Homecare Together did a joint presentation last week to the active retired group in Mount Merrion. This talk was aimed as an introduction to the group, about ways in which to reduce the risk of falls and the exercises that can help. Fit for life in Sandyford, are delivering group classes in Sandyford and also to groups, in their locations. This exercise training, teaches people to participate in exercises based around balance and co-ordination, which can really help to prevent a fall, but also to help you recover your balance during a fall. Once your balance improves, you are less likely to fall and to be able to stop the fall happening, if for example you stumble. They also gave great advice on footwear, which can help prevent falls. Homecare together found the talk by Fit for life an invaluable source of up to date information and we will be encouraging our clients to attend these classes whenever they can. Homecare Together look forward to working with Fit for life in the future!
What are you looking or in a homecare company?
Homecare Together offer a supportive work environment and we can also assist you with further learning and training. Homecare Together will try to fit your working hours around your lifestyle and commitments. You can earn as you learn with our Fetac/QQI level 5 Healthcare and care support courses and avail of our FREE training supervision.
Homecare Together have assisted many of our care staff to complete modules of training and so we are interested in meeting you, even if you are just starting your care career. We know that having a caring, kind and reliable nature is so important when looking after older people. Just as our care plan is all about the client, our training is all about the carer. We offer FREE training and uniforms and local clients, to minimise travel times. We also do not do short half hour visits, as we feel these are too short for the client and the carer. Homecare Together believe in building relationships between carers and their clients, which can be long lasting friendships.
Homecare Together are focused on delivering quality care at home and as such, we regularly visit our clients to see how they are doing. We also have a transparent system of compliments, as well as complaints, as carers like to know when they are doing a good job!
Homecare Together are currently looking for care staff and would love to hear from you! You can email your CV, call into the office in Mount Merrion or call us today on 01-534-7674, for an immediate interview.
We look forward to meeting you.
The Homecare Together team.
Anyone who is concerned that they may have vascular dementia (or any other type of dementia) should seek help from their GP. If someone does have dementia, an early diagnosis has many benefits: it provides an explanation for the person’s symptoms; it gives access to treatment, advice and support; and it allows them to prepare for the future and plan ahead. For vascular dementia, treatments and lifestyle changes may also slow down the progression of the underlying disease.
The doctor will also talk to the person about their medical history (eg high blood pressure or diabetes). This will include questions about dementia or cardiovascular disease in close family members. The doctor will probably do a physical examination and will ask about how the person’s symptoms are currently affecting their life. The GP or a practice nurse may ask the person to do some tests of mental abilities. It is often helpful if a close friend or family member accompanies the person to medical appointments. They may be able to describe subtle changes that the person themselves has not noticed, such as starting to struggle with daily activities.
The GP may feel able to make a diagnosis of vascular dementia at this stage. If not, they will generally refer the person to a specialist. This might be an old-age psychiatrist (who specialises in the mental health of older people) based in a memory service, or a geriatrician (who specialises in the physical health of older people) in a hospital.
The specialist will assess the person’s symptoms in more detail. The way that symptoms developed – in steps or more gradually – may suggest different underlying diseases. The person’s thinking and other mental abilities will also be assessed further with a wider range of tests. In someone with vascular dementia, the test might show slowness of thought and difficulties thinking things through, which are often more common than memory loss.
A person suspected of having vascular dementia will generally have a brain scan to look for any changes that have taken place in the brain. A scan such as CT (computerised tomography) or MRI (magnetic resonance imaging) may rule out a tumour or build-up of fluid inside the brain. These can have symptoms similar to those of vascular dementia. A CT scan may also show a stroke or an MRI scan may show changes such as infarcts or damage to the white matter. If this is the case, the brain scan will be very helpful in diagnosing the dementia type, rather than simply ruling out other causes.
If the person has dementia, and the circumstances mean it is best explained by vascular disease in the brain, a diagnosis of vascular dementia will be made. For example, the dementia may have developed within a few months of a stroke, or a brain scan may show a pattern of disease that explains the dementia symptoms.
The diagnosis should be communicated clearly to the person and usually also those closest to them, along with a discussion about the next steps.
