This was one of the questions I asked myself in the week that saw the reality TV star inaugurated as the new President of the United States. As we know during a delirium there is:
1. disturbance of consciousness (i.e., reduced clarity of awareness of the environment)
2. the development of a perceptual disturbance that is not better accounted for by a pre-existing, established, or evolving dementia
These two points came to mind as I listened to the explanation regards the diminished numbers of people who turned out to watch the inauguration.
‘This was the first time in our nation’s history that floor coverings have been used to protect the grass on the Mall. That had the effect of highlighting any areas where people were not standing, while in years past the grass eliminated this visual’
In contrast we couldn’t fit anymore people in at Erskine for the delirium and dementia education day.
The evidence for delirium in care homes is poorly understood. I think a lot of this has to do with the focus on acute care. However there is increasing acknowledgement that care home staff probably care for as many, if not more, people with delirium.
One statistic puts the prevalence of delirium as somewhere between 8 -15% Derek Barron, Director of Care, tried putting that in context for the staff. Erskine Home has 180 beds which could mean 14 – 27 residents could have a delirium right now. More to the point do staff know for sure who those people are?
The reality of caring for people with delirium and dementia is not something I needed to teach the Erskine staff. That would be hugely disrespectful for a start. What I had hoped to get across was some of the understanding around delirium and how to diagnose/manage it. Central to this is my belief that we should be challenging our own behaviours instead of those we believe to exhibit ‘challenging behaviours’ towards us.
This was something Janice McAllister spoke of in her talk on dementia. We are ‘disabling people with our behaviours and attitudes’. Janice was able to help us see life through the eyes of a person with dementia. More importantly she was able to make us realise that it is the simplest of things that can make the world of difference.
Janet, head of physiotherapy, spoke about her approach of ‘do with’ rather than ‘do to’ in those with cognitive problems. The idea that any rehab should be task specific reinforcing the need to know what matters to the person. Not just what we think matters to them…
This theme continued as the daughters of two of the residents shared their perspective on the care their Mums’ received at Erskine. They spoke candidly about the good and the not as good. You could tell it was hard to hear but what came across was their appreciation as well as admiration for the work the staff do.
Something that really resonated with me was the comment that ‘I have known my Mum for 56yrs and you have just met her’. I find myself saying something similar when I meet relatives which is why I am such an advocate for the ‘Getting to Know Me’ document. I have the medical but none of the personal knowledge to help alleviate their loved one’s distress.
Tommy Whitelaw continued to inspire as he spoke about ‘being the one who makes a difference’
The day was summarised for me with Nadine Schofield of ‘Let’s Respect’ when she spoke about the importance of teaching care home staff the 3 D’s
Know about them and you’ve pretty much covered all of mental health in older people.
Something may have changed and reality may be to some a distorted nightmare. However on that day I left Erskine with a renewed sense of hope and faith in the goodness of people.