Cadbury Competitor Analysis

Cadbury Competitor Analysis INTRODUCTION: Cadbury Dairy Milk is a brand of drain chocolate right now fabricated by Cadbury, aside from in the United States where it is made by MondelÄâ€Å"z International. It was presented in the United Kingdom in 1905 and now comprises of various items. Each item in the Dairy Milk line is made with solely drain chocolate. It is offering around the world. The slogan is Free the Joy. Dairy Milk is 23 percent cocoa solids. A number of the more up to date Dairy Milk assortments are presently fabricated in France. Dairy Milk itself is likewise made in France and these items are sold in the UK. In June 1905 in England, Cadbury made its first Dairy Milk bar, with a higher extent of drain than past chocolate bars, and it turned into the organizations smash hit item by 1914.George Cadbury Junior, in charge of the advancement of the bar, has said A wide range of names were proposed: Highland Milk, Jersey and Dairy Maid. Be that as it may, when a clients little girl recommended Dairy Milk, the name stuck. Fruit and Nut was presented as a major aspect of the Dairy Milk line in 1928, soon took after by Whole Nut in 1933. By this point, Cadburys was the brand pioneer in the United Kingdom. In 1928, Cadburys presented the glass and a half trademark to go with the Dairy Milk bar, to promote the bars higher drain content. Cadbury has constantly attempted to keep a solid relationship with drain, with trademarks, for example, a glass and a half of full cream drain in each half pound and promotions that element a glass of drain spilling out and framing the bar. In 2004, Cadbury began a progression of TV promotions in the United Kingdom and Ireland highlighting a human and a creature (speaking to the humans bliss) debating whether to eat one of a scope of included bars. CADBURY COMPANY RESOURCES: Worldwide sustenance producer Kraft Foods burned through $207.3 million on Cadburys New Zealand operations as a major aspect of its  £11.9 billion takeover of the chocolate creator in 2010, money related explanations appear. The Cadbury resources commanded income for Krafts New Zealand holding organization, Kraft Foods Investments (NZ), which detailed a benefit of $3.5 million in logbook year 2011, the primary outcome for the amalgamated element. Income of $316.6 million thinks about to Cadburys 2010 offers of $274.1 million. New Zealand deals a year ago made up around 1.4% of Krafts $US15.82 billion income in creating markets, which incorporates the Asia Pacific district. Kraft says expanded territorial deals originated from higher estimating over the locale, the Cadbury procurement and more good trade rates. The money thought esteemed Cadburys goodwill at $43.8 million, as indicated by the monetary explanations. Krafts New Zealand unit had $87.6 million in share capital as at December 31. The New Zealand unit spent a further $1.1 million on the Cadbury rebuilding activity to lay off around 145 staff and present mechanized assembling frameworks. The move was reported in August 2008 and is required to be finished for the current year. Rebuilding has fetched Kraft and Cadbury an aggregate $25.3 million in the course of recent years, as per their announcements. The worldwide business referred to the Cadbury takeover as an explanation behind expanded income no matter how you look at it in its 2010 and 2011 money related years, and it supported first-quarter deals 4.1% to $US13.1 billion in the initial three months of this current year. A month ago, Kraft quit its New York Stock Exchange posting for the Nasdaq in an offer to cut expenses. That comes in front of its arranged demerger, where it will turn out and independently list its North American basic supply business, which will keep the Kraft name, while the worldwide nibble nourishments business will work under Mondelez International. Krafts shares rose 0.8% to $US39.21 in exchanging New York on Monday, esteeming the organization at $US69.52 billion. CADBURY TANGILE RESOURCES:- COMPTITORS OF CADBURY:the main competitors of Cadbury are mars and Nestle, Hershey. MARS: Mars is a conspicuous name, however as a privately owned business, it hasnt been one financial specialist can get behind. In 2014, Mars had a piece of the pie of 29.5% in the United States for the chocolate showcase. Some of its best-known brands are MMs, Snickers, Starburst, Twix and Skittles. Mars was the seventh-biggest privately owned business in America in 2014, with offers of $33 billion. The organization contends in six sections: chocolate, pet care, nourishment, Wrigleys (gum), drinks and symbioscience. Alongside contending with Mars for the chocolate piece of the overall industry, Cadbury now goes up against the monster for partake in the worldwide gum showcase on account of Mars procurement of Wrigleys in 2008. Mars $23 billion procurement gave it control of brands, for example, Extra, Orbit and Eclipse, which delivered offers of $5.4 billion preceding the deal. Cadbury has gum marks that incorporate Dentyne, Stride and Trident. Both organizations have solid piece of the overall industry in a gum market that has seen deals decrease. https://www.google.co.nz/search?q=mars+chocolate+companyespv=2site=webhpsource=lnmstbm=ischsa=Xsqi=2ved=0ahUKEwjxzpaJ7OvSAhWCwbwKHRRRBHUQ_AUIBigBbiw=1366bih=662#imgrc=x3_VqJg0MLa7VM: Nestle: Nestle is the biggest nourishment organization on the planet, covering various subsectors of the market. The organizations chocolate market is one of its littlest, however it was adequate for a 5.8% piece of the pie in the U.S. Settle has developed through numerous acquisitions that have given it control of brands that incorporate Kit Kat, Smartys and Gerber infant nourishment. Settles sweet shop fragment was its 6th biggest in 2014. With offers of $9.7 billion comprehensively, Nestle held the number three piece of the pie position. Offers of the organizations chocolate items totalled $7 billion, including $4 billion from the Americas. Like its arrangement with Cadbury, Hersheys additionally licenses a few brands from Nestle for U.S. conveyance rights. This incorporates Kit Kat and Rollo, two Nestle brands. HOW CADBURY MADE IN FACTORY: two primary items are Cadbury Dairy Milk chocolate and Cadbury Old Gold dim chocolate. The exceptional taste and surface of Cadbury chocolate depends on long conventions of skill in chocolate formula and preparing techniques remarkable to Cadbury. Methods are enhancing constantly and new innovation empowers the procedure to be very tuned to buyers advancing tastes and inclinations. Chocolate generation is an exceptionally advanced, PC controlled process, with a significant part of the new pro hardware being delivered to our own plan and particular. https://www.cadbury.com.au/about-chocolate/chocolate-making.aspx CADBURY MAIN PLANT: well Dunedlin industrial facility is the biggest chocolate producing plant in New Zealand. It supplies completed items for the local markets in New Zealand and Australia and, also, sends out chocolate morsel to Cadbury completing plants in Australia, Pakistan and China. For instance of the potential in developing markets, Cadbury Schweppes piece of the pie for chocolate in the Indian market has expanded from 18% in 2002 to more than 75% in 2006. Despite the fact that these business sectors speak to just a little piece of the entire gathering deals (around 20%) they have been distinguished as having the best potential. Dunedin in New Zealand was picked by Cadbury in light of its phenomenal framework and an abundant supply of rich drain for chocolate creation. Chocolate morsel is an item that is sought after internationally as the utilization of chocolate per capita overall increments to record levels. https://www.google.co.nz/webhp?sourceid=chrome-instantion=1espv=2ie=UTF-8#q=what+machines+do+cadbury+use+in+nz* INTENGIBLE RESOURCEES:- CULTURE OF CADBURY: Corporate culture of the association is the thing that the firm says its way of life is, for instance its statement of purpose; while hierarchical culture is what is truly occurring in the firm, and the way things are really done. The idea of authoritative culture is presently more broadly acknowledged that it was in the eighties when the majority of the writing characterizing society and examining how it creates were developed. It is to a great degree hard to build an exhaustive meaning of hierarchical culture, in spite of the fact that Hatch (2006) characterized it as a lifestyle in an association, it can be considered as the magic that binds an association through a sharing of examples of significance. The way of life concentrates on the qualities, convictions and desires that individuals from the association come to share (Siehl and Martin 1984). Distinctive definitions may point at various parts of the association however they share a couple of things in like manner, for example, the conduct of individuals in the association and what they share as aftereffect of working in the association. The idea of hierarchical culture can be broke down utilizing an assortment of models. In this paper, Edgar Scheins hierarchical culture model is utilized to direct a social examination of Cadbury and Lewins administration change model will be utilized to break down the social change after Krafts takeover. Our discoveries depend on different research strategies including books, inquire about papers, online articles and recordings, perceptions and conversing with individuals at the firm. Cadbury is a British-based driving worldwide ice cream parlor organization. It has been a privately-run company since John Cadbury made it in 1824 until Kraft an American nourishment goliath, assumed control in 2010. The Cadbury familys Quaker convictions are what roused the offering of tea, espresso and cocoa as contrasting options to liquor. Cadbury have long and soli d social values that were started from the authors Quaker convictions of advancing human uniformities and judges. Along these lines, it is fascinating to study how that unique qualities have stood the trial of time. Examination OF CADBURY S CULTURE Edgar Scheins model of authoritative culture is a standout amongst the most compelling hypotheses of hierarchical culture, which started in the eighties. As indicated by Scheins model, hierarchical culture comprises of three particular levels which are the essential presumptions, qualities and convictions and antiques. CADBURY REPUTATION IN MARKET:-their notoriety with slips this way, on top of the 2009 family piece estimate decrease, which they somewhat threw in the towel from in 2013 