Tag Archives: dementia


Pain In Dementia Is Often Not Recognised or Treated


Pain in people with dementia is under-assessed and undertreated.

Antipsychotic drugs, sedatives, antidepressants and many other drugs are often prescribed to people with dementia. Anxious, distressed and aggressive behaviour may be the result of pain, which in some cases the person with dementia cannot express or communicate.

If it is difficult or impossible to assess if a person with dementia has pain, would it not be a great step forward to try painkillers for a short period and assess the effect, before commencing all the sedatives?

Click here for Pain Assessment for Residents with Communication Issues

Click here for Nursing Care Plan for Pain which incorporates an Assessment Tool.


Analgesia Awakens Alzheimer’s Patient From Dementia

Click here to view some real success stories of people with dementia improving dramatically after being given painkillers.

My friend’s mother has very advanced dementia and was extremely unsettled, agitated and could be extremely angry and aggressive at times.

She had never complained of pain nor showed signs of being in pain when she was being cared for.

She fractured her femur just over a month ago and was commenced on strong analgesics post operatively.

Her behaviour and quality of life changed almost immediately. She has continued on analgesics regularly and continues to have a much improved quality of life.

She is now settled, calm and  and enjoys spending time with her husband and family.

Her family are so upset that for years no one realised she was in pain.

A review in the Nursing Times discusses the main barriers to effective assessment and management of pain in people with dementia

5 key points

An estimated 115 million people could be affected by dementia by 2050

The prevalence of pain in older people is estimated to be 25-50%

People with dementia receive fewer analgesics than their counterparts who are cognitively intact

One study found three quarters of care homes did not use standardised pain assessment tools

Attitudes and beliefs among patients and nurses can be substantial barriers to effective pain management

People With Communication Issues Can Not Complain Of Pain Or Express Pain

Doctors often are not able to determine if a person with dementia has pain.

Nurses likewise may consider that people with dementia cannot reliably report pain or any change in the level of pain.

Correctly Assessing and Meeting Peoples Needs Improves Quality of Life

A simple tool, based on the ‘PAINAD’ (Pain Assessment in Advanced Dementia scale) could help:

P – Pick up on mood (are they withdrawn or irritable?)

A – Assess verbal cues (are they muttering under their breath, moaning or crying out?)

I – Inspect facial expressions (are they grimacing or looking frightened?)

N – Notice body language (are they pacing, clenching their fists, fidgeting or curled up as if trying to hide?)

Use of assessment tools and guidelines

Increasing the use of assessment tools would assist Nurses and carers in recognising pain.

Education for staff

All staff need training and guidance to be able to care well for a person with dementia. They need training to understand the complex issues of the condition, and how important empathy and understanding are.

Assessment of Pain

Consistency of care with residents with dementia is extremely important in assessing pain and delivering excellent person centred care.

Risk of Falling for Elderly Nursing Care Plan

Elderly Falls and Trips

In the United Kingdom, the number of patients readmitted to hospital after treatment for a fracture had risen significantly since 2008/9.

Click here for the comprehensive falls risk assessment

Trips and falls can be a major hazard for any elderly person.  A fall can have serious and life changing implications for a patient, and the fear of falling can impact negatively on their lifestyle and the activities they enjoy.

It is vitally important that a comprehensive falls risk assessment is completed for all patients and any issues associated with, or increasing, the risks of falls are identified.

This risk assessment must be reviewed at least monthly or more regularly  if the patient’s condition changes, because any deterioration or slight changes in the patient’s condition can increase their risk of falling.

The objective of any person centred Care Plan is to ensure the patient’s issues and needs are set out in great detail and are very much at the core of the Care Plan.

The starting point is a detailed consultation with the patient and their relatives. Any issues which might increase a patient’s risk of falling are discussed and a plan to address the issues is formulated and agreed.

Many factors can increase a patient’s risk of falling, such as their mental state and the impact that may have on memory and poor or impaired eyesight.

Hearing difficulties can sometimes cause balance problems also increasing the risk.

A patient’s mobility, steadiness and gait and any issues they have with that, or an inability to ask for  help, can increase the risk of falls.

Any medication which causes drowsiness including sleeping tablets may result in  falls.

A patient’s room and day rooms must be kept clear of potential trip hazards and where possible the patient should wear well fitting shoes, and not slippers, even though they may be more comfortable.

You should consider any of these issues which are causing an increase in the risk of falling and where possible suggest or agree a plan which will address or improve the issues and record this.

