The importance of positive communication for older adults

positive-communication-older-adultsRobin Dynes, author ofPositive Communication: Activities to reduce isolation and improve the wellbeing of older adultsexplains the reasoning behind his book.

We belong to an ageing society. The National Institute on Ageing informs us that in 2010, an estimated 524 million people were aged 65 or older – 8% of the world’s population.  By 2050, this is expected to increase to 16% – 1.5 billion. A massive challenge for all health, social and care service staff to meet their needs.

As people grow older confidence and self-esteem may be eroded by hearing or sight loss. They are often affected by illness or physical inability to get about and consequently become isolated and lonely. Changes to personal relationships destroy habitual communication patterns and links. Social expectations, shaped by peers and the events and experiences of their time, are out of tune with modern attitudes and the support services are provided by younger people with a different outlook on life. A youth orientated society often makes them feel unimportant, inadequate, isolated and obsolete. Feelings with which I am very familiar, having worked in health, social and care services for over 35 years and as I, and many of my friends, grow older.

It is a fact that older adults who maintain their communication skills and continue to interact socially maintain a more positive view about themselves and are more adept at facing these challenges. They are more able to cope with changes, communicate their feelings, express opinions and wishes and continue to contribute to the society in which they live. They are more likely to retain good physical and emotional wellbeing and maintain a sense of control and achievement in the modern world. Enabling this to happen is essential work in an ageing population.

It is vital that staff within residential homes, drop-in or day centres, hospices, clubs for the elderly, hospitals, nursing homes or support situations, at home with carers help them retain their abilities and wellbeing. We, as activity organisers, group leaders and care workers, are at the forefront of this task. The aim of the book is to provide activities that are easy to use and enables group leaders to achieve this goal.

There are activities to help older adults:

  • Interact and connect with others
  • Retain a positive view of themselves
  • Communicate their feelings , needs, opinions and wishes for the future
  • Talk about and cope with difficult situations
  • Maintain a sense of self control and achievement
  • Meet emotional and spiritual needs
  • Maintain relationships with others
  • Improve their self-esteem and well-being

I hope this book will provide you with an essential tool to aid you to make an impact on the lives, health and wellbeing of the people you support. It is a challenging, enjoyable and rewarding task.

Click here to see an example of some activities included in the book.

Robin Dynes is a counsellor and freelance writer who has worked as a Social Inclusion Officer for Skills and Learning. Robin developed an outreach curriculum to meet the needs of people with disabilities, older people and other vulnerable people.

 

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How has the field of dementia care changed in the past 30 years?

changes in dementia care over 30 years

Dementia Awareness Week 14-20 May 2017

To mark JKP’s 30th anniversary year, Professor Dawn Brooker writes for us on the challenges and achievements of 30 years of dementia care. What has changed and what still remains to be done?

Dementia; Reflections 1987-2017
by Professor Dawn Brooker

The field of dementia care has changed beyond recognition in the last 30 years. In part this has been driven by the sheer numbers of people whose lives are now affected by dementia. In 1987 dementia was a rare condition. It was barely spoken about in its own right but rather was seen as an insignificant part of older people’s psychiatric care. There had been a report published by the Health Advisory Service called “The Rising Tide” in 1982 which highlighted the rising numbers of people we should expect and called for “joint planning and provision of comprehensive services for the elderly mentally ill”. The predictions they made about numbers came true. The number of people with dementia in the UK is forecast to increase to over 1 million by 2025 and over 2 million by 2051. There are over 40,000 people with early-onset dementia (under 65) in the UK. Dementia impacts the whole family and society. A recent survey by Alzheimer’s Research UK showed that a 24.6 million people had a close family member or friend living with dementia. 1 in 3 babies born this year will develop dementia in their lifetime. Unfortunately, the strenuous suggestions the Health Advisory Service made about joined up comprehensive services to meet these growing needs have not yet materialised.