after a shopper kickback, or the as of late reported Crà ¨me Egg formula change. Expelling Dairy Milk drain chocolate from the Crà ¨me Egg formula is another case of individuals having something taken off them, said Wilcox. The main champ will be Whittakers. Whittakers have supplanted Cadbury as the quintessential Kiwi mark. Each time Cadbury lurches, Whittakers win. Whittakers as of late confronted a similar choice and chose to build the cost of their chocolate pieces as opposed to decrease the size. Their believe Whittakers have settled on preferred choices over Cadbury for no less than 10 years, said Wilcox. Theyre a decent case of how to do things right. CADBURY SUPPLY CHAIN: key store network systems, and change and modernisation ventures in progress, while underlining the significance of joint effort amongst retailers and providers. Their motivation is to interface providers to stores, securely and proficiently, to meet their client needs, productive, and ready to contend now and later on. Give likewise took the gathering through the Supply Chain Partnership Framework, concentrating on stock accessibility, value-based effectiveness, course to-market choices, and shared stock administration. There was a solid concentrate on security, and Vaughn called attention to extra staff preparing is being given to guarantee representatives go home safe consistently. Talking in the interest of Foodstuffs South Island, Mullins said there had been fruitful exchanging comes about alongside the many difficulties related with a store network in a seismic tremor inclined area. Their -manufactured flexibility has seen us get by through yet another tro ublesome period bringing about an extremely tasteful move upwards in our piece of the pie, Mullins stated, discussing the current Kaikoura shake. In the interim, the co-agent keeps on putting resources into new vital openings, for example, West Melton, Christchurch and Queenstown. The move brought about huge volume and esteem development, which represented a couple of additional difficulties for the security of supply. To diminish item taking care of and improve benefit conveyance, the organization has put intensely in new streamlined frameworks. Transport Management is a centre concentration for them theyre about enhancing transport deceivability and understanding where they provisions are to guarantee we keep on meeting client desires. http://supermarketnews.co.nz/foodstuffs-takes-stock-of-its-supply-chain/ ORGNIZATIONAL STRUCTURE OF CADBURY:-Cadbury Organization depends on an equitable. Administration style choices are made therefore of a discussion procedure including different individuals from the association (Cadbury). Cadbury Schweppes likewise have two distinct structures. The structure that they use for their directorate has been re-intended to illuminate responsibility and empower swifter expression making. (Quote taken from www.cadburyschweppes.com). Taking a gander at the enhanced association structure it is clear to see who is responsible for which divisions inside the business. (123Helpme, 2012) Taking a gander at Cadburys it is clear to see that the organization, after some time, has conveyed the measure of: Workforce it representatives and supplanted them with more proficient machines. Outsourcing zones of the organization like upkeep and statistical surveying. Representatives are presently multi-talented, along these lines ready to work in more than one region of the busi ness. The organization has expanded its generation and gainfulness or the rebuilding. The Cadbury production lines all work autonomously and the organization as an opening is decentralized as every manufacturing plant utilizes the assets (E.g. drain) of the nation they are in. (123Helpme, 2011) CADBURY HUMAN RESOURCE: Human Resource Management (HRM) has been through a considerable measure of changes the extent that administration of individuals is concerned. Individuals or representatives are frequently seen in three ways: cost, asset, and resource. Additionally, associations these days understand that workers are likewise a determinant variable to the execution of the association. Alongside the many changes in the business condition: new innovation, work enactment, monetary subsidence, society; Strategic changes: more prominent client centres, diminished levels of administration, reception of TQM and group working; customary HRM has likewise advanced. The need of an incorporated and sound way to deal with overseeing individuals brought forth Strategic Human Resource Management (SHRM). MARKET STRETEGY OF CADBURY: Competitive analysis in the Marketing strategy of Cadbury The confectionaries business is much focused and is packed by nearby and national players. While Cadburys parent organization Modeless International is the world pioneer in Bars and chocolates for middle age wage amass, different players like Nestle, Ferrero Rocher , Perfett, Amul , Kraft nourishments and soon have item classifications and client aggregates in which they are represented considerable authority in. Because of high R D and change in organoleptic of drain, changing way of life of Asian markets, dietary patterns and so forth this industry will watch high development energy in the coming yearsMarket analysis in the Marketing technique of Cadbury Confectionaries business is continually developing and because of the changing utilization of drain and daily items, there is more and greater open door that is lying ahead in this industry. The market is administered by few organizations, for example, Cadbury, settle, Mars, Heinz, Perfecta van and so forth. Cadbury has a wide item portfolio in the chocolate fragment like dairy drain, Bourneville, Cadbury crunch, Éclairs and so forth because of which they can lead the market in this section however their other item classes like scones and cakes are enduring because of the restricted item portfolio. customer analysis in the Marketing methodology of Cadbury Customers of Cadbury are from all portions and individuals from all age bunch devour chocolates, scones and refreshments however it is the developing centre salary gather and also the youths who shape the real purchaser fragment. CADBURY NEW PRODUTS: Cadbury Dairy Milk has launches new tablet mixture, which is set to offer purchasers another, energizing various taste understanding. Cadbury Dairy Milk Medley consolidates obvious incorporations with a delicate chocolate focus, wrapped in Cadbury Dairy Milk chocolate. It will be accessible in two 93g tablets the first with dim chocolate chips, scone and fudge pieces; and the second with dull chocolate chips, caramelized hazelnuts and raspberry with a suggested retail cost of  £1.49. It is likewise accessible in  £1 cost checked packs. The new nibble will plan to support incremental development in little tablets, Cadbury stated, especially among ladies matured in the vicinity of 25 and 44 who are searching for something uncommon for a night treat. http://www.foodbev.com/news/cadbury-dairy-milk-launches-new-medley-bar-as-evening-treat/ Moreover Cadbury as launched three new, colossal Dairy Milk bars loaded down with favour new flavours. Energizing chocolate news section one the flavours are Oreo Crunch, Toffee Whole Nut and Triple Choc Sensation. Energizing chocolate news sections two the bars are an incredible 300g each. Only for correlation, their exemplary Dairy Milk is 45g, while the greater bars are generally 200g. The bars are called Cadbury Dairy Milk Big Taste since, well, theyre huge. CADBURY PERFORMANCE IN MARKET: Cad bury Schweppes, the worlds biggest sweet organization, today revealed a 1% ascend in 2004 benefits, supported by a solid execution in key markets including the US. The organization, whose items incorporate Dairy Milk chocolate, Trident gum and Dr Pepper drinks, made fundamental per-charge benefits of  £933m, generally in accordance with experts conjectures of among st  £927m and  £953m. Cad bury said its basic 2004 deals had ascended by 4%, with working net revenues expanding by 0.5%. 2004 was a decent year for Cadbury Schweppes, with brilliant advance in key markets, especially the US, the CEO, Todd Sitter, said. We effectively fabricated deals energy in drinks and candy parlour while incorporating Adams [the sweet shop business procured by Cadburys in 2002] and executing real cost diminishment programs. Cadbury said its US fizzy beverages business had appreciated an effective year, on account of solid interest for beverages, for example, Dr Pepper and eating routine brands, despite the fact that it cautioned that maintaining these exceptional development rates would challenge. The gathering announced that 2004 had not been a simple year for its European beverages business, however said it was starting to see the consequence of changes including an enhanced inventory network. While the outer business condition stays focused, we are sure that we have the system, brands and individuals to convey inside our objective ranges in 2005, Mr Stitzer said. Cadbury partakes in which have ascended on theory that it could draw in a takeover offer said it expected to stay as an autonomous organization. As they have trust they can develop as an autonomous organization, and that is the goal of their self and the board. https://www.theguardian.com/business/2005/feb/23/cadburyschweppesbusiness PART TWO:- POTER FIVE FORCES (LEVEL OF COMPITITIN) Five Forces model of Porter is a system apparatus that is utilized to make an examination of the engaging quality of an industry structure. The Competitive Forces examination is made by the recognizable proof of 5 key aggressive strengths: INDUSTRY RIVERLY :- Numerous organizations are going up against Cadbury and wanting to assume control over the matchless quality the organization has for quite a while. A few contenders are persistently building up their items and advancing thoughts to make contending considerably harder. Organizations, for example, Nestle, Hersheys, Ferrero and so on are Cadburys fundamental adversaries since they are additionally since a long time ago settled confectionary brands and like Cadbury are growing new scopes of items new advancements. Competition will dependably be solid among these organizations since they offer from similar sorts of stores and there items are comparable in a few regards. ENTRY OF COMPITITORS:- The section of contenders will be troublesome on the grounds that there are as of now entrenched organizations inside this market these incorporate, damages, settle, Ferrero, Kraft, Hersheys and Lindt. These organizations overwhelm