22 Dementia - Universities, Colleges and Schools [Update 3 - 24/11/13]

Introduction
Managers, teachers and support staff in each of our universities, colleges and schools may need to develop a vision, objectives and a strategy for:    a)  dementia studies, b)  research, and c)  staffing which embraces the developing national scenarios. 

The concerns and issues now arising with increasing awareness and information are likely to embrace some of the following:

• distressed students who are falling behind with their studies - a parent or grandparent has demenia
• distressed employees, governors and others who are caring for a family member living with dementia
• members of staff or mature students who begin to have memory problems or dementia
• a local settlement which is developing a policy of becoming a more dementia friendly community
• pressures from various groups of stakeholders in a particular industry, eg professions, employers and students, which may be facing concerns about dementia
• many kinds of studies where awareness and information about dementia from research are being drawn into curriculum development and delivery, eg design for dementia friendly care settings, buildings and grey and green environments
• pressures for monies to be allocated for new dementia-related research questions
• finally, there may be other like institutions collaborating though their new membership of a Local Dementia Action Alliance.  

24 Inter-generational Activities for those with Dementia - Children and Young Adults [Update 1 - 20/12/13]

Many families, schools, colleges and universities find that their children or students benefit from involvement in appropriately organised:

• being offered awareness and information session (say 60 minutes) so as to become a dementia friend
• in-class studies about dementia 
• learning sessions which involve those living a journey with dementia and /or their carers, eg discussion  
• leisure or recreation sessions,  
• researching, reviewing and presenting findings, eg a book review
• voluntary work. 

Where voluntary work or other inter-actional activities are held the appropriate safeguarding would be needed to protect both students and those with dementia.

As a subject dementia itself might be an appropriate way to develop an understanding, covering: 

• types 
• symtoms 
• stages of life with dementia
• life-style and other causes
• assessment, diagnosis, and clinical treatment
• social and end-of-life care
• the law of mental capacity 
• legal safeguards to provide that the wishes of the individual are observed as far as possible. 

Leisure and recreation activities provide opportunities for the likes of:

• reminiscing 
• inter-generational transfer of skills
• activities involving information and communication technology
• playing games 
• music and dance 
• walking and other exercise.

Voluntary work, subject to age and other constraints, might include:

• assisting in setting up a dementia friendly community or organisation
• assisting in recreational activities in a care home
• assisting in event management.

A school, college or university might consider that a team of staff become a Dementia Friend or a  Dementia Friend Champion. This is  as a good beginning to get a measure of dementia awareness and information. 

Any adult whether a Dementia Friend or not might go on to become a Dementia Friend Champion (DFC). Awareness and information  sessions are conducted by a DFC but it is not necessary to be a Dementia Friend before becominga DFC! 

An 18 year old student might also be encouraged to become a DFC, perhaps having become a dementia friend at primary school or later.

12 Dementia - Early Decisions, Documents and Action for End of Life

Although some of us will become vulnerable in some way, the matters listed below probably apply to any of us, fit or otherwise. They are for many very difficult matters to even contemplate. They are listed here as being important for those with memory problems or dementia.  Probably not exhaustive, they include:

• Will
• Lasting Power of Attorney for a) property and finance, and  b) health and care 
• Preferred place for any end of life treatment and care
• Decisions for refusal of treatment
• Funeral arrangements 
• Donations of organs and pacemaker, etc
• Family records and history for future generations
• Messages for family members and friends 
• Decisions about distribution of sentimental items
• Declutting of papers, records and chattels
• Trusts and other arrangements for vulnerable members of the family.

Relared posts include Post 12A.

18B Memory Problems and Dementia - Symptoms Update 1 - 28/11/13]

One of the aims of Swanley as a Dementia Friendly Community [see Post 1] is to enhance awareness of dementia, and so support the national policy to increase the rates of diagnoses of dementias. 

The way in which this will be done is to let residents, visitors and those who work in the town know of the symptoms and so encourage those with memory problems or other symptoms to go to their general practitioner (GP), ie a doctor for an assessment.

However, it may be noted that there may be other conditions causing memory problems, eg depression. This Post is a general review of the symptoms that a person living with a dementia may show. [See Post 18 for types of dementia.]

Initial Assessment
Firstly though, you may like to note that a person may exhibit one of these symptoms, eg a problem of memory loss, but that this might be caused by a condition which is not in fact dementia. It is important therefore for the individual to be assessed by a clinical practitioner with relevant training and experience. In some instances the illness will not be dementia. As a result the person may be treated or referred for appropriate treatment after the assessment.

A second aspect of national policy on diagnosis or initial assessment for dementia is that a person over the age of 74 years who is admitted to hospital for 48 hours or more will be assessed routinely for dementia.

Symptoms of Dementia
In life with dementia the various symptoms manivest at different times and may be dormant for long periods. Although there are common symptoms some of those with a particular dementia may not show all of them.

The list which follows is derived from talking to friends at the time when they were early-diagnosed and from written accounts by those who have dementia or by their family members. It is not an attempt to provide clinical  list so what I have called a symptom may be one of the outcomes of an underlying or general symptom.

1. Loss of short term memory
2. Confusion
3. Inappropriate behaviour
4. Expressions of anger, frustration, etc, eg shouting
5. Difficulty with or inability to do simple tasks, eg preparing vegetables
6. Difficulty with reading, eg reading written signage 
7. Difficulty with numbers, eg dealing with money
8. Having a propensity to wander and /or becoming lost
9. Repeatedly asking the same question 
10. Mild to severe cognitive difficulties
11. Being unable to recognise faces, eg family members or friends 
12. Inability to speak or understand
13. Lack of concentration.

Notes
Note 1 Readers in @Europe, @USA and other places may like to note that in the England most residents and long stay visitors are registered with a general practice doctor (GP) in a local NHS primary care surgery. During opening hours, unless an illness or injury is life-threatening, we will be treated by the GP, dentist, pharmacist, etc. Sometimes we go to a minor injuries unit (MIU) or a walk-in centre.

Note 2 Most of us are encouraged to avoid our local (secondary care) NHS hospital unless:

• we are referred to a hospital consultant or the hospital's A&E by our GP or an out-of-hours duty doctor
• we suffer an acute illness or other life threatening injury and emergency paramedics take us to the hospital's Accident and Emergency Unit (A&E), eg by the regional ambulance service, etc
• we become ill out-of-hours, in which case be bettle off to the A&E.  

13 Dementia Advocacy Services [Update 1 - 31.10.13]

Like most public services and professional organisations, the National Health Service (NHS) has a complaints system.  A later post will describe the twists and turns of complaints systems generally, including the NHS complaints system: whereas this post might meet a more pressing need for one of the following local independent services for advocacy on behalf of a person with dementia, a vulnerable member of the family or the care 

Although the emphasis in this post is on those with dementia, the local services may have a wider remit of support for others too.

As an example of what is available locally, there is the Invicta Advocay Network www.invicta-advocacy-network.uk a charity specialising in advocacy. Briefly the services offered include:

• Guidance and support for those with mental capacity to make decisions themselves or with     help
• Guidance and support for those without mental capacity to make their own decisions.

A similar charity in advocacy work is Advocacy Service, Age UK North West Kent.

In the UK the Dementia Advocay Network provides guidance, standards and training for individuals who wish to improve as advocates or to become dementia advocates. 

Reference: Age UK NW Kent  "Guide to Professional Advocacy".