Practical Guide for Alzheimer's Professionals - Fundación Reina Sofía

108 Pages·2012·1.66 MB·English

Practical Guide for Alzheimer’s
Professionals

Content
Chapter 1: Introduction 4 5.2. Social intervention 70
1.1. Background 4 5.3. Social worker’s functions 71
1.2. Description of the Centre 6 5.4. P re-admission and admission
evaluation 72
1.3. Professional team 9
5.5. Adaptation to the Centre 74
1.4. Individual Care Plan 12
5.6. Objectives proposed by the social
Chapter 2: Intervention from the
work area 75
neuropsychology area 14
5.7. Keys to working with families 76
2.1. Neuropsychological profile of
5.8. Mutual help groups 78
people with dementia 16
5.9. Support during the terminal
2.2. Neuropsychological
phase and grief process 79
evaluation techniques 19
Chapter 6: Research Unit for Alzheimer’s
2.3. Intervention methodology 25
disease and related disorders 80
Chapter 3: Intervention from the
6.1. Current status 81
occupational therapy area 32
6.2. Clinical considerations 85
3.1. Functional profile of people
with dementia 34 6.3. Current research into Alzheimer’s
3.2. Functional capacity evaluation disease and related diseases 90
techniques 37 6.4. Research Unit projects
3.3. Intervention methodology 40 in progress 94
Chapter 4: Intervention from the Chapter 7: Conclusions 100
physiotherapy area 50
7.1. Follow-up of treatment 100
4.1. Physical profile of people with
7.2. Importance of active training 101
dementia 50
7.3. Benefits of non-pharmacological
4.2. Neurological signs 53
therapies 102
4.3. P hysical/motor evaluation
techniques 53 7.4. Bioethics in caring for people
with dementia 103
4.4. Intervention methodology 55
Chapter 5: Intervention from the social Bibliography 104
work area 68
5.1. Facing the disease:
institutionalisation 68
3
Content
1.1. Background
1.2. Description of the Centre
1.3. Professional Team
1.4. Individual Care Plan
Capítulo 1
Introduction
Laura Fernández Pérez.
Social worker and
occupational therapist
Director
Alzheimer Centre
Reina Sofia Foundation
1.1. Background
The current phenomenon of population of Spain’s total population, as compared
ageing is the result of factors such as the with 17.2% in 2011.
increase in life expectancy, sharp fall in
the birth rate, new lifestyles, etc. In view There is also a new demographic
of these factors, and according to a phenomenon referred to as the “ageing
National Statistics Institute study on of the aged”, or the increase in the
long-term Spanish population population aged over 80. As a result,
projections, entailing a statistical socioeconomic policies in general must
simulation of population structure over be adapted, particularly gerontological
a 40-year period (2009-2049), the policy, by creating new intervention
highest population growth is strategies. New care resources are
concentrated in the elderly. It also required and existing provisions must be
establishes that the above-64 age group adapted to a higher ratio of elderly and
will double in size to account for 31.9% dependent persons.
4 Practical Guide for Alzheimer’s Professionals
At June 2012, 2,334,387 dependent other support for their personal
persons have exercised their right to autonomy”.
request the benefits provided by the
“Law on Dependence“ (IMSERSO data); As this process of ageing and growth in
a large proportion are elderly people. dependency results in increasing
numbers of people that require
The Law on Dependence defines this specialised care, recourse to the
concept as “the permanent state in which institutionalisation of patients in
people that for reasons derived from age, specialised care centres is also
illness and disability and linked to growing.
insufficient or lack of physical, mental,
intellectual or sensorial autonomy find Within this aged population structure in
themselves, thus requiring the care of need of specialised professional care, we
other person/s or significant assistance in must refer to people with dementia and,
order to perform the basic activities of more specifically, Alzheimer’s patients,
daily living, or, in the case of persons with of which there are around 600,000 in
intellectual disability or mental illness, Spain, based on current estimates.
Introduction 5
This guide has been prepared by work methodology employed to provide
professionals working in the Care comprehensive care. The techniques and
Unit at the Reina Sofia Foundation’s methods are examples of ways in which
Alzheimer Centre. professionals may work with this type of
patients.
It is intended to provide help and
reference material for all professionals Finally, there is a description of the main
who work with patients showing lines of research currently in progress
neurodegenerative dementia. Chapter internationally and at the Alzheimer
by chapter, this guide describes the Centre’s own Research Unit.
1.2. Description of the Centre
There follows a description of the The Ministry of Economy and
Centre; although the professionals Competitiveness (formerly Ministry
involved in the preparation of this guide of Science and Technological
will provide working guidelines for Innovation), through Instituto de Salud
dementia patients in general, and more Carlos III, is responsible for managing
specifically Alzheimer’s patients, it will the Research Unit (Fundación CIEN),
be useful to be able to picture their daily and the Madrid Regional Government
work environment. manages the Care Unit and the
Training Unit. Each of the institutions
The Reina Sofia Foundation’s Alzheimer involved has signed a collaboration
Centre provides comprehensive, agreement and a common work
specialised care for people with project.
