rehabilitation and dementia
TRANSCRIPT
REHABILITATION AND
DEMENTIA
Professor Mary Marshall
Definitions of Rehabilitation
ā¢ āA process aiming to restore personal
autonomy in those aspects of daily living
considered most relevant by patients and
service users, and their family carersā
ā¢ āRehabilitation is concerned with enabling
those with any short or long-term disability
to obtain the maximum psychological or
physical independence possibleā
Definitions
ā¢ āRehabilitation is about enabling people
who are disabled by injury or disease to
achieve their optimum physical,
psychological, social and vocational well-
beingā
Rehabilitation and dementia
ā¢ An unlikely pairing?
ā¢ A way of presenting an optimistic
approach to dementia care
ā¢ Could provide a useful structure for
dementia care itself
Four kinds of rehabilitation
ā¢ Rehabilitation following an acute physical
episode
ā¢ Rehabilitation following a dementia-related
episode
ā¢ Cognitive rehabilitation
ā¢ Rehabilitation as an approach to dementia
care
Rehabilitation following an acute
physical episode
ā¢ Some issues for the acute health sector
ā Low expectations
ā Role of nurses
ā Training gap
ā Pain
ā Delayed discharge
ā Moving between wards
Rehabilitation following an acute
physical episode
ā¢ Some general issues:
ā Communication skills
ā Lateral thinking
ā Doing with not doing for
Rehabilitation following a dementia-
related episode
ā¢ Reviewing medication
ā¢ Detective work
ā¢ Revising the care plan
ā¢ Changing the social and the built
environment
Cognitive rehabilitation
ā¢ Aims to enable clients or patients, and
their families, to live with, manage, by-
pass, reduce or come to terms with deficits
precipitated by injury to the brain
ā Professor Clare will explain how
Rehabilitation as an approach to
dementia care
ā¢ We need to look at the characteristics of
rehabilitation
Characteristics of rehabilitation
ā¢ Teamwork
ā¢ Working with families and supporters
ā¢ Prosthetics
ā¢ Removing causes of excess
(unnecessary) disability
ā¢ Learning and motivation
ā¢ A focus
Teamwork
ā¢ Has to be a joint effort
ā¢ Every profession has a role
ā¢ Consistency is crucial
Working with the family and other
supporters
ā¢ Families and friends can contribute crucial
information and understanding
ā¢ Families and friends may need training
and support
Prosthetics
ā¢ Design
ā¢ Signage
ā¢ Adaptations
ā¢ Equipment
Skilled assessment is essential
Removing causes of excess
(unnecessary) disability
ā¢ Almost any aspect of the personās social
and built environment can be sub-optimal.
For example:
ā Interactions which undermine confidence and
self-esteem
ā Care plans not based on personal
preferences
ā Under-nutrition and dehydration
ā Lack of activities
Learning and motivation
ā¢ Easy to underestimate the capacity to
learn of people with dementia
ā¢ Motivation is linked to self-esteem and
confidence
ā¢ Need for lateral thinking
A focus
ā¢ Could be short term, for example,
restoring confidence in cooking or
restoring continence
ā¢ Could be long term, for example,
maintaining exercise or social skills
The sub-theme
ā¢ Optimism
ā Because
ā¢ Fear has to be acknowledged
ā¢ Dementia is not entirely a negative experience
ā¢ We have increasing evidence about what works
Fear has to be acknowledged(Stephen Post)
ā¢ āIn our hyper-cognitive culture and
societyā¦ nothing is as fearful as AD
because it violates the spirit of self-control,
independence, economic productivity, and
cognitive enhancement that defines our
dominant image of human fulfilmentā¦.the
hyper-cognitive societies..can neglect the
emotional, relational, aesthetic and
spiritual aspects of well-being.ā
Dementia is not an entirely
negative experienceā¢ We need to listen to people with dementia
ā¢ āPersonally, I would not like to go back to not
having dementia. Iām in love with dementia and
fascinated with the condition. I now understand
how a kaleidoscope works, Shake me and find
out!ā
ā¢ We need to focus on the emotional,
relational, aesthetic and spiritual aspects
We have increasing evidence
about what worksā¢ In psychosocial interventions, for example:
ā Singing
ā Activities
ā Training and support for carers
ā Design features
Three questions:
ā¢ Can we be invigorated by increasing
optimism about dementia care?
ā¢ Can we improve rehabilitation for people
with dementia?
ā¢ Is this a useful way to describe dementia
care?
Sources
ā¢ Thanks to all the contributors to: Marshall, M (ed.) (2005) Perspectives on
rehabilitation and dementia. London, Jessica Kingsley Publishers
ā¢ Other references:
ā¢ Brodarty, H., Green, A., and Koschera, A. (2003) āMeta-Analysis of Psychosocial
Interventions for Caregivers of People with Dementiaā, Journal of the American
Geriatric Society 51: pp 657 -664
ā¢ Brown,S.,Gotell,E. and Ekman,S (2001) āSinging as a therapeutic intervention in
dementia careā in Journal of Dementia Care. July/August
ā¢ Fleming,R., Crookes,P., Sum,S. (2009) Design for dementia. A review of the
empirical literature on the design of physical environments for people with dementia.
Stirling, Dementia Services development Centre
ā¢ Huusko T.M.,Karppi,P.,Avikainen,V., Kautiainen,K., Sulkava,R. (2000) āRandomised,
clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture:
subgroup analysis of patients with dementiaā BMJ 2000;321:1107-1111
( 4 November )
Sources cont.
ā¢ Stephen G Post (2000): The Concept of Alzheimer Disease in a Hypercognitive
Society in Whitehouse P. J, Maurer K and Ballenger J F: Concepts of Alzheimer
Disease. Biological, clinical and cultural perspectives. The Johns Hopkins University
Press
ā¢ Spector,A.,Thorgrimsen,L.,Woods,B.,Royan,L.,Davies,S.,Butterworth, M.,Orrell, M.
(2003) Efficacy of an Evidence-Based Cognitive Stimulation Therapy Programme for
People with Dementia: Randomised Controlled Trial, British Journal of
Psychiatry,183, pp 248 ā254.