Treatment and support
There is currently no cure for vascular dementia: the brain damage that causes it cannot be reversed. However, there is a lot that can be done to enable someone to live well with the condition. This will involve drug and non-drug treatment, support and activities.
The person should have a chance to talk to a health or social care professional about their dementia diagnosis. This could be a psychiatrist or mental health nurse, a clinical psychologist, occupational therapist or GP. Information on what support is available and where to go for further advice is vital in helping someone to stay physically and mentally well.
Control of cardiovascular disease
If the underlying cardiovascular diseases that have caused vascular dementia can be controlled, it may be possible to slow down the progression of the dementia. For example, after someone has had a stroke or TIA, treatment of high blood pressure can reduce the risk of further stroke and dementia. For stroke-related dementia in particular, with treatment there may be long periods when the symptoms don’t get significantly worse.
In most cases, a person with vascular dementia will already be on medications to treat the underlying diseases. These include tablets to reduce blood pressure, prevent blood clots and lower cholesterol. If the person has a diagnosed heart condition or diabetes they will also be taking medicines for these. It is important that the person continues to take any medications and attends regular check-ups as recommended by a doctor.
Someone with vascular dementia will also be advised to adopt a healthy lifestyle, particularly to take regular physical exercise and, if they are a smoker, to quit. They should try to eat a diet with plenty of fruit, vegetables and oily fish but not too much fat or salt. Maintaining a healthy weight and keeping to recommended levels of alcohol will also help. The GP should be able to offer advice in all these areas.
Other treatment and support
Supporting a person with vascular dementia to live well includes treatment for symptoms, support to cope with lost abilities, and help to keep up enjoyable activities. For someone who has had a stroke or has physical difficulties, treatment will also include rehabilitation. Homecare Together can assist you with exercise programmes and going for daily walks. We can also assist you to continue to participate in local activities.
The drugs that are routinely prescribed for Alzheimer’s disease do not have benefits for vascular dementia, and are not recommended for it. These drugs may, however, be prescribed to treat mixed dementia (Alzheimer’s disease and vascular dementia).
If someone is depressed or anxious, talking therapies (such as cognitive behavioural therapy) or drug treatments may also be tried. Counselling may also help the person adjust to the diagnosis.
There are many ways to help someone remain independent and cope with the cognitive symptoms of vascular dementia. For example, breaking complex tasks down into smaller steps will make them easier. An environment which is not too busy or noisy will make it easier to concentrate. For someone with memory loss, a regular routine and appropriate technology, such as pill boxes/blister packs or electronic devices, can help. The person can be looked after in the safety and security of their own home with assistance from Homecare Together.
It is important that a person with any type of dementia stays active and continues to do things they enjoy. Keeping mentally active (cognitive stimulation) is known to help with memory and communication. Life story work, in which someone shares their life experiences and makes a personal record, may help with memory, mood and wellbeing. As the dementia worsens, many people enjoy more general reminiscence activities. Homecare Together carers are taught reminiscence techniques and our supervisors will also assist with these activities.
If the person has physical difficulties, for example after a stroke, they will usually benefit from rehabilitation. This could mean working with a physiotherapist (especially for help with weakness, coordination, movement and balance), occupational therapist (for everyday activities) or speech and language therapist (for all aspects of communication). Homecare Together offer allied services which include physiotherapy delivered in your own home.
The details of the support that is available, and how people are generally referred, can vary around the country. The GP can give information about what is available in the local area.
Over time, changes in the person’s behaviour – such as agitation or aggression – become more likely. These are often a sign that the person is in distress. There are many potential causes. For example, the person might be in pain, they may have misunderstood something or someone, or they may be frustrated or under-stimulated. Individualised approaches should try to address the cause. General non-drug approaches (eg social interaction) often help. They should generally be tried before additional drugs are considered, particularly in the case of antipsychotics.
Anyone caring for the person is likely to find these behaviours distressing. Support for carers is particularly important at such times. For more information contact Homecare Together on 01-534-7674 to see how we can help.
Source Alzheimer’s society UK.
How vascular dementia affects people varies depending on the different underlying causes and more generally from person to person. Symptoms may develop suddenly, for example after a stroke, or more gradually, such as with small vessel disease.
Some symptoms may be similar to those of other types of dementia. Memory loss is common in the early stages of Alzheimer’s, but is not usually the main early symptom of vascular dementia.
