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Dementia and assistive technology

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Title: Dementia and assistive technology


1

we help to improve social care standards
Dementia and assisted living technologies
2
Dementia and assisted living technology
This module is just one of a number of resources
supporting Skills for Cares assisted living
technologies learning and development framework.
3
Dementia and assisted living technology
  • Use of an image showing a specific product is
    illustrative only and does not constitute an
    endorsement of the product or the company who
    supplied the image.

4
Welcome, introductions and house keeping
5
The Audience
  • This module will be relevant to members of the
    social care workforce, particularly those working
    with people with dementia and their carers.
  • It is particularly relevant to those who wish to
    know more about dementia and how ALT can support
    people to live happier, safer and more
    independent lives.

6
Task 1
  • In groups spend 5 minutes discussing why you are
    here and your aims for the day.

7
Aims of today
  • By the end of the module you will
  • understand what dementia is and its causes
  • be able to state the early signs of dementia
  • be aware of the impact of dementia on the NHS,
    social care, families and the individual
  • understand the importance of correct assessment
    of individuals with dementia and their carers
  • be able to identify some of the solutions
    including assisted living technologies, that may
    assist the individual, their families and carers
  • understand the links between assisted living
    technologies and the common core principles for
    supporting people with dementia.

8
Task 2
  • In your groups discuss what dementia is and write
    down how you think it is defined.

9
Definition of dementia
  • The term dementia refers to a set of symptoms
    including memory loss, mood changes and problems
    with communication and reasoning
  • Dementia is NOT a natural part of growing old.
    It is caused by diseases of the brain, the most
    common being Alzheimer's.

Alzheimers society, 2012
Alzheimers society, 2012
10
Common core Principles
  • Principle 1 Know the early signs of dementia.
  • Principle 2 Early diagnosis of dementia helps
    people receive
  • information, support and treatment at the
    earliest possible stage.
  • Principle 3 Communicate sensitively to support
    meaningful interaction.
  • Principle 4 Promote independence and encourage
    activity.
  • Principle 5 Recognise the signs of distress
    resulting from confusion and respond by diffusing
    a persons anxiety and supporting their
    understanding of the events they experience.
  • Principle 6 Family members and other carers are
    valued, respected and supported just like those
    they care for and are helped to gain access to
    dementia care advice.
  • Principle 7 Managers need to take responsibility
    to ensure members of their team are trained and
    well supported to meet the needs of people with
    dementia.
  • Principle 8 Work as part of a multi-agency team
    to support the person with dementia.

11
Prevalence
12
Prevalence
Alzheimers society
13
Task 3
  • Think about people you know or have cared for.
    What excuses do they give when they forget things
    and why do you think they do this?
  • From your experience and knowledge what do you
    think causes dementia?

14
Causes of dementia
  • Alzheimers disease (62) This is the most
    common cause which involves changes within the
    structure of the brain and also a reduction of
    the chemicals that help transmit messages.
  • Vascular dementia (17) This is considerably
    less than Alzheimers, this is due to reduced
    blood supply to parts of the brain. This is often
    caused by Transient Ischaemic Attacks (TIAs or
    mini strokes) or a Cerebrovascular accident
    (stoke).
  • Mixed Dementia (10) This is due to combination
    of the two above.
  • Dementia with Lewy bodies (4) This is much
    less common and is caused by brain cell
    irregularities often causing symptoms commonly
    seen in Alzheimer's disease and Parkinsons
    disease.
  • Other causes of dementia (7) There are some
    diseases that have dementia like symptoms which
    include, Creutzfeldt-Jakob disease, multiple
    sclerosis, Huntingdon's disease and Alcohol
    related brain damage.

