Bringing People bring people together through language

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One of the common myths cropping up when people discuss dementia is that it’s an inevitable part of the ageing process. And whilst it’s true that the likelihood of developing dementia increases with age – and that the majority of people living with dementia are over the age of 75 – there is nothing necessarily inevitable about it. In fact, there are many proven ways to minimise risk and reduce the chances of a dementia diagnosis.

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Photograph with permission of Lingo Flamingo

One such way is language learning.

Research shows that those who are able to speak a second language tend to develop dementia up to five years later than monologuists. This is down to the fact that language learning keeps the brain active by employing the ‘desirable difficulties’ of novelty, challenge, and effort. That’s to say, the constant juggling between distinct sounds, new words, and unfamiliar concepts acts as an efficient brain work-out, building up higher levels of what is known as ‘cognitive reserve’, leading to a healthy and active mind.

What’s more, the stimulating effects of language are not confined to those who learnt their second language in early life, nor those who have mastered their language perfectly. Rather, directed language learning has been shown to positively effect mental performance and ability after just one week. Therefore, regardless of your age, ability, or diagnosis, the power of language learning can have a positive impact on your life.

Energised by this research, we at Lingo Flamingo have developed a colourful array of language classes for older individuals.

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Photograph with permission of Lingo Flamingo

One variation of our classes is a language learning experience for those living with dementia. These leisurely classes take into account the medical, physical, and mental health of learners in order to employ the senses, keep the brain active, build confidence, and foster connections between participants. We’ve worked with individuals at all stages of dementia diagnosis, and 90% of our students say they loved the classes and felt an increased sense of confidence and self-worth.

Further to this, we have developed a bespoke basket of classes for those over 65 who embrace life-long learning and who are seeking new, enriching experiences in retirement. These research-powered classes offer a unique way for individuals to get back into learning, build confidence, exercise the mind and, most importantly, to have fun whilst doing it. As we say, our classes are good for the brain and good for the banter.

If this is something you, or someone you know, would be interested in then contact us here to book you free, no obligation taster class.

Contributor

Robbie Norval

Director of Lingo Flamingo

Lingo Flamingo provides language workshops for elderly people in order to fight dementia and promote well being. Classes for people in care homes or groups in Spanish, French, German and Italian.

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This blog was originally posted here and we are delighted to share it with you on Lets Talk about Dementia

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Connecting People, Connecting Support Improvement in Practice – My 6 Top Tips

Dementia is everybody’s business and I strongly believe that improvement in practice is also  everybody’s business.  With the recent publication of Connecting People, Connecting Support I thought it would be a good time to reflect on my experience of improvement in practice so far.  Having always had a strong commitment to improvement but being aware of how much I always have to learn, I keep in mind the following quote:

“Continuous Improvement is better than delayed perfection”

Mark Twain

In 2016 I was fortunate enough to gain a place on Cohort 9 of the Scottish Quality and Safety Fellowship, which was an amazing experience (further information available on the Quality Improvement zone).  This provided me with the opportunity to deepen my knowledge and understanding, as well as receive invaluable mentorship and support.  It also provided me with the ability to develop my use and accuracy (most of the time) of improvement quotes!

Here are my 6 Top Tips supported by some of my favourite quotes.

1. Prepare to Fail

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I was trying to run in the Lake District – lots of failing in preparation for the Lakeland 100 race!

“Ever tried.  Ever failed.  No matter.  Try again.  Fail again.  Fail better.” 

Samuel Beckett

I look back at some of the pieces of improvement work I have been involved in and could write a whole blog about the failures!  The wrong timing, the wrong problem, the wrong data (I could go on) but without the failures, there wouldn’t have been the learning and successes either.  Don’t ever be afraid to try.

2. Seek to Understand

“The biggest communication problem is we do not listen to understand.  We listen to reply.”

Covey

How many times have you met with someone and thought to yourself – “it’s fine, I know the answer to this, I know what this person needs”.  For the AHP Dementia work and for my Fellowship project, we spent a lot of time ‘seeking to understand’ from the real experts – people living with dementia and their families.  We have used numerous methods to gather person experience feedback and have uncovered so much valuable information, at times completely different from what was expected.  Pause and make sure you really listen.

