Guide Signposts Vol 1

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Volume 22 , Issue If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Peter Mann O. Search for more papers by this author. Tools Request permission Export citation Add to favorites Track citation.

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It also enables those without the condition to get to know their preoccupations and interpretations of what is happening to them; this is essential to maintaining contact with them as persons, and learning to relate to them in positive ways. I have been practising in this area for twenty-two years. It is different from the other creative outlets, like painting or singing, because most people with dementia are unable to pursue the art. The process is one of relationship-building through general conversation, followed by silence from myself whilst the person speaks on whatever subject interests them.

Their words are written down or tape-recorded and later transcribed. If a poem emerges, well and good; there will always be a text to hand back in any event. Permission for any sharing that may occur has to be sought. My wife noticed it and told me. I could see the same signs.

He was there with his wife. She had it. On the last three days we stayed together, we found a rapport. This means that I have had to turn myself into a listener, transcriber and shaper of 4. They think, how can they carry on? Poems of this kind allow people to celebrate their lives: an important contribution to wellbeing.

Of course dementia affects fluency of both thought and language, and there are some indi-. I really mean it: if you take your courage in both hands it can be done! With those who appear to be losing language but can still contribute something, the communal poem offers real possibilities. I have found that a group of up. There needs to be age him on this basis. So there is often a practi- a stimulus to set people talking. This can be an cal outcome of this work. In the case of a picthis is implicit in the telling:. First one petticoat, then another, then an other, then another, then another.

And I said, how many do you wear, grandmother? And she said, only one more. Everyone studies the picture and calls out reactions to it. These are written on a flipchart. By a process of negotiation a final version with title is arrived at. Some poems assembled by this method can be long and detailed.

Here is an example of a cogent and insightful one composed by a group of seven persons; the original stimulus is not needed for. She was a tiny little woman. In a one-to-one with someone who is linguistically challenged, time and patience are needed, but the reward, when it comes, can be commensurately greater. One need not disguise the confusion.

With skill it can be integrated into the whole. It may be that the poem emerges from a much larger body of material. Here the skill of the facilitator is in perceiving a common thread of coherence within a mass of perseveration. It offers reassurance to the participant when something of value is rescued in this way. Here is an example of the end-product of such a process, a poem by Ann Boyd on the subject of language itself:.

There are, of course, issues arising from this work, such as who does a poem belong to? Though it consists of the words of the person none of these have been added to it has been shaped by another. It is surely best thought as a collaboration, where the facilitator has succeeded in maintaining the authenticity of the original utterance.

Another issue is that of confidentiality. It is important if work is to be shared that permission is granted. This can usually be obtained verbally and in writing, but conditions may change and a situation can arise in which doubts creep in as to whether the agreement still obtains. This applies to other art-forms as well, but somehow where words are concerned there is an added responsibility for the practitioner.

I put an emphasis on sharing because work of this kind has the potential for challenging the stigma which is still rife in the area of dementia. I read a lot about it myself. Well, from what I can remember. From being a small child, as I got older,. One significant characteristic is the contribution that natural speech can make to the future of poetry.

Peter Elbow in his groundbreaking book Vernacular Eloquence speaks of the qualities. John Killick Dementia Positive johnkillick dementiapositive. Copies of the book can be obtained free from them. Copies are available for a small charge. Stroke survivors and their carers often report that the psychological consequences of their stroke. Additionally, research has demonstrated that car-. University Hospital Llandough, Cardiff and depression, anxiety and post traumatic stress and that psychological support for carers can.

Government, Stroke is the single largest cause of adult disability in the UK with mobility The importance of psychological intervention foland speech problems being the most obvious. However, there is behavioural and emotional difficulties Nys et al. Price, These problems often interact, for Furthermore, community care within stroke serexample difficulties with memory and information vices has consistently been found to be poorer processing may have an adverse effect on be- than hospital-based care Care Quality Commishavioural and emotional functioning. Psychologi- sion, Indeed, in a survey of more than cal difficulties are associated with longer hospi- 2, stroke survivors and carers by the Stroke talisation, poorer functional outcome, increased Association , respondents said that their mortality e.

