cpd day pres jan 2010.final

8/4/2019 CPD Day Pres JAn 2010.Final

1/24

Introduction to psychosocial OT

practice in dementia

Tuesday 18th January 2011

John Stone

Teresa Bartram

Yvonne ThompsonNicola Gibbs

Jo Gambrill


2/24


3/24

Exercise

Dementia and loss


4/24

Brain Pathology in Dementia


5/24

Neuropsychology of Dementia(Wisconsin DOH, 2003)

Thinking processes: Perceptual disturbance

Judgement* Stimulation level

Attention* Cliffs

Perceptions* Heightened intuitionReasoning* Tunnel vision

Organisation* Depth perception

Memory recall* Reading

Communication* Out of sight .... / cuesAbstract thinking* Fluffy

Disorientation Sundowner syndrome

Disrupted social functioning

* >2 Occupational & Social functioning.


6/24

NeuropsychologicalFactors(Finkel, et al, 1998)

%

Perceptual Delusions 20 - 73Misinterpretations 32 - 50

Hallucinations 15 - 49

Affective Depression up to 81Mania 3 - 15

Anxiety ?

Apathy ?

Personality Personalitychange up to 90Agitation up to 50

Behavioral up to 20


7/24

Questions

Why is the degree of expressed Dementia and performance in

tasks not linked to extent of brain pathology we see in scans

and autopsies (Kitwood, 1993) & (Snowdon, 1996)?

Do psychometric assessments offer the best prediction of real

world functional performance (Lowenstein & Acevedo ,

2010)?

Is Dementia a process of degeneration with little hope of

improvement in functional performance (Gail Mountain,

unpublished)?


8/24

POEM


9/24

D=P+B+H+NI+SP

Ddementia

Ppersonality

BbiographyHphysical health

NIneuropathology

SPsocial psychology


10/24

Dementia: a psychological response as a means of

coping with brain damage

Tom Kitwood

(2003)

LOVEAttachment


11/24

Mental

Health ax

Physicalhealth/medication

Social/family history

Past

psychiatrichistory

Psychiatricinventory

Sleep, cognition (ACE-R),psychosis, appetite

Mood/affect

Interaction/communication

risk assessment

Occupationalperformance

COTES

AMPS

Interestchecklist

PAL

Model ofcreativeability

COPM

ICT Mental Health Assessment


12/24

NICE (2006)

Diagnosis and assessment Basic dementia screen, usually in primary care:

- routine haematology (nurses)

- Biochemistry tests

- thyroid function tests

- Serum vitamin B12 and folate levels Perform midstream urine test if delerium is a possibility.

Conduct investigations such as chest X ray or ECG by clinicalpresentation.

Factors that may affect performance, including educationallevel, skills, prior level of functioning and attainment,language, sensory impairment, psychiatric illness and physicalor neurological problems.


13/24

NICE Guidelines Dementia (2006)

Promoting Independence and

Maintaining Function

ADL advice and skill training from an OT

Advise re independent toileting skillsEnvironmental modifications to aid

independence

Physical exerciseSupport for people to go at their own pace and

take part in activities they enjoy


14/24

Pool Activity Level (PAL)

Instrument for Occupational

Profiling

Profiles what level of

ability the person has.

Designed to enable carers

to use the PAL instrument

to engage clients in

meaningful occupation.


15/24

The Pool Activity Level (PAL)

Instrument for Occupational Profiling

(Pool, 2008) PAL Personal History Profile

PAL Checklist Individual Action Plans for personal care

activities

PAL Activity Level Profile

Outcome Sheet for recording results


16/24

Life History Work

As we go through life we build up a personal historywith its unique mix of joys and pleasures, sorrows andpains. Our sense of who we are is linked to that historyand if we lose that we lose something of ourselves

(Kitwood)


17/24

PAL checklist

1 Bathing / washing

2 Getting dressed

3 Eating4 Contact with

others

5 Groupwork skills6 Communication

skills

7 Practical activities

(craft, domestic

chores, gardening)

8 Use of objects

9 Looking at a

newspaper /magazine


18/24

PAL Levels

Planned; Can work towards goal directed activities with atangible outcome, but may not be able to solve problems thatarise

Exploratory; Can carry out familiar activities in familiar

surroundings, but more concerned with the effect of doing theactivity than the final outcome.

Sensory; Primarily concerned with experiencing the sensationof the activity and moving their body in response

Reflex; Often unaware of surrounding environment, moves asa sub conscious, reflex response to direct sensory stimulation.


19/24

Exercise

In groups complete the PAL checklist based on

your observations of the video

OBJECTIVE:

Decide on the overall level the client isfunctioning at.

.


20/24

Going Home


21/24

Discussion


22/24

Final Statement

As we become more emotional and less cognitive, its the way

you talk to us, not what you say, that we will remember. We

know the feeling, but dont know the plot. Your smile, your

laugh and your touch are what we will connect with. Empathy

heals. Just love us as we are. Were still here, in emotion and

spirit, if only you could find us.

Christine Bryden, Dancing with Dementia, 2005 p138)


23/24

References and Bibliography

Chester, R and Bender, M (1999) Understanding Dementia: The Man with the Worried eyes. Jessica Kingsley, London.

Finkel SI, Costa e Silva J, and Cohen G (1996) Behavioural and psychological signs and symptoms of dementia: a consensus

statement on current knowledge and implications for research and treatment. International Psychogeriatrics; 8 (Supplement

3): 497500.

Kitwood, T (1993) Person and Process in Dementia.International Journal of Psychiatry8 (7): 541-545.

Lawlor, B (2002) Managing behavioural and psychological symptoms in dementia The British Journal of Psychiatry 181: 463-465.

Lowenstein, D and Acevedo, A The relationship between Instrumental Activities of Daily Living and Neuropsychological

Performance. In Thomas, D and Grant, I (eds) (2010) Neuropsychology of Everyday Functioning Guildford Press. London.

U.K.

Snowdon, D, A., Kemper, S, J., Mortimor, J, A., Greiner, L, H., Wekestein, D, R., and Markesbery, W, R. (1996) Linguistic abilityin early life and cognitive function, and Alzheimers disease in later life: Findings from the Nun study. Journal of the

American Medical Association275, 7, 528-532.

Wisconsin DOH (2003) Progressive Declines of Alzheimers Disease & Related Dementia: Physical Changes That Effect

Perception of the Environment. Bureau of Aging & Long Term Care Resources, Wisconsin. USA.


24/24

References/resources

Wenborn et al (2008) Assessing the validity and reliability of the PAL Checklist. Aging & Mental Health, in press.

Stoddart (1998) Dementia Care: Supporting a plea for personhood. Scottish Journal of Healthcare Chaplaincy 1: 9-11.

Everybodys business: integrated mental health service for older adults: a service development guide. Department of Health (2005)

www.dh.gov.uk

The National Institute for Clinical Excellence (2006): dementia. www.nice.org.uk

Pool (2007) The Pool Activity Level (PAL) Instrument for Occupational Profiling: A Practical Resource for Carers of

People with Cognitive Impairment. Bradford Dementia Group Good Practice Guides. Jessica Kingsley Publishers; 3Rev Ed

edition.
http://www.dh.gov.uk/http://www.nice.org.uk/http://www.nice.org.uk/http://www.dh.gov.uk/

cpd day pres jan 2010.final

Documents