3. Power of relationships

“Coming together is the beginning.  Keeping together is progress.  Working together……is success.”

Henry Ford

We have been privileged to work alongside such motivated and talented teams whose commitment to improvement in practice is inspiring, both for the AHP Dementia work and within NHS Dumfries & Galloway.  Any successes are due to great relationships and teamwork so thank you!  Chocolate also helps.

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4. Start small, then make it smaller, then make it smaller again!

“Dream Big.  Start Small.  Act Now.”

Robin Sharma

While dreaming big is usually never an issue, I am grateful to the numerous people who have suggested that my Aim may not be achievable within my timescale (or the next decade come to that!).  Ask for help in breaking your idea down in to chunks and Act Now.

5. The importance of measurement

“without data you are just another person with an opinion”

Deming

This has got to be one of my favourite quotes and I think it speaks for itself.  Be clear on what you are measuring and why and then your data will also speak for itself.

6. Patience and reflection

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I have foregone a final quote in favour of my dogs who I like to include in any presentations or blogs!  Here is a rare photo of Scapa (left) and Ruby sitting still to illustrate the importance of patience and reflection as those are two key elements of any improvement journey.  I’ll finish by thanking the many people who have supported and contributed to my improvement journey so far………

Contributor

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Alison McKean,

Alzheimer Scotland AHP Post Diagnostic Lead, and Mental Health Occupational Therapist, NHS Dumfries & Galloway

Caring to Communicate: Enabling care partners to support people with dementia

Connecting People, Connecting Support highlights the valuable role of AHPs in supporting people living with dementia to have positive and fulfilling lives.  Communication, and the ability to make meaningful connections, helps to maintain psychological wellbeing and reduce stress and distress.  In the remote communities of the Western Isles, we respect and value the assets of Third Sector organisations in keeping people living with dementia connected to the people and places they value the most.

Like most Board areas, there are only a few Adult Speech and Language Therapy (SLT), so exploring new ways of partnership working is essential to accommodate the changing needs of the local population.  We offer a rolling programme of training sessions to Third Sector carers (paid and unpaid) and volunteers throughout the year.

Simple communication supports such as visual menus, communication passports, music, and sensory stimulation are explored.  The aim is to empower carers and volunteers to support positive communication by offering simple, practical communication advice.  We also aim to highlight access to our service, so that carers can contact us directly for advice and support.

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AHPs often worry about an ‘avalanche’ of new clients when they experiment with new ways of working.   Although contacts within our service have definitely increased, these are often consultative in nature, with carers getting in touch to see what THEY can do to enhance interaction.  Carers have commented on how helpful it is to be able to speak directly to SLT rather than having to navigate complex referral systems just to get some simple advice.

“Loved the focus on preserving humanity and dignity of the person to the last”

“Learned little easy tools to help people communicate”

“Don’t feel so lost”

Karen Mackenzie

Speech and Language Therapist/Scottish Voice CEN Secretary

Western Isles Hospital

We need to continue to challenge the expectations of what it means to live with dementia

When I joined the Care Inspectorate in January 2013 one of the first conversations I had with colleagues was about building on the work of Remember I’m Still Me, a thematic piece of research on dementia in care homes published in 2009 by the Mental Welfare Commission and the then Care Commission.

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Last year, the Care Inspectorate published the report My life, my care home (The experiences of people living with dementia in care homes in Scotland). It presents the findings of our focused inspection work examining the extent to which the Standards of Care for Dementia are having an impact on the lives of people living with dementia in care homes. This report builds on some of the work of Remember I’m Still Me and sets the scene for a range of improvements in the coming years.

 

 

Person-centred care

Scotland has a unique policy landscape with a range of dementia standards, educational frameworks and three national dementia strategies. These strategies have mapped the experiences of the person living with dementia from diagnosis through end of life. At every stage of this policy development an important aspect was listening to the lived experience of people affected by dementia, those living with the condition and those supporting them. This policy context sits well within the new national Health and Social Care Standards and positions the person experiencing care and support at the heart of everything we do.

