Communicating with people with advanced dementia

There are 850,000 individuals with a diagnosis of dementia in the UK, many of whom are likely to progress to a state of advanced dementia. Professional care places a considerable strain on NHS resources and the distress that Alzheimer’s places on those living with the illness, their loved ones and professional caregivers cannot be underestimated. Much of this distress owes to the breakdown in speech-based communication that accompanies the illness.

People with advanced dementia who have lost the ability to speak are typically thought to have no communicative abilities or desire to interact and, as such, are typically excluded from the social world. Research by Dr Maggie Ellis and Professor Arlene Astell of the School of Psychology & Neuroscience has found that, despite a lack of speech, people with advanced dementia retain both the urge to interact and individual repertoires of non-verbal communicative capacities including sounds, movements, facial expressions and the capacity to imitate. These behaviours can be used by caregivers to re-engage individuals with advanced dementia in social interaction - an approach now known as 'Adaptive Interaction'. Organisations providing care for individuals with dementia have recognised the value of this evidence-based approach. For example, Alzheimer Scotland recommends Adaptive Interaction in a public document and the Alzheimer’s Society commissioned Dr Ellis to develop a training programme in the approach that is currently being rolled out to approximately 1000 volunteers across the UK.

While not eliminating Alzheimer’s disease, Adaptive Interaction supports the interpretation of behaviour as intentionally communicative and provides the means to engage with those living with advanced dementia. By supporting communication, Adaptive Interaction increases the wellbeing of those diagnosed and their family members and the job satisfaction of formal caregivers.

Research:
Astell, A. J., & Ellis, M. P. (2006). The social function ofimitation in severe dementia. Infant and Child Development, 15(3), 311-319.

Ellis, M. P., & Astell, A. J. (2011). Adaptive Interaction - a new approach to communicating with people with advanced dementia. Journal of Dementia Care, 19(3), 24-26.

Psychological intervention to alleviate heightened fears of recurrence of cancer patients

Fear of recurrence is a major concern for many cancer patients, as highlighted in a major review by Professor Gerald Humphris and Dr Gozde Ozakinci of the School of Medicine. The Adjustment of Fear, Threat or Expectation of a Recurrence (AFTER), developed for general cancer patients, includes an innovative validated Fear of Recurrence (FoR) measure. The measure identifies patients with high fear of recurrence in NHS oncology services to enable psychological therapeutic treatments to be targeted, thus improving the quality of patient care. AFTER is being widely and successfully employed with cancer survivors in UK cancer services and international oncology centres to reduce their FoR and depression. Additional funding is ensuring further implementation of the AFTER intervention into cancer services through training workshops and staff supervision to build a targeted service for NHS patients. A clinical service of the AFTER intervention is provided in the NHS Lothian Edinburgh Cancer Centre for out-patients, and training workshops on the intervention are currently being conducted to enable health professionals in England in their use. Other European and International Cancer Centres are also adopting AFTER for use in the EU and North America.

CIRCA: Conversation support for people with dementia and their carers

CIRCA, Computer Interactive Reminiscence and Conversation Aid, is a novel touchscreen computer system designed to support conversation between people with dementia and their caregivers. CIRCA was based on research into the memory and communicative problems of people with dementia conducted by Prof. Arlene Astell, Dr Barbara Dritschell and Dr Maggie Ellis of the School of Psychology and Neuroscience.

Typically, people with dementia experience impairments in short-term memory, whilst retaining relatively well-spared long-term autobiographical memory. As such, it is often easier for people with dementia to talk about the past rather than recent events.
In collaboration with the University of Dundee and a major care home provider, the researchers developed CIRCA as a means of presenting multimedia reminiscence material – photographs, videos and music – to people with dementia and their caregivers. It was found that people with dementia were more likely to initiate conversations about the material and were more equal partners in the conversations when using CIRCA as compared to traditional reminiscence methods (Astell et al., 2010; doi: 10.1016/j.intcom.2010.03.003). The CIRCA system allows individuals with dementia to choose from a range of subjects from the past, thereby facilitating their retained long-term memory and providing prompts for successful conversations. CIRCA has been installed in numerous residential or day-care settings around the UK, including NHS and Council run residential care centres, Age Concern and Alzheimer’s Scotland Centres and private care homes.

The project has been funded by: Engineering and Physics Sciences Research Council (EPSRC), the Alzheimer’s Association and the Technology Strategy Board.

"Sticking plaster" treatment for skin cancer and acne

A wearable light source that can treat many skin cancers and acne has been invented by Professor Ifor Samuel (School of Physics and Astronomy) working with Professor James Ferguson (Ninewells Hospital, Dundee) in light-emitting-polymers. Using support from Scottish Enterprise, they showed organic light-emitting diodes (OLEDs) could be used to make a light-emitting "sticking plaster" that provides a new light source for medicine. The light-based treatment is gentler than surgery and so leads to a better cosmetic outcome. It is an improvement over conventional photodynamic therapy (PDT), which is only available in a limited number of hospitals because of the specialised equipment involved, because the patient can move around during treatment, pain is reduced, and a hospital visit can be avoided.

Ambicare Health Ltd developed the prototype ambulatory devices into a form suitable for regulatory approval and manufacture. This resulted in two products, “Ambulight”, a portable, wearable light source with battery pack, used for treating non-melanoma skin cancers and dysplasia, and “Lustre” for the treatment of acne. The more effective, simplified treatment with Ambulight has meant an increase in the number of patients treated per clinic, a success rate of 84% of lesions being clear after one year, and patients having a comfortable, portable, home-based treatment. The advantage of Lustre is that it enables acne to be treated at home, using blue light treatment rather than drugs or chemicals. Both systems are in use in the UK and the Netherlands.