the confectionary advertise with their own specific sorts of chocolates. This makes the boundary for section hard for another new organization to begin Cadburys rivals have the ability to pull in and impact the clients by more alluring substitute, costs and advertising strategies. THREAT OF SUBSITITUTE:- The primary danger of substitutes which Cadburys and whatever other confectionary brand is the grocery store possess brands this is on the grounds that they watch out for copycat well known chocolates for instance settle Kit Kat and give their own particular image on the racks at a less expensive cost. Besides, the main deterrent that may influence the creation of Cadbury is to locate a decent area and accumulate the prerequisites for the smooth passage and the remote arrangement that may influence its operation. BARGNING POWER OF BUYERS:- For Cadburys they have a substantial purchasing force being one of the biggest confectionary makers on the planet, however this might be undermined because of the June 2006 review of chocolate bars which contained salmonella this has been said to influence Cadburys and ought to lose some of their purchasing power. However Cadburys purchasers are scattered all around the globe and they are in billions. The cost subjectivity of the items is not a question for the general population but rather the expanding number of contenders that offers a similar sort of items at a lower cost may be the reason for client steadfastness adjustment. Hence Cadbury must be exceptionally precautious in choosing about costs and keep the clients fulfilled. BARGNING POWER OF SUPPLEIRS:- Cadbury prides itself on making and keeping up positive associations with its providers everywhere throughout the world. It has an extensive buying power and the providers of farming wares offer an item that is a long way from extraordinary and henceforth Cadbury has higher haggling power than its providers as the business depends intensely on a complex agro business store network. In spite of the fact that there is a current rivalry, crude materials like nuts, drain, cocoa or exceptional fixings are sufficiently adequate to fulfill Cadburys generation. Cadburys have the primary control over its providers since they are so vast organizations providing them require their business so Cadburys can utilize economies of scale and purchase there crude materials for less expensive and more in mass than a medium measured business could. https://www.google.co.nz/search?q=what+is+industry+rivalry+in+cadburyespv=2site=webhpsource=lnmssa=Xved=0ahUKEwjirNiy4uvSAhXKJpQKHYlzBCgQ_AUIBygAbiw=1366bih=662dpr=1 IMPACT OF TECHNOLOGY:- Technology elements that will influence the brand are the web as the item will be advanced utilizing web promoting. The automated assembling will likewise help in speedy creation. Economic components that will influence it are intrigue and expansion rates as it will influence generation, world financial development and current subsidence will likewise impact it. There will be likewise some natural components that will influence like vitality and condition and reusing of the plastic and different items like chocolate can be stuffed in totally recyclable bundle. Legal/Educational variables will likewise impact like view of individuals and what individuals consider the wealthier drain chocolates. ENVIORNMENTAL IMPACT: Cadbury has declared a 17-percent decrease in water utilization since 2006 by expanding its effectiveness underway, recuperation, collecting and reusing water. The organization detailed that by 2008 it met its objective of executing water diminishment programs at 100 percent of water rare locales as a component of its Purple Goes Green activity, propelled in 2007. Other key focuses under Cadburys natural activity incorporate a 50 percent lessening in its outright carbon outflows, a 10% decrease in standard item bundling, and a 25 percent focus for regular and blessing bundling. http://economics-on-cadbury.blogspot.co.nz/2013/10/economics-analysis-of-cadbury.html CONCLUSION: Cadbury has had much market control in the candy parlor industry everywhere throughout the world. Cadbury understands their prosperity depends fundamentally on the estimation of the Cadbury mark while depending on its phenomenal notoriety for their item quality and enhances, available, and reasonable cost. In the current monetary state, they are as yet confronting and need to deal with the issue of the shortage of cocoa and the cost increments in cocoa. Plus, they have to contend with other chocolate marks the same number of firms has entered uninhibitedly in the market. To remain a noteworthy player in the ice cream parlor industry, they should be compelling in the present market by presenting all the more new items and respond to the choices inside the market. REFERENCES: https://www.google.co.nz/search?q=mars+chocolate+companyespv=2site=webhpsource=lnmstbm=ischsa=Xsqi=2ved=0ahUKEwjxzpaJ7OvSAhWCwbwKHRRRBHUQ_AUIBigBbiw=1366bih=662#imgrc=x3_VqJg0MLa7VM: https://www.cadbury.com.au/about-chocolate/chocolate-making.aspx https://www.google.co.nz/webhp?sourceid=chrome-instantion=1espv=2ie=UTF-8#q=what+machines+do+cadbury+use+in+nz* http://supermarketnews.co.nz/foodstuffs-takes-stock-of-its-supply-chain/ https://www.google.co.nz/search?q=what+is+industry+rivalry+in+cadburyespv=2site=webhpsource=lnmssa=Xved=0ahUKEwjirNiy4uvSAhXKJpQKHYlzBCgQ_AUIBygAbiw=1366bih=662dpr=1 http://economics-on-cadbury.blogspot.co.nz/2013/10/economics-analysis-of-cadbury.html

You Might Want to Do Some Introspection

You might want to do some introspection. For each of the eight intelligences in the Howard Gardner list, think about your own level of talents and performance. For each intelligence, decide if you have an area of expertise that makes substantial use of the intelligence. For example, perhaps you are good at music. If so, is music the basis of your vocation? Students can also do this type of introspection, and it can become a routine component of PBL lessons.Students can come to understand that they are more naturally gifted in some areas than in others, but that they have some talent in all of the eight areas identified by Howard Gardner. Curriculum and instruction can be developed to help all students make progress in enhancing their talents in each of these eight areas of intelligence. Robert Sternberg Many teachers have provided testimonial evidence that PBL encourages participation on the part of their students who do not have a high level of â€Å"school smarts. They report that some of their students who were not doing well in school have become actively engaged and experienced a high level of success in working on projects. These observations are consistent with and supportive of the research of Robert Sternberg. As noted earlier in this chapter, different researchers have identified different components of intelligence. Sternberg (1988, 1997) focuses on just three main components: Practical intelligence–the ability to do well in informal and formal educational settings; adapting to and shaping one's environment; street smarts.Experiential intelligence–the ability to deal with novel situations; the ability to effectively automate ways of dealing with novel situations so they are easily handled in the future; the ability to think in novel ways. Componential intelligence–the ability to process information effectively. This includes metacognitive, executive, performance, and knowledge-acquisition components that help to steer cognitive processes. Sternberg provides examples of people who are quite talented in one of these areas but not so talented in the other two.In that sense, his approach to the field of intelligence is somewhat like Howard Gardner's. However, you can see that Sternberg does not focus on specific components of intelligence that are aligned with various academic disciplines. He is far more concerned with helping people develop components of intelligence that will help them to perform well in whatever they chose to do. Sternberg strongly believes that intelligence can be increased by study and practice. Quite a bit of his research focuses on such endeavors. Some of Sternberg's work focuses specifically on â€Å"street smarts† versus â€Å"school smarts. He notes that some people are particularly talented in one of these two areas, and not in the other. This observation is consistent with the work of Lev Vygotsky (Fosnot, 1996) who argues that the type of learning that goes on outside of s chool is distinctly different than the type of learning that goes on in school. While some students are talented in both informal and formal education, others are much more successful in one rather than the other. A teacher who is skillful in developing PBL can help students to design projects that are consistent with their learning abilities and interests.David Perkins In his 1992 book, Smart Schools, David Perkins analyzes a number of different educational theories and approaches to education. His analysis is strongly supportive of Gardner's theory of multiple intelligences. Perkins' book contains extensive research-based evidence that education can be considerably improved by more explicit and appropriate teaching for transfer, focusing on higher-order cognitive skills, and the use of project-based learning. Perkins (1995) examines a large number of research studies both on the measurement of IQ and of programs of study designed to increase IQ.He presents detailed arguments that IQ has three major components or dimensions. Neural intelligence. This refers to the efficiency and precision of one's neurological system. Experiential intelligence. This refers to one's accumulated knowledge and experience in different areas. It can be thought of as the accumulation of all of one's expertises. Reflective intelligence. This refers to one's broad-based strategies for attacking problems, for learning, and for approaching intellectually challenging tasks. It includes attitudes that support persistence, systemization, and imagination.It includes self-monitoring and self-management. There is substantial evidence to support the belief that a child's neural intelligence can be adversely affected by the mother's use of drugs such as alcohol and cocaine during pregnancy. Lead (such as from lead-based paint) can do severe neural damage to a person. Vitamins, or the lack thereof, can affect neural intelligence. Moreover, there is general agreement that neural intelligence has a â€Å"use it or lose it† characteristic. It is clear that neural intelligence can be maintained and, indeed, increased, by use.