The big question is: have things changed since Remember I’m Still Me was published? Overall, I would say yes because in many ways we have seen tangible changes. For example, we found that many care homes are now collecting rich personal details about the person they are supporting, including life story books full of great family photos. However, we did not always find this information is being used to make a positive difference in the lives of those who are being supported.

We also found that the majority of care homes now have secure gardens. However, the next question is whether people can people access these gardens independently. We found that this was not always the case. In fact, over a third of care home gardens cannot be accessed independently and require staff to be available if a person wants to go out into the garden.

So, we can see that the key ingredients of quality care and support are often present. However, something appears to be lost in how these components come together. It was interesting to see that where staff understand and live the vision of the service then outcomes are better for those living in that care home. So, maybe this is how we move from task-driven care to a truly person-centred approach?

Within the Care Inspectorate, we have embedded the Promoting Excellence Framework for all health and social services staff working with people with dementia, their families and carers. However, this framework still needs to be fully understood and implemented in care homes. For example, staff development is not simply keeping a record of attendance at training. It should be a live and dynamic learning and development opportunity, which leads to improvements in the culture and delivery of care and support.

I was extremely encouraged to see that the majority of services no longer look to medication as the frontline response to stress and distress in a person living with dementia. This is a positive move and a key indicator that staff are looking more into the complexity of what it means to live with dementia. However, when we looked at whether care homes promote continence or manage incontinence we know work remains to be done to challenge expectations and what is considered ‘good enough’.

What next?

I believe that we need to continue to challenge the expectations of what it means to live with dementia. We need to think about rights and citizenship being maintained, regardless of the degree of cognitive impairment that a person may be experiencing. We need to continue to support the sector to test out improvements, which can make a difference not only to the lives of people living in a care home but also to the staff working there.

We need to take a holistic view, so that one domain of a person’s life is not seen as more important than any other. The fundamentals of care are absolutely essential but so are providing meaning and opportunities for growth. Potential and hope need to be the bases of our expectations for care and support.

At the Care Inspectorate we are committed to ensuring that quality of life for people is not limited due to lack of expectations of what it means to be an older person living with dementia in a care home.

If you would like to find more information and resources on improving care for people living with dementia visit The Hub website’s Spotlight on Dementia.

The report My life, my care home is available on the Care Inspectorate website and the report Remember, I’m still me is available on The Hub website.

Written By 

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Heather Edwards, AHP Consultant, Improvement Support Team (Portfolio: Dementia, Frailty and Palliative and End of Life Care) Care Inspectorate

@HeatherAHP

Blog first published on the 18th December 2017 at

http://www.careinspectorate.com/index.php/news/4172-blog-we-need-to-continue-to-challenge-the-expectations-of-what-it-means-to-live-with-dementia

Home based memory rehabilitation in the Borders, Scotland An occupational therapists personal perspective

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I am an occupational therapist working in NHS Borders as part of the mental health service for older adults. Predominantly I provide a service to those living with dementia helping to adapt current and develop new activities to help retain independence and achieve wellbeing.

As part of a national project NHS Borders participated in the initial pilot of the Home-Based-Memory-Rehabilitation (HBMR) programme. This concept was originally developed by Mary McGrath, a pioneering Occupational Therapist from Belfast, and was packaged and further evidenced by an innovative team of occupational therapists in NHS Dumfries & Galloway. The pilot consisted of 6 individuals living with dementia, in the early stages, within NHS Borders. It began in December 2016 and consisted of a 6 week programme delivered in the individual’s home implementing memory strategies in a systematic way. This was then reviewed 3 months later and reviewed just recently, at one year, in December 2017.

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In the Borders HBMR has been positively received by NHS colleagues, the 6 individuals living with dementia and their families.  Obtaining feedback that you have made a difference in people’s lives by helping people regain their independence via establishing new routines and helping them feel more in control day to day is what, I feel, being an occupational therapist is all about. It is gratifying to have a beautifully presented resource that can be shared with individuals and their families; to have had the opportunity to spend time working through it with them has been an enjoyable experience. When I returned at three months and after one year I found that many of those strategies and routines that were still being implemented. This really highlights how much of a positive change we as an occupational therapy service have made to their participation, wellbeing and self efficacy. I feel that is a fantastic achievement.

