Section A: The scope of cognitiveimpairment across the lifespan I. Defining and outlining thescope 1. explain what is meant by the followingterms:a.
cognitive impairment: Minor mental problems: problemsrecalling memories and problems thinking b. dementia:Group of symptoms: memory loss,thinking difficulty, mood swings and thinking differently. c. learning disability:Learning disability refersto people to struggle to learn life skills. Examples include communication,money management, and reading, writing or caring for them. Some people are bornwith it, other develop it after an accident 2. What is the prevalence of dementiaand learning disabilities in the UK population?Dementia:700000 people have it Learning disability:1.5 million People in UKhave learning disability.
3. Identify the most common types andcauses of: a. dementia (4 most common types)Alzheimer’s disease.Vascular dementia.Dementia from Parkinson’s disease Dementia with Lewy bodies. b. learning disabilities (3 mostcommon causes)Dyslexia.
ADHD Dyscalculia 4. Identify 3 or 4 areas ofeveryday functioning affected by cognitive impairment at different stages ofthe life course; briefly explain how each area of functioning is affected:a) Lifelong impairments (i.e. thosewith which people are born or which develop early in life) Unable to think clearlyMemory Communication issuesCooking/Dressing b) Acquired impairments (thosewhich develop or are acquired during adulthood) Being depressed Mood swings and aggression Wandering or getting lost. II. Signs, symptoms andresponses to learning disabilitiesa) What might be early signs of learningdisabilities within the first five years of life?Speech DelayedProblems pronouncing wordsReading difficultiesCan’t hold concentration forlong b) How might a child’s developmentbe affected?Children willfeel bad, which gives low self-esteem. They will also have many physiologicalissues, which will inhibit their learning because they can’t learn like theirpeers c) How might family life be affected?Friction betweenparent and child affected. The child may cry or have tantrums.
This can be verystressful because of this since this is hard for the parents to understand. III. Signs, symptoms andresponses to dementiaa) What early signs and symptomscould indicate that a person might be developing dementia? It might be helpful to reflect on a person who has dementia that youmay have come across personally, professionally or via the media to answer thisquestion. ConfusionIssuesIssuesrecalling memoriesConcentrationLoss b) Discuss why you would need torespond sensitively if you encountered someone with the early stages ofdementia. How would you ensure your response was sensitive? Taking intoaccount of the person’s feeling is very important to their psychological state.They most likely already are frustrated that they can’t do many actions thathealthy people can do. I need to takeinto account that they may have physical/mental disabilities, trying to avoidproblems which bring up or highlight their problems. I would discuss thebenefits and be more optimistic if they bring up their concerns.
Section B: Living well with cognitiveimpairmentI. Person-Centred Care Person-Centred Care is about treating eachperson as an individual and providing care and support to meet their needswhilst respecting their personal beliefs and values. It acknowledges that everyperson, including those living with cognitive impairment, is different and thathow these impairments affect each person will be different. a) Consider your own beliefs andvalues.
Think about what you would consider to be important for others to knowabout you as an individual to enable them to offer you person centred care. Forexample, do you have particular routines for self-care, or favourite food anddrinks? i) What would you wantothers to know? Iwould tell the healthcare professional, my lifestyle routine and habits. In orderto receive the optimal healthcare, the healthcare professional would need toknow how I lived to find the possible reasons why issues are caused. ii) Why would thisbe important for others to know? What impact might it have on your care andwellbeing if this was not carried out? It’s important toknow my lifestyle routine because they can figure out what can be changed to inorder to recover. Habits would also be revealed, habits cause an unhealthylifestyle. Not mentioning my lifestyleroutine and habits will lead to non-person centred care.
Care has to betailored towards an individual or it won’t be effective b) Cultural Diversity: Identify 2 or 3 ways in which cultural background and ethnicitymight impact on a person with cognitive impairment in terms of functioning andwellbeing? For example, think about theinfluence that personal history, country of origin, religion and first languagemight have on an individual’s experience of living with cognitive impairmentand accessing care. Certainethnicities may be more susceptive to cognitive impairment than others. Familymedical records should be accessed. Certain ethnicities will react differently,for instance there is a stigma in Chinese culture that medication gives manyside effects, makes a person weak and old. Certain religions, i.e.
Christianity, reject medicine, and instead choose prayer. Certain regions aremore susceptible to dementia which will make people living in that area to bemore aware of the disease and may trust healthcare professionals especially ifthey’ve had multiple close friends, family members affect c) Within your professional role considerhow you might be involved in delivering person centred care in relation topeople of any age living with cognitive impairment. Give two examples consideringdifferent life stages. Elderly- Adaptcommunication to meet needs of old person, nonexclusive and using moretraditional communication methods, since the elderly will most likely not goonline and look for information. Young Children-Information given in short, concise bits. Children are unlikely to understandvery complex medical information.
