Areas for guidance
CASE STUDY 3 | MICHAEL Michael is 43-year-old man who has Down Syndrome and a mild Intellectual Disability. He lives in supported accommodation. Michael had until lately travelled either by bus or train to visit his family or to attend matches as he is a passionate supporter of his local and county GAA teams. Monday to Friday he attends a day service where staff have observed that he was “not himself” and that he was not engaging with either them or his colleagues. He has appeared to be withdrawn at times. He has also become more reliant on others and less likely to initiate activities. Reports from the staff in his home have concurred that Michael has lost interest in doing everyday things for himself. Michael recognises that he is struggling more now, his coping skills are diminishing, and he is finding it increasingly difficult to make sense of the world around him. There is evidence of reduced emotional control, irritability and loss of self direction. He is less tolerant of his peers, and with decline in social behaviours becoming more evident, he has begun shouting at staff and other residents, for no obvious reason. Michael attended the memory clinic. A full physical work-up was carried out to out rule out pseudo dementia and to inform differential diagnosis. He had a full cognitive work up and following comprehensive interviews with family members, key staff from his home setting and his workplace a consensus diagnosis agreed that he met ICD-10 criteria for Alzheimer’s type dementia. It was agreed that Michael is presenting with a very compressed decline and that the level of support that he will require in the future will be significant. The psychiatrist has told Michael that he is presenting with memory problems and has explored with him what that means for him. Prior to engaging with a person with an Intellectual Disability and using the AFIRM response, it is important to acknowledge that the person may find it hard to express how they are feeling. Consequently, it is important that staff who know the person very well, and who understand the person’s usual methods of communication are involved when a diagnosis is being explored – particularly where the person involved does not use words to communicate.
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Facilitating discussions on future and end-of-life care with a person with dementia
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