Fundamentals of Fundamentals of Dementia Care for Health Dementia Care for Health

Facility PersonnelFacility Personnel

Funded by:Funded by:

Indiana State Department of HealthIndiana State Department of Health

Co-sponsored by:Co-sponsored by:

IAHSAIAHSA

IHCAIHCA

HOPEHOPE

Module 1:Module 1:Understanding Memory LossUnderstanding Memory Loss

In this section, we will cover:In this section, we will cover: Definition of dementia and Alzheimer’s Definition of dementia and Alzheimer’s

diseasedisease Stages of the disease and the Stages of the disease and the

expectationsexpectations Current medications and treatmentsCurrent medications and treatments

What is Dementia?What is Dementia? Dementia is a disease processDementia is a disease process

– Progressive decline in cognitive functionProgressive decline in cognitive function

– Memory lossMemory loss Over 170 irreversible dementiasOver 170 irreversible dementias

– HIV, Vascular, Lewy Body, Parkinson’s, HIV, Vascular, Lewy Body, Parkinson’s, Alzheimer’sAlzheimer’s

Some forms are reversible (treatable)Some forms are reversible (treatable)– Thyroid disorders, drug interactions, Thyroid disorders, drug interactions,

dehydrationdehydration

Delirium, Depression, and Delirium, Depression, and DementiaDementia

DeliriumDelirium– Acute onset, can be treatedAcute onset, can be treated

– Altered state of consciousnessAltered state of consciousness DepressionDepression

– Gradual onset, can be treatedGradual onset, can be treated

– Look for signs, such as low self-esteemLook for signs, such as low self-esteem DementiaDementia

– Gradual onset, might be treatedGradual onset, might be treated

– Memory loss and decline in cognitive functionMemory loss and decline in cognitive function

Alzheimer’s DiseaseAlzheimer’s Disease Most common form of irreversible Most common form of irreversible

dementiadementia

– Nearly 70% of all dementias are Alzheimer’sNearly 70% of all dementias are Alzheimer’s

– Over 4.5 million Americans have Alzheimer’sOver 4.5 million Americans have Alzheimer’s

– It is estimated that 60% of all nursing home It is estimated that 60% of all nursing home residents have Alzheimer’s diseaseresidents have Alzheimer’s disease

Alzheimer’s is not normal agingAlzheimer’s is not normal aging

– Learning new information make take longerLearning new information make take longer

– May be difficult to filter out noiseMay be difficult to filter out noise

Brain ScanBrain Scan

The Diagnostic ProcessThe Diagnostic Process Multidisciplinary approach that is 80-Multidisciplinary approach that is 80-

90% accurate90% accurate

– Brain scan, blood and urine tests, Brain scan, blood and urine tests, hearing/visual examshearing/visual exams

– Neuropsychological testing and interview with Neuropsychological testing and interview with caregiverscaregivers

The only way to confirm diagnosis is The only way to confirm diagnosis is with an autopsywith an autopsy

StagesStagesEarlyEarly Needs Needs

remindersreminders Daily Daily

routines routines difficultdifficult

ConcentratiConcentration-ion is on-ion is difficultdifficult

MiddleMiddle May need May need

hands on hands on carecare

May get lost May get lost easilyeasily

Changes in Changes in personalitypersonality

LateLate Severe Severe

confusionconfusion Needs hand Needs hand

on care for on care for most most personal personal carecare

May not May not recognize recognize self or self or familyfamily

Areas of the Brain AffectedAreas of the Brain AffectedCognitionCognition MemoryMemory LearningLearning LanguageLanguage Praxic Praxic

FunctionFunction Abstract Abstract

thinkingthinking Psycho-Psycho-

motor speedmotor speed

BehaviorBehavior Communi-Communi-

cationcation SafetySafety Personal Personal

care care deterioratesdeteriorates

Lapses in Lapses in clarityclarity

Hallucina-Hallucina-tions tions

DelusionsDelusions

EmotionEmotion Disregulated Disregulated DisorganizedDisorganized Apathy (loss Apathy (loss

of energy, of energy, willingness)willingness)

