Decisions, Decisions, Decisions: How to assess the mental capacity of people with dementia

Dr Catherine Pennington is a Senior Clinical Research Fellow at the Centre for Dementia Prevention, University of Edinburgh, and honorary Clinical Lecturer at the University of Bristol ReMemBr Group. In the accompanying article she reviews different tools for assessing decision making capacity in people with dementia. 

Dementia is one of the greatest health challenges of our time. People with dementia experience changes to their ability to understand, evaluate and retain information, and may have problems expressing and remembering their decisions. These changes all affect whether or not someone has the mental capacity to make their own decisions, but we should not automatically assume that dementia equals a loss of capacity. Many people with mild or moderate dementia will still have the ability to make informed choices, particularly when information is given in an appropriate format. This could mean simplifying the language used, repeating information, and using clearly written, short documents.

My future wishes: Advance Care Planning for people with dementia

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

The “My future wishes: Advance Care Planning (ACP) for people with dementia in all care settings” document was recently published by NHS England, Dementia Team and End of Life Care Team.

Advance care planning (ACP) is a vital part of personalised care planning. This recently published document acts as a resource to support clinicians and practitioners who provide health and social care for people with dementia. It aims to ensure people living with dementia can develop an ACP through initiating conversations with their supporting clinicians and/or loved ones. It aims to offer a consistent standard of support for patients diagnosed with dementia using ACPs that are developed in partnership with patients and families.

The Lonely brain

Dr Samuel Barnes Ph.D is a Lecturer at Imperial College London in the Division of Brain Sciences and was recently awarded a UK Dementia Research Institute Fellowship. The goal of his research is to understand the role of neural circuit plasticity in aging and neurodegeneration. His group uses a combination of in vivo voltage and calcium imaging, bioelectronics and electrophysiology to investigate the neural plasticity factors that make the aged brain susceptible to neurodegeneration and ultimately dementia. You can read more about his work here.  He will be speaking at the Loneliness in Older People and its Impact on Health event on 13 June at Wellcome Collection in London.

Daydreaming can be one of life’s great pleasures. Losing yourself in a thought or spending time quietly reflecting on the day’s events is an important part of modern life. But what if solitary thought was the only option? For many older people periods of loneliness are all too frequent. Such periods of social isolation can involve little to no contact with people for prolonged periods of time. What do these prolonged stretches of loneliness do to the brain?

To answer this question, we must consider how the brain processes the sensory and social world. The substrate of thought is the electrical activity that flows between neurons in the brain. These tiny nerve cells are connected to each other forming complex circuits that store and process sensory experience.

Do you know what Yoga is?

Tania Plahay is a yoga teacher and author of Yoga for Dementia: A Guide for People with Dementia, Their Families and Caregivers. Tania is passionate about bringing yoga to a wider audience and adapting the practices of yoga for those living with Dementia. Prior to writing her book Tania ran the FoNS project Yoga for Dementia, in a residential home in Thamesmead London. Tania divides her time between the Costa Blanca, Spain and the UK, where she runs yoga classes, retreats, workshops and training.

There has been a huge growth in the number of yoga practitioners in the UK and US in recent years. With this growth the image of lithe young yoga practitioners has spread around the globe, and has been used to sell products from cars to Tic Tacs.  Therefore, you would be forgiven if you thought that yoga was only for younger, fit women and that it mainly consisted of bending your body into pretzel like poses. However the practice of yoga goes far beyond the physical poses (known as asanas), and yoga can be attainable by all.

The Wild Wild Southwest: BGS Regional Meeting, Bath

Alasdair Miller is a ST6 Specialist Registrar in Geriatric Medicine at Royal United Hospital, Bath.

In the warm spell between the two flurries of snow and ice which have buffeted the UK in recent weeks, Bath’s Kingswood School Sports Pavilion played host to the Southwest Regional Meeting of the BGS. The event attracted a wide variety of attendees from different walks of Geriatric Medicine across the southwest- a multidisciplinary crowd ranging from junior trainees to eminent seniors, and with strong representation from both community and hospital teams. The day’s remit: to share learning and innovation from across the patch, update ourselves on topical and important areas within Geriatric Medicine, and foster links, cooperation and friendship with colleagues.

