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Dancing With Dementia

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Blog Whatever: Allinformation is based on a recent placement undertaken at a residential homefocused on dementia. The blog below are all thoughts that came across my mindthroughout the placement. It is all STRICTLY opinion and again I believe Icould have expanded in many ways.

Recently I have had theopportunity to work at a dementia residential home. As a student of pharmacysome of you may be asking, why? However, there were many aspects that appealedto me for example; whilst working at a couple of pharmacies, guys working withmonitored dosage systems occasionally complained about care staff withreference to medication and prescriptions, however each case is individual soit is incorrect of me to assume anything from these conflictions between staff.Other reasons for my interest were the differences in ‘care’ we as a professionare involved in and it seems from my experiences, specific levels are care arenot taught, but we should be aware of them...

                It isalmost funny how as students we are made aware of dementia by basicpharmacology and therapeutics... So I am glad I undertook this experiencebecause if I did not, I think I would feel like I have been let down by what Ihad been taught. No one can learn everything, but certain impacts of diseasesshould be stressed a lot more. I believe it is true to say that if a person issuffering from Alzheimer’s it is not only that person, but those who are aroundthem.

                Thedegradation of the mind is hard to understand. From various books and bits I’veread, degeneration cannot be stopped once it begins. Even though some drugs canbe used for the treatment of moderate Alzheimer’s disease such as donepenzil,galantamine, rivastigimine and memantine (BNF 61) it was interesting to see howmany residents were actually on any of these.

                Thisled me to question the use of these drugs. Again although I have notextensively researched about dementia, it is clear to me that the disease isunique and based on the individual. Therefore treatment should be based on theindividual as well. So when I saw it in this light, it was understandable why someresidents were not on specific medication; again the BNF states the use of minimental-state examinations for consideration of pharmacological treatment, thescores of which will vary in individuals.

                Althoughthe above points are interesting to me as a pharmacy student, I was, to behonest, more interested in the care of the residents. It was nice to see the carethat was given to the residents – I have limited knowledge on health and social care apart from the double GCSE I studied at school. The basis of this is PIES.PIES is the physical, intellectual, emotional and intellectual needs of anindividual. So I was aware for what I was looking out for in some aspects.Neglect and abuse in care homes (http://www.bbc.co.uk/news/uk-england-kent-13737300 Accessed: 14 June 2011)is something that has been in the news recently. A recent edition of BBC’spanorama (http://www.bbc.co.uk/news/uk-13611089 Accessed: 14 June 2011) also captured some horrific events.

                I wasimpressed to see residents were able to do what they want, were treated withdignity and were stimulated in various ways. I myself had the privilege ofgoing dancing with some of these residents. It was clear to see thatindividualised care was also in place and from this experience I believe thisshould be stressed in patients with dementia. The book 'Contented dementia' byOliver James also gives some sound advice on how to deal with individualssuffering from dementia; I would recommend this book to anybody that workdirectly and indirectly with dementia.

                At theend of the placement, after being emotionally up and down all week, I foundmyself coming back to pharmacy and I have questions, especially to that of acommunity pharmacist:

                How isthat we as pharmacists can ‘clinically’ check medicines for patient in varioustypes of homes without having a true knowledge of their condition. Is itethical to dose dementia sufferers with Lorazepam? How would we know if thiswas/wasn’t the case without seeing them?

I then questioned communitypharmacy again. Patient notes are still unavailable to most pharmacists.Therefore without constantly ringing up GPs practices are pharmacists actually‘clinically’ checking or accuracy checking?

The code of ethics and ethics played on my mind throughout the week especially ‘Make the care ofpatients your first concern’. Yes, I believe the profession is evolving, butI also believe we have a long way to go. I hope I am not the only one whofeels this way.

 

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