Lability Lability (moods (moods change)change)

MedicationsMedications Cholinesterase Cholinesterase

InhibitorsInhibitors– CognexCognex

– AriceptAricept

– ExelonExelon

– ReminylReminyl

Glutamate ReceptorsGlutamate Receptors– NamendaNamenda

Module 2:Module 2:Person Centered CarePerson Centered Care

In this section, we will coverIn this section, we will cover Understanding person centered care Understanding person centered care

and its characteristicsand its characteristics Identifying strategies for implementing Identifying strategies for implementing

person centered careperson centered care Find ways to take care of the Find ways to take care of the

professional caregiverprofessional caregiver

Person Centered CarePerson Centered Care Person centered care is truly putting the Person centered care is truly putting the

PERSON firstPERSON first CharacteristicsCharacteristics

– Behaviors are a desire to communicateBehaviors are a desire to communicate

– We must maintain and uphold the value of the We must maintain and uphold the value of the personperson

– Promote positive healthPromote positive health

– All action is meaningfulAll action is meaningful

Person Centered Care, Cont.Person Centered Care, Cont. Core psychological needs must be met Core psychological needs must be met

to provide quality careto provide quality care– LoveLove

– InclusionInclusion

– AttachmentAttachment

– IdentityIdentity

– OccupationOccupation

– ComfortComfort

Implementing Implementing Person Centered CarePerson Centered Care

RecognitionRecognition NegotiationNegotiation Collaboration/Collaboration/

FacilitationFacilitation

PlayPlay TimalationTimalation CelebrationCelebration

RelaxationRelaxation ValidationValidation HoldingHolding

Stress!Stress! Stress can lead to poor quality care, Stress can lead to poor quality care,

quality of life, and abuse and neglectquality of life, and abuse and neglect Signs of stressSigns of stress

– Too little or too much sleep, nightmaresToo little or too much sleep, nightmares

– FatigueFatigue

– Headaches, backaches, joint painHeadaches, backaches, joint pain

– Diarrhea/constipationDiarrhea/constipation

– Frequent accidentsFrequent accidents

Module 3:Module 3:CommunicationCommunication

In this section, we will cover:In this section, we will cover: The impact of verbal and non-verbal The impact of verbal and non-verbal

communicationcommunication Examine and demonstrate techniques Examine and demonstrate techniques

for promoting meaningful for promoting meaningful communicationcommunication

Understand the correct use of validation Understand the correct use of validation and reality orientationand reality orientation

Verbal and Non-verbal Verbal and Non-verbal CommunicationCommunication

VerbalVerbal ToneTone PitchPitch RateRate PausePause

Non-verbalNon-verbal Gestures Gestures Facial expressionsFacial expressions PosturePosture

Each person is uniqueEach person is unique Behaviors are a form of communicationBehaviors are a form of communication Communication is only 10% verbalCommunication is only 10% verbal People with Alzheimer’s maintain the ability to People with Alzheimer’s maintain the ability to

understand non-verbal long after verbal is forgottenunderstand non-verbal long after verbal is forgotten

Non-verbal StrategiesNon-verbal Strategies Your mood will be mirroredYour mood will be mirrored Approach from the frontApproach from the front Establish eye contactEstablish eye contact Speak at eye levelSpeak at eye level Use gentle touchUse gentle touch Point or demonstratePoint or demonstrate

Verbal StrategiesVerbal Strategies Use calm, gentle voiceUse calm, gentle voice Call person by nameCall person by name Identify yourselfIdentify yourself Use short, simple sentencesUse short, simple sentences Speak slowly and respectfullySpeak slowly and respectfully Eliminate distracting noisesEliminate distracting noises Use familiar wordsUse familiar words Give simple choicesGive simple choices Give one instruction at a timeGive one instruction at a time Allow time for the person to respondAllow time for the person to respond