Love makes the world go round but sex adds the sparkles: A review of “Dementia, Sex and Wellbeing”

Uruakanwa Ekwegh is a Specialty Doctor in Medicine for older people, with an interest in acute frailty and medical education. Her Twitter handle is @Kanwa10

Before I started to read this book, I asked myself, “what do you think of when you hear ‘dementia and sex’?” Two phrases leapt to my mind: “inappropriate behaviour” and “safeguarding issues”. The author acknowledges this perspective when she states that in this group of people, the issue of sex is only raised in the context of problems or concerns. She pointedly asks, “Why would we choose to ignore sex when so many adults consider it to be one of their activities of daily living?” Sex as an ADL? What a novel idea!

While reading this book, I was drawn into her conversational style of writing. She cleverly navigates the line between “stuffy” and “fluffy”. Just as I would start getting bogged down with the academic stuff, she would bring in a practical or true life example to liven things up again. And she expertly uses her words to paint the pictures of the people in her examples; you are present and witness the conversations that she references.

Spring Speakers Series: Promoting Activity, Independence and Stability in early Dementia and Mild Cognitive Impairment (PrAISED)

Professor Rowan Harwood is a geriatrician at Nottingham University Hospitals NHS Trust, and the University of Nottingham, with particular interests in delirium, dementia and end of life care, who maintains an active portfolio of research. He tweets @RowanHarwood He will be speaking at the upcoming BGS Spring Meeting in Nottingham.

Why diagnose dementia? And why diagnose dementia early? Because we want to do something to make lives better? If so, what?

People living with dementia are vulnerable to a cascade of failing abilities, inactivity, deconditioning and crises from which they may not make a full recovery. Most people living with dementia are, by definition, frail – prone to deterioration and adverse events. The average age of diagnosis is about 85. Ideally early intervention should preserve activity and independence and reduce risk, including risk of the commonest adverse event, falls. Yet the ‘offering’ of health service in response to a dementia diagnosis is painfully thin – cholinesterase inhibitor drugs, cognitive stimulation therapy and a dementia advisor maybe.

Book review: Visiting the Memory Café and other Dementia Care Activities

Matthew Berrisford is a Charge Nurse at The Meadows Community Hospital, Pennine Care NHS Foundation Trust. In this blog post he reviews the recently published book: Visiting the Memory Cafe and Other Dementia Care Activities. He tweets @berrisfjord

Caroline Baker follows her previous publication, Developing Excellent Care for People Living with Dementia in Care Homes, with another informative and practical guide to asset-based and person-centred care.

Visiting the Memory Cafe and Other Dementia Care Activities has been developed by Baker and her colleagues at Barchester Healthcare as a framework for planning and implementing programmes of activity that optimise the wellbeing of people living with dementia.

The framework encompasses seven domains of wellbeing – identity, connectedness, security, autonomy, meaning, growth and joy – and aligns these with evidence-based activities that can be tailored to individual ability, history, and preference.

Book review: ‘Memory’s last Breath’ – a written exploration of life, love and personhood

Rachel Manners is a speciality doctor in hospital based complex continuing care in Edinburgh.  She is a particular interest in end of life care and in complex dementia care.  Her twitter handle is @RachelMannes1 (due to an unfortunate spelling incident that she cannot figure out how to fix!).

Journeying beyond questions of how and why disease happen; to considering what they truly mean in the lives of individuals is one of the great challenges of clinical practice. Dementia brings out this challenge particularly strongly given the questions it raises about not only what it means to think and remember, but what it means to be.  That is it to say, it forces the practitioner to consider what it truly means to be a person. For those of us who work with and for those who live with dementia (or experience it in our personal lives) these are important questions. My own practice in recent years has led me to wonder not only what I have to offer people with dementia, but also to begin to consider what they have to teach and offer me .

Thinking about these ideas, I came to the book  ‘Memory’s last breath:  field notes on my dementia’ to help me develop my understanding. This is the autoethnographic study of Gerda Saunders’ journey with and into dementia.

15 years of dementia treatment in 15 papers: an online themed collection in A&A

Elizabeta Mukaetova-Ladinska is Professor of Old Age Psychiatry at Leicester University and an Associate Editor at Age and Ageing journal. She has curated this free collection of papers on the theme of treatments in dementia.

Age and Ageing journal is delighted to be able to publish this free online collection of 15 papers to provide an update on the advances of pharmacological and non-pharmacological interventions in dementia over the last 15 years. The published studies reflect the efficacy of the current anti-dementia treatments, preventive treatments of cardio and cerebrovascular incidents (known to be risk factors for dementia), alongside the use of antidepressant medication and non-pharmacological interventions for treatment of behavioural and psychopathological symptoms of dementia (BPSD). We also address the future preventative steps and therapeutic strategies currently in development to combat the devastating consequences of dementia.