Information easily accessible online for theparents if the child forgets the advice. d) Describe how views and attitudes of others might impact on the livesof people (children, young people and adults) with cognitive impairments, theirfamilies and carers. For children with cognitive impairments, family and healthcareprofessional relationships are important in dementia’s early stages. Factorswhich affect how people with cognitive impairment include: exclusion,discrimination. A person with cognitive impairment will more likely be closedoff and have problem integrating if they were bullied as children over theirimpairment. e) Identify some of the barriersfaced by people with cognitive impairments, and their families and carers. Howdoes the social model of disability help to identify these barriers? Some barriers face by people with cognitive impairment includesdiscrimination, prejudice, and loneliness. Social model of disability tries tolead to a positive self-image.
f) Why is it important to addressinequalities and social stigma for people of any age with cognitive impairmentsand identify adjustments which may be necessary to support themPeople with cognitive impairment will startto believe their negative stereotypes. Addressing the social stigma with cognitiveimpairment will greatly improve adherence to medication/support. If the personwith the cognitive impairment is positive and believes they can recover, thereis a bigger chance. II. Support for people with cognitiveimpairment and their familiesThere are a range of organisations thatsupport people with cognitive impairment or their families, carers, andprofessionals such as Carers’ Support Groups, Dementia Cafés, Activity Groups,Advocacy Services, Memory Services, Information and Advice Services, AssistiveTechnology, Benefits Advice, Befriending etc. With your profession in mind, identifythree services to which you might refer or signpost a person who has acognitive impairment and briefly explain why. https://www.nhs.
uk/Conditions/dementia-guide/Pages/dementia-help-and-support.aspx1) Dementia UK- Support forfamilies with dementia and nurses who are dementia trained 2) Talking Point- AlzheimerSociety’s forum. Used to share dementia advice and information. A self supportgroup 3) Alzheimer’s Society- Charitywhich provides information on dementia/Alzheimer, living with the disease andwhere to get help.
III. AdvocacyWhat is meant by advocacy? Public support for a specific situation/ policy Why might this be important in supporting people of any age with acognitive impairment? People withcognitive impairment may be unable to express in words their needs and wants.They may not even know what is missing from social services.
Advocacy will bring attention to theirissues, allowing more funding and hopefully lead to a solution. Section C: Enhancing Well-being through CommunicationDuring the IPL1 session we spoke about someof the challenges that people with information processing difficulties or cognitiveimpairments might face with communication and how, as professionals, we mightimprove our communication techniques to support more effective communication. Onthe websites and links below there is information about communicationstrategies: http://www.nhs.
org.uk/about-brain-injury/individuals/effects-of-brain-injury/communication-problems/cognitive-communication-difficulties/ List below 10 strategies for communicatingwith individuals who have communication and interaction difficulties which willbe useful for you in your professional role. 1. Raise awarenessof dementia and encourage people to seek help-2. Good-qualityinformation for people with dementia and their carers3. Easy access tocare, support and advice after diagnosis4.
Developstructured peer support and learning networks5. Improvecommunity personal support services for people living at home6. Improve thequality of care for people with dementia in general hospitals7.
Consider howhousing support, housing related services, technology and telecare can helpsupport people with dementia and their carers8. Improve thequality of care for people with dementia in care homes9. An informed andeffective workforce for people with dementia10. Improveassessment and regulation of health and care services and of how systems areworking Case Study 1Mrs Smyth is a 70 year old lady withadvanced Alzheimer’s disease and arthritis; she lives at home with her daughterand son-in-law. Her daughter had her first baby two days ago and is now home.Over the past few months Mrs Smyth’s mobility has reduced and she spends mostof her time in bed.
She now uses incontinence pads and relies on regular carersvisiting four times a day to manage her personal care needs. She has difficulty communicating verbally.The carers and family report that Mrs Smythhas become ‘aggressive’, biting and scratching when they carry out continencecare and other personal care tasks.