The most common cognitive symptoms in the early stages of vascular dementia are:
- problems with planning or organising, making decisions or solving problems
- difficulties following a series of steps (eg cooking a meal)
- slower speed of thought
- problems concentrating, including short periods of sudden confusion.
A person in the early stages of vascular dementia may also have difficulties with:
- memory – problems recalling recent events (often mild)
- language- eg speech may become less fluent
- visuospatial skills- problems perceiving objects in three dimensions.
As well as these cognitive symptoms, it is common for someone with early vascular dementia to experience mood changes, such as apathy, depression or anxiety. Depression is common, partly because people with vascular dementia may be aware of the difficulties the condition is causing. A person with vascular dementia may also become generally more emotional. They may be prone to rapid mood swings and being unusually tearful or happy.
Other symptoms that someone with vascular dementia may experience vary between the different types. Post-stroke dementia will often be accompanied by the obvious physical symptoms of the stroke. Depending on which part of the brain is affected, someone might have paralysis or weakness of a limb. Or if a different part of the brain is damaged they may have problems with vision or speech. With rehabilitation, symptoms may get a little better or stabilise for a time, especially in the first six months after the stroke.
Symptoms of subcortical vascular dementia vary less. Early loss of bladder control is common. The person may also have mild weakness on one side of their body, or become less steady walking and more prone to falls. Other symptoms of subcortical vascular dementia may include clumsiness, lack of facial expression and problems pronouncing words.
Progression and later stages
Over time a person with vascular dementia is likely to develop more severe confusion or disorientation, and further problems with reasoning and communication. Memory loss, for example for recent events or names, will also become worse. The person is likely to need more support with day-to-day activities such as cooking or cleaning.
As vascular dementia progresses, many people also develop behaviours that seem unusual or out of character. The most common include irritability, agitation, aggressive behaviour and a disturbed sleep pattern. Someone may also act in socially inappropriate ways.
Occasionally a person with vascular dementia will strongly believe things that are not true (delusions) or – less often – see things that are not really there (hallucinations). These behaviours can be distressing and a challenge for all involved.
In the later stages of vascular dementia someone may become much less aware of what is happening around them. They may have difficulties walking or eating without help, and become increasingly frail. Eventually, the person will need help with all their daily activities.
How long someone will live with vascular dementia varies greatly from person to person. On average it will be about five years after the symptoms started. The person is most likely to die from a stroke or heart attack.
Who gets vascular dementia?
There are a number of things that can put someone at risk of developing vascular dementia. These are called risk factors. Most of these are things that contribute to underlying cardiovascular diseases. Some of these risk factors (eg lifestyle) can be controlled, but others (eg age and genes) cannot.
Age is the strongest risk factor for vascular dementia. A person’s risk of developing the condition doubles approximately every five years over the age of 65. Vascular dementia under the age of 65 is uncommon and affects fewer than 8,000 people in the UK. Men are at slightly higher risk of developing vascular dementia than women.
A person who has had a stroke, or who has diabetes or heart disease, is approximately twice as likely to develop vascular dementia. Sleep apnoea, a condition where breathing stops for a few seconds or minutes during sleep, is also a possible risk factor. Someone can reduce their risk of dementia by keeping these conditions under control, through taking prescribed medicines (even if they feel well) and following professional advice about their lifestyle.
There is some evidence that a history of depression also increases the risk of vascular dementia. Anyone who thinks they may be depressed should seek their doctor’s advice early.
Cardiovascular disease – and therefore vascular dementia – is linked to high blood pressure, high cholesterol and being overweight in mid-life. Someone can reduce their risk of developing these by having regular check-ups (over the age of 40), by not smoking, and by keeping physically active. It will also help to eat a healthy balanced diet and drink alcohol only in moderation.
Aside from these cardiovascular risk factors, there is good evidence that keeping mentally active throughout life reduces dementia risk. There is some evidence for the benefits of being socially active too.
Researchers think there are some genetic factors behind the common types of vascular dementia, and that these are linked to the underlying cardiovascular diseases. Someone with a family history of stroke, heart disease or diabetes has an increased risk of developing these conditions. Overall, however, the role of genes in the common types of vascular dementia is small.