Dementia: Alzheimer’s Disease and Social Care Diploma

Unit DEM 301 Understand the process and experience of dementia This unit provides you with the knowledge on the neurology of dementia including the causes, difficulties and needs of the person with dementia. This will help to support your understanding of how people may experience dementia. With the development of improved health care and healthier lifestyles, people are living longer. With an increase in an ageing population come age-related conditions such as dementia. Age is not the only cause of dementia as you will discover within this unit. In this unit you will learn about: the neurology of dementia he impact of recognition and diagnosis of dementia how dementia care must be underpinned by a personcentred approach. 1 Level 3 Health & Social Care Diploma 1. Understand the neurology of dementia 1. 1 Causes of dementia The word ‘dementia’ is a term which describes a serious deterioration in mental functions, such as memory, language, orientation and judgement. How ever, the causes are still not yet fully understood. Research in this area is ongoing and to date a number of types of dementia and their causes have been identified. The brain is a complex organ and is divided up into different areas that control different functions within the ody. The brain contains around 100 billion cells. In dementia some of these cells stop working properly. The part of the brain that this occurs in will affect how that person thinks, remembers and communicates. Senile dementia is a term that refers to dementia in people aged over 65. It is not uncommon for people under the age of 65 to develop dementia. This is known as early onset dementia. Cerebral cortex Ventricles Healthy brain Hippocampus Cortical shrinkage Moderately enlarged ventricles Mild Alzheimer’s disease Dementia is a major health condition which affects over 820,000 people in the UK. Worldwide, more than 35 illion people are estimated to have dementia, with 4. 6 million new cases being di agnosed every year. Shrinking hippocampus Severe cortical shrinkage Severely enlarged ventricles Types and causes of dementia Alzheimer’s disease Many people ask if dementia and Alzheimer’s disease are the same thing. The short answer is no. Alzheimer’s disease is the most common cause of dementia. It is responsible for approximately two-thirds of dementia in older people. Dementia is a contentious topic, with many proponents wishing to enable rights and choices of individuals with dementia Alzheimer’s is caused by nerve cells dying in certain areas of the brain. In addition to this, the connections between affected nerve cells deteriorate. As he disease progresses, it spreads and affects cells in other parts of the brain. The cause of the brain cells dying and the deterioration of the connectors is not fully known. 2 Severe Alzheimer’s disease Severe shrinkage of hippocampus Brain affected by dementia and unaffected brain. Vascular dementia Vascul ar dementia is a form of dementia caused by damage to the brain through deprivation of oxygenated blood. Oxygenated blood is carried around your body and brain through arteries. Deoxygenated blood is carried through your body in veins. It is these arteries and veins that make up part of your vascular system.When an organ in your body is deprived of blood, that organ (or part of it) will die. This is what happens to the brain in vascular dementia. The conditions which can cause these problems are preventable and include high blood pressure, heart problems, diabetes and high cholesterol. When supporting people into leading a healthy lifestyle, it is important to bear this condition in mind, in the hopes of preventing the onset of vascular dementia. Understand dementia Rarer forms of dementia Creutzfeldt-Jakob disease (CJD) CJD is a form of dementia caused by prion disease. Prions are proteins which are found in mammals.When these proteins cluster together in the brain, they cause brai n cells to die. When these cells die they leave holes in the brain called spongiosis. Examining the brain under a microscope reveals the cells to appear spongelike. This damage to the brain causes neurological difficulties and dementia. There are four forms of CJD: †¢ †¢ †¢ †¢ sporadic familial iatrogenic variant. Although each of these conditions is very rare, their prognosis is extremely poor. The affected person’s life expectancy is radically reduced, with death occurring usually within 6 to 24 months from early diagnosis. The isease can take many years from the time it infects a person to it causing recognisable symptoms. The cause of Sporadic CJD is unknown and its onset is very fast. It affects people over the age of 50 and can cause death within a matter of months. Familial CJD is an inherited form of the disease. Its symptoms usually affect the person at an early age from 20 to 60 years. Death occurs between two and ten years of symptoms beginning. Iatrogenic CJD occurs as a result of contaminated blood or tissue entering the healthy person’s body. This can take place with corneal transplants, grafts or the use of growth hormones.To prevent the risk of contamination, transplants are no longer taken from people known to have the disease and growth hormones are now developed artificially. Because prions cannot be destroyed using normal sterilisation procedures, any surgical instruments used on people with CJD are not used on other patients. The last form of CJD is known as Variant CJD. This form affects people at a younger age with the average age of death being 29 years. The average time the person is affected by this disease is 14 months. Variant CJD is caused by bovine spongiform encephalopathy (BSE) – a form of prion disease which affects cattle.The person contracts this disease by eating infected beef products. Unit DEM 301 To reduce the risk greatly of infected beef products reaching the market, manufacturer s now remove the animal’s brain and spinal cord from general sale. Functional skills Maths: Recording data This information can be used to record data in a chart and shows the use of working out averages for statistical purposes. Biswanger’s disease This is a form of vascular dementia in which damage occurs to the blood vessels in the deep white matter of the brain. It affects people over the age of 60 and is often as a result of long-term hypertension or high lood pressure. Dementia and learning disabilities Some people with learning disabilities are at risk of developing dementia in adult life. People with Down’s syndrome are at risk of developing Alzheimer’s disease. The risk of Alzheimer’s increases as the person gets older. It is estimated that over half of the people with Down’s syndrome will develop Alzheimer’s disease when they are in their 60s. Fronto-temporal dementia Fronto-temporal dementia is a rare form of dementia. It t ends to affect younger people and is more common within men. The condition is caused by damage to the frontal lobe and/or the temporal parts of the brain.These areas are responsible for the person’s behaviour, emotional responses and language skills. The condition includes those known as Pick’s disease, Frontal Lobe Degeneration and dementia associated with motor neurone disease. Dementia with Lewy Bodies (DLB) Lewy Bodies are tiny protein deposits which are found inside the nerve cells of the brain. These deposits alter the way the brain functions and can be found in people with either dementia or Parkinson’s disease. Approximately four per cent of the older population who have dementia are affected by DLB. This form of dementia has characteristics of both Alzheimer’s andParkinson’s disease. 3 Level 3 Health & Social Care Diploma 1. 2 Types of memory impairment commonly experienced with dementia Within humans, the term ‘memory’ refers to information stored in the brain. Apart from storage, it also includes the retention or keeping and recalling of that information. A person’s brain is extremely complex and can store, retain and recall many, many pieces of information for many, many years. The ease with which the person can remember information will vary depending on the subject, the person and their state of mind. If the information is unusual or interesting, they ay remember this more so than information which is uninteresting or mundane. Memory loss can be defined in different ways depending on the situation it is being used for and the type of memory which is lost. Memory loss can be the inability to retrieve information from the long-term memory. This type of memory loss usually happens when the person is distracted or is not fully concentrating when the memory is formed. Another form of memory loss is when new memories are stored within the brain replacing older memories. Think of your brain as a fil ing cabinet; there is only so much information you can store n it at any one time. To make room for new information, you will need to take out or discard some old information. This type of memory loss is normal and is experienced by everyone. Memory loss can also be described as the fading away of memories. This sort of memory loss can occur with telephone numbers, facts or people’s names if you have not used them for a while. Think back to when you were at school. You would have known the names of many of the students and teachers. Can you recall all of the students’ and teachers’ names now? You may barely remember what their faces looked like and you may be truggling to remember everyone’s names. This could be because you have not had any reason to remember this information. It is not something you have had to use on a regular basis. Memory loss due to the ageing process can be defined as being the shrinking of the hippocampus, which is responsible for the storage of long-term memories. The hippocampus is usually the first part of the brain which suffers damage, leading to Alzheimer’s disease. Hippocampus Location of the hippocampus. Case study Recognising normal memory loss Christine is 43 years old and is concerned about her memory. She is a very busy lady with a stressful job.Christine is walking down the corridor at work heading to yet another meeting. She is going over in her mind what she needs to raise in the meeting and checking through her diary to see what time she needs to leave to get into town for her third meeting of the day. Carol, one of Christine’s colleagues, bumps into her and tells her that Mark has telephoned and would like to see Christine later today at 3. 15pm in the staff canteen. Christine says, ‘OK,’ and carries on to her meeting. 4 At 3. 30pm Christine is sat at her desk writing up the minutes from a meeting last week when the telephone rings.It is Mark; he is in the staff can teen waiting for Christine and he is not very happy. He asks if she had received his message. This jogs her memory and she realises she should be in the staff canteen. She apologises and tells him she is on her way. 1. Explain in detail why you think Christine forgot about meeting Mark. 2. Why is it that Christine is able to remember what was discussed in a meeting a week ago, yet cannot remember what she was told earlier that day? Understand dementia Functional skills English: Writing; Reading In this unit there are a number of examples of case studies. These studies have all been laid out using a uitable format and attention has been paid to ensure that spelling, punctuation and grammar are accurate. You will need to use these skills when writing case studies in your place of work. You will need to read and understand both straightforward and complex texts, and use the information in an appropriate way. Within psychology, memory loss is usually defined as the inability to retrieve declarative memories from the long-term memory. An example of this could be amnesia. The person experiencing amnesia may not be able to remember facts or declarative memories, but they retain their procedural memory which is responsible or remembering skills such as riding a bicycle, reading or talking. People with dementia may experience short-term memory loss. Their ability to store, retain and recall information may be affected due to the damage of the cells within their brain. Short-term memory loss Short-term memory can differ from one person to another. Research has been carried out on this by asking subjects to remember numbers. A list of numbers is read out at approximately one per second. The subject is then asked to recall these numbers and on average it has shown that a person can remember seven consecutive numbers.A person with dementia may have difficulties remembering things that happened only a short while ago. However, the same person may be able to remember things that happened many years ago. Other memory difficulties could include: †¢ †¢ †¢ †¢ †¢ †¢ a difficulty in recognising people or remembering their names the inability to find the right words for things or objects repeating conversations that they have already had asking the same question in a short space of time forgetting appointments or recent events misplacing items, forgetting where they have put things or where they are usually kept †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢Unit DEM 301 the inability to recall what they have had to eat or even forgetting they had eaten the loss of skills such as self-care, washing, dressing, putting clothes on in the wrong order, shopping and cooking the inability to judge time, thinking it is time to get up when it is the middle of the night forgetting where they live becoming unaware of their surroundings forgetting to take medication, possibly thinking they have already taken i t forgetting their disabilities such as getting up to walk even though they are not able, which results in their falling an inability to have empathy which could make the erson appear selfish personality changes – if previously extrovert, they could become introverted and vice versa the loss of social etiquette including making thoughtless comments, being rude or exhibiting sexual behaviours in public. Initially people experiencing these memory losses may feel frustrated or angry with themselves. They are angry because they know that they have forgotten, and frustrated because they are unable to remember as they used to. Activity 1 Memory impairments Think about the people you support. What types of memory difficulties do they experience and how do you know about this? Functional skillsEnglish: Speaking and listening Have a discussion with colleagues about the types of memory difficulties that people you are working with have. Ensure you take an active part in the discussion and that you show effective listening skills. It is important to keep in mind that no two people’s memories will be affected by dementia in the same way. The inappropriateness of their behaviours is caused by a physical change to the brain and therefore the person has no control over it. 5 Level 3 Health & Social Care Diploma 1. 