The individuals involved in the process have given feedback that this would be beneficial to everyone who receives a diagnosis of Dementia. It helps reinforce that things can improve, in that everyday memory problems can be reduced and they still have the ability to learn new things. This programme puts the focus back on what the individual can do, their remaining skills, and not on what they are no longer able to do.

I believe providing the resource to the individual and their families is instrumental to the programme; they can keep it as they continue on their journey with dementia and return to it as any new issues potentially arise. The folder of tip sheets is colourful and well presented and providing the materials (whiteboard, memory book, prompt card, notebook, etc) to the individual makes it easier for them to test out potential new memory strategies. It also, I believe, reinforces to the individual that they are important to the service and they are worth this investment.

The amount of sessions required and the opportunity to return periodically really gives you a chance to get to know the individual and their families, which fosters a good therapeutic relationship and has been such an enjoyable experience for me personally.

As an occupational therapist I found this pilot to have been a fantastic experience and something that I am proud to provide to the people I work with in NHS Borders. It has been an educational and exciting process being part of the wider occupational therapy community piloting this on a national level. I look forward to continuing to work on this project to roll it out for others to benefit within the service.

Thank you for reading my first ever blog, please get in touch and let me know what you think?

Louise

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You can find out more about home based memory rehabilitation here

Contributor

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Louise Shanks,

Occupational Therapist, NHS Borders

I am an occupational therapist working in NHS Borders as part of the mental health service for older adults. Predominantly I provide a service to those living with dementia helping to adapt current and develop new activities to help retain independence and achieve wellbeing.

Connecting people, connecting support SPOTLIGHT: Allied health professionals maximising physical wellbeing

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Background

Connecting People, Connecting Support is a new AHP dementia policy in Scotland and shares  how allied health professionals (AHPs) in Scotland CAN support people with dementia, their families and carers to live positive, fulfilling and independent lives for as long as possible.

The policy presents an evidence-informed case to support a biopsychosocial approach to practice for ALL AHPs in Scotland when working with people living with dementia – what we call the AHP approach.

The fundamental understanding driving the AHP approach is that people living with dementia CAN benefit from AHP-led interventions.   In this week’s blog we are sharing the AHP contribution to maximising physical wellbeing.

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The AHP approach

Maximising Physical Wellbeing  Blog3

What do we mean by physical wellbeing?

This is about encouraging people to be more active, with the aim of preventing the potential negative outcomes of dementia. The primary focus is factors such as mobility, physical activity and fitness, falls reduction, foot care, identification of previously undetected pain or discomfort, management of pain, diet, nutrition and hydration, and swallowing, and inclusion in physical rehabilitation approaches delivered by AHPs.

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Why is physical wellbeing important? 

  1. Physical activity benefits people with dementia in many ways, including enhancing activities of daily living, independence and reducing feelings of loneliness and isolation.
  2. A positive connection has been shown between physical activity and improvements in balance and muscle strength.
  3. Diet, nutrition and hydration play an important role in maintaining health and wellbeing.
  4. What we eat and drink can also be used to celebrate life events and helps define who we are.
  5. Sensitive and inclusive design of dining rooms, kitchens, furniture, lighting and tableware can all make important contributions. 

3 ways allied health professionals CAN maximise physical wellbeing?  

1. Keeping physically active

AHPs have the knowledge, skills and expertise to promote physical activity for people with dementia through providing advice, signposting, referring on and delivering specific interventions. They can advise on how physical activity can be incorporated into people’s routines, realising benefits such as prevention of muscle wasting and mobility problems, and improving sleeping routines, mood and social participation.

Exercise is a more structured form of physical activity, often with a specific goal such as increasing strength, flexibility, balance, co-ordination or cardiovascular fitness. AHPs, primarily physiotherapists, have the relevant expertise to give general advice to people living with dementia and design personalised exercise programmes to best meet needs.

