – Tom aged 6 with Mother and Father 1963" - be as specific as possible as that will ensure that anyone looking at the life story book will also be able to guide the person will dementia as they read along.


Enjoy the memories - they are all precious!

Posted by Anna White

Happy New Year 2015!

Saturday, 17 Jan 2015



This year is about empowerment.
The best thing about the future is that it comes one day at a time.

"I am a firm believer in the people. 
If given the truth, we can be depended upon to meet any national crisis. 
The great point is to bring them the real facts."
Abraham Lincoln

Roll Back Memory
This is when the memory starts rolling back from the present day.
This is because the brain is not able to store new memories and so that is why you will find a person will speak of times gone past as these are the memories that remain in the mind.  
Therefore enjoy this roll back memory - be in same place they are.  
This can also be a source of bonding and give reassurance.  
Email us if you have questions, we are here to help.
We can give those we help the joy of life if we can enjoy the joy in the moments we have together.


Live with passion!


Posted by Anna White

Too much Radio!

Thursday, 27 Feb 2014
I went into a care home the other day to visit a friend.  I noticed that there was a lady in one of the sitting rooms in her wheel chair who had lost the ability to talk and she had dosed off.  The radio had been left on in the room with her.  It was quite loud and I did wonder if it was too loud!  Then I saw her take the cushion next to her and try to cover her ears with it!  IT WAS too loud - and this was her way of trying to convey it.  Remember training is key - we need to be ever careful and watchful.  
Posted by Anna White

Watch out for those chairs!

Monday, 24 Feb 2014
Hi everyone.  I was reminded today when I saw my sister sit in a chair that her legs did not touch the floor.  Of course!  That is why she has a back ache.  Remember to use a footstool for those who need it so they can make sure they don't get a back pain.  Now where did I leave the footstool last I am thinking . . . . !  Take care and more soon.
Posted by Anna White

The Joy of Music

Sunday, 23 Feb 2014
Have you ever thought when you are listening to the radio how it brings back memories?  It is like a time capsule that takes you right back to the place you were when you first heard it or a special memory?  Well for someone with Dementia it is just the same.  We have seen examples of where people may have lost the ability to speak but can sing a song.  

Remember to bring music in to the lives of those you care for.

More soon!
Posted by Anna White