Anything, however simple, that can be done to help should be recorded and implemented, such as ensuring the environment is free of clutter and ensuring a call buzzer or alarm is given to the patient.

Safety of the patient is of course paramount, and a key consideration when preparing this Care Plan.

You need to look at ways of ensuring the patient’s safety, which may involve the use of a pressure mat next to the bed to alert staff when the patient gets up, bed rails to prevent a patient falling out of bed or a lap strap in a wheelchair.

Any form of restraint must be assessed as a benefit to the patient and agreed with the patient and relative. You need to record your assessment in detail.

You need to look at any equipment which the patient will be using, such as a zimmer frame or walking aid and assess what risks they might have by using them.

When considering the issues central to a falls Care Plan, you need to strike the right balance, and look at what risks prevail in promoting and encouraging the patient’s independence, but at the same time minimise as far as possible the risks of falling.


Make Your Care Home More Dementia Friendly

It is such an important goal for all care homes and care facilities to ensure they enhance and, where possible, improve the quality of life for the residents with dementia. The Kingsfund assessment tool enables Care Homes to do this. It contains seven different sections looking at different aspects of the physical environment and a set of questions for each section. It encourages everyone to become involved in assessing how dementia friendly their care facility is.

Kingsfund Tool

Click here to download the Kingsfund Tool.

This tool was brought to my attention by an independent sector development officer. He talked of the merits of taking a good hard look at your Care Home from the perspective of the person with dementia and he recommended this tool.

It is a real beneficial and practical help to the manager and staff, because it helps to evidence improvements and developments in a Care Home or care service.

We changed many things as a result of using the assessment tool. Some  changes were very small, but overall these changes improved the level of how dementia friendly our Care Home was, and is today.

Each section prompted analysis and improvement. Simple things such as looking how inviting the entrance was, how obvious was the location of the doorbell, and how easy was it to use. This of course not only helps residents with dementia, but also those with diminished sight. The tool re-enforced the importance of group seating to encourage conversation and interaction between residents.

The names plates on bedroom doors were doubled in size to make them more obvious to the resident. We created new signage for the public areas of the Care Home, again making it far more noticeable than previously, but this also included a lot more additional signage to help direct residents around the Care Home.

The garden area was developed to add raised flower beds to give residents the opportunity to enjoy gardening without bending if they did not want to do that. Garden areas were also secured to give residents complete freedom to be outdoors whilst at the same time ensuring their security.

The residents, relatives, staff, management, and other healthcare professionals were involved in the assessment and the residents were consulted and involved in the decision making process. Everyone has learned from and enjoyed the whole experience.

The changes which can be made are in many cases, small and inexpensive, and relatively easy to make. Collectively they help the residents to maintain their independence and enhance their quality of life.


Nurses in Britain are Buried by Paperwork

Nurses in Britain are Buried by Paperwork

Nurses in Britain buried in paperwork planningforcare.co.ukNurses in Britain spend an estimated 2.5 million hours a week on “non-essential” paperwork that’s where Planning for Care can help

The Royal College of Nursing believes nurses are burdened with too much paperwork and too many targets.

I think every nurse would support that belief.

The view adopted by the inspectors and auditors appears to be ‘if it’s not written down, it’s not happening.’

In reality, there can be a well written Care Plan but the quality of care might bear no resemblance to what is set out within the Care Plan.

Nurses would much rather spend their time caring for patients or residents than completing paperwork such as care plans.

Unless nurses are producing excellent Care Plans, Care Home grades will suffer.

30 years ago written Care Plans did not exist, but the care delivered was, in the main, very good or excellent.

Perhaps this was because nurses did not have to spend much of their time producing the volume of paperwork that is necessary today.

I do very much believe in the benefit of care plans today.

It is the way forward and if written well, can really have the capacity to have a substantial effect and improve the quality of care.

Documentation is a crucial aspect of care, which facilitates the continuity of care and it forms an accurate record of care provided. It is now vitally important that the quality of resident’s care and nursing documentation is of the highest standard.

How Our Care Plans Can Help

A good system of Care Planning undoubtedly can help the nurses and carers complete the paperwork far quicker and more comprehensively.

A system of personalising care planning for the elderly, which Planning for Care provides, can vastly improve the delivery of care and help Care Homes improve the grading they are awarded by the Care Inspectorate by helping them meet their regulatory requirements.

“The challenges facing everyone in the care sector are growing exponentially with constant changes in law, increased regulation and the potential threat of litigation.”

The focus on nursing appears to have changed and, instead of it being a wonderful, satisfying and fulfilling occupation, it is now very much a race against time.