House et al. Cognitive and 8. Evidence suggests that peer support can provide and informational support in the community. The emotional, informational and affirmational sup- group aims to support individuals in adjusting to port for individuals affected by chronic conditions and coping with change following their stroke and Dennis, ; Piette et al. Peer support to address issues that may arise after they have engages a person who has experiential knowl- left hospital Stroke survivors who are further on edge rather than formal training Morris and Mor- in their recovery post-stroke, offer social, practiris, Preliminary studies of peer support in cal and emotional support to people who have stroke services reported positive findings in more recently experienced a stroke.

The peer group for stroke was co-designed and Benefits have also been reported by stroke survi- is co-facilitated by stroke survivors together with vors who have become peer supporters, includ- Clinical Psychologists and runs weekly at the Reing increased self-esteem and confidence Morris habilitation Day Hospital at University Hospital and Morris, Peer support embraces the Llandough UHL. It was initially set up by a principles of prudent health care in using co- trainee clinical psychologist as part of his docproduction to offer an effective intervention at a toral training programme.

A number of stroke time where this type of support is most needed survivors received training in running groups and Stroke Association, There is currently no specialist community stroke group aims to provide information, emotional and service in Cardiff and Vale i. NICE problems with memory and concentration. The have highlighted that improving commu- group also discusses matters such as practical nity-based treatments and access to psychologi- tips, benefits, exercise and socialising. The group cal interventions within stroke services is para- has now run five times with over sixty five people mount.

For many people, it is only when they are with stroke and their family members attending. As such, the There is ongoing evaluation of the groups and Psychology Department set out to implement a analysis of the first three groups has been undergroup based on the peer support model for taken by Chris Stamatakis Trainee Clinical Psystroke survivors and their family members in or- chologist. In this evaluation period, forty-seven der to increase the provision of psychological stroke survivors and their relatives were ran9. Additionally, mediation analysis was used to explore the processes underlying peer support.

Intervention group participants completed a. Assess- the group comparison group. Higher scores denote ments were completed at baseline, post- greater perceived social support intervention five-weeks and at follow-up fourweeks. Further analysis revealed that perceived social support mediated the relationship between group condition and psychological distress. There has been an extremely positive response in terms of qualitative feedback from those who have attended the group as well as from the peer supporters.

Group members reported feeling en-. Figure 3: Examples of subjective feedback from and confidence, as well improving the psychoparticipants attending the peer group.

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It was amazing…. Members of Peer Support Group. Conclusion Peer support can facilitate improvements in psychosocial wellbeing for stroke survivors and their relatives and social support was found to be an important mechanism underlying peer support. Thus, the peer support group provides an effective and cost effective way of offering longer-term support to stroke survivors and their families in the community.

We believe that co-production has been pivotal to the success of the group as peer supporters, relative to professions, are able to offer a different type of knowledge and empathy with regards to living with stroke. It demonstrates the significant resource and strength of many individuals who have experi-. Long-term conditions and mental health: the cost of co-morbidities. The Kings Fund: Centre for Mental. Ayerbe, L. Retrieved 18 October from Wolfe, C. Algra, A. The prognostic Special Review. London: Care Quality Commission; Peer support within a health care con- stroke. Neurology, 64, — International Journal of Nursing Studies, 40, Piette, J.

A diabetes peer support intervention that improved glycemic. Department of Health National stroke strategy. Lon- control: mediators and moderators of intervention effectiveness. Chronic Illness, 9 4. Retrieved January 5 from don: Department of Health. Health recovery social networks: explor- nihms Stroke Recovery Canada. Paper prepared for Pohjasvaara, T. Depression is an independent predictor Annual Conference, Ottawa, May 28, Retrieved 10 Feb- of poor long-term functional outcome post-stroke.

European ruary from www. Mortality at 12 tudinal study of post-stroke mood disorders; diagnosis and and 24 months after stroke may be associated with depres- outcome at one and two years, Stroke, 18 5 , sive symptoms at 1 month. Stroke, 32, — Royal College of Physicians Sentinel Stroke National Morris, R.

Stroke Association Feeling overwhelmed: the emoNational Audit Office Progress in improving stroke tional impact of stroke. London: Stroke Association. London: The Stationary Office. Viesser-Meilly, A. Linderman, E. Depression: treatment and management of depression in Intervention studies for caregivers of stroke survivors: A critiadults, including adults with a chronic physical health problem. Patient Education and Counselling, 56, — Naylor, C.