15
Early signs of dementia
  • One of the core principles for supporting people
    with dementia is recognising the early signs.
    These symptoms may include
  • loss or lapses of recent memory
  • poor concentration
  • problems communicating
  • getting lost in familiar places
  • making mistakes in a previously learned skill
    (e.g. cookery)
  • problems telling the time or using money
  • changes in sleep patterns and appetite
  • personality changes-the brain does not process
    images as normal
  • mood changes or uncharacteristic behavior (in
    later stages this will become more pronounced).
  • Adapted from Common core principles for
    supporting people with dementia (SFC)

16
Treatment For Dementia
  • No single treatment has yet been developed that
    slows, changes or reverses the progressive
    decline of brain functions.
  • There are a number of potential drug and non-drug
    therapies, that focus on treating some of the
    symptoms of dementia.
  • People with dementia are at an increased risk of
    physical health problems.
  • For these reasons, high quality support to
    remain independent and have the best quality of
    life are crucial to people with dementia.

17
Task 4
Below is a chart displaying four columns 1,2,3
and 4, this represents billions of pounds
spending per year on health and social care for
the following conditions Cancer, heart disease,
dementia and stroke. Put them in the correct
order of spending.
Alzheimers Research Trust 2010
23bn
18
How did you do? surprised?
  • Most of the cost of dementia 12.4 billion per
    year - is in unpaid carers. Social care costs are
    9 billion, health care 1.2 billion and
    productivity losses 29 million.

Alzheimers Research Trust 2010
19
Prevalence of Dementia
  • There are suggestions that 30 of beds on older
    persons wards are occupied by those with dementia
  • Around 60 of people with dementia live at home,
    with spouses or family members acting as carers.

Housing LIN 2012
20
Carers
  • In the UK there are 670,000 people acting as main
    carers for people with dementia.(Alzheimer's
    society 2012).
  • Unpaid caring can be for more than 50 hours per
    week (NHS Survey of carers 2009/10).
  • Carers UK (2010) state that within the next 3 to
    4 years the numbers requiring care will exceed
    that able to provide unpaid care.

21
Task 5
  • Weve looked at lots of hard facts about
    dementia, but what about the human impact?
  • Watch this clip and reflect on your thoughts
    about it
  • http//www.youtube.com/watch?vb7ZcbHrJP6ofeature
    player_embedded

22
Risks for people living with dementia in their
home.
  • Falls leading to injury and hypothermia
  • Fire, flood or harm due to inappropriate use
  • of household appliances - leaving the cooker on,
  • leaving taps on
  • Admitting unwelcome visitors or harassment
  • Failure to take medications or taking too many
  • Leaving home at inappropriate times and/or
  • getting lost.

23
Risks for people living with dementia in their
home.
  • Many of these problems may be seen as not
    coping or not being safe and may be used as
    reasons to move the individuals away from own
    homes to another place of care.
  • ALT can assist in decreasing many of these risks
    and therefore
  • potentially allow the individual to stay in their
    own home
  • environment.

24
Dementia policy - the role of Assistive technology
  • The National Dementia Strategy was published in
    2009 and
  • makes explicit reference to the potential
    benefits of telecare....
  • Three key steps
  • Ensure better knowledge of dementia and remove
    the stigma
  • Early diagnosis, support and treatment
  • Develop services to meet changing needs better

The needs of people with dementia and their
carers should be included in the development of
housing options, assistive technology and
telecare. As evidence emerges, commissioners
should consider the provision of options to
prolong independent living and delay reliance on
more intensive services.
25
  • The Prime Ministers challenge on dementia
    Delivering major improvements in dementia care
    and research by 2015 A report on progress

26
What are Assisted Living Technologies (ALT)?
  • Skills for Care define ALT as including
  • telecare - the use of technology, including
    monitors and sensors, to promote independent
    living and support to people in need of care to
    live longer at home, in homely environments and
    in their communities
  • digital participation services can help people
    stay connected to their communities and loved
    ones. They can enable social interaction and
    provide education, entertainment and access to
    information. Examples might be the use of social
    networking sites or video-links to keep in touch
    with geographically remote family or friends. By
    doing so, services can help to reduce the risks
    associated with social isolation.