In 1987 I was working as the lead clinical psychologist in the NHS services for older people in Birmingham. Even the language then was radically different. My job title was the EMI (Elderly Mentally Infirm) Clinical Psychologist. My office was in a psychiatric hospital (the asylum) covering many long-stay wards which were mainly populated by elderly people. Some had lived all their lives in hospital having been admitted for being pregnant out of wedlock or for some other “misdemeanour”. Many patients that I saw in those early days had undergone hundreds of electric convulsive therapy treatments, brain surgery and prescribed mind-bending drugs.  There was little formal diagnosis of dementia. People were generally classified as senile. The ward that catered for people with advanced dementia and physical health problems was known as the “babies ward” by the nursing staff and known as “the non-ambulant dements ward” in official documents. This was 1987, not Victorian England. Continue reading

Ageing and Spirituality: What does it mean to grow old in the twenty-first century? by Elizabeth MacKinlay

ageing spirituality 21 century“Many of us have the potential to live out their later years with hope, resilience and growing into fullness of life, coming to new realisations of what it means to grow old in the twenty-first century.”

Elizabeth MacKinlay is a registered nurse, an Anglican priest and Professor in the School of Theology, Charles Sturt University. Here she discusses changes in the field of ageing and spirituality since the first edition of her book ‘The Spiritual Dimension of Ageing‘ was published in 2001. The updated second edition of this seminal text was published by Jessica Kingsley Publishers in February 2017.

The first edition of my book The Spiritual Dimension of Ageing was published in 2001 and since then we have continued to learn so much more about ageing and spirituality. What really started my interest in this field, both as nurse and priest, was the question of why, given the same medical diagnosis, two different patients could have very different outcomes, even with the same medical treatment. There seemed to be ‘something more’ that we needed to understand.
This continuing search has led to a number of studies since then and much listening to older people. The crucial factor in the different outcomes for those living with the same diagnosis often seemed to come back to matters of meaning and hope, which for me are strongly linked to the spiritual dimension, to the very depths of our being.

When I was researching for and writing the first edition of this book I was really seeing ageing from the outside. I was listening intently to the stories of people who were growing older, wanting to know what the actual experience was like. I was particularly interested in knowing how people saw meaning in life and the way they lived out spirituality in these later years.  Continue reading

Confused, Angry, Anxious? How to understand and tackle challenging behaviours in older people in care

challenging behaviours dementia

In this extract, the authors of Confused, Angry, Anxious? look at one of the many challenges healthcare professionals can face when working in older and dementia care. With an accessible and easy-to-read style, the authors offer advice on how to best handle challenging behaviours effectively, professionally and with confidence.

click here to read the free extract!

 

This book intends to create a link between person-centred care methods and what is described as the low arousal approach, a method which aims to manage challenging behaviours in a calm and positive manner to minimise conflict, stress and fear. With many examples of everyday challenges and how to deal with them, this book has the potential to change your (working) life.

 ‘It is not the people with dementia whose task should be to behave themselves, rather it is the caregivers whose task should be to create a context that allows these people’s everyday life to function’.

Click here to find out more about the book.

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Dementia Care and Support in a Hypernormalised World, Creating a Virtual Unreality – by Shibley Rahman

Dementia Care and Support in a Hypernormalised World, Creating a Virtual Unreality

Dementia Care and Support in a Hypernormalised World, Creating a Virtual Unreality

 

 

 

 

 

 

 

 

 

In March 2016, the Secretary of State for Health said, “A dementia diagnosis can bring fear and heartache, but I want Britain to be the best place in the world to live well with dementia”.

Of course, where fantasy begins and reality stops for Jeremy Hunt is a matter of conjecture, given the wilful blindness to the catastrophic A&E waiting times and delayed discharge performance.

On this theme, “HyperNormalisation” by Adam Curtis has just been aired on the BBC iPlayer. It tells an epic narrative spanning 40 years, with an extraordinary cast of characters. They include the Assad dynasty, Donald Trump, Henry Kissinger, President Putin, intelligent machines, Japanese gangsters, suicide bombers and Colonel Gaddafi. All these stories are woven together to show how today’s fake and hollow world was created. Rather than face up to the real complexities of the world, Curtis articulates that they instead constructed a simpler version of the world in order to hang onto power.