Alzheimer’s and other neurodegenerative
dementia. The complex is divided into The Training Unit addresses specific
three areas: a Training Unit, a Care Unit matters relating to Alzheimer’s and
and a Research Unit. other dementias, as a benchmark centre
for this kind of training. Courses target
The project dates back to 2001, when Alzheimer’s patients’ families and
the Reina Sofia Foundation began to caregivers, professionals related to the
study the possibility of creating a space sector, volunteers and students, i.e.
in which to give specialised care to anybody that is interested in and
persons with this type of pathologies. sensitive to these pathologies. The Unit
Following a preparatory phase, the has an annual schedule comprising
project was completed in March courses, seminars, workshops,
2007 when the Centre was opened symposia, international congresses, etc.
in the Vallecas district of Madrid, All its activities are continually
on land assigned by Madrid City evaluated by the Department for Social
Council. Affairs, which is responsible for
monitoring.
Once completed, the Reina Sofia
Foundation assigned the Training Unit The Care Unit, in which public places
and the Care Unit to the Madrid are allocated by the Madrid Regional
Regional Government’s Department for Government, comprises a Live-In
Social Affairs, which is responsible for Residence (for 156 patients), a Day
managing the Centre through the Centre (40 patients) and a Weekend
company Clece Servicios Sociales. Centre (20 patients).
6 Practical Guide for Alzheimer’s Professionals
The Day Centre provides the professionals, direct care personnel
comprehensive care required by these and the interdisciplinary team deal
patients, from Monday to Friday, with a group of people that, to the
supporting families and in some cases extent possible and bearing in mind the
delaying permanent difficulty that this entails, are in the
institutionalisation. We have the same phase of Alzheimer’s.
necessary professionals to cater for all
our patients’ needs and to stimulate The Centre’s architecture is designed to
them physically and cognitively, be tailored to the needs of its users and
together with the necessary equipment professional team. Its luminous, low
and facilities. The same applies to the buildings occupy an extensive area.
Weekend Centre. Each life unit has a garden area to
ensure that patients are in permanent
The Live-In Residence includes beds for contact with the exterior, through a
Alzheimer’s patients and other large central window, so as to facilitate
neurodegenerative disorders, and for their perception of time and the seasons.
their companions; this allows the
patient’s healthy partner or elderly We also have a large exterior garden
family member to live in the Centre, with walking areas and therapeutic
though not an Alzheimer’s patient, zones for activities such as horticulture,
where all their needs are covered and garden therapy, aromatherapy and
their receive full care. mechanotherapy, which are so
important for patients’ motor, cognitive
The residence is divided into nine life and functional capabilities. This garden
units, based on the patient’s degree of is also a meeting point for family
impairment. There are six type-I units members and residents; it has a play
(three for patients in the initial phase area for children to ensure that their
and three for patients in the moderate visits are dynamic and pleasant,
phase) and three type-II units (for allowing different generations to share
severe Alzheimer’s patients). their time together as if they were in a
play area inside a park.
This distinction between life units
allows the comprehensive care and As indicated, the complex includes a
therapies applied to be specific to the care area, a training unit and a
resident’s Alzheimer’s phase. research centre. Work can therefore be
performed combining these three
There are a maximum of 18 residents in viewpoints, thanks to the collaboration
each type-I unit and a maximum of 16 agreement between the institutions
in each type-II unit, due to their involved in the project. With this in
increased physical, cognitive and mind, a Multidisciplinary Support Unit
behavioural needs. has been created (MSU).
This is a benchmark centre in terms of The MSU is formed by specialists in
its design, which has a positive impact neurology, psychiatry and sociology
on both patients and professionals. from the Research Unit and involves
Quality and welfare are apparent and various specialists in geriatrics,
merge with the functionality required neuropsychology, physiotherapy and
for daily activities. occupational therapy from the Care
Unit, who systematically evaluate the
Division into small life units means that Care Unit patients so as to achieve a
users find themselves in small spaces multidisciplinary assessment (clinical
that are more familiar and cosy, and sociodemographic) of the
favouring spatial orientation; residents.
Introduction 7
Through the MSU, the aim is to obtain a) Neuroimaging of residents.
a multidisciplinary profile for users; b) Neuropathology area: samples of
this entails the use of data such as their brain tissue are taken from deceased
clinical history (evaluation on donors in order to conduct a
admission and subsequent evolution), postmortem study to arrive at a
co-morbidity, neuropsychological state, neuropathological diagnosis; the
additional deficiencies, possible samples are preserved for future
complications, aspects related to the research.
caregiver and the environment, social c) Cellular biology laboratory: blood,
and healthcare data, etc. The data are urine and brain samples are taken
complied by the Centre’s from deceased donors for subsequent
interdisciplinary team through its analysis.
six-monthly evaluations, to ensure that
data are not duplicated. Once compiled, (It should be noted that all evaluation,
the data are furnished to the MSU’s sampling and neuroimaging is
researchers, which may in turn observe authorised by the residents’ family
the residents and consult the care members; it is not a prerequisite to
personnel in contact with them on a access the Centre.)
daily basis.