Adapted from Lewin et al 2010 Lewin, D, Adshead
S, Glennon B et al (2010) Assisted Living
Technologies and Disabled People in 2030. London
Plum Consulting
27
What are Assisted Living Technologies (ALT)?
  • Wellness Services are technologies that support
    people to have healthier lifestyles. They can
    help people reduce their chances of becoming ill
    and can help those with chronic conditions to
    care for themselves. Examples might be a
    smartphone application to support someone to give
    up smoking. Another example might be a piece of
    wearable technology that monitors how much
    exercise someone does every day to promote
    greater physical activity.  

28
Who can use Assisted Living Technologies (ALT)?
  • ALT can be used to help people with many
    different requirements, needs and goals. For the
    rest of the workshop, we will focus on dementia
    as a condition where ALT can support the family
    and carers.
  • However, for a broader view of the potential
    benefits of ALT, please look at the other
    resources supporting the Skills for Care learning
    and development framework.
  • www.skillsforcare.org.uk/assistedlivingtechnologyr
    esourcehub

29
Task 6
  • Think about people you meet regularly. Have you
    come across any ALT, at work or in your home
    life? Write down the examples of ALT with reasons
    why you think they are used.
  • If you havent had experience of ALT think about
    the definition of ALT, can you identify any
    individuals that may benefit from such
    technology?

30
ALT and dementia
  • ALT generally falls into two categories
  • Active Devices-
  • This requires the user to actively make the
    device work (e.g. a personal alarm)
  • Passive devices
  • This device is one that operates without the user
    activating it themselves (e.g. a smoke alarm)
  • It is more likely that an individual with
    dementia will use the passive devices.

31
Benefits that ALT can bring
  • It can
  • promote independence and autonomy, and control
    both for the person with dementia and those
    around them
  • help manage potential risks in and around the
    home
  • support the individual and carers reducing early
    entry into care homes and hospitals
  • facilitate memory and recall
  • reduce the stress on carers, improving their
    quality of life, and that of the person with
    dementia.
  • The Alzheimers Society, 2012

32
Using ALT to support memory
  • ALT can help orientate people to time and place
    if they are having memory problems. Examples
    might be large display clocks or talking watches.
  • ALT can also help people from the early stages of
    dementia when their memory becomes less reliable.
    Examples might include electronic prompts which
    remind people if they are expecting visitors or
    have other appointments.

33
Using ALT to support taking medication regularly
  • Memory problems might affect someones ability to
    remember to take their medication correctly.
    There are a range of different ALTs that can help
    here, from simple clocks through to more
    sophisticated medication dispensers.

34
Technology used to assess behaviour
  • Motion sensors can be placed in the home of
    someone with dementia. These sensors can provide
    a record of movement that provide data for
  • Assessment e.g. Is someone up and about at
    appropriate times? What time and how long for?
  • Monitoring Family members or carers can monitor
    someones behaviour and look for patterns.
  • One system (others are available) is Just
    Checking http//www.justchecking.co.uk/the-system
    /index.php

35
Technology to enhance safety in the home
  • The changes in individuals with dementia may lead
    to an increased risk of
  • fire
  • flood
  • natural gas leak due to cookers being left on.
  • Simple telecare devices can therefore help
    provide early warning of hazards
  • smoke/heat alarms
  • flood detectors
  • natural gas alarms.
  • These devices link to a call response centre who
    will alert emergency services, the individuals
    carers or relatives.

36
Falls and people with dementia
  • People with dementia are at particular risk of
    falls and their after-effects
  • 2-3 times the risk of falling compared with
    someone without dementia
  • 60-80 of people with dementia will fall at least
    once every year
  • risk of sustaining a fracture is 3-4 times
    greater than a cognitively healthy person
  • worse outcomes following treatment for
    fall-related fracture.
  • Harlein et al (2009)
  • Falls prevention and detection is extremely
    valuable for people with dementia this may
    include bed sensors or lights sensors.