Rachel is a social entrepreneur and professional artist. Some residents, like Margaret, occasionally struggled to find the words to express themselves, but this did not mean they had nothing to share. The more images and paintings I brought in with me, the more people wanted to contribute their thoughts and, in turn, share stories including staff! It was then that. The Ignite Programme was developed to provide people at all stages of dementia with a space to communicate, interact and share their stories. As a social enterprise, our purpose is to improve quality of life for people living with dementia and By using mentia care where meaningful conversations Montessori principles such as guided repetition, forms part of everyday life, where people are task breakdown, enabling environments and prosupported, encouraged and up-skilled where gressing from simple to complex, we hope to esnecessary to communicate and inspire conver- tablish an interactive and personal relationship sation in support of those living with dementia.

When discussing paintings and images, where response is the focus, not remembering, all that is required is a reaction — positive or creating an opportunity for people to communinegative! This journey of joint discovery is called cate and to be heard. An Ignite session is a safe an Ignite session.

As a trained Montessori teacher, the sessions this safety comes confidence and, often, commuwere designed according to Montessori princi- nication. For some it may be sitting on the edge ples, which are aligned with person-centred care. She started with just a few words and the occasional nod. At the end of the sixth session we an asylum in Rome. By observing their behaviour looked at a colourful painting of figures dancing. Nowadays The format of the sessions is simple and structhere are Montessori schools all over the world tured. Neither facilitator nor resident need have producing some of the most innovative minds of any knowledge of art.

Sessions are themed, e. New sesfect tool to zoom in and explore the art. The ac- sions are provided each month with new digital companying materials include dementia friendly images of artworks and accompanying materials, questions to provoke discussion, along with his- so the licence holder is fully equipped to begin. More for their residents or patients. We realize June explains;. The Ignite Programme is now available as a li- Using the session themes as a starting point for cence to individuals in health or social care or- meaningful activity, we provide inspiring ideas for ganisations in order to offer a package of high follow-on creative workshops, such as craft acquality experiential training, session materials tivities and sensory sessions.

The training also includes The Pop-up Dementia Experience. Trainees ex- We believe that meaningful conversation is imperience sensory deprivation, both visually and portant for every person and can make a huge through touch, whilst listening to audio of confus- difference to wellbeing. We hope that by providing sounds. They are asked to complete what ing inspiring training combined with quality matelook like simple every day tasks.

We can never rials we can spread these wonderful sessions so know what it is like to live with a dementia but that people in health and social care settings being faced with some basic restrictions can help everywhere become skilled communicators. Combined with the Com- Working in dementia care has opened up a municating Artfully technique — connect, commu- whole new way of being for me. People with dementia teach us to slow McKeefry and Bartlett Likewise activities asking questions about sight?

How often are which incorporate more sensory input are often assessments. When information is Where activities become more difficult to carry shared with a person, e. An tary organisations. They are specialists in provideye examination can pick up the first signs of an ing support to people with sight loss and vision eye condition before changes in vision are no- problems with orientation, mobility, activities of ticed.

This can enable access to vital treatment daily living or communication skills. NHS sight tests are free to those over 60 and to 6 Provide information on falls those with other entitlements, such as people with diabetes or a family history of glaucoma in Sight loss and dementia are risk factors associScotland they are free for everyone. Those over ated with falls. Talk to the person about falls pre70 are entitled to free eye tests every year. Information on local providers Suzy England and Catherine Dennison. Contact: research pocklington-trust.

Other than for four years working at Bath University, he worked in the NHS from until when he took up his present post. What has your role taught you about working with people with dementia?

Awakening to Oneness Vol 1

In recent years I have been increasingly interested in thinking about dementia as an existential threat — something that has been explored within. I am Richard Cheston and I work at the Univer- with threat better if they are able to establish sity of the West of England in Bristol as a Profes- meaning in the world and to have higher levels of sor of Dementia research.

I also work as a Clini- self-esteem. One route to creating both meaning cal psychologist, for one morning each week, at and higher self-esteem is to invest in social relathe RICE memory clinic in Bath. There are a number of challenges about working have significant potential to help us to underin a University again, not least the fact that I stand all manner of threats, from our own, perprobably work longer hours now than when I sonal, sense of mortality, to much broader worked as a Clinical Psychologist in the NHS. However, I think What has changed in the time that you have there are many other ways of thinking about how been working?