Validation vs. RealityValidation vs. RealityValidationValidation Become part of the Become part of the

person’s realityperson’s reality AcceptanceAcceptance Feelings into wordsFeelings into words AcknowledgementAcknowledgement

RealityReality Early stages, only if not Early stages, only if not

upsettingupsetting Short explanationsShort explanations New information can be New information can be

frustratingfrustrating Reality becomes based on Reality becomes based on

the pastthe past

Therapeutic FibbingTherapeutic Fibbing The use of telling fibs or lies in an effort The use of telling fibs or lies in an effort

to calmto calm We are never sure how much We are never sure how much

information a person may be able to information a person may be able to process or rememberprocess or remember

Should only be used when absolutely Should only be used when absolutely necessary, look for other ways to calm necessary, look for other ways to calm and support, such as redirectionand support, such as redirection

Module 4:Module 4:Understanding BehaviorsUnderstanding Behaviors

In this section, we will cover:In this section, we will cover: Understanding of how and why Understanding of how and why

behaviors become challengingbehaviors become challenging Ways to prevent behaviorsWays to prevent behaviors Techniques for responding to Techniques for responding to

challenging behaviorschallenging behaviors Emotions a person with dementia is Emotions a person with dementia is

likely to experiencelikely to experience

Human EmotionsHuman EmotionsJoyJoy

Pleasure, love, Pleasure, love, happiness, sexualityhappiness, sexuality

AngerAnger

Rage, hate, displeasureRage, hate, displeasure

FearFear

Guilt, shame, anxietyGuilt, shame, anxiety

SadnessSadness

Misery, griefMisery, grief

Respond to FeelingsRespond to Feelings Enter the person’s realityEnter the person’s reality Look for feelings behind the wordsLook for feelings behind the words EmpathizeEmpathize Be non-judgmentalBe non-judgmental Respect their needsRespect their needs Your emotions will be mirroredYour emotions will be mirrored Communicate comfort, warmth, and praiseCommunicate comfort, warmth, and praise Smile!Smile! Put the person’s feelings into wordsPut the person’s feelings into words Allow for negative feelingsAllow for negative feelings

Problem Solving BehaviorsProblem Solving Behaviors TaskTask

– Too complicated, too many steps, not modified, Too complicated, too many steps, not modified, unfamiliarunfamiliar

EnvironmentEnvironment– Too large, too much clutter, excessive stimulation, no Too large, too much clutter, excessive stimulation, no

clues, poor sensory, unstructured, unfamiliarclues, poor sensory, unstructured, unfamiliar

Physical healthPhysical health– Medications, impaired vision/hearing, acute illness, Medications, impaired vision/hearing, acute illness,

chronic illness, dehydration, constipation, depression, chronic illness, dehydration, constipation, depression, fatigue, physical discomfortfatigue, physical discomfort

MiscommunicationMiscommunication

The 11 W’sThe 11 W’s Who has the behavior?Who has the behavior? What is the specific behavior?What is the specific behavior? Why does it need to be addressed?Why does it need to be addressed? What happened just before?What happened just before? Where does it occur?Where does it occur? What does the behavior mean?What does the behavior mean? When does the behavior occur?When does the behavior occur? What is the time, frequency?What is the time, frequency? Who is around?Who is around? What is the outcome?What is the outcome? What is the DESIRED change?What is the DESIRED change?