37
Falls prevention and detection
Automatic lights
Chair/bed sensors
Fall detectors
Darkness can increase the risk of falls.
Automatic lights can be installed which will come
on whenever the person gets out of bed.
Used to detect falls quickly, these alert a
monitoring centre (or, if appropriate, a live-in
carer) if an individual gets up and does not
return within a defined period.
Often worn on a belt, if an individual does fall,
help is summoned quickly by a monitoring centre.
This can provide reassurance and reduce the
health risks associated with falls.
Image provided by Tunstall
Image provided by Tynetec
Image provided by Tynetec
38
ALT to promote safer walking
  • People with dementia are at risk of getting lost,
    falling, or being involved in an accident when
    walking outside their place of residence.
  • ALT interventions which may be useful
  • Automatic voice reminders (triggered by movement)
    not to leave the house at odd times.
  • Door sensors that alert a call centre if the door
    is opened at certain times (e.g. during the
    night).
  • Safe walking systems can be carried or worn by
    users. These devices which can be within mobile
    phones or watches include GPS that allows a
    persons position to be located.

39
ALT and Reminiscence
  • Aids for reminiscence - There are different
    multimedia software available to facilitate
    conversation and encourage memories this can be
    achieved by looking at photographs or films about
    how life used to be, and playing familiar music
    or favourite songs to the person.
  • Talking photo albums can also be useful
    reminiscence aids, this where a message can be
    recorded for each photograph.
  • http//www.youtube.com/watch?vr0nx1g4Dtr4

40
ICT and dementia
  • SCIE have put together a website looking at
    information and communication technology (ICT) in
    activities for people with dementia.
  • Aimed at managers and staff in the care sector,
    and those who organise activities for people with
    dementia.
  • The technology can be used to find pictures,
    information, entertainment, keeping in touch and
    reminiscence activity.

41
Technology to promote health in people with
dementia
  • The presence of more than one disease is common
    in people with dementia.
  • Some people may benefit from the remote
    monitoring of vital signs (telemonitoring) but
    this has not really been evaluated in people with
    dementia.

Other diseases will include many of the long-term
conditions, for example heart failure, chronic
obstructive pulmonary disease (COPD).
In addition, medication reminders and dispensers
may help with physical disease management.
42
Case study
  • Doris is 83 years old, a widow who lives with her
    daughter. Doris came to live with her daughter
    when Fred her husband died 3 years ago, as she
    just wasnt coping on her own.
  • Joan, Doriss daughter noticed 8 months ago that
    Doris had become more forgetful than usual and
    often forgot how to make a cup of tea, but she
    put it down to old age and what do you expect
    when you are 83?. Whilst Doris was at a routine
    visit to the GPs Joan mentioned the
    forgetfulness to him and he decided to
    investigate this. Doris was eventually diagnosed
    with Dementia.

43
  • Joan is worried about how she will cope as Doris
    has fallen twice in the last month at night when
    getting up. Joan has also noticed that her mum is
    getting up more frequently during the night and
    not always knowing why. Joan isnt sleeping well
    as she feels shes always listening out for her
    mum.
  • Joan works in a charity shop 2 days a week and a
    busy social life. She is finding it more
    difficult to go there as she is tired and is
    constantly worrying if her mum is ok? She has no
    one else to help as they are at work and have
    their own lives. She has stopped going out and
    contacting her friends as she feels she is always
    moaning and has nothing to talk about.

44
  • On one of the few days that Joan has
  • managed to go to the charity shop, she
  • started talking to one of the regular
    customers to the shop about her
    worry that she would have to give up her work due
    to concerns regarding her mum.
  • As luck would have it she had a friend who had a
    similar situation and told her that there were
    things available to help.
  • With a new determination Joan decided to make
    some enquiries.

45
  • After a few phone calls Joan found that there was
    quite a lot that would potentially help her mum
    and give her piece of mind at night and when
    Doris was on her own at home.
  • Joan and Doris were visited and were assessed by
    a nice lady who seemed to understand what was
    happening and has told her about some of the
    equipment available. Joan began to feel
    optimistic about the future.