3 How individuals process information with reference to the abilities and limitations of ndividuals with dementia The workings of the brain are very complex. As stated previously, the human brain is made up of around 100 billion cells. In the main these cells are called neurons. It may be easier to think of these neurons as switches which are either switched on or switched off. If the neuron is switched off it is resting; when it is switched on it fires electrical impulses along its body known as the axon. At the end of this axon there is a small part which releases a chemical. The chemical travels over a gap known as the synapse where it turns on ano ther neuron. These chemicals are known as eurotransmitters. There are 60 identified chemicals involved in the brain’s activity. The following are some important neurotransmitters relating to the process of memory and associated functions. Dopamine The chemical dopamine is critical for controlling your body’s movements. If you do not have enough dopamine, you will not be able to move or control your movements very well. Dopamine also controls the flow of information from other areas of the brain, especially memory, attention and problem-solving tasks. Serotonin The chemical serotonin is the neurotransmitter enhanced by many antidepressants, such as Prozac, nd has become known as the ‘feel-good’ neurotransmitter. It has a profound effect on mood, anxiety and aggression. Acetylcholine (ACh) ACh controls activity in the areas of the brain that are connected with attention, learning and memory. People with Alzheimer’s tend to have low levels of ACh in th eir brain. Glutamate Glutamate is vital for making the links between neurons that are the centre of learning and long-term memory. Reading about these chemicals and what they do can help towards explaining how the person with dementia, 6 who has damage to these neurons, has difficulty with their memory.Because the neurons are damaged or destroyed, they are not able to produce or transmit important chemicals which are required for the person to function fully. Nerve cell Synapse Axon Dendrite The amount of electricity the human brain produces when each of its neurons is firing is equivalent to a 60-watt light bulb. Left-sided and right-sided brain The collection of 100 billion cells or neurons in the brain is divided into two halves, known as hemispheres. The right side of the brain is responsible for putting information together – for example, information received from eyes. If you see a lady the information goes from our eyes to the right side of your brain, firing neurons, putting the information together so you are able to say, ‘I can see a lady. ’ The left side of the brain analyses information which is collected by the right side of the brain. It enables you to expand on what you see so you are able to say, ‘I know who that lady is, it’s my sister Michelle. ’ People with dementia who have damage to the neurons on the right side of the brain will have difficulty putting information together. They will be able to ‘see’ things, items or people, but will not be able to make the connection of what those things, items or people are.People who have damage to the neurons on the left side of the brain tend to be affected by depression. They will have more organisational problems and will have problems using language. Understand dementia 1. 4 How other factors can cause changes in an individual’s condition that may not be attributable to dementia Experiencing a loss or reduction in memory does not always i ndicate a form of dementia. There are other health conditions which could affect somebody’s level of memory. These are often referred to as reversible dementias. The part of the brain that has become damaged will determine how the person will be affected.Unit DEM 301 Drug and alcohol induced memory loss The effects of drug misuse including excess alcohol can cause damage to the neurons in the brain, resulting in neurological difficulties including memory disruptions. Myalgic Encephalomyelitis (ME) Conditions affecting memory ME, otherwise known as Chronic Fatigue Syndrome (CFS) or Post-Viral Fatigue Syndrome (PVFS) is a chronic, disabling neurological disorder. It is characterised by persistent fatigue and muscle pain. Symptoms can include cognitive problems such as loss of memory and concentration, recurrent sore throat and enlarged neck glands, disturbed sleep patterns and ersistent headaches. Brain injury Medication Injuries to the brain can be caused by external trauma su ch as a blow to the head, or internal factors such as a result of a stroke or aneurism. The level of brain injury can be anything from mild to severe. This can result in both short-term and long-term or permanent difficulties. Some prescription medications can have side effects which can affect somebody’s memory. Brain tumour A tumour of the brain can be benign (slow-growing, non-cancerous) or malignant (invasive, often growing rapidly and cancerous). sensation hearing movement speech, movement and sensory functions Parietal obe Frontal lobe Occipital lobe Temporal lobe Cerebellum hearing and vision Brain stem Parts of the brain and their primary functions. Diet Some foods can have an effect on a person’s memory. It is believed foods such as those containing vitamin C and sugars can have an effect on memory. Encephalitis Encephalitis is an inflammation of the brain, usually occurring as a result of viral infection. Huntington’s disease Huntington’s diseas e is a hereditary, neurodegenerative disorder of the central nervous system. It can cause emotional, intellectual and movement problems. The course of Huntington’s is characterised by involuntary ovement of the limbs, trunk and face, progressive loss of mental abilities, and the development of psychiatric problems. Huntington’s disease usually appears in middle age (30–50 years) but can develop in younger and older people. Hydrocephalus Hydrocephalus is usually associated with Spina Bifida and is caused by a build-up of cerebro-spinal fluid (CSF) in the brain. This condition can also be caused by infections such as meningitis, premature birth, head injury or stroke. Hydrocephalus can lead to problems with concentration, short-term memory, organisation and coordination. Lack of sleep/insomniaPeople who have difficulty sleeping may experience various health problems including memory difficulties. 7 Level 3 Health & Social Care Diploma Lyme disease Lyme disease is an infectious disease caused by the bacterium Borrelia Burgdorferi. The disease is transmitted to humans through the bite of an infected tick. If left untreated, Lyme disease may affect a person’s memory. Multiple sclerosis (MS) MS occurs as the result of damage to myelin – the protective sheath surrounding nerve fibres of the central nervous system. This damage interferes with messages between the brain and other parts of the body.Parkinson’s disease This is a progressive neurological condition, which can affect the person’s ability in talking, walking, swallowing, writing and memory. Stress Stress is the emotional and physical strain caused by your response to pressure from the outside world. Stress can affect your health in many ways, including memory difficulties. Stroke A stroke occurs because of a disruption to the blood supply to a particular area of the brain, causing damage to that area of the brain. 1. 5 Why the abilities and needs of an individ ual with dementia may fluctuate Each person may experience dementia in different ways.There is no definitive direction or path that the condition will follow and there are no exact timescales in which the condition may progress. You have examined how the person’s condition will deteriorate over time, but during that time it can also fluctuate or come and go. Fluctuation of needs and abilities It is not fully known why somebody with dementia can have ‘good days’ and ‘bad days’. Part of the answer for this could be because we all have good and bad days. This very much depends on how we are feeling, how much sleep we have had, what activity we are doing and how much we want to do that activity. 8When you are having a bad day, everything you do seems to go wrong. Could this be simply because you are feeling so negative? Can your attitude have an effect on the outcome? Think about this for a while. If you do not like doing something, it seems to take fore ver to get it over and done with. The time drags and your level of boredom or uninterest rises. On the other hand, when you are doing something you enjoy, the time rushes by so that before you know it the activity comes to an end. This theory could also relate to the person with dementia. If the person is doing something that is familiar to them, something that they have done many imes and have developed a routine for, the person may appear very confident and able to do it with ease. They may appear to show no signs of dementia. However, take the person out of their familiar surroundings and out of their routine, and their confusion will grow, causing their symptoms to be more obvious. Stress has been identified to have an effect on our memory. In the early stages of dementia, the person may be fully aware that they have forgotten where they have put things. This can cause their stress levels to rise, resulting in added memory difficulties, frustration and confusion.In these earlier stages it is important for you as a care worker to give the person emotional support. Do not be tempted to take over what they are having difficulty with. Help them to calm down and think about what they are doing. The more the person becomes agitated, the greater their difficulties will become. As the condition progresses, the more support the person will require. This will include support with day-to-day activities. You can give support through reminding the person what they need to do. Do not overload them as this will increase their stress and therefore their symptoms. If the person asks you a question and epeats it several times within a short space of time, answer it as though it is the first time you have heard the question. Do not show your frustrations as this will only cause them to become upset when they see how their behaviour is affecting you. In the later stages, the person will become emotionally and physically frail. Their reliance on care will increase to the point where they are no longer able to care for themselves. They may lose their ability to eat, walk or speak, with only the occasional word being shouted or crying out. Understand dementia Unit DEM 301 2. Understand the impact of recognition and diagnosis f dementia 2. 