Preventing BehaviorsPreventing BehaviorsDiversion or distractionDiversion or distraction RemovalRemoval

RedirectionRedirection Task breakdownTask breakdown

Stimulus ControlStimulus Control Environmental Environmental manipulationmanipulation

ReassuranceReassurance Setting limitsSetting limits

Responding to BehaviorsResponding to Behaviors Anxiety/agitationAnxiety/agitation

– Response to misinterpretation of environment Response to misinterpretation of environment or peopleor people

Aggressive reactionsAggressive reactions– Usually directed at caregiver or another personUsually directed at caregiver or another person

RummagingRummaging– Looking for something meaningfulLooking for something meaningful

Repetitive crying outRepetitive crying out– Unresolved pain or discomfortUnresolved pain or discomfort

Module 5:Module 5:Activities of Daily LivingActivities of Daily Living

In this section, we will cover:In this section, we will cover: Causes for resistance to ADL’sCauses for resistance to ADL’s Strategies that promote participationStrategies that promote participation Possible techniques for managing Possible techniques for managing

ADL’sADL’s Identifying signs of abuse and neglectIdentifying signs of abuse and neglect

Causes for ResistanceCauses for Resistance Memory lossMemory loss Decreased attention spanDecreased attention span Impaired judgmentImpaired judgment Loss of ability to communicateLoss of ability to communicate Difficulty with motor skillsDifficulty with motor skills

Strategies for ParticipationStrategies for Participation Anticipate problems or eventsAnticipate problems or events Provide a routineProvide a routine Establish rapportEstablish rapport Talk with a calm voiceTalk with a calm voice Do not attempt to use reason or logicDo not attempt to use reason or logic Do not rushDo not rush Avoid arguingAvoid arguing Focus on abilitiesFocus on abilities

Strategies for Participation, Strategies for Participation, ContCont

Approach—knock, announce, privacyApproach—knock, announce, privacy Encourage the person to do as much as Encourage the person to do as much as

they canthey can Praise for small successesPraise for small successes Provide for privacyProvide for privacy Do not keep person waitingDo not keep person waiting Demonstrate what you want done Demonstrate what you want done Stop when frustration occursStop when frustration occurs

ADL TipsADL Tips DressingDressing

– Layout clothes, limit choices, item to strokeLayout clothes, limit choices, item to stroke

BathingBathing– Keep routine consistent, privacy, adequate lightingKeep routine consistent, privacy, adequate lighting

ToiletingToileting– Evaluate!Evaluate!

Eating and swallowingEating and swallowing– Ensure adequate intake, pleasurable experience, Ensure adequate intake, pleasurable experience,

independenceindependence

SleepingSleeping– Reassure, speak softly, adequate lightingReassure, speak softly, adequate lighting

Module 6:Module 6:FamiliesFamilies

In this section, we will cover:In this section, we will cover: Empathizing with feelings that a person with Empathizing with feelings that a person with

Alzheimer’s and their families may experienceAlzheimer’s and their families may experience Identifying and informing families of resourcesIdentifying and informing families of resources Identifying strategies for building a positive Identifying strategies for building a positive

relationship with familiesrelationship with families Understanding the unique opportunity for a Understanding the unique opportunity for a

long term relationshiplong term relationship

Family FeelingsFamily Feelings DenialDenial FrustrationFrustration IsolationIsolation GuiltGuilt AngerAnger Loss/griefLoss/grief Letting goLetting go

Conflict ResolutionConflict Resolution Denial can be healthyDenial can be healthy Educate in small dosesEducate in small doses Do not push to hardDo not push to hard Encourage support groupsEncourage support groups AcknowledgeAcknowledge ListenListen FeedbackFeedback PrivacyPrivacy

Internal ResourcesInternal Resources Staff membersStaff members LibraryLibrary AdministratorAdministrator Family counselsFamily counsels Care plan meetingsCare plan meetings

Alzheimer’s AssociationAlzheimer’s Association HelplineHelpline Family EducationFamily Education Support GroupsSupport Groups Care ConsultationCare Consultation Safe ReturnSafe Return

Strategies for Positive Strategies for Positive RelationshipsRelationships

Show supportShow support

– Family tours, communication processesFamily tours, communication processes

– Validate emotions, develop realistic Validate emotions, develop realistic expectations, compliment, report good newsexpectations, compliment, report good news

Promote successful visitsPromote successful visits

– Offer suggestions and supportOffer suggestions and support

– Bring in family videos, picturesBring in family videos, pictures

– ActivitiesActivities