It is in everyone’s interest that the standards of care improve.

The National Health Service, and nurses in Britain are wonderful institutions which have to survive and flourish.

Progress is a great thing, but there needs to be a balance to ensure there is no deterioration in the very core standards and values of nursing. We need to rethink the path we are taking.

The days of placing massive importance on positioning each pillow case with the closed end facing the entrance door of the ward have gone!

But was it really such a pointless exercise?

In those days every nurse knew every detail about every patient, and every aspect of patient care was delivered with precision and thought.

Patient care may have been delivered in a task orientated way, but attention to detail was everything.

The pride nurses had in their job was tangible.

A mixture of the nursing cultures of yesteryear and today is, I think, needed to help elevate nursing to the high standard of profession it should be.

View our free sample Care Plan or our full range of Care Plans here. 


Music can be an Amazing Therapy for Dementia

Dementia and Music

In my experience music can reach many individuals who suffer from dementia in a very special way.

We asked families to tell us the resident’s favourite music which we recorded onto an ipod, the music was specifically chosen for them.

For some residents it had a remarkable effect.

For one gentleman who had very little interaction with his wife or carers, and very little interest in anything it gave him a real interest in something. He was much more expressive and animated, and he started communicating with everyone.

His wife admitted that when she was first asked to try this, she was really sceptical.

She said that she could not believe the difference in her husband, he was much more happy, he showed a real interest in everything and his quality of life improved dramatically due to the music.

An improved or good quality of life for any elderly person should be every nurses or carer’s goal.

Music has dramatically improved many resident’s quality of life, It has been wonderful for the person and very special for their families.

Music has power especially for individuals with Alzheimer’s disease and related dementias.

It can spark compelling outcomes even in the very late stages of the disease.

When used appropriately, music has the power to change mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function, and coordinate motor movements.

This happens because rhythmic and other well-rehearsed responses require little to no cognitive or mental processing.

A person’s ability to engage in music, particularly rhythm playing and singing, remains intact late into the disease process because, again, these activities do not mandate cognitive functioning for success.

Most people associate music with important events and a wide array of emotions.

The connection can be so strong that hearing a tune can evoke a memory of the event and take the person back to that time and place.

Prior experience with the piece is the greatest indicator of an individual’s likely response.

Music that is soothing for one person may remind another of the loss of a loved one and be tragically sad.

If the links with the music are unknown, it is difficult to predict an individual’s response.

Therefore, observe a person’s reaction to a particular arrangement and discontinue it if it evokes distress, such as agitation, facial grimaces or increasing muscular tension.

It is such a simple idea but is really worth trying as it can make a difference.

Click here for a person centred Nursing Care Plan for dementia.


‘Dementia link to sudden low blood pressure and dizziness’

People who experience frequent drops in blood pressure or dizziness when suddenly standing up are at increased risk of dementia, scientists say.

Writing in Plos Medicine they suggest that less blood reaches the brain during these moments, leading to brain cell damage over time.

Dementia experts say this is a “robust study” and “plausible explanation” that needs further investigation.

Charities point out that factors such as smoking carry higher risks.

But they say the work adds to growing evidence that changes in blood pressure have an impact on the brain.


Previous studies have linked high blood pressure to types of dementia.

But in this paper scientists focused on transient periods of low blood pressure – also known as postural hypotension – which become more common in older age.

These episodes can sometimes leave people feeling dizzy or give them “head rushes” when standing up suddenly.

Researchers from the Erasmus Medical Center, in the Netherlands, tracked 6,000 people for an average of 15 years.

They found those who suffered repeated periods of low blood pressure on standing were more likely to develop dementia in the years that followed.

Researcher Dr Arfan Ikram said: “Even though the effect can be seen as subtle – with an increased risk of about 4% for people with postural hypotension compared to those without it – so many people suffer from postural hypotension as they get older that it could have a significant impact on the burden of dementia across the world.”

He told the BBC: “If people experience frequent episodes of dizziness on standing, particularly as they get older, they should see their GPs for advice.”

But he added that young people, who have one-off episodes of dizziness when standing up because of dehydration for example, should not be unduly worried.

‘Not death sentence’

Prof Tom Dening, from Nottingham University, described the research as “an important study”.

He added: “The suggestion is that feeling dizzy, which results from a fall in blood pressure, may interfere with the circulation of blood round the brain and that over time, this causes damage which may contribute to dementia.

“This is a plausible hypothesis and has support from other research. It is possible that something else may be going on.”

He said: “A dizzy spell is not a death sentence nor does it mean you are certain to develop dementia.