People from certain ethnic groups are more likely to develop cardiovascular disease and vascular dementia than others. Those from an Indian, Bangladeshi, Pakistani or Sri Lankan background living in the UK have significantly higher rates of stroke, diabetes and heart disease than white Europeans. Among people of African-Caribbean descent, the risk of diabetes and stroke – but not heart disease – is also higher. These differences are thought to be partly inherited but mainly due to lifestyle factors such as diet, smoking and exercise.
Source: Alzheimer’s society UK
Vascular dementia is the second most common type of dementia (after Alzheimer’s disease). The word dementia describes a set of symptoms that can include memory loss and difficulties with thinking, problem-solving or language. In vascular dementia, these symptoms occur when the brain is damaged because of problems with the supply of blood to the brain.
Vascular dementia is caused by reduced blood supply to the brain due to diseased blood vessels.
To be healthy and function properly, brain cells need a constant supply of blood to bring oxygen and nutrients. Blood is delivered to the brain through a network of vessels called the vascular system. If the vascular system within the brain becomes damaged – so that the blood vessels leak or become blocked – then blood cannot reach the brain cells and they will eventually die.
This death of brain cells can cause problems with memory, thinking or reasoning. Together these three elements are known as cognition. When these cognitive problems are bad enough to have a significant impact on daily life, this is known as vascular dementia.
Types of vascular dementia
There are several different types of vascular dementia. They differ in the cause of the damage and the part of the brain that is affected. The different types of vascular dementia have some symptoms in common and some symptoms that differ. Their symptoms tend to progress in different ways.
A stroke happens when the blood supply to a part of the brain is suddenly cut off. In most strokes, a blood vessel in the brain becomes narrowed and is blocked by a clot. The clot may have formed in the brain, or it may have formed in the heart (if someone has heart disease) and been carried to the brain. Strokes vary in how severe they are, depending on where the blocked vessel is and whether the interruption to the blood supply is permanent or temporary.
A major stroke occurs when the blood flow in a large vessel in the brain is suddenly and permanently cut off. Most often this happens when the vessel is blocked by a clot. Much less often it is because the vessel bursts and bleeds into the brain. This sudden interruption in the blood supply starves the brain of oxygen and leads to the death of a large volume of brain tissue.
Not everyone who has a stroke will develop vascular dementia, but about 20 per cent of people who have a stroke do develop this post-stroke dementia within the following six months. A person who has a stroke is then at increased risk of having further strokes. If this happens, the risk of developing dementia is higher.
Single-infarct and multi-infarct dementia
These types of vascular dementia are caused by one or more smaller strokes. These happen when a large or medium-sized blood vessel is blocked by a clot. The stroke may be so small that the person doesn’t notice any symptoms. Alternatively, the symptoms may only be temporary – lasting perhaps a few minutes – because the blockage clears itself. (If symptoms last for less than 24 hours this is known as a ‘mini-stroke’ or transient ischaemic attack (TIA). A TIA may mistakenly be dismissed as a ‘funny turn’.)
If the blood supply is interrupted for more than a few minutes, the stroke will lead to the death of a small area of tissue in the brain. This area is known as an infarct. Sometimes just one infarct forms in an important part of the brain and this causes dementia (known as single-infarct dementia). Much more often, a series of small strokes over a period of weeks or months lead to a number of infarcts spread around the brain. Dementia in this case (known as multi-infarct dementia) is caused by the total damage from all the infarcts together.
Subcortical vascular dementia is caused by diseases of the very small blood vessels that lie deep in the brain. These small vessels develop thick walls and become stiff and twisted, meaning that blood flow through them is reduced.
Small vessel disease often damages the bundles of nerve fibres that carry signals around the brain, known as white matter. It can also cause small infarcts near the base of the brain.
Small vessel disease develops much deeper in the brain than the damage caused by many strokes. This means many of the symptoms of subcortical vascular dementia are different from those of stroke-related dementia.
Subcortical dementia is thought to be the most common type of vascular dementia.