1 The impact of early diagnosis and follow-up to diagnosis For most people, receiving the diagnosis of dementia is very distressing. It is also very upsetting for their family. Many people today still think of dementia as being a condition which causes people to go ‘mad’. It is these negative images that can add unnecessary distress to both the person and their family. funeral through the drawing up of a will. They can be encouraged and supported to sort out any bills and arrange for future bills to be paid for by direct debit so that important bills are not overlooked. The person may ind comfort in keeping busy during the initial stages and they may feel reassured that their future has been planned to meet t heir needs. If you are supporting somebody who is exhibiting any signs or symptoms of forgetfulness, confusion or the inability to find the right words when communicating, it is important that they see their GP. Diagnosis can be difficult to make in the early stages as the symptoms of dementia can develop slowly. They can also be similar to symptoms of other health conditions. The GP or health professional will be able to monitor any pattern of symptoms and undertake tests over a period of time o measure any changes in the person’s mental ability. A brain scan can help with diagnosis; this could be a CT scan or MRI. If a diagnosis is made, the person may be referred to a specialist for further treatment. Early diagnosis The early diagnosis of dementia is essential in order to: †¢ †¢ †¢ rule out other conditions that may be treatable access advice, information and support allow the person with dementia and their family to plan and make arrangements for the futur e. Receiving an early diagnosis of dementia can help the person and their family to plan and prepare for the future. Although there is no cure at present, there are arious medications available which can help improve symptoms and, for some, slow down the progression of the disease. Early diagnosis can help the person to identify and access sources of advice and support for their condition. The early education of the person and their family can help them to develop a better understanding of what the future may hold. The person will have time to put their finances in order and to make wishes for their Discussing the future with the person can help with understanding and accepting. Following diagnosis, the person may want to live as independently as they can for as long as they can.They may not appreciate someone taking over their life in these early stages where they are still able to care for themselves. To enable the person to remain as independent as possible, it may be an idea to encourage them to contact social services, if they have not already done so, to find out what support they could be entitled to. In order to aid their memory the person could place a list of important telephone numbers by their phone. This way they will always know where a telephone number is if they need it. Labels could be placed on cupboard doors to remind them of the contents. Notes could be placed n doors as a reminder to lock them. Lists could be put on a noticeboard of things to do and days to do them on, such as putting the rubbish out for the refuse collectors. 9 Level 3 Health & Social Care Diploma The most important thing to support the person with is in continuing to enjoy their life. Support them to continue with their hobbies or interests. One good activity which will help them in the future is the development of a life history book. Encourage and support them to collect together photographs of people who are important to them, events which hold important memories such as the birth of their first randchild, their wedding day or family holidays. Encourage the person to label each photograph clearly in the book so that they can look back at it at any time and be reminded of good memories. Early diagnosis can enable the early introduction of specialist services. The services may include: †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ family GPs – referring the person for further tests, reviewing medication district nurses health visitors community psychiatric nurses consultants memory clinics neurologists geriatricians neuropsychiatrists physiotherapists dieticians clinical psychologists speech and language therapists.In the very early stages of dementia the person may have days or episodes of forgetfulness which could be put down to the person being off-colour or having an off day. These episodes may be masked by their ability to recall past events easily. They may be able to give a re ason as to why they cannot remember what you have just said to them. They may say that the television was too loud and they did not hear you. They may even be adamant that you had not told them anything, giving rise to you questioning your own memory. The person may have difficulty understanding or following new ideas or regimes. To cover these ifficulties they may say that they preferred the old way, as it is not as confusing. They could hide occurrences of misplacing items, making out that someone has moved the item or someone has taken it. All of these events, happenings and reasons could be very genuine and indeed the person themselves may believe in what they are saying to be true. If they were all true, the person would be a very unlucky person to be experiencing all of these negative events. The likelihood of them all occurring to the same person in a short space of time would be rather remote. Recording all of these occurrences would enable you nd the team to build up a pict ure of the person’s mental and physical health. Recording times that they In many cases, the earlier the diagnosis and follow-up, the sooner the person can start regaining their life again. This is not to say that they will receive a cure – at this moment in time the only option open to people is acceptance and treatment in slowing down the progress of the condition. 2. 2 Recording possible signs or symptoms of dementia in line with agreed ways of working The health and well-being of a person should be monitored on a regular basis to ensure any resulting needs can be actioned without delay.When monitoring somebody’s condition, it is important to record any findings in line with your organisation’s policies and procedures. 10 Misplacing items can be one of the first symptoms of dementia. Understand dementia needed reminding to do something or became confused or disorientated would enable you to look back and identify frequencies to ascertain if their memor y is deteriorating. Involving the family When supporting somebody with dementia, it may be of immense benefit to involve the family. Encourage and support the family to keep a diary of the person’s symptoms. As a care worker, you may not see the erson as much as their family do and therefore they can help to give you a better picture of the person and their needs. The diary that the family compiles could help them and you to identify changes in the person that may be otherwise missed. The diary could also aid in monitoring any current interventions and the resulting benefits to the person. Unit DEM 301 Suggested monitoring and recording The person’s GP or neurologist may benefit from the information recorded in altering any medications or treatment the person receives. The following areas are those which it is important to monitor and record in the erson, as these will show what changes have occurred and over what period: †¢ †¢ †¢ †¢ †¢ †¢ †¢ memory behaviour personality ability to cope with daily living skills care-giving strategies – have they worked? activities the person enjoys any medications they have taken that day (including prescriptions, over-the-counter and herbal remedies) with details of medication name, dosage, and when and how many taken daily. Case study Identifying dementia Geoffrey had been living in sheltered housing for a number of years following a stroke. His confidence in his own abilities since the stroke had been very low and he as often heard mumbling to himself. Geoffrey is visited every morning by the warden Leona to check that he is OK. Geoffrey always met Leona on his doorstep as he put out his empty milk bottle. One morning Geoffrey was not on his doorstep as usual, which concerned Leona. She rang his doorbell and waited. Geoffrey came to the door and greeted her with his usual smile. ‘Are you all right Geoff, you haven’t put out your empties? ’ she asked . Geoffrey nodded, scratched his head and replied, ‘I’m fine, I haven’t finished the bottle yet as I didn’t drink much yesterday. ’ ‘As long as you are all ight then,’ Leona replied, waving goodbye as she turned and walked away. The following day, once again Geoffrey was not on his doorstep. Leona rang the doorbell again and was greeted by Geoffrey still wearing the same clothes as he had on the previous day. ‘No milk bottles to put out again today? ’ she asked. Geoffrey agreed, saying he had decided to drink more water: ‘I’m cutting down on my cups of tea, getting a bit of a beer belly,’ he joked. Leona was a little concerned but then shrugged it off, believing Geoffrey was always getting his words mixed up, due to his age. As the weeks passed Geoffrey had days when he did ot put out any empty bottles, and then he would put out three or four at a time. Some days Geoffrey looked unwashed or unshaven, whi ch was unlike him. Leona was concerned but on talking to Geoffrey she felt she was worrying about nothing. Geoffrey’s behaviour had been up and down for over 12 months when Leona announced she was changing her job and a new male warden, Patrick, would be taking over. Geoffrey did not take this news very well and he became agitated, blaming Leona for the death of his wife. Leona was very shocked by this, especially as Geoffrey had never been married. She mentioned this to Patrick during her andover and explained she thought something was not quite right but she could not quite put her finger on it. Patrick asked how long had this been going on for and then said he would take care of it. 1. After visiting each resident in the sheltered housing, what actions should Leona have taken? 2. What concerns would you have had regarding Geoffrey? 3. How would records of Leona’s visits to Geoffrey have been of benefit? 4. What actions should Patrick take now, especially regarding G eoffrey? 11 Level 3 Health & Social Care Diploma The diagnosis of dementia does not generally occur following the first visit to the GP.Generally there is a process in which the person goes through in order to receive a definitive diagnosis. During this process it is vital that any potential signs of dementia are reported following your organisation’s policies and procedures, and in line with government guidelines. National Institute for Health and Clinical Excellence (NICE) NICE has devised detailed guidelines in supporting people with dementia. This also includes the early diagnosis of dementia. Within this guide it states that primary health care staff should consider referring people who display any signs of mild cognitive impairment (MCI) for ssessment. MCI is a relatively new term to describe those who show some difficulties with their memory but do not have dementia. Studies have shown that 50 per cent of people with MCI go on to develop dementia later in life. NICE al so includes in its guidelines information regarding the diagnosis and assessment of dementia. It states that diagnosis should only be made following assessment to include: †¢ †¢ †¢ †¢ the person’s history a cognitive and mental state examination a physical examination a review of all medication including over-the-counter remedies. As a care worker, your input in reporting possible signs f dementia would go towards the person’s history. Your input can help them receive the care that they need, when they need it. It is for this reason that you should ensure timely reporting of any observations you make or concerns you may have. To report a concern, you must follow your organisation’s guidelines. If you are unsure of what these guidelines state, you should speak with your line manager as soon as possible to ensure your actions follow best practice for the person. In general terms, most reports are given to a designated member of staff. This may be your line manager, supervisor or manager.Your verbal report should be factual and to the point. Try to avoid giving your own opinions. Although opinions can help to look 12 at and clarify various issues from differing viewpoints, they can also be unhelpful if used inappropriately. Once you have given a verbal report, you should back up what you have discussed with the appropriate person, by writing a written report. Again your written report should be factual and detail all of the actions you have taken. Some reports will have an increased impact if they are delivered in a certain way. For example, you may have been asked to monitor somebody over a set period of ime and report back your findings. Simply writing those findings down may not have the same effect as plotting your findings on a graph. A graph or chart will give a visual representation of your findings, which may give a better explanation as to the person’s mental state and any changes that have occurred. 10 Inc idence of wandering 2. 3 Reporting possible signs of dementia within agreed ways of working 8 6 4 2 0 Week Reporting occurrences such as wandering can have a greater impact if plotted on a graph. Activity 2 Process of reporting Speak with your manager or line supervisor to identify our organisation’s policy and procedures on the process of reporting information. Functional skills English: Speaking and listening This discussion can be either formal or informal and can give you the opportunity to practise taking part in a one-to-one discussion. Understand dementia Reflect Imagine you, or someone you love, had just been given the news that you or they had dementia. Being honest, what would be your initial thoughts or feelings? Do you feel it is OK to feel or think this way? Is there anything you feel that society can do to help with the acceptance or understanding of dementia?Unit DEM 301 2. 4 The possible impact of receiving a diagnosis of dementia on the individual and their f amily and friends Receiving news which you know will have a major impact on your future and those who are close to you can be very frightening and overwhelming. The person may feel very insecure at the time, despite possibly having family and friends around them. The impact on the person and their family and friends can vary; some may see it as a relief that the cause of their difficulties has been diagnosed, while others may be in disbelief, preferring not to acknowledge what they have been told.Many older people fear becoming a burden on their family more than they fear death. 