For instance, TMT suggests that when As a clinician, I became interested in how I could faced with an existential threat, we tend to invest help people to adjust to the emotional impact of more heavily in those values which reflect our dementia. It seems to me that this is by running groups in which people affected by something that so many people that I have dementia could explore the significance of the known who are affected by dementia do: they diagnosis within a secure, therapeutic setting.

My clinical work fits into this in the sense that the ideal. I have been involved in a number of re- Well, just as we are all mortal, so we have a finite search studies that look at the impact of psycho- career as a researcher or as a clinician. I hope therapy groups on the levels of depression and that in the next ten years or so that I can conquality of life of people affected by dementia, but tinue to explore some of these issues, and to test I have also tried to look at the process by which out whether TMT does indeed help us to underpeople create meaning from their diagnosis.

One stand the experiences of people affected by deof the things that has come out of this work is the mentia, and to develop or adjust our clinical interway in which, for some, there is a balance to be ventions to take account of any new insights. This book began its formation in the process of the 4th National Conference on Ageing and Spirituality hosted by the Centre for Ageing and Pas-. It is a collection cept. There are of 17 essays which examines ageing in the contwo main inter- text of the growing number of religions and culof tures that make up Western society.

Each essay. Each essay includes issues ing. Current health and social care practitioners are older people who are homeless in the United increasingly called upon to provide person cen- Kingdom. It has a refreshingly style of writing betred care to older people from a range of reli- cause the medium of poetry has been used to gious and secular backgrounds.

Within the spiri- examine issues pertaining to ageing and spiritutual component of person centred care, practitio- ality. It is therefore important in relevant to practitioners working with multicultural delivering holistic care to older people that practi- and multi religious communities in the United tioners understand the wider context in which.

The stories and poems presented are moving and thoughtful, on occasions disconcerting and at times amusing. The book demonstrates the. Written by fathers, mothers, sons, people who are dying and professionals the published pieces portray how it feels to be facing death, grieve for a loved one or provide care for someone who is dying. Final Chapters: Writing about the end The collection includes a moving poem about of life.

As a clinician I had a particular interest in those poems and stories written by fellow heath care providers, those which focus upon the care relationship and those about dementia. Final Chapters is the result of a creative writing competition run by the Dying Matters Coalition. Final Chapters presents a collection. This story offers a forthright insight into the feelings and thoughts that can be evoked when carers are involved.

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The issues and feelings raised in this piece are ones which are seldom discussed or acknowledged. The Enhancing Dementia Recipe struck a particular resonance, written by a nurse it creative, eloquent and at times wryly amusing. It demonstrates how dementia care should not be provided, yet sadly on many occasions still is. Personally I would like to see this story being read End of Life Care: A Guide for an individual who has dementia, as it presents a Therapists, Artists and Arts Therapists by all people who provide care and treatment to very powerful message.

A number of. This book would make a welcome addition to any care giving setting. It should be read by all professionals who wish work with people with life limiting conditions and those who wish to gain further insight into death, dying, loss and bereavement. The author, a former music therapist himself and Director of Supportive Care at St. Hartley gives a very personal and honest account of his thoughts and feelings he experienced when working together with patients coming to the end of their life.

While talking about how rewarding an experience it can be, he does not shy away from talking about practical and emotional difficulties an arts therapist might encounter. For example Hartley advocates that therapy ses With its clear language and vast too poorly to engage in another session or might amount of shared experiences combined with pass away in the course of the therapy which can useful references throughout, this book is a most be difficult both emotionally and practically.

He useful guide particularly for arts therapists in end also gives an example of mourning for a patient of life care, but would provide an interesting, inwho had died that he had developed a strong formative and insightful read for any professional bond with and highlights the importance to have working in a care setting. Alex Stach Placement Student life care therapy.

Practical advice includes providing a sample funding application to potential funding bodies and a sample project form. All of the information given is highly relevant and without a doubt most useful particularly for, but by no means limited to, aspiring or current arts therapists. Overall Hartley seems to have covered every thinkable aspect in connection to end of life care, For book lovers! The puzzles are made from plastic making them It is possible to get copies of your favourite books extremely durable and easy to clean.

