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.  

17 Lasting Powers of Attorney and Dementia, etc [Update 2 - 20/11/13]

This Post identifies documents where an individual has expressed wishes about a) medical treatment, c) preferred final place for care, d) welfare, e) finance, f) property, e) provision for family members and others following death.

An individual with early onset dementia might need to consider having:

•  a Will
• two kinds of Lasting Powers of Attorney these might cover 1) finance and property and  2) clinical and welfare, including long term care
• an Advance Decision to Refuse Treatment. 

All the above mentioned will be need to be made whilst the person with dementia has mental capacity to make decisions. They will be important for the patient's GP, hospital doctors and nurses, care home staff and other professionals wishing to take cognisance of the patient's wishes, eg a)  for their treatment, b) where they want to be, and c) their care. You may like to note that, of course, the documents are formal and have nuances of law which affect the way they come into effect.

As an illustration, Swale Clinical Commissioning Group (CCG) in Kent is developing an integrated end of life health and care pathway for those who have a few months to live, say upto 12 months. For those with dementia the period may be longer. The CCG's approach is to provide all professional's in the integrated care pathway to have on-line access to:

• the patient's wishes as expressed in the legal documents, namely, the lastings power of attorney concerning health and care
• the planned pathway for integrated care 
• the ongoing clinical and care records as kept by the professionals on a daily basis.

It is conceivable that where a person living with dementia wishes to remain at home, this will be more readily acheived.

Related posts include: Post 12

18A Dementia - List of Types of Dementia [Update 4 - 23/12/13]

This morning I was in a village talking to the librarian about dementia to when another member of the public joined in saying: "I don't know the difference between "Alzheimer's" and "Dementia". The three of us then explored the topic very very briefly whilst my books were being processed.

I have not yet worked out the number of dementias or much of the detail but the following list gives some notion of terminology, ie by types and in some instances causes:

1. Alzheimer's Disease (dementia) - very roughly 60% of those living with a dementia
2. Vascular dementia - very roughly 30% of those with dementia
3. Frontotemporal dementia
4. Pick's disease (dementia)
5. Dementia with Lewy bodies (Lewy body disease) (see www.lewybody.org )
6. Hodgekinson's Disease (with dementia)
7. Parkinson's Disease (with dementia) 
8. Dementia as a result of brain damage, eg as a result of a motor accident, combat "shell shock" [see Post 33 - re traumatic brain injury TBI]
9. Dementia as a result of drinking abuse
10. Dementia as a result of taking drugs abuse
11. Mix of dementias. 

Needless to say, I am doing some more work to get numbers or proportions to these dementias - so please bear with me. [Several updates will be required! In the meantime Post 18B looks at symptoms.]
In the meantime those who want details might like visit the Azheimer's Society website; http://www.alzheimers.org.uk/

16A Assistive Technology for Those with Dementia [Update 2 - 08/11/13]

In an early post I highlighted assistive technology to help those living with dementia. This Post identifies several areas where assistive technology is available. you may like to note that a variety of desciptive terms are sometimes used, eg for online systems or devices  m-heath and tele-health. 

1. activity monitoring communication systems inter-sourced through laptops, mobile phones, personal computers, TV set-top boxes, etc - usable 24/7 
2. exit door monitoring, so preventing access to areas to avoid risks of harm 
3. fire prevention and mitigation
4. information and communication technology for reminiscing and cognitive skills maintainance
5. healthcare data communications by wireless technology (tele-health devices)
6. integrated care and clinical treatment
7. mobile telephone for tracking or tracing an individual who is carrying a mobile telephone
8. patient record systems
9. personal alarms for assistance to a call centre 24/7 
10. purchasing on-line
11. signage technology for access, etc.  

 Later material will be added to expand insights into the above and develop other pertinent topics.

You may like to note that assistive technology is likely to become more prominent in health and care in the next few years. Emphasis is being put at presnet by government and industry in reviewing and developing a strategy for assistive technoligy.

Profile 4 Kent County Council - Library Services for Dementia [Update 2 - 10/12/13]

A public library can be an important facility for those living with dementia, and their carers or family. In Kent the Kent County Council Library Service is coming much to the front in the quest for dementia friendly communities. 

In Swanley an event will be held in the town's Library on Tuesday 17 December 2013. It will inter alia publicise a range of materials which may be used to help those with dementia. 

