The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
1
Early Dementia
DIAMOND MODULE Pre-Quiz
Test what you already know about
Diamonds!
1. When working with a diamond, it
is best to make as many changes
as possible.
True or False
2. Diamonds are typically
characterized by an easy-going,
laid back disposition.
True or False
3. As a caregiver, you should lay
down the ground rules and not
be willing to change the way you
do things.
True or False
If you answered FALSE to all of these
questions, you are well on your way
to working effectively with
Diamonds.
Why do we use the gems?
The Senior Gems™ are based on the Allen Cognitive Disability Theory. Each
gem represents a stage of dementia from normal aging through late stage
dementia. We use the gems to help us understand the changes that are
taking place and to know what our clients are still able to do in order to
provide the best care possible.
Dear Learner,
This training guide was designed for you to complete as a self-study
activity. Please do the following in order to ensure successful completion:
First, read through EVERYTHING. There is a lot of important in-
formation through the guide. If you find something that will be
helpful to you and your clients underline or highlight that infor-
mation.
If you have a question, please ask:
__________________________
Once you are finished take the quiz at the end and review these
answers with your supervisor. You will need to answer 8 out of
10 questions correctly to pass.
The packet will be yours to keep, but you must turn the quiz into
your supervisor.
Due Date: _________________
Taking the time to complete these learning guides show that you
care about your clients and want to provide the best service
possible. Thank you for your hard work and dedication!
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
2
What’s Inside?
Introduction p. 1
Objective p. 2
Characteristics of Diamonds p. 2
Early Warning Signs p. 3
Normal Aging vs. Dementia p. 3-4
Diagnosing Dementia p. 4-5
Types of Dementia p. 6
Communication Techniques p. 7-8
Activities p. 9-11
Environment p. 12
Transitioning to the next Gem p. 12
Quiz p. 13
Caregivers completing this learning module will be able to
identify the characteristics of diamonds, ways to promote
effective communication, techniques for care and activities that
work in order to create a more positive and fulfilling day for
their clients.
Characteristics of Diamonds
On the gem’s scale diamond is the first stage of dementia meaning the cognitive changes that are
happening are no longer “normal.” A diamond is the gem selected to represent this stage because
diamonds are still clear, but they are very rigid. In other words, a diamond can still do things as they
always have, but they are going to struggle with new information. Below are some basic characteristics
of a diamond:
Diamonds can be rigid, hard and totally inflexible, but they also shine and sometimes can be
perfectly fine.
They can do what they have always done; they often get upset when things change.
They have many facets, so it is possible that different people see different sides of a diamond.
The most important words you will use working with a diamond are “I’m sorry.”
Diamonds have trouble learning new information, but they can remember old stories.
Fast Facts
1 in 8 people aged 65 or older have
Alzheimer’s disease.
Nearly half of people aged 85 and
older have Alzheimer’s disease.
Source: Alzheimer’s Association
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
3
10 Warning Signs of Dementia
Since diamond is the first stage of dementia, it is a time when
there may be some uncertainty about whether or not there is
a problem. The Alzheimer’s Association has created this list of
early warning signs to help identify whether or not there is a
need to see a doctor:
Memory changes that
disrupt daily life.
Challenges in planning or
solving problems.
Difficulty completing
familiar tasks at home, at
work or at leisure.
Confusion with time or
place.
Trouble understanding
visual images and spatial
relationships.
New problems with words
in speaking or writing.
Misplacing things and
losing the ability to retrace
steps.
Decreased or poor
judgment.
Withdrawal from work or
social activities.
Changes in mood and
personality.
What should you do if you
think your client has
dementia?
Based on your experience and
education it may be clear to you that
a client is having a problem with their
cognitive functioning. As you
understand, this may be extremely
distressing to both the client and
their family. If you feel that there is a
problem, please contact the Senior
Helpers office to let them know what
you are noticing. That way you as the
caregiver are not the one sharing this
information and potentially causing
your client to lose trust in you, or be
angry with you.
Review of Normal Aging vs. Dementia
Normal Aging Dementia
Continues to be independent in daily activities.
May complain of memory loss, but is still able to provide
considerable details about incidents of forgetfulness.
Occasional word finding difficulties.
Does not get lost in familiar areas.
Able to operate common appliances.
Maintains prior level of social skills.
Person becomes dependent on others for key
independent living activities.
Will only complain of memory problems if specifically
asked.
Memory problems worsen with time.
Notable decline in memory for recent events.
