2.2 Describe how individuals with dementia may feel excluded

This guide will help you answer the NCFE CACHE Level 2 Award in Awareness of Dementia Unit 2.2 Describe how individuals with dementia may feel excluded.

Social Isolation

Individuals with dementia often experience social isolation. This can stem from their difficulty in maintaining conversations. They may struggle to follow along or to express themselves clearly. As a result, friends and family might reduce their visits or invitations to social events. This can lead to a gradual but significant decrease in social interaction.

Social isolation can manifest in various ways:

• Reduction in social outings: They may stop attending community events or meeting friends.
• Limited family interaction: Family members might visit less frequently, either due to fear of awkward interactions or simply not knowing how to communicate effectively.

Emotional Exclusion

People with dementia often feel emotionally excluded due to a lack of understanding from those around them. Emotional exclusion can occur when:

• Feelings are dismissed: Caregivers or loved ones might not take their feelings seriously. This could be because they assume the person with dementia doesn’t understand what’s happening.
• Overprotectiveness: Sometimes, family members may be overprotective, making decisions on behalf of the individual with dementia without including them in the process. This can lead to feelings of helplessness and marginalisation.

Communication Barriers

Dementia can severely impact communication skills. These barriers often result in exclusion, as individuals find it challenging to express their needs or engage in conversations.

Key communication barriers include:

• Language difficulties: They might struggle to find the right words or repeat stories.
• Understanding: They may have trouble understanding what others are saying.
• Non-verbal cues: Reading body language and facial expressions can become difficult.

Physical Exclusion

Physical exclusion happens when the environment is not accommodating to the needs of individuals with dementia. This can include:

• Accessibility issues: Public spaces might not be designed to cater for those with dementia. For example, complex signage and busy environments can be overwhelming.
• Residential care rooming: In care homes, they might be placed in separate or more restrictive areas, isolating them from general activities.

Cognitive Exclusion

Their cognitive impairments can lead to exclusion in various day-to-day activities. They might be left out of mental engagement opportunities because of:

• Tasks becoming too complex: They may no longer be involved in activities that once were a part of their daily routine because others believe they can’t handle them.
• Overlooking their ability to learn: It is a myth that people with dementia can’t learn new things. However, if others assume they can’t, they might stop providing stimulating activities that could promote cognitive engagement.

Stigma and Prejudice

Stigma plays a significant role in the exclusion of individuals with dementia. It can result from:

• Lack of awareness: Many people don’t understand dementia and might make uninformed judgments or assumptions.
• Negative stereotypes: Such as the belief that all people with dementia are completely dependent or that their quality of life is irreparably diminished.

Institutional Exclusion

In institutional settings like care homes or hospitals, individuals with dementia might feel excluded due to:

• De-personalisation: They may be treated as part of a group rather than as individuals with unique needs and preferences.
• Rigid schedules: Institutions often follow strict routines which may not always align with the personal habits and preferences of those with dementia.

Relational Exclusion

The changes in behaviour and personality, which often occur with dementia, can lead to relational exclusion:

• Strain on relationships: Friends might drift away, unsure of how to handle the new dynamic. Family relationships can also become strained due to the stress of caregiving.
• Loss of identity: As dementia progresses, individuals may lose parts of their identity, making it difficult for others to relate to them as they once did.

Practical Strategies to Minimize Exclusion

Understanding these aspects is important, but also knowing how to address them is important. Here are some practical strategies:

• Encouragement and Support: Active encouragement in communicating and participating in activities.
• Education and Awareness: Spreading awareness and educating both caregivers and the wider community about dementia.
• Adapting Environments: Creating dementia-friendly environments, both at home and in public spaces.
• Personalised Care Plans: Developing person-centred care plans that consider the individual’s past experiences, preferences, and abilities.
• Maintaining Routine: Allowing for flexible but familiar routines can help in maintaining their engagement.

Final Thoughts

By understanding these exclusion factors and actively working to address them, we can actually improve the quality of life for individuals with dementia. Inclusion should be front and centre in both care practices and daily interactions. This approach ensures that people with dementia continue to feel valued members of society, rather than being marginalised due to their condition. It is our collective responsibility to foster an environment of inclusion, empathy, and support.

This detailed exploration aims to shed light on how individuals with dementia may feel excluded and provides actionable steps to mitigate those feelings of exclusion. By applying these strategies, we can create a more inclusive society for everyone.

Example answers for unit 2.2 Describe how individuals with dementia may feel excluded

Example Answer 1: Social Isolation

Individuals with dementia often feel excluded due to increased social isolation. Many people find it hard to communicate with someone who has dementia because of the person’s memory problems and confusion. This often means friends and family stop visiting or inviting them to social events. I remember one client who used to enjoy playing cards with friends every week. As her dementia progressed, she struggled to participate, and eventually, her friends stopped including her in their weekly gatherings. This led her to feel very isolated and lonely.

Example Answer 2: Emotional Exclusion

Emotional exclusion is also a big issue for those with dementia. Their feelings can be easily dismissed by carers and family members who might think they don’t fully understand what is happening around them. One of my clients, Mr. Thompson, often expressed sadness because he felt like his family didn’t listen to him anymore. They made decisions for him without consulting him, thinking it was in his best interest. This left him feeling helpless and marginalised, as if his opinions no longer mattered.

Example Answer 3: Communication Barriers

Communication barriers can actually exclude people with dementia. They may struggle to find the right words or to follow a conversation, leading others to give up on communicating with them. For example, I cared for a lady named Mrs. Hughes who had trouble understanding complex sentences. Her family would talk over her and not seek her input, which made her feel excluded and frustrated. Simple, short sentences and maintaining eye contact helped improve her participation in conversations.

Example Answer 4: Physical Exclusion

Physical environments can also be excluding for individuals with dementia. Many public places aren’t designed with their needs in mind. I recall taking Mr. Patel to a local café which had very complex signage and a noisy atmosphere. He found it overwhelming, and we had to leave quickly. In care homes, individuals with dementia might be placed in more restrictive areas away from communal activities because staff think it’s safer, but this often leads to them feeling cut off and excluded.

Example Answer 5: Cognitive Exclusion

Cognitive exclusion happens when people assume that individuals with dementia can’t participate in activities due to their mental impairments. I worked with a gentleman named George who loved puzzles. As his dementia progressed, staff stopped bringing him puzzles, thinking he couldn’t enjoy them anymore. This denied him mental stimulation and joy. However, when we introduced simpler puzzles tailored to his current abilities, he was able to engage and felt included once more.

Example Answer 6: Stigma and Prejudice

Stigma and prejudice can heavily contribute to the exclusion of individuals with dementia. Many people in the community don’t understand the condition and might use negative stereotypes, which can be damaging. During an outing with one of my clients, Mrs. Clark, I noticed people staring and whispering because she was repeating herself and looking confused. This made her very self-conscious and reluctant to go out again. Promoting awareness and understanding within communities can help reduce this kind of exclusion.

By sharing these specific examples, I hope to emphasize the various ways in which individuals with dementia can feel excluded and the importance of taking active steps to ensure their inclusion in social, emotional, physical, and cognitive aspects of life.