The range of services available is likely to be increased in the foreseeable future. At present they include the following:

• books and other materials which can be borrowed 
• eBooks and eAudiobooks for downloading from the Library's website
• a carer's ticket which allows: a) borrowing more books than usual, b) for a longer period of loan, and b) without fines for missed dates
• over 20 themed reminiscence boxes (at least 153) to help those with dementia to recall their past - at least 153 boxes containing DVDs, CD, books, posters, toys and the like are available
• peer support to help the newly diagnosed and others with information and guidance
• libraries with improved environments - under the Safer Places scheme 
• working with groups at dementia cafes in the county
• Talk Time Groups.  

Other actual or potential services include volunteers running:

• library home delivery and support service
• Computer Buddy service for on-line activities
• groups for those who mightbotherwise be isolated.

Reference

KCC Select Committee (2011) Dementia - A new stage in life, (p108) Select Committee Report, KCC County Hall, Maidstone, Kent, UK
Linked Post(s)
Reviw 1 The Dementia Diaries (27/10/130 

No 8C Dementia - Sale etc of Property to Fund Care

A person living with dementia may decide, for example, to remove to another property. This may be a) a smaller property near a family member, b) a larger property with a members of his or her family, or c) a care home. [Sometimes the decision may need to be taken by a relative or carer who has enduring power of attorney, ie on behalf of the person with dementia who is no longer able to take such decisions as may be necessary.]

A need will be for funds to enable the move to be made. A list of some possible sources is given in Post 8B. If the person with dementia has sufficient investments, the disposal of these, subject to any capital gains or other taxes may provide sufficent funds.

Sale of Home
The sale of the individual's home may need to be carried out. If it is his or her sole or main residence that is sold, no capital gains tax should arise.

The amount available for the later move will be: the gross price agreed less a)  estate agent's costs and fees, b) solicitor's costs and fees, and c) removal costs.

Letting of Home
If the person with dementia is moving to a care home, an alternative to a sale might be letting the home for a regular rent to meet or partly meet the care home fees.

Again taxation needs to be considered - since only the net income from the let property will be available. Once let, the net income less annual costs will be subject to income tax. For tax purposes the annual costs allowed against annual gross rents include property insurance, maintenance, repairs, management fees, and other allowable costs. Before letting it amy be appropriate to repair and improve the property so that it can be let. Also, the letting agent's costs and fees need to be considered.

Thus, the net of tax income will be available to help pay for care home costs, etc.

No 8B Estate Agency Businesses and Dementia [Update 4 - 07/11/13]

This Post is exploratory and raises, firstly, the services needed by seniors in general possible concerns that an estate agent may have that arise from the need for a person with memory problems or dementia to move from his or her home. It is written by one who is not an expert! Legal advice should be sought as appropriate in the circumstances. [Post No8C will explore the options for selling or letting with property, together with something of the taxation consequences.]

[It may be noted that in many parts of the country only about 50% of those with dementia have been diagnosed with the the condition. In the area of the Dartford, Gravesham and Swanley CCG the percentage is targeted to become about 60% by 2015.]

Estate Agents may be approached about selling (or possibly, renting out) a home owned by a such a person. The approach may be made by: a) the person alone, b) by the person accompanied by a family member or the carer, or c) by a person with power of attorny - a family member, carer, friend or a professional.

The purpose behind such an approach might include the likes of:

• An intention to downsize into a smaller home or to a care home
• An intention to move to be near a member of his or her family
• An intention to move into a larger house with a family member's family. 

The first, perhaps basic, concern might be with the estate agency's staff having awareness of dementia and the need to conduct meetings discussions, telephone calls, visits, correspondence and the like in an appropriate manner. Managers and staff may need to be inducted, trained and developed in dementia awareness in terms of:

• the kinds of dementia [see Post No 18], and
• the symptoms as manivest in certain kinds of behaviour. 

The second concern is likely to be whether managers and staff have had training and experience concerning the legal capacity of the person wishing to sell (or buy) a property. Normally the person's solicitor would be expected to advise on such matters. 

If the person has been diagnosed, it may be that they do have legal capacity or that they made arrangements for lasting power of attorney to be held by another by a family member, etc [see Post No 17]. Where the dementia is advanced the estate agent may need to ascertain whether legal documents exist concerning estate and financial affairs and wishes of the person with dementia. This type of information will be available from the person with any valid lasting power of attorney or legal advisor.

At least one estate agency has developed an action plan under their town's Dementia Action Alliance. It emphasises the need for staff training in awareness of dementia and the kind of customer service needed for those with dementia.