Clinicians are very keen to label persons with dementia as ‘abnormal’ in terms of cognitive or behaviour, when often these decisions are pejorative and based on an arbitrary cut-off point of what is normal. With people with dementia being seen in hospitals described as ‘overstretched, underfunded and understaffed‘ by the Royal College of Physicians recently, with savage social care cuts as described clearly by the King’s Fund, it is hard to see where precisely the claim for ‘the best country to have dementia in’ can come from? Cited in the Hypernormalisation film is “Roadside Picnic” (Пикник на обочине), a short science fiction novel written by Arkady and Boris Strugatsky in 1971. Roadside Picnic is a work of fiction featuring zones exhibit strange and dangerous phenomena not understood by humans, and contain artefacts with inexplicable, seemingly supernatural properties.

For clinically diagnosed persons with dementia, performance at some stage in cognitive domains, with supportive evidence say from neuroimaging, EEG, CSF or blood tests, the paradox exists for people with dementia having difficulty in ‘thinking faster’ are caught up in a hyper-fast hyper-connected world.  The Internet of things (“IoT”) is the trendy internetworking of physical devices, vehicles (also referred to as “connected devices” and “smart devices”), buildings and other items—embedded with electronics, software, sensors, actuators, and network connectivity that enable these objects to collect and exchange data. The IoT allows objects to be sensed and/or controlled remotely across existing network infrastructure, creating opportunities for more direct integration of the physical world into computer-based systems, and resulting in improved efficiency, accuracy and economic benefit. This can of course make the blurring between fantasy and reality even more difficult.

Care or nursing homes, hospitals or hospices, all seem to suffer a dire shortage of trained staff, and local problems might exacerbate this situation in future.  And the search is on for suitable companions, including a pet. But sometimes animals are not allowed in nursing homes or day care centres, due to the risk of injury to patients, staff or visitors, the possibility of allergic reactions, and the potential nuisance of cleaning up after the animals.

Unsurprisingly, robots might be the next big thing in dementia care and support. The term ‘robot’ was first used in 1920 by the Czech playwright, Capek in a play entitled Rossum’s Universal Robots. Here robots turned against their human masters, a plot which may partially explain the tension between fascination and distrust of robots.

Change and even progress may be happening fast. In 2013, MIT engineering professor John Leonard told the MIT Technology Review that “robots simply replacing humans” would not happen in his lifetime. Today, Google’s autonomous cars have travelled more than 1m miles on public streets, and self-driving taxis seem all but inevitable. Domino’s Australia have even unveiled a pizza delivery robot in Brisbane, and Amazon are talking about making deliveries by drone.

In the last few years, many projects have addressed the use of robots for supporting elderly people aging in place, including people with dementia.  With the increasing incidence of dementia and the societal demand for cost reduction in care in general, a need grows for innovative care concepts to sustain and preferably improve the quality of care.

Socially Assistive Robots (SAR) are an emerging form of assistive technology encompassing all robotic systems capable of providing assistance to the user by means of social interaction.

SAR can deliver help at different levels:

(a) supporting user’s cognitive or functional abilities (e.g., task reminding and monitoring);

(b) offering the user opportunities to enhance social participation and psychological well-being (e.g., communication and social applications, companionship);

(c) providing remote and continuous monitoring of user’s health status (e.g., blood pressure or fall detection sensors); and

(d) coaching the user to facilitate the promotion of healthy behavior and achievement of health-related goals (e.g., improving nutrition. physical activity).

The therapeutic use of SAR in the context of dementia care has received increasing attention over the last decade as illustrated by a growing body of research. Most of these studies have focused on PARO, a therapeutic animal-like robot modelled on a baby harp seal, mainly employed to encourage social behaviour and/or alleviate stress among persons with dementia. It has five types of sensors: tactile, light, audio, temperature, and posture, with which it can perceive people and its environment. It can respond to stimuli, perceived by its sensors, by making noise, moving its eyes, head, and flippers.

Several intervention trials demonstrated promising effects of participating in PARO therapy in increasing motivation, improving mood, reducing stress, and increasing social communication in elderly people.

There’s also a need to consider the context of the usage of an assistive robot which takes into account the presence of other human beings. This may be much more challenging: functionalities of robots should be designed by taking into account various social contexts, which include, for example, the possibility of a robot to assist the caregiver and not directly the person with dementia?

