From 21-27 September Australia will observe Dementia Action Week 2020. September is also observed as World Alzheimer’s Month. In support of these, the Australian College of Nursing (ACN) is hosting a webinar Dementia – A Patient Centred Approach in collaboration with Arjo.
The webinar is aimed at helping nurses better assess and support people living with dementia. As a result, nurses will be able to identify dementia symptoms and have tools to approach patient’s symptoms without the need for medication. The webinar will be conducted by Dr Steph Daly, a specialist GP in dementia who is also an advocate for patients living with dementia.
In this article, Dr Daly answers some questions and clarifies the common misconceptions surrounding dementia.
What is dementia?
Dementia is an umbrella term for several diseases, 70% of the Dementia’s seen in Australia are either Alzheimer’s Disease, Vascular Dementia or a mixture of the two. The remaining 30% of Dementia associated diseases include conditions such as Parkinson’s Disease Dementia, Huntingdon’s disease Dementia, Lewy Body Dementia and others, in total there are over 100 types of dementia related diseases.
There are 459,000 people living with dementia in Australia and it is the leading cause of death in women and second leading cause of death overall for all adults (Dementia Australia Website)
According to the World Alzheimer’s Report (World Alzheimer’s Report), 62% of health providers misconstrue dementia as part of normal ageing. In fact, it is a global neurodegenerative disorder, the presenting symptoms include with gradual cognitive decline, short term memory loss, problems with language such as word finding difficulties, poor concentration and inattention, there is also loss of functional ability, inability to perform activities of daily living. Dementia can often present in similar way to anxiety and depression and it is important to differentiate from these other disorders. It is important to remember that ultimately Dementia is a terminal disease.
How are nurses uniquely positioned to have an impact on a dementia patient’s health?
Nurses are the main caregiver to the patient and as such can be a key advocate for patients needs. Their role involves taking a detailed admission history about the patient, their family, background, and their likes and dislikes; this is known as the personal history, and understanding the patients background can improve the patients journey in whichever care setting they are in.
Having a deeper understanding of who the person is improves care for the patient, particularly if they have agitation, distress or anxiety related behaviours as a result of changes in their circumstances or care needs. For example if a person living with Dementia is transitioning to an aged care facility this can be an unsettling time, knowing more about a person’s character can allow nurses to tailor care to that person on an individual basis.
Nurses might also be the first person to recognise that patients have or are at risk of cognitive impairment/dementia and can have conversations with patients and their carers about concerns they may have about dementia. For example if a person is admitted to the ward with confusion, this may be due to their illness but can also be a red flag for underlying cognitive impairment. Nurses are able to spend time talking to family members and individuals about changes they may have noticed, previous functional ability and how things have changed over time. Families may feel more at ease disclosing concerns to nurses than to other medical staff.
In what ways can nurses play a vital part in looking after someone with dementia?
Nurses are key in helping to manage patients needs either as inpatients in hospital or in the residential aged care setting. They have the ability to assess their working environments and see if there are changes they can institute that may improve a patient’s well-being. Nurses can be advocates for change and encourage employers to think about the work environment as more patient centred and less task driven so that conversations and listening to concerns can occur. For example, providing engaging activities, using music therapy, daily exercise, changes to light or sound environment and reducing the reliance on psychotropic medications.
How will the webinar address the findings of the Royal Commission into Aged Care with respect to nurses’ role in working with dementia patients?
The Royal Commission report stated.
‘We have heard countless stories about how much people grieve for all they have lost when they arrive in residential care. They become ‘just a resident’, just another body to be washed, fed and mobilised, their value defined by the amount of funding they bring with them. They become infantilised, lose autonomy, and are prevented from making decisions or doing physical things that were routine when they lived at home, on the grounds that they ‘could hurt themselves’. They lose their basic rights to take risks, to choose what to do in their day, to live a life as close as possible to their previous home and community. There is no joy in this.’
‘A Shocking Tale of Neglect’
Extract from the Royal Commission into Aged Care Interim Report – foreword 2020
From the above statement, it’s clear that nurses can really make a difference, particularly by recognising the impact of losing autonomy on the people living dementia within their aged care facilities. They can enable people to continue doing tasks that give them meaning and purpose and allow them to have some level of independence.