Mixed dementia (vascular dementia and Alzheimer’s disease)
At least 10 per cent of people with dementia are diagnosed with mixed dementia. This generally means that both Alzheimer’s disease and vascular disease are thought to have caused the dementia. The symptoms of mixed dementia may be similar to those of either Alzheimer’s disease or vascular dementia, or they may be a combination of the two.
source: Alzheimer’s society UK
Dementia with Lewy bodies
Dementia with Lewy bodies gets its name from microscopic deposits that are found in the brains of people with the condition. These deposits cause damage to, and the eventual death of, nerve cells in the brain. Dementia with Lewy bodies develops slowly and tends to progress gradually, like Alzheimer’s disease.
Parkinson’s disease is also caused by Lewy bodies and some symptoms of this disease are shared with dementia with Lewy bodies. Early symptoms of this type of dementia may also overlap with those of Alzheimer’s disease, but there are several important differences.
Unlike Alzheimer’s disease, in the early stages of dementia with Lewy bodies the person’s attention and alertness often vary widely from day to day, or even during the course of a single day. This can often be puzzling for those around them.
Most people with dementia with Lewy bodies also have recurrent visual hallucinations. These are much more common than in early Alzheimer’s disease and are very detailed, often of animals or people. Misperceptions and auditory hallucinations (hearing sounds that are not real) are also very common. These symptoms may explain why people with this dementia often falsely believe that they are being persecuted.
Half or more of those affected by dementia with Lewy bodies have movement problems when the dementia is diagnosed, and this proportion increases as dementia progresses. These symptoms are like those of Parkinson’s disease, such as slowness of movement, stiffness and sometimes tremor. The person may also have difficulty judging distances and be prone to problems with balance, falls and fainting.
As dementia with Lewy bodies progresses, some of the symptoms become more like those of middle or late stage Alzheimer’s disease, including greater problems with day-to-day memory and behaviours that challenge , such as agitation, restlessness or shouting out. Worsening of Parkinson-type symptoms means that walking gets slower and less steady. The risk of falls remains high. The combination of symptoms in a person with dementia with Lewy bodies can be particularly stressful for family and carers.
After the symptoms of dementia with Lewy bodies begin, people live on average for six to twelve years. However, each person will experience dementia with Lewy bodies differently.
Autumn around the corner
As autumn draws near, now is a great time to think about care for yourself or your loved one. The evenings will be getting longer and darker earlier and it makes it harder for older people to get out and about safely. This is a good time to think about getting some care in place, so that the winter doesn’t feel too long. Homecare Together offer FREE assessments in your own home or hospital and will match your carer to you. Our carers can provide companionship, as well as more personal care help and also cooking and house-keeping. We can also go out with you, to maintain social activities in your area. These can include attending local groups, religious services and sports activities.
To find out more or to arrange your FREE assessment today call 01-534-7674 and we will visit you as soon as possible!
Hospital to Home Convalescence and Post- Operative care
Homecare Together offer bespoke options for care, after an operation or leaving hospital.
All our packages can be tailored to include Physiotherapy visits and can be adapted to your needs. We offer qualified/vetted carers to assist you with your personal care, meal preparation, medication management and specific exercises, if recommended by your Doctor and Physiotherapist.
These care packages are delivered in your own home. This means you can recuperate in comfort and safety, with your familiar things around you and with your loved ones nearby.
Our Convalescence packages can include catheter care and the application of surgical stockings, which can be difficult to manage alone.
This service is fully supervised, so you will also have a visit from your carer manager, during your first week at home. They will check that you are progressing as hoped and can liaise with your GP or Public Health Nurse as required.
Homecare Together can organise and help with shopping and even return hospital visits and appointments. Our service allows you to take control of your recovery and because you are in your own home, you will be able to get back to normal, as soon as possible.
Homecare Together have put together some tips for people who drive and have been diagnosed with Alzheimer’s or another form of dementia. Three steps you MUST take following a diagnosis of dementia. Firstly always follow the advice of your GP.
Step 1: You must inform your insurance company of any major changes in health status and this includes dementia. If you do not do this your policy may be invalid. Your insurance company should tell you what you need to do to keep your cover in place they should NOT automatically remove your cover or increase your costs especially if your GP and your on-road driving assessment say you are safe to continue.