“On the other hand, if this problem occurs frequently, then it is worth seeing your doctor as there may be remediable causes, for example if you are taking medication it should be reviewed.”

Dr Laura Phipps, of the charity Alzheimer’s Research UK, said: “While the risks found in this study are reasonably small compared to other known risk factors for dementia, it adds to a growing and complex picture of how blood pressure changes throughout life can impact the brain.

“As well as maintaining a healthy blood pressure, the best current evidence suggests that not smoking, only drinking in moderation, staying mentally and physically active, eating a balanced diet, and keeping cholesterol levels in check can all help to keep our brains healthy as we age,” she said.

Source BBC News



A lack of vitamin D ‘could cause dementia’

A lack of vitamin D – which comes from sunshine – could raise your risk of getting dementia, according to research.

It is already known that someone’s genetics can raise their danger of developing dementia, as can smoking or being overweight.

But a new study from Edinburgh University has found a lack of sunshine could increase the risk.

People around the world with low vitamin D levels were found to have a higher risk of developing dementia, with researchers suggesting they could in future be advised to take supplements or spend more time outside to protect themselves.

The vitamin, which people get when their skin is exposed to sunlight, helps to clear the protein build-up which can cause Alzheimer’s disease.

It was found to be a potential environmental cause of dementia along with exposure to air pollution, pesticides and excessive levels of minerals such as aluminium in drinking water.

Dr Tom Russ, of the Alzheimer Scotland Dementia Research Centre at the University of Edinburgh, said: ‘Our ultimate goal is to prevent or delay the onset of dementia.

Environmental risk factors are an important new area to consider here, particularly since we might be able to do something about them.’

Source Mail Online

MP shares memories of Morton legend dad with dementia

INVERCLYDE MP Ronnie Cowan has shared treasured memories of his Morton legend dad with a group of elderly football fans who have dementia.

Mr Cowan’s father Jimmy also famously starred for Scotland and he is one of the favourite topics of conversation for those taking part in the new memories group at Cappielow.

Ronnie, who was elected at last year’s general election, was delighted to come along to their latest meeting to chat about the glory days – and it proved an emotional day for all those round the table.

“I spoke with Tracy from Alzheimer Scotland and wanted to do all I could to help, so I brought along images that I have around the house.

“It is incredible my dad died when he was 42 but people still remember him and talk about him.

“There were stories that I heard growing up, and they were being talked about by the group.

“I thought to myself – ‘so they were true!’.

“It was a great way to get people talking.”

Morton Memories was set up by the local branch of Alzheimer Scotland and the club community trust to help those with dementia revive memories.

Football fan Roy McGibben, who lives in Marchmont Nursing Home, is one of those taking part.

He said: “It is really wonderful, out of this world. Jimmy Cowan was a lovely man.”

Roy spent time talking to Ronnie and others about all the players of Jimmy’s generation.

Jimmy Cowan, main pic and inset after Scotland’s famous 3-1 victory over England in 1949, is regarded as one of Scotland’s finest ever ‘keepers.

He signed for Ton in 1944 and stayed for nine years, playing against Rangers in the famous Scottish Cup final of 1948.

During that time he was capped a remarkable 25 times for Scotland.

Jimmy remained a popular figure in the town after his retirement before he passed away in June 1968.

In 2007 he was recognised as a true Scottish footballing great by being inducted into the Hampden Hall of Fame.

Marchmont’s senior carer Sarah White brought a group of elderly residents to Cappielow for this week’s memories session along with activities co-ordinator Fiona McNeilly and they said it had a terrific impact.

She said: “To get that kind of reaction from Roy and others is incredible. It is amazing. Roy just didn’t want to stop talking.”

Alzheimer Scotland Inverclyde branch co-ordinator Tracy Gilmour today thanked MP Mr Cowan for his support.

She said: “Everyone wanted to talk about Jimmy Cowan, so I got in touch with Ronnie. It worked out so well and was a great success.”

The next Morton Memories group meeting is on November 1 at Cappielow.
To find out more contact Tracy Gilmour on 01475 261102.

Source Greenock Telegraph



Cardiff University dementia genes study breakthrough hope

Scientists in Cardiff say they are on the verge of an “enormously exciting” breakthrough in understanding the causes of Alzheimer’s disease.

Their study will suggest the body’s own immune system could be attacking brain cells of those genetically susceptible.

It builds on global studies identifying 30 genes linked to the disease.

About 45,000 people in Wales are thought to be living with dementia, with Alzheimer’s the most common form of the illness.