13 Level 3 Health & Social Care Diploma Feelings NICE requirements The person may be shocked on first hearing the diagnosis; this can often turn to denial. One theory on loss or grief shows that the process usually goes through five stages including: NICE guidelines state that following a diagnosis of dementia, health and social care professionals should provide the person and their family with written infor mation regarding: 1. 2. 3. 4. 5. †¢ denial anger bargaining depression acceptance. It is felt that the person may not necessarily go through ach stage in this particular order, and indeed can go backwards and forwards, repeating various stages a number of times before reaching and remaining at acceptance. The person may experience fear or the concern that they will lose control over their lives and their future. They may also fear becoming a burden on their family and friends. Some may feel guilty, blaming themselves, thinking that they could have prevented their condition happening. Whatever feelings the diagnosis creates in the person, you should encourage and support them to talk about their feelings. Some may not feel comfortable voicing heir feelings to their family and friends, preferring to talk with someone they do not know. The person’s family and friends should not be upset by this decision and should respect the wishes of their loved one. Initially the person may simply want to curl up and lock out the world around them. Family and friends need to be supportive in these situations. Telling the person to ‘get a grip’ or that what they are doing is silly is not going to be of any benefit – in fact, it will often make things worse. 14 †¢ †¢ †¢ †¢ †¢ †¢ †¢ the signs and symptoms of dementia the course and prognosis of the condition treatments ocal care and support services support groups sources of financial and legal advice, and advocacy medico-legal issues, including driving local information sources, including libraries and voluntary organisations. Any advice and information given to the person and their family should be recorded in the person’s care notes. The confidentiality of the person should be respected if they decide they do not wish any information to be given to their family. Understand dementia Unit DEM 301 3. Understand how dementia care must be underpinned by a per son-centred approach 3. 1 Person-centred and nonperson-centred approaches to ementia care It is important to remember that people with dementia are individuals first, with their condition of dementia coming second. They may also be mothers, fathers, brothers, sisters, sons or daughters. They may have led a fulfilling life before the condition of dementia took hold of their memories and personality. How could the care of any person be anything other than individual, specific to their needs, involving and respecting their views on how they want their care to be delivered? Person-centred care is a way of providing care with the person at the centre of everything you do. Another way f describing it is individualised care – care that is given to the person according to their needs, wishes, beliefs and preferences. One would hope that gone are the days when everyone in a care home got up at the same time, ate their breakfast at the same time, got washed and dressed at the same time , even going to the toilet at the same time. These regimented routines of care homes were devised for the benefits of the staff, not the people being supported. The day revolved around tasks, duties that had to be met, more often than not putting the people’s specific needs at the end of the priority list.If you needed support, which type of care home would you choose? Earlier on in this unit we looked at how dementia can affect people and identified that no two people would necessarily follow the same process through the condition of dementia. This being the case should automatically exclude all people with dementia being treated in the same way. Studies have shown that a person-centred approach can help reduce agitation in the person with dementia. Agitation is often caused by the person’s frustration in not being able to express themselves. The expression could be one of sadness, pain, thirst, hunger or tiredness.Other studies on a person-centred approach have shown that the person often remains living in their own home for longer. A person-centred approach can also ensure that the person does not endure the degrading, discriminatory and abusive practices which could otherwise occur. People and all those involved in their care should feel safe, feeling that they are a part of what is going on, receive continuity of care, have purposeful goals which they are supported to progress towards and have a feeling that they do matter. How does a person-centred approach benefit the person? As a care worker, you should identify the specific needs f the person with dementia. These needs could arise from their gender, ethnicity, age, religion and personal care. Other needs could also arise from their physical health or physical disability, any sensory impairment, communication difficulties, problems resulting from poor nutrition, poor oral health or learning disabilities. The person’s needs should be identified with input from the person, their fami ly, friends and any other persons that may be important in that person’s life. Once the person’s care needs have been identified, plans should be made to draw up a support plan which will describe how those needs will be met.As with the assessing of needs, the person must be at the centre of the support planning process. Nothing should be planned for them without them. 15 Level 3 Health & Social Care Diploma Case study The importance of a person-centred approach It is approaching lunch time but Mrs Lancaster is not really hungry. She would like a drink and would prefer to remain in her room as she is comfortable and her favourite television programme is about to start. Mrs Lancaster is not able to voice these preferences verbally, as she finds it very difficult to verbalise and so has given up trying. Tracy, one of the senior care workers, entersMrs Lancaster’s room and makes her jump, as Mrs Lancaster did not hear Tracy entering. ‘Come on then love, your dinner’s ready,’ Tracy tells Mrs Lancaster. She then promptly holds Mrs Lancaster under the arm and says, ‘Up you come chum. ’ Mrs Lancaster reels back in pain and cries out. Tracy responds saying, ‘Don’t be silly, now come on, your dinner’s going to get cold,’ again pulling up under Mrs Lancaster’s arm. Mrs Lancaster pulls away, which makes Tracy annoyed. She bends down and puts her face close to Mrs Lancaster’s and says, ‘I’ll leave you here to starve if you carry on like that. ’ Mrs Lancaster cannot take any more bullying or hreats from Tracy so she brings her head back and then sharply forward, head-butting Tracy. ‘You nasty woman, you ought to be locked up doing things like that! What have I ever done to you to deserve treatment like that? ’ Tracy shouts, leaving the room with a bloodied nose. 3. 2 Different techniques to meet the fluctuating abilities and needs of the individua l with dementia people with dementia. Seize the challenge and look forward to the unexpected. As the saying goes, ‘variety is the spice of life’. 1. Explain six things in detail that could have possibly led to Mrs Lancaster head-butting Tracy. 2.What should Tracy have done to prevent this occurrence? 3. Describe a way Mrs Lancaster could be supported to communicate in future. 4. Describe how her care could be given using a person-centred approach. Knowing the person Many people with dementia are able to live in their own homes for most of their lives with care being given to them by their families. It is important that the person is supported to recognise that the condition that they have is not the fault of anyone, especially not their own. When supporting the fluctuating needs and abilities of the person, it is very important that you recognise that hey are not responsible for the things that they do. It is not the person who is spitting out their food; it is the cond ition’s effects on the person’s ability to communicate which is preventing them from saying, ‘I don’t like that. ’ It is not the person who is constantly wandering around the environment; it is the condition that has taken away their spatial awareness. As a support worker, you must focus on the skills and abilities that the person has, rather than those that they have lost. Ensure that you are fully aware of and respect the person’s background, their history, likes and dislikes.Be prepared for changes and adapt a flexible approach. No two days may be the same in supporting 16 By learning about each person’s history and background, you can design the care and support you provide around their specific needs. For example, the person may have been a sergeant major in the army, which could account for his shouting out his orders. The person may have experienced a traumatic event in their lives such as being trapped in a collapsed building, which could account for them becoming agitated and screaming when the lights are switched off in their bedroom at night. Without this background knowledge, nd more importantly understanding, the person who shouts his orders may be wrongly labelled as being noisy and dictatorial. The person who screams in the dark may be wrongly labelled as disruptive and attention-seeking. A person’s physical condition can be affected by their dementia. Their mobility may be reduced as may the person’s ability to maintain their own personal care or diet. Combining these factors can increase the person’s susceptibility to other illnesses such as chest infections or physical conditions such as pressure sores. Understand dementia Ensure the person’s support plan is kept as up to date s possible and shows alternative methods to use for various fluctuations in their support needs. Support other care workers by sharing proven practices. As a support worker, you may have identif ied triggers to somebody’s behaviour. Do not keep this information to yourself; inform other care staff and have it recorded in the person’s support plan. This would be the same for identifying any new method or way of supporting the person to meet their fluctuating needs. Provide a stable environment and suitable surroundings One of the main triggers resulting in somebody with dementia becoming agitated and confused is a change n their routine. Any changes to the person’s life or daily routine can cause them to become unsettled, which could lead to inappropriate behaviours. To ensure stability it is important to: †¢ †¢ †¢ †¢ have consistent, regular staff. Unfamiliar faces can cause the person great upset. Ensure they know the staff and ensure the same staff member provides care to the person in their own home maintain a familiar environment. It is an eventuality in everyone’s life that their surroundings will change at some point. Th is could simply be through redecoration or changes in furniture. Where possible, if decoration needs to be undertaken within the erson’s environment, try to make the new decor similar if not the same as it was previously. If relocation is required for the person, ensure this is minimised by confirming the suitability of the new location. This will save on the person needing to be relocated again due to the environment not being suitable for their needs ensure the person is in a non-stressful, constant and familiar environment establish a regular routine, regular physical activity and adequate exposure to light to improve any sleep disturbances. Specific strategic support People with dementia may behave in a way that is completely out of character.Some of these behaviours can be disturbing to onlookers and especially the person’s family, seeing their loved one behaving in a way they have never seen before. The following are examples of the types of behaviours people wit h dementia may display. Unit DEM 301 Wandering People with dementia may tend to walk or wander apparently aimlessly for a variety of reasons. This could be because they are bored or they feel they need to escape or get out of the environment they are in. The person may simply need to use the bathroom but cannot remember where it is. On occasions this wandering may take them out of the house or even own the street. This could lead them into becoming ‘lost’ if they are unable to find their way back home. For most people, wandering may only be a short phase that they go through. And, although little comfort at the time, people with dementia often retain a good degree of road sense and are seldom involved in traffic accidents. To reduce incidents of wandering, promote physical activities to reduce the person’s boredom and to help use some pent-up energy. What dangers could wandering have for somebody? Incontinence Loss of bowel or bladder control usually occurs as th e dementia progresses. Sometimes these accidents may appen because the person cannot remember where the bathroom is or cannot get there in time. If the person does become incontinent, you need to help them to maintain their dignity and respect by being understanding and reassuring. Incontinence pads, sheaths or catheters can be obtained to help keep the person free from unnecessary embarrassment and frustration. 