Elderly or dementia and distress

Working with indiviudals in distress d8.is/b2 can be stressful for us as carers. Within an older population it is important for carers to gain an understanding of some of the effects ageing can have. D.ESCAL8™ hope this overview will give an introduction to the myriad of changes a person goes through later in life.

The ageing senses

With age our senses change and decrease. This affects our vision, hearing, touch, smell and taste. This can affect the way that we perceive the information coming from our senses and can be frightening and conflicts can occur with what we see and hear and what we perceive.

Vision can be affected by the perception of colour and it’s harder to see the contrast between colours, reduced peripheral vision, smaller visual field, less able to tolerate glare, sharpness of the vision deteriorates (visual acuity) and decreased pupil size so they are less able to take in light. This reduction in our vision can be very confusing and you may notice the individuals may wear brighter coloured clothing, may not be able to get to the bathroom in time, or losing their way around the building due to sight issues.

Hearing is affected with the loss of high frequency hearing, and they may have tinnitus. Hearing also affects balance so individuals are more likely to fall. Individuals may not be able to hear the higher notes in a tune, or female carers’ voices as they tend to be softer and higher in pitch. Hearing noises that are not present in the environment can be distracting and will interfere with normal hearing.

Taste declines including less sensitivity to sweet and salty tastes. The sense of smell diminishes after the age of 70. Taste and smell can also be affected by medications. As individuals may feel their food tastes bland which can lead to malnutrition. Individuals may not notice that they need a wash if their smell has declined or that their clothes haven’t been washed or the smell of the food. You may notice that individuals are having more sugar in their tea or putting more salt on their dinner. Food could be adapted with herbs, and spices to enhance the flavour and colour. We can also use brighter coloured dishes and cups to enable individuals to see the food. You may find that individuals will eat more if they can see it and if it tastes good to them.

Touch may be reduced or changed with aging, individuals are less able to detect vibration and pressure which increases the risk of injuries. They may have a reduced sensitivity to pain or an increased sensitivity to light touch. The individual may experience problems with walking due to the reduced ability to perceive where your body is in relation to the floor. Watching for signs of pain by flinching or facial expression is important as if they have dementia, stroke or Parkinson disease they may not be able to tell you they are in pain or may not be able to find the words.

What is dementia?

The term 'dementia' describes a set of symptoms which include loss of memory, mood changes, and problems with communication and reasoning and it affects 800,000 people in the UK. Damage to the brain occurs by certain diseases, including Alzheimer's disease and damage caused by a series of small strokes. Dementia is progressive, which means the symptoms will gradually get worse. How fast dementia progresses will depend on the individual person and what type of dementia they have. Each person is unique and will experience dementia in their own way. It is often the case that the person's family and friends are more concerned about the symptoms than the person may be themselves.

Symptoms of dementia may include the following:

  • Loss of memory - this particularly affects short-term memory, for example forgetting what happened earlier in the day, not being able to recall conversations, being repetitive or forgetting the way home from the shops. Long-term memory is usually still quite good.
  • Mood changes - people with dementia may be withdrawn, sad, frightened or angry about what is happening to them.
  • Communication problems - including problems finding the right words for things, for example describing the function of an item instead of naming it.

In the later stages of dementia, the person affected will have problems carrying out everyday tasks and will become increasingly dependent on other people.

More information about dementia is available on the Alzheimer’s Society website.

Dementia affects more than a person’s memory, it can also affect the following:

  • What people see, or interpret what they see
  • What people hear, or how they interpret what they hear
  • The language and words people use (they may think they are using the right word for something when they are not)
  • How people react to things and their emotions
  • How people relate to others
  • The things people are able to do: walking, eating, co-ordination, etc.
  • Physical ability / habits
    • swallowing
    • knowing when they need the toilet
    • knowing when to sleep etc.

Dementia care and distress

As carers working with older people with dementia you will be involved in looking for the reason for, or the triggers to behaviours. Many of the individuals you work with may not be able to verbally express how they are feeling, what they want or need, so you will need to know about the individual's history and be observant to help them when they become distressed. Knowing how to distract an individual as some may think they need to pick up children from school, cook tea, go shopping, go to work, things that in their adult life they would have done. Reassuring them is very important so that they won’t worry.

As the disease progresses and an individual will become more dependent it is still important that we encourage the individual to maintain their independence and give them a sense of purpose. Encouraging an individual to complete tasks that they are able to do is important i.e. folding napkins, cooking, etc this will be individual per person. Finding out the music that they like and playing it for them, reminiscing using their family photos or objects this is especially important as their mobility decreases. Placing objects of interest to that person where they can see them and encouraging any speech where possible. This could be sorting through a handbag, showing a dvd about a place that is important to them, triggers to stimulate a memory.

The course was well delivered and it reinforced the low arousal approach that we advocate and support here. Highly recommended!
— M.C. – Service Director

D.ESCAL8™ BILD Accredited Courses:

3 day Foundation Developing Positive Relationships with individuals in distress – Adults

3 day Foundation Developing Positive Relationships with individuals in distress – Children and Young People

In house Trainers Project