For years, scientists have been looking at a small number of genes which apply to very rare forms of Alzheimer’s but they have been trying to find the ones which apply to more common forms of the disease.

To do that, they need to study of the genes of far greater numbers of people.

Forty research groups led by scientists in Cardiff, France and the United States have been working more closely together and have now pooled a worldwide database of 90,000 samples.

“We’re about to submit a paper that is enormously exciting and which I think will really change, without a doubt, what we think of Alzheimer’s disease going forward,” Professor Julie Williams, head of the research team at Cardiff University, said.

“Over the last five or six years we’ve been successful in identifying 30 genes that increase – or decrease – your risk for Alzheimer’s disease.

“Now this is telling us what some of the major components in disease development are. It’s new, it’s exciting; it’s a different perspective on what Alzheimer’s disease is.”

A lot of dementia research over the last two decades has been looking at a few elements in brain behaviour such as amyloid plaques – the tangles that occur within the neurons.

Prof Williams said now they were looking at something different – backed by genetics – which is the immune response in those people who go on to develop Alzheimer’s disease.

“Our immune response is about how the brain keeps us safe, it’s about getting rid of things which might invade the brain, getting rid of nerve cells and bits that go wrong,” she said.

“It has a very complicated set of activities and some of those are actually, I think, dismantling the brain at its roots.”

One of these involves a pruning function which is quite normal and helps our brains develop as we grow.

But now scientists believe it is triggered again in some people as they get older and actually eats away at synapsis [connections between nerve cells] and brain cells.

Researchers will also look at how factors such as lifestyle and exercise could play a part.

Cardiff University’s range of scanners at its new £44m brain imaging research centre Cubric will be used in the research.

It includes Europe’s most powerful brain scanner – which has been described as the “Hubble telescope of neuroscience”.

One research project is targeting 180 people in the Cardiff area, aged between 40 to 60, to help study the genetic risks of Alzheimer’s and how issues like lifestyle and obesity interact.

Volunteers will be given MRI scans as well as having blood and saliva samples taken.

Cardiff University is also looking for volunteers for research into early onset dementia.

Meanwhile scientists in Bangor have developed new ways of helping individuals develop new skills or re-learn skills they have lost, and lead projects allowing patients to create visual art.

They are looking into ways to communicate with patients who have lost the ability to speak.

Prof Williams said: “It’s great people are living longer, it’s something to celebrate but it means there will be more disease out there and Alzheimer’s and dementia will be up at the top of that list unfortunately.”

Source BBC News

Mobile game Sea Hero Quest ‘helps dementia research’

Dementia researchers have developed a video game that could lead to the development of early diagnostic tests for the disease.

The way players navigate the 3D levels in Sea Hero Quest will be anonymously tracked and sent to the researchers.

Understanding how people navigate 3D environments is important because the skill is often one of the first lost by people who have dementia.

Researchers say the game could generate an unprecedented amount of data.

“We have never seen anything undertaken in dementia research at this scale before,” said Hilary Evans, chief executive at Alzheimer’s Research UK, one of the organisations involved.

“The largest spatial navigation study to date comprised fewer than 600 volunteers.

“Providing the research community with access to an open-source data set of this nature, at this scale, in such a short period of time is exactly the kind of innovation required to unlock the next breakthrough in dementia research.

The free game was developed by the charity, researchers from University College London and the University of East Anglia, with the backing of communications giant Deutsche Telekom.

Players follow a sailor’s quest to revisit some of his father’s memories, and battle fantastical sea creatures.

The routes they take will generate global “heat maps” that will show researchers how people generally explore 3D environments.

The ultimate goal is to develop new diagnostic tests that can detect when somebody’s spatial navigation skills are failing.

Researchers from UCL said the game generated useful data about 150 times faster than lab-based experiments.

“In my research team, I could only test about 200 people a year, and that’s working hard,” Dr Hugo Spiers, from UCL, told the BBC.

“But last night I tested 200 people in one minute with this game.”

Players can opt to reveal their gender, age and location to the researchers, although they can choose to take part completely anonymously.

“This project provides an unprecedented chance to study how many thousands of people from different countries and cultures navigate space,” said Dr Spiers.

“It’s a massive online citizen science experiment that will give us an idea of what is ‘normal’ through this game.

“If we tile that information together, we can get a sense of how dementia changes over a lifetime, and other demographic factors.”

Dr Spiers stressed the game was not itself a test for dementia.

“If you’re worried about your memory or any changes to your health, speak to your GP,” he said.

The researchers plan to share the first results of their data collection in November.

Source BBC News