46
Task 7
  • Having thought about Doriss needs, what ALT may
    be of benefit to her?

47
Collaborative care
  • For an individual to feel safe, secure and as
    independent as long as possible collaborative
    care is a priority.
  • Collaboration is a relationship between two or
    more people, groups or organisations working
    together to define and achieve a common purpose
    Hornby and Atkins (2000)
  • Collaborative care is a key component in the
    National Dementia Strategy 2009.

48
Initial assessment
  • During the initial assessment, Doris would have
    been asked these questions.
  • What are your goals and aspirations?
  • What is important to you?
  • Do you need help with any aspect of your life?
  • What help you get now?
  • What extra help you think you may need?

49
Initial assessment
  • Things that have to be considered when assessing
    the individual is their ability to consent
    regarding ALT.
  • The next section will look at decision making of
    an individual with dementia and ALT.

50
Active decision making
  • What is active decision making?
  • It is the process of decision making that keeps
    the individual and their family at the centre,
    whether it is about the use of ALT or the
    introduction of home care, or going into
    alternative accommodation either temporarily or
    permanently.

51
Active decision making
  • The person with dementia should still be involved
    in making the decision we need to find out
    their views and wishes.
  • People who know the person well family, friends
    and care staff should be consulted.
  • The decisions should where possible limit
    restrictions placed on the person.
  • Active decision making should be underpinned by
    an understanding of ethical principles

52
What do we mean by ethics?
  • At the broadest level, ethics is the study of
    peoples moral behaviour (e.g. Good/evil
    right/wrong).
  • That may sound rather abstract, but the
    aspiration to act ethically should underpin
    everything we do.
  • To start, well discuss some broad ethical
    principles and healthcare issues, before looking
    in more detail at ALT.

53
Ethics for social care
  • The most commonly used approach is that of
    Beauchamp and Childress (2008) which has four
    principles
  • Respect for autonomy Allowing people to make
    independent choices.
  • Beneficence Acting in a way that benefits
    others.
  • Non-maleficence The principle of doing no harm.
  • Justice Ensuring fairness in care e.g. Making
    sure that everyone have the same access to care.
  • Another Key issue that relates to ethics is
    mental capacity.
  • Using active decision making keeps all these
    principles at the forefront of any intervention.

54
Task 8Ethical principles and ALT
  • For the ethical principle that your group has
    been allocated, think about a possible
    circumstance where ALT
  • supports that principle
  • challenges that principle.
  • Where there are ethical challenges, how can you
    work along side the individual and their families
    to reach a decision? What might you need to take
    into account?

55
Real world ethical concerns
Doubts raised over safety of doctor by
broadband Patients could be put at risk by using
internet-based equipment to manage their
conditions from home, the lead investigator of a
nationwide trial into the technology has warned.
Reduced human contact
Dependence on technology
Big Brother
56
Ethical benefits
Fairer distribution of resource
Quality of life benefit
Enhanced self-care and independence
57
Supporting ethical practice
Holistic assessment
Privacy and dignity
Robust governance
Informed consent
58
Guidance on ethics in ALT
59
The Mental Capacity Act (2005)
  • The Act states that ...a person
  • lacks capacity in relation to a matter
  • if at the material time he is unable to
  • make a decision for himself in relation
  • to the matter because of an
  • impairment of, or a disturbance in the
  • functioning of, the mind or brain

60
The Mental Capacity Act (2005)
  • The definition means that individuals receiving
    AT with dementia may be deemed to lack capacity.
    The brief key principles are
  • someone should be considered to have capacity
    unless it can be shown that they dont
  • everything practicable should be done to help
    someone make a decision for themselves before
    deciding that they lack capacity
  • nobody should be considered to lack capacity
    simply because they make an unwise decision
  • anything done for someone lacking in capacity
    must be done in their best interests
  • when acting on behalf of someone who lacks
    capacity, we must consider other ways of
    achieving goals that are less restrictive of the
    person's rights and freedom of action.