Caring for the carers is a huge aim of person-centred dementia care worldwide. Results over many years have indicated that due to significantly higher levels of care provision in recent years, spouses experience differentially more depressive symptoms, physical and financial burden, and lower levels of psychological well-being.

There is also remarkably little research how the views of persons with cognitive impairment and caregivers converge or diverge regarding the acceptance of SAR. A more comprehensive approach should include both groups’ perspectives to better understand technology acceptance and usage intention of SAR in the general context of dementia care.

Part of the cognitive footprint of people with dementia can be marked attentional problems, for example manifest as impulsivity, disinhibition or distractibility. The symptoms of people with behavioural variant of frontotemporal dementia (“bvFTD”) are most often a change in personality and behaviour. With the application of “virtual reality”, it might now be possible to elicit and examine the patient’s actual interpersonal behaviour and responses to avatars while manipulating the social-emotional environment. The immersion of bvFTD patients in a virtual environment also allows the exploration of potential rehabilitation strategies for dealing with their social-emotional changes.

In a parallel universe, carers also might give themselves avatars and be involved in peer support groups known to be effectively reduce stress from caring for someone with dementia. While online groups have been shown to be helpful, submissions to a message board (vs. live conversation) can feel impersonal. Having avatars can have its advantages: it allows the carers to join the group even when they have a busy day, and may not have had a chance to put on their best T shirt in the way they would prefer for another video viewer.

A problem is, however, that in virtual environments, we can be fooled into thinking that we are our avatars. People in virtual environments tend to behave in ways that are expected of their avatars. For example, if you embody a tall avatar, you’ll negotiate more aggressively than if you were given a shorter body.

As the world moves towards a future based on virtual reality, artificial intelligence, and machine learning, we have to think about where to draw lines to mark the distinction between reality and fantasy, what kinds of situations are problematic, and how to refashion the rules for a digital world. There are many legal and ethical issues involved.

The future is here?

Hyperconnectivity is the increasing digital interconnection of people – and things – anytime and anywhere. By 2020 there will be 50 billion networked devices. This level of connectivity will have profound social, political and economic consequences, and increasingly form part of our everyday lives, from the cars we drive to the medicines we take. All of our institutions will have to make increasingly thoughtful trade-offs between the value inherent in a hyperconnected world and the risk of operational disruption, intellectual property loss, public embarrassment, and fraud that cyber attacks create.

Concerns have been raised about a possible relationship between virtual reality and desensitisation. Desensitisation means that the person is no longer affected by extreme acts of behaviour such as violence and fails to show empathy or compassion as a result.

Another issue related to this is ‘cyber-addiction’. There are people who become addicted to virtual reality games and as a consequence, start to blur the boundary between real and virtual life.

But all of this might be Sir Lynton Crosby’s “dead cat strategy”, the man behind David Cameron’s ‘successful’ 2015 general election campaign.

Adam Bienkov describes the strategy thus:

“”Let us suppose you are losing an argument,” Boris Johnson wrote earlier this year.

“The facts are overwhelmingly against you, and the more people focus on the reality the worse it is for you and your case.

“Your best bet in these circumstances is to perform a manoeuvre that a great campaigner describes as ‘throwing a dead cat on the table, mate’.”

Going on to describe the manoeuvre he explains: “The key point, says my Australian friend, is that everyone will shout ‘Jeez, mate, there’s a dead cat on the table!’; in other words they will be talking about the dead cat, the thing you want them to talk about, and they will not be talking about the issue that has been causing you so much grief.””

This new hyper normalised and hyper connected world may be the best thing to happen to person-centred integrated care in dementia ever.

Or it might be a dead cat simply presenting a virtual unreality.

Follow Shibley Rahman on Twitter and find out more about his books here.

A Q&A with Gary Mitchell, author of Doll Therapy in Dementia Care

Mitchell_Doll-Therapy-in_978-1-84905-570-3_colourjpg-print

We caught up with Gary Mitchell on the publication of his important new resource for dementia care professionals – Doll Therapy in Dementia Care.