Chapter 6 of this guide provides
Moreover, the Care Unit cooperates detailed information on the research
with other areas of the Research Unit in projects currently undertaken by
the following ways: Fundación CIEN.
8 Practical Guide for Alzheimer’s Professionals
1.3. Professional team
In addition to the general services team her shift; this entails:
(maintenance, cleaning, laundry, • Reading reports prepared by
gardening, catering and reception), we doctors, nurses and geriatric
have an interdisciplinary team of nursing assistants.
professionals engaged in structured and • Visiting the units to clinically
synergic activities in order to provide supervise all residents that are
comprehensive care. convalescent.
• Asking the infirmary to measure
At the Reina Sofia Foundation’s vital signs and to apply simple
Alzheimer Centre, this team is formed diagnosis methods, if appropriate.
by the following professional categories • Changing treatments as applicable.
and supervised and coordinated by the • Informing the infirmary of changes
Centre’s management team: to medication for immediate
- Doctor. application.
- Nurse. • Reflecting evolution in clinical
- Social worker. history files.
- Neuropsychologist.
- Occupational therapist. Nurse
- Physiotherapist. - Prepare the infirmary case file
containing the admission evaluation.
This team meets regularly to discuss - Prepare and administer medication to
incidents relating to residents and to residents following the doctor’s
establish and review individual care instructions; keep an administration
plans. These meetings result in the care record.
plan for the Centre’s users. All matters - Measure vital signs on a regular basis.
and guidelines addressed in the - Perform glucose tests on diabetic
meetings are duly recorded in each residents.
resident’s personal file. - Take blood for analysis, Sintrom tests,
etc.
In general terms, the members of this - Prepare cultures for subsequent
professional team perform the following analysis (urine, feces…).
functions: - Apply treatments following the
doctor’s instructions.
Doctor
- Monitor observance of diets ordered
- Assess the resident’s health on by doctors.
admission, defining care and - Liaise between geriatric nursing
treatment guidelines. assistants and the medical
- Prepare and update his or her clinical department.
record. - Attend to residents’ needs, providing
- Write prescriptions, if required by the the doctor with the necessary
healthcare centre (not all healthcare cognitive data.
centres allow residence doctors to - Complete the relevant healthcare
officially stamp prescriptions). registers.
- Refer residents to a hospital when
deemed necessary. Social worker
- Review incidents that have arisen - Arrange resident pre-admission,
during previous shifts and incidents obtaining information to facilitate
that could be repeated during his or admission.
Introduction 9
- Preparation and monitoring of the (applying standard scales).
resident’s social history. - Prepare the resident’s treatment plan.
- Liaise between the Public - Encourage patient independence,
Administration and the Centre. focusing basically on mobility issues.
- Collaborate in the preparation of the - Collaborate with the occupational
Centre’s activities programme. therapy department to select the most
- Encourage the integration of residents appropriate technical assistance for
and their family members. each resident.
- Contact family members. - Train geriatric nursing assistants in
- Evaluate on a multidisciplinary basis. techniques to mobilise residents.
- Communicate with public bodies. - Review objectives with the other team
- Interview family members. members in order to enhance the
treatment afforded to residents.
Occupational therapist
- Improve/maintain the resident’s
- Training residents in basic daily capacity to move in the most
activities that can be recovered. independent and functional way
- Maintain autonomy in basic activities possible.
of daily living (ADLs) that can still be - Improve/maintain independence in
performed independently. movements.
- Adapt the resident’s environment to - Improve/maintain joint mobility and
encourage ADL independence. muscle tone to avoid stiffness and
- Maintain autonomy in instrumental atrophy.
activities of daily living that can still - Improve/maintain the best possible
be performed independently. posture.
- Stimulate cognitive capabilities to - Reduce joint and muscle pain.
slow the progressive deterioration - Work to prevent falls.
caused by the disease. - Contribute, through physical exercise,
- Maintain cognitive capabilities that to an improvement in the resident’s
are preserved. state of mind and sociability.
- Encourage upper limb mobility.
- Encourage social and leisure skills. Neuropsychologist
- Perform an initial evaluation of the - Perform a neuropsychological
resident’s functional status (applying evaluation of the resident’s cognitive,
standard scales). behavioural and emotional state
- Prepare the resident’s treatment plan (applying standard scales).
and assign adequate therapies. - Prepare and apply an individual or
- Encourage the resident’s physical, group treatment plan, proposing
cognitive and emotion autonomy. therapeutic objectives.
- Collaborate with the other team - Plan cognitive, behavioural and
members in the preparation of the affective intervention strategies.
Centre’s activities programme. - Monitor interventions.
- Oversee technical assistance required - Meet with families in the process of
by patients. accepting the disease, evolution and
- Encourage resident integration to grief.
prevent loneliness, through leisure - Lead mutual help groups.
activities and games.
- Collaborate with the psychology In addition to this interdisciplinary
department in cognitive workshops. technical team, the work of assistants
caring directly for the patients is
Physiotherapist
particularly relevant, as they carry out
- Perform an initial evaluation of the the most tasks with residents; we refer
resident’s physical-functional status here to the geriatric nursing assistants,
10 Practical Guide for Alzheimer’s Professionals