61
Remember
  • People with dementia should feel safe and secure
    and are able to be as independent as possible
  • Promoting Excellence (2011) NHS education
    Scotland

62
In summary
  • Many people with dementia are happier if they can
    live in their own home for as long as possible.
    Living in familiar surroundings and maintaining
    regular routines can be reassuring and with the
    right support can often help the person maintain
    their independence for a longer period of time.
  • Much can be done to enable someone with dementia
    to remain in their own home, even when their
    dementia is quite advanced. However, a person
    with dementia who is living alone will need
    increasing support.

63
Aims of today
  • By the end of the module you will
  • understand what dementia is and its causes
  • be able to state the early signs of dementia
  • be aware of the impact of dementia on the NHS,
    social care, families and the individual
  • understand the importance of correct assessment
    of individuals with dementia and their carers
  • be able to identify some of the solutions
    including assisted living technologies, that may
    assist the individual, their families and carers
  • understand the links between assisted living
    technologies and the common core principles for
    supporting people with dementia.

64
Common core Principles
  • Principle 1 Know the early signs of dementia.
  • Principle 2 Early diagnosis of dementia helps
    people receive
  • information, support and treatment at the
    earliest possible stage.
  • Principle 3 Communicate sensitively to support
    meaningful interaction.
  • Principle 4 Promote independence and encourage
    activity.
  • Principle 5 Recognise the signs of distress
    resulting from confusion and respond by diffusing
    a persons anxiety and supporting their
    understanding of the events they experience.
  • Principle 6 Family members and other carers are
    valued, respected and supported just like those
    they care for and are helped to gain access to
    dementia care advice.
  • Principle 7 Managers need to take responsibility
    to ensure members of their team are trained and
    well supported to meet the needs of people with
    dementia.
  • Principle 8 Work as part of a multi-agency team
    to support the person with dementia.

65
Any questions?
66
If you wish to find out more regarding dementia
  • Skills for Care provide a range of modules within
    their Qualifications and Credit Framework
  • DEM 201 Dementia awareness
  • DEM 202 The person centred approach to the care
    and support of individuals with dementia
  • DEM 205 Understand the factors that can influence
    communication and interaction with individuals
    who have dementia
  • DEM 207 Understand equality, diversity and
    inclusion in dementia care
  • DEM 305 Understand the administration of
    medication to individuals with dementia using a
    person centred approach
  • DEM 308 Understand the role of communication and
    interactions with individuals who have dementia
  • DEM 310 Understand the diversity of individuals
    with dementia and the importance of inclusion

67
If you wish to find out more regarding ALT
  • Skills for Cares Assisted Living Technologies
    Learning and Development Framework.
  • There are a number of resources available that
    may be of use.

68
Further reading
  • www.dementia2010.org
  • Alzheimer's Society Assistive technology May 2011
  • Housinglin.org.uk- Assistive technology as a
    means of supporting people with Dementia A
    Review. (2012)
  • JIT (2010) Telecare and Dementia Using telecare
    effectively in support of people with dementia.
  • Alzheimer's society (2012) Dementia 2012 A
    National challenge
  • MCA - Making decisions A guide for people who
    work in health and social care http//www.justice.
    gov.uk/downloads/protecting-the-vulnerable/mca/opg
    -603-0409.pdf
  • SCIE. Using ICT in activities for people with
    dementia -
  • http//www.scie.org.uk/publications/ictforde
    mentia/files/ictfordementia.pdf

69
Further reading
  • www.skillsforcare.org.uk/assistedlivingtechnologie
    s
  • www.skillsforcare.org.uk
  • www.skillsforcare.org.uk/assistedlivingtechnologyr
    esourcehub
  • Hornby S and Atkins J (2000) Collaborative care
    interprofessional, interagency and interpersonal.
    Oxford Blackwell publishing

70

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