Assessing the mental health needs of older people
A number of organisations now provide training for staff in the particular features of dementia and its impact on people's lives. Dementia awareness training should be available to all staff working with older people.
The following is an extract from Cambridgeshire Social Services Department's toolkit for training residential care staff. It aims to help practitioners understand the older person's experience from their point of view.
You and your team may know older people with dementia have the full range of emotions. but think about it:
You have just heard your mother has died and someone is trying to get you to play bingo!
You are so ashamed you haven't been able to find the toilet - two strangers force you to take your clothes off and pretend it doesn't matter.
The door won't open - you need to get home to collect your son - the tears of frustration fall down your face - RELIEF, there's someone on the other side - you shout - they just smile and walk away.
Manners maketh man - you can hear your father's voice. Food and meals were central to your family life as a daughter and mother. How could you be at a table with people who spill food down their front, spit it out and this woman who keeps trying to force you to eat?
There are strangers trying to kiss you pretending to be your family - you've never seen them before - no one understands - all the people around you are conned by them.
Alarms go off all the time in this place. Should you be doing something or going somewhere? - the fire might get you!
Why do they call me Elizabeth?...no one does...I'm Libby!
Best practice in dementia care: A training strategy toolkit, Cambridgeshire SSD
Try to understand 'difficult' behaviour such as aggression, or apparently aimless walking about (try to avoid the term 'wandering') by thinking about the possible meaning behind the behaviour for the older person.
The following is a case example from Royal College of Psychiatrists Changing Minds campaign:
He used to be an angry young man but now he's an angry old one. He was quite a sight in those days - printing pamphlets, shouting from the platform, struggling with the police. He was a leader of the student revolution. They took notice of him then. Now they only pay attention when he threatens the nurse with his stick.
Dementia affects the brain. The person gradually loses his intelligence, his memory and his personality. Some go quietly, others rebel. They can shout or swear or even strike out. This is distressing for people close to them.
But for the man himself? Perhaps it is better than being invisible.Changing Minds - Alzheimer's Disease and Dementia © Royal College of Psychiatrists (2003)
People who develop behaviour that challenges should be assessed to try to establish the underlying causes, including possible physical ones, and to identify suitable interventions tailored to the individual.
The need for good communication skills in working with people with dementia is increasingly recognised. Much of this work has been undertaken within residential and day care services, but can also be applied to assessment services.
The Bradford Dementia Group, for example, has evolved an approach based on understanding that all observed behaviour carries a communication. Their method of working, first developed by Tom Kitwood, is called Dementia Care Mapping.
The Joseph Rowntree Foundation has identified a range of communication approaches and techniques that help workers understand their clients' views and preferences: Exploring ways for staff to consult people with dementia about services.
The Alzheimer's Society's Building on strengths training package involves identifying an individual's strengths and abilities, and finding ways to support the person to retain these abilities and build on them to enhance self-esteem and independence. For example, a person with dementia may be able to continue to dress themselves so long as someone has laid out the clothes ready for them, in the right order.
The Brighton-based consultancy and training organisation Dementia Care Matters is developing an approach called 'Being Together with Dementia', based on the idea of 'relationship-centred care', in which the emphasis is on the person with dementia's relationship with their partner or other significant people. Pilots in Peterborough and Hounslow have involved facilitating couples to explore what being together with dementia means for them, and to see how this experience can be used to enhance dementia care.
For other innovations and developments in dementia care, see the work of the regional Dementia Care Services Development Centres.
The Alzheimer's Society produces a range of advice sheets to help carers cope with particular behaviours.
The Royal College of Psychiatrists has produced a leaflet on dementia as part of their Changing Minds campaign.
Next: Mental capacity