The size in large print if your eyesight is letting you down. Images have or www. There are jigsaw puzzles available that have been designed for people living with memory difficulties. The Simple Music Player is specifically designed for easy use by those with dementia, without any assistance, and is a valuable tool for improving quality of life, especially if living at home.

It is available in red, green and walnut. The proportion of people living with dementia in the UK, and men living with dementia in Spain, had fallen. However, the nationally. The programme will showcase the lat- scientists involved with the study believe that imest research alongside best practical guidance provements in the health of the general populaon helping improve the lives of people with de- tion and education surrounding the risk factors mentia.

The study shows that the proportion of older people living with dementia in the UK has fallen. This is in direct contradiction to the predictions that the number of cases would soar. The report analysed twinned dementia studies that were conducted in the same way, but decades apart.

It showed that the proportion of people in the Netherlands and Sweden, and women in Spain, living with the condition had stabilised. Lead researcher Prof Carol Brayne said the expected rise "had not occurred". The age-specific prevalence has gone down so even though the population has got older, the number [of patients with dementia] has stayed the same.

It still doubles What we're hoping from not be given a full tour of the whole exhibition as it is quite large! There will be tea, cake, and muthis research is that it will provide more evidence sic with different ceramic items available for you to touch, hold and chat about. A family member, for focusing research beyond drug discovery. The exhibition explores the artistic and expressive possibilities of clay as a material, including the contradiction between two of its innate qualities — durability and fragility. Lunch, 1 — 2pm. Maximum 20 people — please book in advance We would love for you to join us for lunch if you have taken part in either or both of our sessions today.

Family members, friends and helpers are also invited. Teapots and Clay pots, 2pm-4pm. Maximum 10 people — please book in advance In this hands-on session, you can have a go at modelling with clay, and to smell and try different kinds of tea. A family member, friend or helper. For more information, please contact: Jennifer. Dudley museumwales. Lile-Pastore museumwales. Dementia-friendly workshops — Free! But limited availability so please book in advance On October 1st we will be running a day of free workshops for people living with dementia and their carers, with activities inspired by the Fragile?

The workshops will be relaxed and friendly. No previous experience is required for any of the activities. Tea and biscuits will be provided and chatting is encouraged! Workshop schedule Explore the exhibition, 11am-1pm. Maximum 10 people — please book in advance In the morning, we will take a look at some objects in Fragile? You will Books Available for Review: We currently have a number of books that require reviewing, if you are interested in providing a review please contact us.

Thank you. Julian C. Hughes, Sue Read, Murna Downs and Barbara Bowers, The Forgiveness Project - Stories for a vengeful age. Marina Cantacuzino, Mindfulness-Based Interventions for Older Adults. Evidence for Practice. Grandma's Box of Memories. Jean Demetris, Welcome to the latest edi- Contents: tion of Signpost. I hope that has been a happy and 2.

I was very pleased to be in- 4. Within this role I support the Nutrition and Dietetic ser- The Mental Health Dietetic Team are core to the delivery of mental health services across the age spectrum Although language appears to be increasingly chal2 lenging with the progression of Dementia, John ex- is evident throughout this reflection. It is different from the other creative outlets, like painting or singing, because most people with dementia are unable to pursue the art -to-one, and latterly have experimented with group composition.

Here is an example of the end-product of such a process, a poem by Ann Boyd on the subject of language itself: There are, of course, issues arising from this work, such as who does a poem belong to? From being a small child, as I got older, with individuals, are considered in depth by the Australian Trisha Kotai-Ewers in Listen to the Talk of Us: People with Dementia Speak Out, the only full-length study so far published on the therapeutic aspects of the work.

Peter Elbow in his groundbreaking book Vernacular Eloquence speaks of the qualities Of course, people have borrowed from me for quite a while now so not got everything here now. Stroke Peer Support Group of independence and confidence, reduced social participation and difficulties returning to work. Stroke survivors and their carers often report that the psychological consequences of their stroke Dr Sam Fisher, Dr Julie Wilcox, Prof Reg are the most challenging to cope with, and psy- Morris, Chris Stamataskis, John Griffiths, chological difficulties are the most frequently Cliff Barber and Ken Nazareth cited type of unmet need Rothwell et al.

