Reference no: EM133845115

Question

Chris has been caring for her husband, Geoff for 3 years. The first 18 months after Geoff was diagnosed with dementia was difficult with Geoff constantly forgetting information and becoming confused. Geoff struggled with knowing he had dementia and was embarrassed to leave the house or have friends over. Geoff had run his own business until the age of 68, loved gardening and was well known at local garden shows and competitions prior to being diagnosed with dementia. He was a very social person, involved in the local bowling club, service club and was a member of a vintage car club. Geoff had been a man very much in control of his life and extremely fortunate to never have suffered any major illnesses. The loss of control around what was happening to his brain was overwhelming for him. The couple had only shared 2 years of retirement before Geoff was diagnosed with dementia.

Chris has had to watch Geoff deteriorate dramatically over the past 18 months. What seemed to be moving slowly suddenly seemed to swallow up the person Chris knew so well. Geoff was no longer able to stay at home alone resulting in support staff coming into the home daily. You are one of those support staff, visiting 4 days per week.

Geoff requires help and supervision during all activities of daily living. With prompting he can do tasks he is familiar with but staff need to support him constantly or he will lose his concentration and become distracted. Geoff requires full support with all personal care. If prompted, and taken to the bathroom, he will use the toilet every 2 hours but wears incontinence aids for accidents which are happening more frequently. Geoff spends much of his day shuffling through papers on a desk in a sunroom, believing he is still running his business. Often he just sits at this desk and stares out a nearby window. He will spend short amounts of time watching television but becomes distracted and wanders around the house until he finds his desk again. On two occasions Geoff has wandered away from the house and has been found streets away at the local shops. This has resulted in Chris now locking all of the doors and only letting Geoff go outside when he is supervised.

Geoff is very repetitive when speaking, telling you many times each shift that "things are going bad with business". Chris will often tell Geoff to, "Stop, you haven't got a business anymore", but he will only become distressed and agitated in response to these comments. You can see Chris becoming impatient and frustrated by the repetitiveness of the conversation. Chris will then usually change the subject and Geoff will become distracted until taking up the issue regarding his business a little while later. Geoff's repetitive communication is also very frustrating for the support staff who try to involve him in activities or get him to watch TV in order to distract him.

Geoff will also become distressed and confused for what appears to be no reason at all. He will often become anxious in the early afternoon, and pace around the house. Nothing seems to settle Geoff at this point. When people try to communicate with him he will often become angry and yell in response to questions. Chris will occasionally go out while staff are around in the early afternoon to avoid this behaviour but Geoff only seems to become more unsettled without Chris and so staff are finding it harder and harder to support Geoff at this time.

The few friends Chris maintains contact with tell her she needs to look at Geoff moving into aged care as he won't know the difference but Chris is not ready for this and feels her husband needs her and their home. She is also concerned that she will need to sell the family home to finance a move into aged care and expresses that she doesn't even know where to start with this as Geoff always took care of the family finances. Chris will often share her feelings of loss and despair with you when you visit, asking for your opinion about whether you believe Geoff should move into aged care. Chris will also ask you to explain why Geoff is behaving in a particular way and asks for advice on what she should do to help Geoff reduce these behaviours.

When taking Geoff to the doctor with Chris, Geoff did something he had never done before by walking out in front of the traffic when Chris had her back turned. This panicked and distressed Chris, especially when one man pulled over his car to ensure Geoff was alright and made the comment that Geoff obviously needed more supervision than he was being given. Chris felt guilty and unsure whether she was doing the right thing by her husband.

Question 1

Describe the potential feelings of anger or despair that Geoff may have experienced as his dementia has progressed.

Question 2

Describe the potential feelings of loss and grief that Chris may have experienced while caring for Geoff since his diagnosis.

Question 3

Describe the changes in the social lives of both Geoff and Chris and how this may have affected each of them in terms of their feelings of being valued and included.

Question 4

Describe the impact the attitude of friends and people in the community may have had on both Geoff and Chris.

Question 5

Describe the type of support you would focus on providing to Chris.

Question 6a

How would you respond to Chris asking for your advice about Geoff going into aged care?

Question 6b

How would you respond to Chris asking for your advice about the financial burden associated with aged care?

Question 6C

How would you respond to Chris telling Geoff to stop talking about his business?

Question 7

Describe the verbal and physical contact strategies you would use when Geoff becomes confused and distressed.

Question 8a

How would you respond to Geoff's repetitive comments regarding his "business going bad"?

Would you use reality orientation - why or why not?

Question 8b

Would you use validation therapy - why or why not?

Question 9a

Describe how you might be able to use familiar routines and skills to maintain some of Geoff's independence.

Question 9b

Why is it important to maintain routine and a stable environment for Geoff?

Question 10a

Describe two strategies you would trial to support Geoff during his early afternoon unsettled period.

Question 10b

When evaluating the effectiveness of your trial who would you include in the discussion?

Question 10c

Why should you report the outcome of the trial to your supervisor?

Question 11a

You have been asked to organise a new activity for Geoff to be involved in to keep him active and occupied.

How would you determine the most appropriate activity for him to be involved in?

Question 11b

How would you ensure that the activity is appropriate in maintaining Geoff's safety?

Question 12

One of the ideas you have suggested to Chris is that Geoff may enjoy attending a local day activity program. Chris is concerned that Geoff's tendency to wander may compromise his safety. Explain the importance of balancing the risk with the opportunity for Geoff to do something active.

Question 13

Identify a service that is focussed on supporting people with dementia that may be a useful support to Geoff and Chris. Outline the types of support that are provided by this service and why this could benefit this family.

Question 14a

You observe that Geoff enjoys being in his garden, but has a tendency to want to start pulling the plants out of the ground, stating that they are "infested". He becomes very agitated when you try to put the plants back in the soil.

What could you say to Geoff to acknowledge his reactions?

Question 14b

What actions could you take to minimise the likelihood of this reaction when Geoff is outside in the yard?

Question 15a

When talking with another member of Geoff's support team, she indicates that she is feeling very stressed. You share that you are feeling stressed too, as you feel like Chris is very reliant upon you for advice on matters that are of a financial nature.

What should you do to ensure you are taking care of your own wellbeing?

Question 15b

Who could you seek support from.