Physiotherapists and occupational therapists play a crucial role in maintaining and improving people’s mobility through interventions such as assessing function and activities of daily living, providing equipment and walking aids and offering gait re-education. AHPs, primarily specialist physiotherapists, have the knowledge and skills to use manipulation, acupuncture, mobilisation and electrotherapies to combat pain. Other non-pharmacological interventions used by AHPs in advanced dementia (usually physiotherapists and occupational therapists and often in partnership with families and carers) include passive movements, positioning, splinting of contractures and pressure care. 

2. Falls reduction and fracture prevention

AHPs play a crucial role at all stages of falls reduction and management pathways by supporting self-management of falls and fracture risk, identifying people at risk and delivering prevention interventions, such as strength and balance programmes.

Multifactorial programmes based on individual risk assessment are key evidence-based interventions to prevent and reduce falls. While these programmes can be delivered by a range of health and social care professionals, physiotherapists and occupational therapists are key to implementation. Effective interventions include individualised strength and balance exercise programmes, environmental assessments and home modifications, and use of telecare.

Good foot care can impact positively on a person’s ability to self-manage and can reduce falls, lessen the risk of infection, increase independence and participation in social activities and boost psychological wellbeing. Podiatrists have the skills and knowledge to help prevent and treat foot ulceration, but can also provide evidence-based self-care advice on foot health and support people with dementia to maintain their mobility and independence. Podiatrists will also provide support to others who may be providing foot-care services. 

3. Eating well

AHPs, particularly dietitians and speech and language therapists, use their expertise to help people maintain adequate nutrition and hydration. Dietitians can identify, assess and, where appropriate, provide practical advice to maintain nutritional health (Molyneux, 2016) and address issues arising as a result of the dementia, including taste changes, weight gain (weight-management advice) or loss (nutritional support), hydration issues, constipation and making the eating environment more suitable.

Dietitians offer nutritional assessments, support and therapeutic dietary advice, translating evidence into practical advice. Speech and language therapists assess changes in swallowing function and, with dietitians, advise on compensatory strategies, including alternative ways to support nutrition when needed. The aim is always to balance risk against quality of life and the continued enjoyment of the social activity of eating. Appropriate specialist advice increases independence, helps to maintain eating skills and can reduce the risk of undernutrition, dehydration, chest infections and aspiration.

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On reflection

Thank you for taking the time to read this blog and we would like to know

  • As an AHP, how do you currently support people living with dementia to maximise the persons physical wellbeing?
  • As person living with dementia, what support would you like to receive from allied health professionals to maximise your physical wellbeing?
  • As family carer, what support would you like to receive from allied health professionals to maximise your physical wellbeing?

We look forward to hearing from you

References

There are references supporting this text which you will find in the original policy document and can be viewed here  https://www.alzscot.org/assets/0002/7356/AHP_Report_2017_WEB.pdf with all the evidence informing the policy available at www.alzscot.org/ahp

Connecting people, connecting support SPOTLIGHT: Allied health professionals maximising psychological wellbeing

Background

Connecting People, Connecting Support is a new policy document in Scotland and shares how allied health professionals (AHPs) in Scotland can support people with dementia, their families and carers to live positive, fulfilling and independent lives for as long as possible.

The policy document presents an evidence-informed case to support a biopsychosocial approach to practice for ALL AHPs in Scotland when working with people living with dementia – what we call the AHP approach.

The fundamental understanding driving the AHP approach is that people living with dementia CAN benefit from AHP-led interventions.   In this week’s blog we are sharing the AHP contribution to maximising psychological wellbeing.

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The AHP approach

 

Maximising Psychological Wellbeing Blog5

What do we mean by psychological wellbeing?

The central importance of finding ways to communicate (verbal and non-verbal) that work for each individual and which make meaningful connections that may have wide-ranging benefits in relation to overall wellbeing and quality of life is recognised. Psychological interventions of different intensities are reflected to promote emotional health and psychological wellbeing, with the provision of psychological interventions for depression, anxiety, and expressions of stress and distress. This element builds on established AHP psychological interventions and therapies.

