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APPLYING A PERSON-CENTRED APPROACH
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These recommendations are applied to case study four as presented in the following.
CASE STUDY 4: CARING FOR A CALD RESIDENT LIVING
WITH DEMENTIA WHO HAS DEVELOPED BPSD
Angela is 86 years old and is from a Greek background. She moved to the care home recently for permanent care due to the late stage of Lewy Body Dementia. This type of dementia has many similarities with Alzheimer’s disease, but is characterised by visual hallucinations and fluctuating cognition (or having ‘good days’ and ‘bad days’).
The characteristics of changed behaviours among people who are diagnosed with Lewy Body Dementia can be found from ‘Help Sheets’ developed by Alzheimer’s Australia . More details related to Lewy Body disease are available from the Alzheimer’s Australia website.
Angela and her husband migrated to Australia from Greece in the 1950s. They met and married in Australia and worked for a car manufacturer until their retirement.
They raised four children and have ten grandchildren. Their home had a big garden as both of them liked to work in the garden and enjoyed growing trees, fruit and vegetables, flowers and seeing birds in their garden. Angela’s husband passed away seven years ago. Five years ago when Angela developed Lewy Body Dementia, Vik, her 60 year old daughter became the main carer. Vik is also her Guardian and is bilingual, speaking both English and Greek.
Although Angela could speak some English previously, she can no longer speak or understand English and now only speaks in the Greek language. Angela also experiences deafness in her right ear. The deafness combined with Angela’s inability to communicate in English sometimes causes her distress when care staff attempt to provide her with assistance. In recent days, staff identify that Angela talks to herself and tries to repeatedly check her wardrobe, removes her dresses from the wardrobe and places them on the bed or leaves them on the floor. She also refuses to be assisted with morning care and yells at staff. In addition, she repeatedly walks to the exit door and tries to follow staff out of the secure unit.
RN David informs Angela’s daughter Vik of the situation and seeks her assistance in identifying possible triggers for Angela’s changed behaviours and in developing a care plan to meet Angela’s needs. Vik reports to David that Angela tells her when she visits, that she is seeing ‘strangers’ in her room. The strangers are hiding in the wardrobe and trying to steal her dresses and jewellery. Angela also wants to go home and does not want to be with strangers in a strange place.
Discuss the triggers of changed behaviours
Using the ABC approach (antecedent behaviour descriptionconsequence) to interpret the behaviours from Angela’s viewpoint, record your discussions in Table 7 and share your discussion with other groups:
125 ANTECEDENT (TRIGGERS) BEHAVIOUR DESCRIPTION CONSEQUENCE
Table 7: Using the ABC approach to interpret behaviours from Angela’s viewpoint
Please note, the answers listed in the table are suggestions only. The Facilitator will need to encourage staff to discuss antecedent, behaviour description and consequence based on their experiences.
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What can the care team do in this situation to meet Angela’s needs?
Using the ‘Clinical Practice Guidelines and Principles of Care for People with Dementia’
on BPSD management as described above, discuss a person-centred approach to meet Angela’s needs. ‘Valuing People’ framework as described in Table 4 also needs to be considered.
Please use
ü
to indicate a good response and X to indicate a poor response in the box for each statement. Please also discuss the reason why you think it is a good or a poor response.a. The RN needs to contact Angela’s doctor for further assessment to identify possible triggers of changed behaviours.
b. Work in collaboration with Angela’s daughter to make Angela’s room environment look like that of her own home, for example by decorating the walls with family photos, pictures or artefacts that are meaningful to Angela.
c. Work in partnership with Angela’s daughter to create a profile of Angela by using photos or pictures of significant events in her life that she still enjoys.
The profile will enable staff to know Angela’s past history and identify and accommodate her individual needs.
d. Take out Angela’s hearing aid because it might be causing her distress and she cannot understand English anyway.
e. Assign a staff member who can speak Greek to assist Angela when possible.
f. Work in collaboration with Angela’s daughter to create a communication booklet that enables Angela to express her needs for her care in the morning and have autonomy to say when she is ready to receive morning care.
g. Use cue cards with pictures of Greek words as prompts to communicate with Angela to help to understand her needs; and use non-verbal communications such as miming, eye contact, a smile and gentle touch while explaining any care.
h. Commence a pain assessment utilising a tool specifically designed for people living with dementia (for example Pain Assessment in Advanced Dementia Scale (PAINAD) or the Abbey pain scale; please check the tool used in your care home) to determine if there is any correlation between pain and changed behaviours.
i. Lifestyle staff to work with Angela’s daughter to assess Angela’s social and spiritual needs, identify activities that Angela still enjoys and provide Angela with opportunities to choose the activities she would like to participate in. For example Lifestyle staff could design activities that reflect her hobby of gardening.
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