RCOT Innovation Award - A new approach to Dementia care

Individuals with dementia and postural care needs are at risk of developing fixed postures, increasing their risk of pressure injury, contractures and pain. This can lead to challenges in delivering care, unnecessary hospital admission and can reduce dignity and quality of life. 

As the brain dies, this not only affects the person’s memory but it also impacts their motor and sensory abilities. As the dementia progresses, the person is described as living in the ‘now’ moment. The person with dementia progresses through the process of child development but in reverse. The assumption that the citizen will end in the foetal position with contractures but this is not inevitable and can be avoided. 

The impact of the changes in the sensory areas of the brain is where the Belgium concept focuses its attention. 

The behaviour of citizens with dementia that we typically observe include grabbing at staff, hitting or pinching them, pushing back when being assisted to lean forward. This is the person’s means of communicating that they don’t feel safe. 

Put yourself in the scenario that you’re in the ‘now’ moment being supported on the bed and a carer rolls you onto your side to wash your back, you lose the security of feeling safe and suddenly you don’t know where your back is and you feel fearful. Understanding this enables us to understand why you suddenly grab at the member of staff or push backwards. You are looking for safety and reassurance. This action however usually ends up with the carer ratio being increased. 

I attended National Back Exchange conference in September 2022, where I was able to attend a session run by Jo de Clercq, Physiotherapist on his personal care and dressing technique ‘Turn Only Once’ (TOO).

I was so impressed by what I saw and heard. I applied for an Innovation award to help fund my project. The application process was really straight forward and I was delighted to hear in February this year that I had won the award. As part of my research, I visited Woonzorgnet Dijleland, a care home in Belgium, to see this work first hand. 

There were 170 residents with advanced dementia living in the home. 

The home is divided into houses (8 residents), streets (2 houses linked) and communities (4 houses). Mobile residents able to walk can walk freely between the 2 houses. Each house is staffed by one nurse and one health care assistant per shift and therapy staff work between houses. Despite the complexity of the person’s needs, not one of the residents is double handed to meet their care needs or for moving and handling. No resident has or has had a pressure sore or a contracture in the past 5 years. 

Each house had a sense of calm, as the resident’s sensory needs are being met. Although there was a basic routine of the day, the routine was changed to meet everyone’s individual needs. No one was woken up for breakfast at a certain time, personal care and breakfast was completed when the person was awake.

The colour scheme within the environment has been carefully considered. Contrasting colours used to highlight an area for a person such as the toilet but colour was also used to ‘hide’ areas such as exit doors or gates. 

The comfort and posture of the person is considered over a 24-hour period, when seated or in supine they are fully supported. In bed, a sleep system providing sensory feedback to the whole body is used. The body is immersed and enveloped within the system therefore allowing the person to relax as they feel safe. When the person is continually fighting their environment to feel safe, they burn a large amount of calories, which is why we see dramatic weight loss in people with dementia, this weight loss leads to increased risk of pressure injuries and pain. All of the residents in the home were a healthy weight. The sleep system is often combined with a weighted blanket so that the person is supported throughout their body, receiving the appropriate level of sensory stimulation from underneath and from above.

The Turn Only Once concept does what it says on the tin. The person is turned once during the washing and dressing routine, however it does rely on specific equipment such as bathing gloves, hoist and adaptive clothing being available. The bathing gloves for example are clinically tested and wash, moisturise and dry naturally reducing the amount of sensory stimulation given. The type of incontinence product used is also important. 

The clothes adapted are the person’s own clothes which is important to the person and to the family and this also keeps costs are kept to a minimum. The clothes are adapted using magnets or plastic poppers.

Based on the feedback of my visit, Denbighshire County Council have gone on to commission Jo De Clercq to deliver training to a range of staff from Health including District Nurses, Tissue viability nurses, OTs, physios and residential care home managers.
 
My next step is to complete a small research study looking at the effectiveness of TOO and I’m just starting the process of gaining ethical approval through Glyndwr University. 

Sara Thelwell

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