They say that she is constantly calling outand they cannot understand why.She often refuses medication, and her dietand fluid intake has reduced. a) What do you think some of theconcerns might be around Mrs Smyth’s physical, psychological and socialwell-being? Some concerns around Mrs. Smythphysical’s wellbeing appear to be reduced mobility, communication fatigue,problems with personal care. Her psychological and social wellbeing includesissues communicating and using incontinence pads. She tries to communicate bycalling out but others find it odd and are unable to comprehend what she issaying. Her biting and scratching is alienating her family members and carers. b) What might Mrs Smyth be tryingto communicate? E.
g. pain, distress, anxiety? It is verydifficult to know exactly what Mrs Smyth is communicating. She would mostlikely is communicating some sort of discomfort and may feel frustrated thatshe is unable to express it properly. c) Considering your professionalrole, how might you support Mrs Smyth, her carers and her family in theircommunication? I as a healthcare professional can use a written pieceof paper/ keyboard to communicate. If she is unable to write/type physically,although not ideal method of communicating, at least the exact thoughts of MrsSmyth can be transcribed onto a piece of paper. A bell can be used call forattention.
This can reduce the loud yelling and aggressive behaviour. Case Study 2: Josh is a 9-year-old boy with Down’ssyndrome who lives with his mother; he has two older brothers. His parentsseparated when he was five years old. He visits and stays with his father everyother weekend. Josh had a bike accident when he was 7years old.
He sustained a head injury, was unconscious for 72 hours and spent 4weeks in the local hospital, followed by a further two months’ recovery at home.He does not remember what happened and appeared to have recovered well from hisaccident, although he sometimes complains about headaches and not being able tosee. At these times his speech isdifficult to understand. Josh’s school has been raising concernsover the last year about his behaviour, such as aggression towards hisclassmates and difficulties in learning. Last week he became angry when histeacher asked him a question in class, and he walked out of the classroom.
Inthe school’s view, he is becoming increasingly ‘unmanageable’, and his teachersare worried about him. Similarly, Josh’sparents are very concerned about his increasingly unruly behaviour and anxiousabout his future. a) What do you think some of theconcerns might be around Josh’s physical, psychological and socialwell-being? Josh physicalailments disabilities include: headaches, loss of visionJosh’spsychological and social wellbeing issues include: having behaviour consideredantisocial by teachers. Aggression towards classmates and having ‘unruly’behaviour according to his parents b) What might be causing Josh’sbehaviour? What could be some of the consequences? Josh’s behaviourcould be a combination of irritation, social factors and the surroundingenvironment. The deterioration of brain cells will cause this physicalirritation. Some of the consequences of deterioration are an exaggeration ofthe symptoms. Josh may not be able to express their physical pain in words dueto cognitive function loss. c) Considering your professionalrole, how might you support Josh and his family to manage Josh’s behaviour? I would first tryto find the cause and exactly why Josh reacts the way he does at the time.
Hewill also face pain, which should not be accounted as the cause. I would try totake his feelings into account first; this will explain many of the actions.Encouraging his family and friends to be patient and take breaks when they havea moment. Ensuring the safety of Josh should be the priority of bothprofessionals and family. Case Study 3: Martin is a 57-year-old retail manager who experienceda stroke at work 6 months ago. He has been employed by the same retail companysince he was 17-years old and has worked his way up.
He is a popular anddynamic manager. Martin seems to be recovering well. He canwalk without assistance, and move around the house as normal. However, hisspeech is slower than before and he has difficulty pronouncing some words whenunder stress. He has not regained full control of his bladder and hasdifficulty with stairs. He wants to return to work in 4 weeks’ time.
His daughter Jade is worried about him asshe feels he is anxious, moody and depressed. He is like a different person altogether: not the loving Dad she grew upwith. Their relationship has become very difficult and Jade has stopped her 2year old son from visiting due to concerns that Martin will frighten him. a) What do you think some of theconcerns might be around Martin’s physical, psychological and socialwell-being? Martin has thefollowing physical ailments: Bladder control, motor impairmentMartin hasdifficulty with communicating. He has had mood changes.
His speech is sufferingand unable to pronounce certain words. He is suffering from early stages ofAlzheimer’s b) What might be causing Martin’s distress?Martin may havethe early stages of dementia. He seems have some of the early symptoms. He isunable to express his physical pain and therefore it is causing distress withdaughter’s relationship.
c) How might your profession beinvolved in supporting Martin and his family? Communicatingwith Martin and not constantly reminding him of his reduced abilities and Explainingthe situation to her daughter may make her more reasonable toward her father’snew problems. I could also try toimprove communication methods by allowing Martin to write down his needs. Your future roleUsing the skills and knowledge that youhave developed during the 2 hour IPL team-working session and information youhave discovered as part of completing this workbook, describe one approach youwill adopt in working with people with cognitive impairment in your future roleas a healthcare professional. Next Steps: Is there any additional study you could do to equip yourself towork effectively with people with information processing and/or cognitive orcommunication impairments, and their families or carers? I have read a book called “Activities to dowith your parent who has Alzheimer’s Dementia” This book gave a great insightinto seeing the life in eyes of person who suffered from dementia.