Cognitive and 8 Evidence suggests that peer support can provide and informational support in the community. Individuals who have more recently been discharged Context from hospital post stroke are invited to attend the five-week group along with their relatives. The There is currently no specialist community stroke group aims to provide information, emotional and service in Cardiff and Vale i.

In this evaluation period, forty-seven der to increase the provision of psychological stroke survivors and their relatives were ran9 domly assigned to either a five-week peer support group intervention or a waiting-list comparison condition. Intervention group participants completed a scores before and after the intervention and at one-month follow up for those attending the peer support group intervention group compared to those waiting to attend group process questionnaire TFI Group members reported feeling en- Figure 1: Graph demonstrating score on the General Health Questionnaire GHQ before and after the inter- couraged and supported by the group and the vention and at one-month follow up for those attending the many commonalities, for example, fatigue or peer support group intervention group compared to those emotional difficulties.

Importantly group members waiting to attend the group comparison group. Lower reported an increase in well-being and hopeful- scores on the GHQ denote lower psychological dis- ness. Figure 3 illustrates quote from some group tress. Members of Peer Support Group Conclusion Peer support can facilitate improvements in psychosocial wellbeing for stroke survivors and their relatives and social support was found to be an important mechanism underlying peer support.

Signposts to success for occupational therapists | British Journal of Therapy and Rehabilitation

A diabetes peer support intervention that improved glycemic Department of Health I had been asked to teach painting to residents but, for many, it Rachel is a social entrepreneur and professional artist. Anything goes, and sometimes it pretty much does! With As a trained Montessori teacher, the sessions this safety comes confidence and, often, commuwere designed according to Montessori princi- nication. Family or Daily Life, with artworks shown in a 14 digital format on the backlit iPad or tablet — a per- with people at all stages of dementia.

People with dementia teach us to slow 15 down, truly listen and to appreciate the moment we are in. Oxford: Oxford University Press 16 discussing this week. Others find the climb more difficult, either due to physical reasons or due to Memory Strategies Group Tea and coffee and biscuits are Angharad Jones handed around whilst people take their seats, and there is small talk about what people have Angharad is currently working as an Assistant Psychologist at The Memory Team, Cardiff and Vale UHB.

It can signal the 17 beginning of an illness such as dementia, but can cognitive rehabilitation work, so it is a core elealso be due to vascular conditions or external ment of our group sessions as well. Relaxation typically forms a core part of 18 freely while being guided by their intention to crucial.


It is the people who attend that monologue will be negative and problem- keep the group vibrant, as the topics of discus- saturated. I always attempt to be aware of the where the members feel safe to voice concerns discussions and group dynamics around me, and my place within these.

At the beginning of each session we Through their conversation, group members ad- openly discuss the principles of the group. Through discussion, the person decided that it gave them the Encouraging the development of a dialogue, as feeling of being in control of at least one aspect opposed to a monologue, during the sessions is of their lives. Dementia, along with many other 19 things, is out of our control and many people the members may have met me previously in struggle to live with uncertainty.

People were very friendly, and chatting together was Balancing the voices of the group is another helpful in many ways.

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During the sessions, 20 we discuss different strategies that could help Sheehan J. Dementia and Sight Loss Interest Group The Dementia and Sight Loss Interest Group was set up in as part of Vision UK, to develop and promote a better understanding of the issues facing people affected by sight loss and dementia and how best to support them through involvement in research, developing resources, having a presence at events and writing for publications.

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Both dementia and sight loss are under diagnosed. Mary was diagnosed with Alzheimer's 18 22 months ago following her daughter noticing she however it is also common for people with sight was becoming increasingly forgetful. For more information on sight loss conditions refer to RNIB's guides to individual conditions: Hidden sight loss www. However, after cataract surgery, she began talking about the birds in her Impact of dementia and sight loss garden, restarted her previous activities and The effects of having both sight loss and demen- showed interest in going out again.

The ability of someone with dementia to cope with sight loss is It is common for older people and professionals reduced when compared to someone with an to think deteriorating sight is part of normal ageotherwise similar health profile, but without de- ing. This can significantly impact on activities example through wearing the correct glasses or of daily living and cognitive performance cataract surgery RNIB These are some McKeefry and Bartlett How often are which incorporate more sensory input are often assessments conducted that have visual recommended for people living with dementia.

Do you have difficulty reading small print? Do you have difficulty recognising faces?