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Why is psychological wellbeing important?

  1. People with most types of dementia will at times struggle to find the right words or follow a conversation.
  2. Communication difficulty can be exhausting for the person, families and carers
  3. We know that people can often find it difficult to talk about dementia and many people living with dementia experience social isolation
  4. Dementia can have a profound psychological impact and may be linked to feelings of anxiety and depression.
  5. A non-pharmacological therapeutic approach is advocated for the treatment of psychological symptoms and a person-centred stepped-care model of support.

 3 ways allied health professionals CAN maximise psychological wellbeing?  

1. Maintain and maximise communication

AHPs are aware that optimum communication occurs in environments that are comfortable, where a person can feel relaxed and safe, and when the AHP-led intervention is tailored and individualised. AHPs have experience in training others in conversation skills and cuing strategies, identifying key elements for effective everyday communication and supporting opportunities to practice communication strategies in a social context, helping the person to gain confidence in the interaction. Speech and language therapists can provide personalised communication advice (aimed at, for example, developing communication passports, assessing communication networks and maximising communication opportunities) that is shared with family members to facilitate their communication skills. Where language difficulties present as a primary feature of the dementia, as in primary progressive aphasia, speech and language therapists will carry out assessments to identify specific communication impairments and abilities. Their findings will contribute to the diagnosis and be used to plan therapy and strategies.

2. Psychological interventions

AHP core psychological skills are unique to each profession and vary according to their undergraduate education and postgraduate development activity. AHP interventions to maximise psychological wellbeing require excellent communication skills and the ability to integrate psychological interventions and psychological therapies into core AHP practice.

A number of approaches based on the psychological understanding of dementia and its effects, including reminiscence approaches, life-story work, anxiety management, and engaging in everyday occupations and activities, will be core to AHPs’ day-to-day practice.

With additional enhanced training opportunities, psychological interventions can also become core to AHP roles and integral to a team approach to a stepped-care model of assessment and intervention. Psychological interventions include motivational interviewing, behavioural activation, mindfulness based cognitive therapy, cognitive stimulation therapy, cognitive rehabilitation and cognitive behavioural therapy. Specific psychological interventions providing individualised, formulation-led interventions in response to stress and distress in dementia, ranging from low-intensity to specialist interventions, can also be within AHP remits.

3. Psychological therapies

Psychological therapies are highly specialised psychological interventions that include the established AHP disciplines of art psychotherapy and music therapy.

Art psychotherapy creates opportunities for verbal and non-verbal communication by using art to enable people to feel connected to a sense of self, other people and the environment around them. It can support people living with dementia by reducing anxiety and increasing coping skills (Safer & Press, 2011), depending on how interested the person is in art activities, art materials and how they feel about one-to-one or group activities. Art psychotherapy can be particularly helpful for people who find it hard to express their thoughts and feelings verbally, enabling self-expression and enhancing sense of self and personhood.

Music therapy builds on people’s ability to respond to music to develop a therapeutic relationship and facilitate positive changes in emotional wellbeing and communication through engagement in live musical interactions. It has a robust evidence base as an effective, non-pharmacological intervention that can significantly improve and support the mood, alertness and engagement of people with dementia, reduce the use of medication, and help to manage and reduce agitation, isolation, depression and anxiety (Ridder et al., 2013).

These art-based therapies are particularly helpful when people find their emotions are too confusing to express verbally, when verbal communication is difficult or when words are not enough.

Supervision for the AHP professions is integral to all of the interventions.

On reflection

Thank you for taking the time to read this blog and we would like to know

  • As an AHP, how do you currently support people living with dementia to maximise the persons psychological wellbeing?
  • As person living with dementia, what support would you like to receive from allied health professionals to maximise your psychological wellbeing?
  • As family carer, what support would you like to receive from allied health professionals to maximise your psychological wellbeing?

We look forward to hearing from you

References

There are references supporting this text which you will find in the original policy document and can be viewed here https://www.alzscot.org/assets/0002/7356/AHP_Report_2017_WEB.pdf with all the evidence informing the policy available at www.alzscot.org/ahp