Dementia falls presentation Abby Whiting Dementia Falls Nurse for - - PowerPoint PPT Presentation

Dementia falls

presentation

Abby Whiting Dementia Falls Nurse for Suffolk

Training outcomes

• Introductions
• Overview of dementia and falls
• Case study of Alice
• FAIL & GAIN
• Questions and feed back
• Tool kit

What is Dementia?

The term 'dementia' is used to describe the symptoms that occur when the brain is affected by specific diseases and conditions. Symptoms of dementia include loss

• f memory, confusion and

problems with speech and understanding.

(Alzheimer's Society 2011)

‘Dementia a national priority’

Launched in 2009, the National Dementia Strategy set out a vision for transforming dementia services with the aim of achieving better awareness of dementia, early diagnosis and high quality treatment at what ever stage

• f the illness in what ever setting. (DH Dementia strategy 2009)

2008 2038 700,000 1.4 MILLION 17 MILLION OVER 50 BILLION

YEAR PEOPLE LIVING WITH DEMENTIA IN THE UK ESTIMATED COST

Alzheimer’s

Vascular dementia

Lewy bodies

Frontal- temporal

Global symptoms

• Forgetfulness
• Communication difficulties
• Personality changes
• Mobility difficulties
• Decreased judgement
• Disorientation
• Difficulties in performing

familiar tasks

• Depression/anxiety
• Mood swings
• Sleep disturbances

MOVEMENT ORIENTATION PERCEPTION OF STIMULI RECOGNITION REASONING PLANNING SPEECH MOVEMENT EMOTIONS VISUAL PROCESSING PERCEPTION MEMORY SPEECH

What is a fall?

A fall is an event that results in the person, or a body part of the person, coming to rest inadvertently on the ground or surface lower than the person, whether or not an injury is sustained.

(NHS slips, trips and falls policy 2009)

Someone with Alzheimer's is three times (3x) more likely to fall

WHY

The three key stages

• 1. Early stage

Dementia patients have similar risk for falls as elders residing in the community, patients may develop psychiatric complications such as depression, or complications that may cause orthostatic hypertension.

• 2. Mid-stage

Dementia patients may fall for a variety of reasons. Patients begin to lose fine motor coordination and forget how to perform basic functions of daily living. Patients misinterpret their environment and fail to recognize unsafe situations such as loose rugs, loose floor boards, etc.

• 3. Late stage

Dementia patients are particularly prone to falls. Patients forget how to walk (gait apraxia) and seem uncoordinated with the placement of their

• feet. Patients can no

longer follow verbal direction and communication barriers complicate intervention.

Falls for the individual

• Injury/pain
• Hospitalisation
• Isolation
• Fear of falling again
• Changes in medication
• Immobility
• Death

Related issues

Common causes of delirium

• P Pain
• IN Infection (urine/chest infections, wounds)
• C

Constipation and poor nutrition

• H

Hydration

• M Medication
• E Environmental changes

Case study

• F flawed environment
• A altered perceptions
• I inappropriate medication use
• L lack of resources and training

FAIL

(Starkestein et al 2004)

People with Alzheimer’s Disease

• r probable Alzheimer’s Disease

have a poor awareness of danger.

Environment

Mayo clinic 2011 Glenn Smith, Ph.D.

The term "sundowning" refers to a state of confusion at the end of the day and into the night. Sundowning isn't a disease, but a symptom that

• ften occurs in people with

dementia.

Sundowning

Sundowning

Think……!

LIGHTING FLOORING HEATING FOOTWEAR & CLOTHING INACCESSIBLE ITEMS MIRRORS NOISE CLUTTER

Perception

People with dementia very often seem to see more than we do, to see through things, round things, past things. Their senses appear at times to be differently deployed so that they hear smells, see voices, taste pictures.

Karen Hayes from The Landscape of Dementia (unpublished)

Test your senses

Agnoisa

Dementia affects the brain‘s ability to understand and recognize visual input (what is seen). A loss of ability to recognize

• bjects, people, sounds, shapes or smells.

Dementia can cause someone to mistake a glare, a dark shadow or a reflection of themselves in a mirror for an imposter, a patterned carpet for insects and vermin. They may try and manoeuvre around rugs and carpets thinking they are holes in the ground.

Medication management

Antipsychotics are drugs designed to treat conditions such as schizophrenia, however they are often inappropriately prescribed as a first response to behavioural and Psychological Symptoms of Dementia.

Side-effects can include excessive sedation, dizziness, unsteadiness, and symptoms that resemble those of Parkinson's disease (shakiness, slowness and stiffness of the limbs), chest infections, ankle swelling and falls.

Antipsychotic medication

Ballard and Howard 2006.

All people with dementia who are receiving antipsychotic drugs should receive a clinical review from their doctor to ensure that their care is compliant with the current best practice guidelines and the alternatives to medication have been considered by the 31 March 2012.

Medication risks in the elderly with dementia

Polypharmacy means ‘many drugs’ and refers to problems that can occur when a patient is taking more medications than are actually needed.

Polypharmacy

• G getting to grips with the environment
• A awareness of altered perception
• I improved medication management
• N necessary equipment and training

GAIN

Toolkit

Questions and feedback

Dementia falls presentation

For more information contact:

Abby Whiting

Dementia Falls Nurse for Suffolk

abby.whiting@smhp.nhs.uk

Image references