Brain and Behaviour: A personcentred understanding for dementia care

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Brain and BehaviourA person-centred
understanding for dementia care

• Dr Elizabeth Milwain
• Freelance Dementia Care Trainer

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Why bother with the brain?
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Why not?

• We all live in and use the mind software with
  great skill knowing about the underlying brain
  hardware isnt necessary
• It is squishy and squeamish
• It is complicated and too difficult to understand

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Kitwood Personhood is bestowed

• NEW CULTURE
• PERSON with dementia
• Subjects of care
• Feelings, needs and agency of person central to
  care provision

• OLD CULTURE
• person with DEMENTIA
• Objects of care
• No feelings
• No needs
• No agency

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Division in the field

• Biomedical Model
• Organic brain disease
• Deficits and dysfunction
• Old Culture
• Denial of personhood
• Helpless and hopelss

• Psychosocial Model
• Disability
• Support and therapy
• New Culture
• Recognition of personhood
• Promoting well-being

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Unity

• Biomedical Model
• Organic brain disease
• Deficits and dysfunction
• Old Culture
• Helpless and hopeless
• Robbed of personhood

• Psychosocial Model
• Disability
• Support and therapy
• New culture
• Quality of life
• Recognition of personhood

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Status of the old culture

• Old culture is a culture of excuse making based
  on medical ignorance and not medical evidence
• Poor understanding of the brain damage associated
  with dementia has been used as a source of
  convenient excuses

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Common excuses

• They dont understand
• They wont remember
• They cant feel pain
• They cant do anything
• They are attention-seeking

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What is dementia?(World Health Organisation,
2007)

• A syndrome due to disease of the brainin which
  there is disturbance of multiple higher cortical
  functions
• Memory Thinking Orientation
• Comprehension Calculation
• Learning Capacity Language
• Judgement
• Usually accompanied by deterioration in
• Emotional Control Social Behaviour
• Motivation

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Different kinds of cortex

• Sensory cortex
• Gives us conscious experience
• (seeing, hearing and feeling are of particular
  importance)
• Motor cortex
• Gives us intricate control over our body and
  allows for complex action and behaviour
• Association cortex
• Higher level, intermediate areas that make sense
  of all that we sense and do

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Key Points

• There are patterns of strength and weakness
• Patterns vary from individual to individual
  depending upon location of the damage
• A world of unknowing
• Can still sense feel
• Can still act
• But understanding is fragmenting

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The vulnerability of recent memory
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Transfer to long-term memory
TEMPORAL CORTEX
OLD MEMORIES
THINGS WE DO OVER AND OVER AGAIN
IMPORTANT MEMORIES
LEARNS, BUT LEARNS SLOWLY
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Common confusions

• Problems in recognising people, even close family
• Problems in interpreting and understanding the
  environment
• Problems in understanding personal role/identity
• Hidden motivations for what seems like bizarre
  and irrational behaviour

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Whos in charge?

• It is the persons brain, and not ours, that is
  in charge of their behaviour
• They respond to their understanding of the world
  and what they need, not ours

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Amygdala

• The cortex is not the only structure capable of
  matching sensory inputs to suitable behaviours
• Amygdala is a very powerful interpreter of
  emotional information and coordinator of
  emotional behaviour

amygdala
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Threat-Central

• Strong links with the autonomic nervous system
• Picks up threat-information
• Activation of sympathetic fight or flight
  system
• Does not pick up threat-information
• Activation of parasympathetic rest and digest
  system

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Threat signals

• Unfamiliarity
• Chaos/Busyness
• Pain/poor health
• Unfriendly/unconcerned people
• Body language
• Facial expressions
• Tone of voice
• Unmet needs

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Threat Responses

• Fight Aggression
• Anger
• Agitation
• Flight Anxiety
• Escape
• Freeze Withdrawal
• Apathy
• Flock Following

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Safe signals

• Objects that are familiar comforting
• Environments that are calm, pleasant and simple
• Suitable activity
• Friendly people
• Needs/beliefs acknowledged

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The brain and care cultures

• Old culture
• Sets up an environment that is full of threat
  signals
• Likely to cause excess disability
• Likely to trigger challenging behaviours
• New culture
• Aims to set up an environment that is full of
  safe signals
• Likely to support remaining abilities
• Likely to lead to trusting relationships

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Feedback from Quantum Care Staff

• What did you learn/what was good?
• Better understanding of the brain and more
  insight into dementia
• How the brain functions. I have learnt to analyze
  cases of dementia to encourage and promote more
  independence on functions which are functioning
  well.
• It was a good insight into understanding more
  about dementia
• How the brain worked. With interest.
• A lot, it has been very helpful.

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Feedback from Norwich and Waveney Mental Health
Trust

• Fantastic so clear, a hard subject made
  understandable. I am a visual learner so thanks
  for the pictures and demonstrations.
• All topics covered were useful as there was
  enough time to link to practice. Very effective
  delivery
• Very easy to listen to and approachable
• Good range of information, explanations and
  interactive learning made this all very
  interesting and stimulated a need to find out
  more and apply to practice
• Everything explained so well and all applied to
  dementia. Very good presenter, very knowledgeable
• Very nice relaxed style

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Feedback from Study Dayhosted by Bradford
Dementia Group

• More enjoyable than expected really learned
  things I can use
• Deeper understanding of interactive elements of
  brain function. Good revision but plenty more
  aspects to consider in relation to dementia
• Excellent content
• Really useful, more understanding about dementia
  and residents behaviours
• Clear, concise delivery

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Contact Details

• Elizabeth Milwain
• milwains_at_blueyonder.co.uk