17 Level 3 Health & Social Care Diploma Agitation Agitation can include behaviours such as sleeplessness, verbal or physical aggression and irritability. These types of behaviour often increase with the stages of dementia and can become quite severe.Agitation may be triggered by a variety of factors including environmental factors, fear and tiredness. Most often agitation is triggered when the person feels as if they are no longer in control of the situation. You can help reduce episodes of agitation by reducing the intake of caffeine, sugar and processed foods. The reductio n of noise or crowds can also help, as does the maintenance of the person’s routines. is a list for further reading which will help your knowledge and understanding further. Doing it well Meeting the needs of people with dementia †¢ Know the person well, including their history and background. Keep their support plan up to date. †¢ Provide a stable environment and suitable surroundings. †¢ Ensure specific strategic support. †¢ Improve your knowledge and understanding. Repetitive speech or actions It is a common occurrence with those who have dementia to repeat a word, statement, question or activity more than once in a short amount of time. This repetition can be frustrating and stressful to the care giver and their family. Repetition is often as a result of the person becoming anxious, bored, fearful or agitated. One way of reducing this is to provide them with reassurance. Alternative strategies could include isplaying reminders of activities around thei r home such as ‘Dinner is at 6:30pm’ or ‘Dave comes home at 5pm. ’ This may assist with reducing anxiety and uncertainty about anticipated events. Paranoia People with dementia may suddenly become suspicious, jealous or start accusing others of things. When this happens, the person will believe in what they are saying and therefore you should not try to argue or disagree with them. Stay calm and encourage the person to calm down. Ask them what is wrong and let them know that you are there to help them. Improve your knowledge and understanding Many organisations have helpful information on nderstanding and supporting people with dementia. Set yourself a goal to develop your practices through research, talking to people who are in the early stages of dementia or family and friends of those who have it. Learning about dementia from those who have firsthand experience is often more beneficial than reading a book, although books have the benefit of being portabl e and accessible at any time. At the end of this unit there 18 3. 3 How myths and stereotypes related to dementia may affect the individual and their carers Dealing with the difficulties that come with the diagnosis of dementia is not going to be made any asier with the myths and stereotypes that society has created. Within society, dementia is often seen as a condition that causes the person to require 24-hour care in a secure environment so they cannot get out and wander aimlessly. People who are newly diagnosed with the condition are sometimes disbelieved because they appear ‘normal’ and are dribbling or babbling. Some myths or falsehoods can create an unrealistic hope within the person or their family. Some of these untruths profess to offer cures or preventions. The following information can help you to identify fact from fiction. Q – Can using aluminium saucepans affect the risk of eveloping Alzheimer’s? A – No, there is no convincing evidence that cooking with aluminium saucepans increases the risk of developing Alzheimer’s. Q – Is it true that people who follow a healthy lifestyle reduce the risk of developing dementia? A – Yes. Research shows that people who enjoy a healthy lifestyle by eating a well-balanced diet, not smoking and taking regular exercise reduce their chances of developing dementia. Recent research has shown that being healthy in mid-life can help lower our risk of developing dementia as we age. Understand dementia Q – Can Ginkgo Biloba help people with dementia? A – No.Unfortunately, the latest evidence shows that Ginkgo Biloba has no benefit for people with dementia. Q – Does eating meat have any connection with developing Alzheimer’s? A – There is no convincing proof that eating meat is linked to developing Alzheimer’s. Q – Do people who have dementia become childlike? A – No; it is very important to remember that people wi th dementia are adults and should be treated with the dignity and respect other adults receive. Many people, quite wrongly, have stereotypes when it comes to dementia. It is these stereotypes that can become the fear of reality for people newly diagnosed ith dementia. Sometimes it is the person’s own stereotyping of dementia that they have to face. Facing and resolving this can only occur with education and acceptance. Unit DEM 301 3. 4 Ways in which individuals and carers can be supported to overcome their fears Research has shown that many people fear the thought of developing a form of dementia. The worry of losing one’s identity, independence and mind for some is a greater fear than the fear of death. Worrying about a condition that you may not develop seems futile. Worrying about a condition which you have developed will not do your health much good.Simply telling somebody who has received a diagnosis of dementia or their family not to worry is insufficient. Advis ing the person and their family to talk about their fears will help towards them overcoming any uncertainties. Ignoring the condition or pretending it is not happening is simply denial. To help all those involved to overcome worries for the future, the person and their family should be supported to learn the truth, what they can expect from the future. Activity 3 Understand the condition What’s in a name? The person and their family should be supported to develop a true understanding of the condition they are acing. Information can be obtained from GPs’ surgeries, health centres, libraries and the Internet. When obtaining information from books or the Internet, you need to ensure it is up to date and reliable. Internet sites run by organisations such as the Alzheimer’s Society or NHS Direct can be seen as reliable sites, as can educational sites such as those ending with . org. Some of the facts relating to dementia do not always make for easy reading; however, the person and family need to know what to expect. Skirting around these issues will not enable the preparation that may be required. This could lead to a bigger shock when it ctually happens, which would not do anybody any favours. Devise a simple questionnaire which you can either send out to colleagues or staff within your organisation, or give to your family and friends. Ask questions such as, ‘Give the first word that comes into your head when you hear the word â€Å"dementia†. ’ Include a few questions that relate to the myths around dementia to see if your colleagues or family know the truth or not. Compile the results from your questionnaire and discuss these with your assessor. People’s inappropriate views or opinions on dementia often arise from ignorance. For many, the only portrayal hey have of dementia is that which they see on television. Storylines shown in films are often of people in the advanced stages of dementia. If this is the only per spective you have, then there is no wonder why society looks at this condition in the way it does. If the individual newly diagnosed with dementia or their family has only ever known of dementia in this way, then their fears will understandably be heightened. Encourage future planning Once the person and their family are aware of how dementia may affect the future, they should be supported to think ahead and be ready for the changes that will follow.The person and their family will need to prepare things not just materially but emotionally as well. At some point the person may require support with toileting and other personal care needs. They may not want their family attending to this sort of personal care, 19 Level 3 Health & Social Care Diploma preferring to have a care worker attend to their needs at home. There may come a point where the person is unable to stay in their own home due to the advancement of their condition. The fear of this eventuality can create a lot of worry f or them. Supporting the person to plan for this can help allay those fears.They and their family could be supported to identify a care home which the person may move into in the future. Simply knowing that this step has been arranged can help them feel a little easier, knowing that they will not be placing a burden on their family. Making life easier The person may have received a diagnosis of dementia because of their current memory difficulties. The family may worry that the person will not be able to cope very well at home, forgetting to take their medication, forgetting to lock doors and windows when going out and so on. These sorts of worries for the family will not necessarily lessen.As each day passes they may worry. As each day passes the person’s condition may increase, making the family worry all the more until it becomes a vicious circle. To help reduce these fears, the person can be supported to remain as independent as possible at home with the use of notes, labe ls, lists – any memory joggers. The environment in which the person lives can be made safer – for example, installing grab rails or an emergency pull cord system. Making these minor changes to the person’s home may reduce the natural worries of the family with regards to their loved one’s safety. Dealing with the diagnosis of dementia is never going to e easy. Some people and their families may benefit from receiving counselling. This can often b

William Shakespeares Macbeth Plot Summary

Macbeth, the play which is considered  Shakespeare’s most intense tragedy, is condensed into this plot  summary, capturing the essence and important plot points of the Bard’s shortest play. Macbeth Summary King Duncan hears of Macbeth’s heroics at war and bestows the title Thane of Cawdor on him. The current Thane of Cawdor has been deemed a traitor and the king orders that he be killed. The Three Witches Unaware of this, Macbeth and Banquo meet three witches on a heath who predict that Macbeth will inherit the title and eventually become king. They tell Banquo that he will be happy and that his sons will inherit the throne. Macbeth is then informed that he has been named Thane of Cawdor and his belief in the witches’ prophecy is confirmed. King Duncans Murder Macbeth contemplates his fate and Lady Macbeth encourages him to act to ensure the prophecy is realized. A feast is organized to which King Duncan and his sons are invited. Lady Macbeth hatches a plot to kill King Duncan while he sleeps and encourages Macbeth to carry out the plan. After the murder, Macbeth is full of regret. Lady Macbeth scorns him for his cowardly behavior. When Macbeth realizes that he has forgotten to leave the knife at the scene of the crime, Lady Macbeth takes over and completes the deed. Macduff finds the dead King and Macbeth accuses the Chamberlains of murder. King Duncan’s sons flee in fear of their lives. Banquos Murder Banquo questions the witches’ predictions and wants to discuss them with Macbeth. Macbeth sees Banquo as a threat and employs murderers to kill him and his son, Fleance. The murderers botch the job and only manage to kill Banquo. Fleance flees the scene and is blamed for his father’s death. Banquos Ghost Macbeth and Lady Macbeth host a feast to lament the death of the King. Macbeth sees Banquo’s ghost sitting in his chair and his concerned guests soon disperse. Lady Macbeth urges her husband to rest and forget his wrongdoings, but he decides to meet with the witches again to discover his future. Prophesies When Macbeth meets the three witches, they concoct a spell and conjure apparitions to answer his questions and predict his fate. A bodiless head appears and warns Macbeth to fear Macduff. Then a bloody child appears and assures him that â€Å"none of woman born shall harm Macbeth.† A third apparition of a crowned child with a tree in his hand tells Macbeth that he will not be vanquished until â€Å"Great Birnam Wood to high Dunsinane Hill shall come against him.† Macduffs Revenge Macduff travels to England to help Malcolm (King Duncan’s son) avenge his father’s death and overthrow Macbeth. By this time, Macbeth has already decided that Macduff is his enemy and kills his wife and son. Lady Macbeths Death The doctor observes Lady Macbeth’s strange behavior. Every night she acts out washing her hands in her sleep as if trying to wash away her guilt. She dies shortly after. Macbeths Final Battle Malcolm and Macduff have assembled an army in Birnam Wood. Malcolm suggests the soldiers each cut down a tree in order to advance on the castle unseen. Macbeth is warned that the wood seems to be moving. Scoffing, Macbeth feels confident that he will be victorious in battle as his predicted invincibility that â€Å"none of woman born shall harm him† will protect him. Macbeth and Macduff finally confront each other. Macduff reveals that he was ripped from his mother’s womb in an untimely manner, so the â€Å"none of woman born† prophesy does not apply to him. He kills Macbeth and holds his head aloft for all to see before declaring Malcolm’s rightful place as king.