Step 2: Inform your driving licence service (NDLS). You need to do this in person and they recommend you make an appointment if possible. You will need to show your current driving licence your PPS number and a completed driving application form (d401) and a completed Driving Licence Medical Report Form (D501). Your GP will complete this form You can download this from the RSA website too. Your appointment with the NDLS should be free. If your medical report says you are safe to drive they will issue a new licence.
Step 3: Complete your on the road driving assessment. Your GP or insurance company most likely will ask you to have this assessment. It is not the same as a full driving test. An assessor will usually drive around familiar areas in your local area. The assessor will focus on your ability to drive safely. Following the assessment the assessor will write a report with one of three outcomes. a: you can continue to drive b: You can continue but with restrictions so this may be that you should not drive at night or alone it may also recommend a retest say in 6 months time. c: You need to stop driving immediately.
This report will usually be sent to your GP and your insurers. Your GP or Public Health Nurse will have a list of qualified assessors experienced with working with clients with dementia. Each on the road assessment has a cost, for which currently, there is no grant available.
So in addition to passing your assessment, you should also follow some tips to keep you and others safe.
DO: Drive familiar routes, keep journeys short, allow plenty of time, travel with someone else.
DON’T: Drive if you feel tired or stressed or upset, drive at busy times such as rush hour, drive in bad weather, drive at night.
At some point you will need to stop driving. This is because over time dementia will affect your ability to drive safely. Your safety and the safety of others is the most important thing. Giving up driving is a difficult step for many people as we link driving with independence and freedom. There are services like Homecare Together offer, which can supply friendly care staff who can drive you. You can also use local taxi services, voluntary services or rural transport schemes. Also family and friends may be happy to help.
Remember when you give up driving, you can reduce your costs and use the money to fund other ways of getting out and about.
Useful contacts : The Alzheimer’s Society of Ireland Helpline Freephone:1800 341 341
The National Driving Licence Service: www.ndls.ie
The Road Safety Authority: www.rsa.ie.
The Rural Transport Network: www.ruraltransportnetwork.ie or phone 066 714 7002
If in any doubt about any of the advice given or your health please contact your health care professional.
Source of additional information: The Alzheimer’s Society of Ireland Factsheet 1002
Homecare Together have taken care to ensure the accuracy of this information which may be subject to change. Homecare Together is not liable for any inaccuracies, errors, omissions.
Dehydration: Recognize The Symptoms
Those caring for elderly persons should watch for these signs of dehydration:
- Dryness of mouth; dry tongue with thick saliva
- Unable to urinate or pass only small amounts of urine; dark or deep yellow urine
- Cramping in limbs
- Crying but with few or no tears
- Weakness, general feeling of being unwell
- Sleepiness or irritability
More serious dehydration:
- Low blood pressure
- Severe cramping and muscle contractions in limbs, back and stomach
- Bloated stomach
- Rapid but weak pulse
- Dry and sunken eyes with few or no tears
- Wrinkled skin; no elasticity
- Breathing faster than normal
Dehydration: Staying Hydrated
Everyone knows—but many people seem to forget—that water is what sustains life. Here are just two of the benefits of being hydrated:
- Older people who get enough water tend to suffer less constipation, use less laxatives, have fewer falls and, for men, may have a lower risk of bladder cancer. Less constipation may reduce the risk of colorectal cancer.
- Drinking at least five 8-ounce glasses of water daily reduces the risk of fatal coronary heart disease among older adults.
Caregivers should make sure the older person has water by their side at all times. Encourage frequent drinking in moderate amounts.
A good formula for how much water is needed every day is to take one-third of the person’s body weight in pounds and drink the equivalent number of ounces of water daily. For example, a 150-pound woman would need 50 ounces of water daily, or about 6 8-ounce glasses of water.
Other tips to consider:
- If the older persons current intake, is below the required amount, have them increase the amount they drink gradually.
- Encourage your loved one not to wait until thirsty to start drinking water: At that point dehydration has already started.
- One sign of proper hydration is the colour of the urine—it should be clear or a pale yellow.
- Alcohol should be avoided. Minimize the number of beverages with caffeine because of its diuretic effect, causing the kidneys to excrete more water.
- When you see early signs of dehydration, offer a sports drink to enable quick replenishment of water and electrolytes needed by the body.
- Severe dehydration requires medical attention; if you see any signs or even just suspect it, call the doctor.