What motivated you to write the book – Doll Therapy in Dementia Care?

I qualified as a nurse in 2010 and my first post was in a dementia care unit in Northern Ireland.  When I began working on the unit I quickly saw the benefits of person-centred care and non-pharmacological interventions.  One particular intervention that was regularly taking place on the unit was ‘doll therapy’.  Initially it was an intervention that I wholeheartedly rejected because I felt it perpetuated stigma that can be associated with dementia.  I felt like playing with dolls would undermine the person-hood of the individuals living with dementia I was nursing.  After some time I began to see some very positive outcomes in some of our residents’ quality of life who engaged with doll therapy.  On reviewing the evidence in 2010, I found that there wasn’t really that much out there.  Over the past number of years I have closely studied doll therapy in dementia care through my practice and academia.  My opinions on doll therapy, informed by evidence and practice, are starkly different.  In short, doll therapy can enhance the quality of life for some people who live with dementia.  This was the sole reason for writing this book – to share the evidence and practice about doll therapy so as people living with dementia who will benefit from it can be enabled to do so. Continue reading

2016 Dementia Catalogue – New & Bestselling Titles

Take a look at our latest Dementia Catalogue. For more information on any of the titles, or to purchase a book, go to www.jkp.com.

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Shibley Rahman talks about his book, Living Better with Dementia

shibley

Identifying current global policy challenges for living well with dementia, this book tackles controversial topics at the forefront of public and political debate, and highlights pockets of innovation and good practice from around the world to inform practical solutions for living well with dementia in the future. We talked to Dr Rahman about the book and his thoughts on the current process of dementia diagnosis. 

What motivated you to write Living Better with Dementia?

The name of the only national dementia strategy for England so far was ‘Living well with dementia’. This name is problematic, as it potentially sets people up to fail. What if a person has a bad day? We’re all entitled to have a bad day.

The actual strategy expired in 2014, exactly five years after it was launched by a previous government in 2009. I wanted to keep with the ethos that it is possible to aspire to live as well as possible with dementia. The prism of long term conditions suits people with dementia much better than the approach which relies solely on drug treatments.

The title of the book, Living Better with Dementia, is in fact from Chris Roberts, living with mixed dementia of the Alzheimer type and vascular type. I am honoured that Chris wrote one of the forewords. Kate Swaffer, Chair of Dementia Alliance International, wrote the main foreword.

There has to be an alignment of rhetoric and reality. That’s why I respect the work of Beth Britton who wrote the final foreword. Beth has an intimate lived experience of dementia from family, and professional experience in how this impacts on actual care. The topics of my book give a realistic state-of-the-art exploration of key themes in wellbeing in dementia, not entrenched in dogma, but which promote awareness and education. Continue reading

Living Beyond Dementia – an interview with Kate Swaffer

brain

 

Kate Swaffer was just 49 years old when she was diagnosed with a form of younger onset dementia. In her book, she offers an all-too-rare first-hand insight into that experience, sounding a clarion call for change in how we ensure a better quality of life for people with dementia. We caught up with her to find out a bit more about the book and the experiences that motivated her to write it. 

What made you want to write ‘What the Hell Happened to my Brain?

Following the diagnosis of dementia, for the first few years whenever I attended something to learn more about dementia, it was always people without dementia telling me how and what I was feeling, what was happening to me, and also what was best for me. At no time, did anyone bother to ask me. I suppose, that is really what started me writing about living with dementia as I was sick of it, and could not believe (still cannot) people without dementia felt they could truly believe what it is like being diagnosed and living with dementia. On top of that, the public narrative and discourse is still almost always about suffering, and although I do suffer some of the time (from dementia and other ailments), it is not the sum total of my experience, so I wanted to share that it is possible to “Live Beyond Dementia.”

My blogging was also a way of cataloguing my daily experiences and thoughts, and very quickly became a communication tool between family and close friends, and then the wider dementia community, as well as a memory bank for me to go back to. So the habit of writing now, almost daily, for more than four and a half years, also gave me the discipline and practice to write a book. Continue reading

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Dementia Catalogue – New & Bestselling Titles 2016 

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