Frequent word-finding pauses and substitutions.
Gets lost in familiar areas.
Loss of interest in social activities.
Unable to operate common appliances.
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
4
Normal Aging vs. Dementia: Review Activity
For each statement below, identify N for “normal aging” and D for may have “dementia.”
Answer Key:
1. Mr. Johnson got up to get a drink,
once he got to the
kitchen he forgot why he was
there. After retracing his steps, he
remembered. _______
3. When Mrs. Jackson’s caregiver
arrived at her house, the
caregiver was shocked to find that
Mrs. Jackson had tried to cook a
frozen meal in the toaster.
________
5. Today you are scheduled to take
Mr. Chin to the doctors. Every time
you remind him about the
appointment, he tells you he’s
never heard of having any
appointment today. ________
2. Mrs. Morris has played bridge with
a group of friends every
Tuesday for ten years. Recently,
she says she does not want to go
anymore, she’s “done with bridge.”
________
4. Mr. Thompson no longer likes to
drive at night because he has
problems with his night vision.
________
6. Mrs. Robinson is very agitated. She
keeps asking to go home, but she is
home.
________
1. N 2. D 3. D 4. N 5. D 6. D
Diagnosing Dementia
Diagnosing dementia requires a complete medical and neuropsychological
examination. Getting a proper diagnosis is vital, because there are other
diseases that may mimic dementia and can be treated. Although there is no
cure for many forms of dementia, knowing what you are working with will
make a difference in care. The following are usually included in the
examination:
A review of history and onset of symptoms
Medical history and medications
Neurological exam
Laboratory tests
Brain imaging
Mental status testing
Fast Fact
50% of those who meet
the diagnostic criteria for
dementia, never receive
a diagnosis.
Source: Alzheimer’s Association
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
5
Diseases that Mimic Dementia
As we noted before, getting a physician’s diagnosis of dementia
is important. There are many very treatable conditions that
actually mimic the symptoms of dementia. So, for example, a
family may be thinking their loved one has just “gotten old and
gotten dementia,” when really, they have a nutritional deficiency
which could easily be reversed.
Examples of the diseases that can actually mimic dementia
symptoms are:
Depression
Side-effects from medication
Substance abuse
Nutritional deficiencies
Thyroid Conditions
Hypercalcemia (electrolyte imbalance)
How does dementia affect the brain?
It is important to realize, dementia is not just a memory problem. There is a disease at work and the
brain is physically changing. In fact the brain is dying, and shrinking. People with dementia can lose up
to 2/3 of their brain mass through the course of the disease. The picture below shows a healthy brain
on the left and the brain of someone who died from Alzheimer’s on the right. Both of these
individuals had the same head circumference in life, so the difference in size
is due to the disease process. As you care for clients with dementia, keep in
mind, their brains are undergoing major changes. Sometimes it is hard to
remember that since we cannot see the way the brain is changing, we can
only see the behaviors. The behaviors are not on purpose, they are the
result of a very real disease.
Fast Facts
Alzheimer’s disease is
the 6th leading cause of
death in the United
States and the 5th
leading cause of death
for those aged 65 and
older.
Alzheimer’s is the only
cause of death among
the top 10 in America
without a way to
prevent, cure, or even
slow its progression.
Source: Alzheimer’s Association
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
6
Types of Dementia
Although most of us are familiar with Alzheimer’s disease it is actually just one
type of dementia. Knowing some of the other types of dementia may help
you with caregiving. Below you will find a brief description of a few of the
most common forms of dementia.
Source: Alzheimer’s Association
Fast Fact
Most common forms of
dementia:
1. Alzheimer’s Disease
2. Vascular Dementia
3. Mixed Dementia
Source: Alzheimer’s Association
Type Description
Alzheimer’s
Disease
Difficulty remembering names and recent events is often an
early symptom. Later symptoms include impaired
judgment, disorientation, confusion, behavior changes and
difficulty talking, swallowing, and walking.
Vascular
Dementia
Impairment is caused by decreased blood flow to parts of
the brain, often due to a series of small strokes that block
arteries. Symptoms often overlap those of Alzheimer’s,
although memory may not be as seriously affected.
Dementia with
Lewy Bodies
Pattern of decline may be similar to Alzheimer’s, including
problems with memory and judgment as well as behavior
changes. Alertness and severity of cognitive symptoms may
fluctuate daily. Visual hallucinations, muscle rigidity and
tremors are common.
Mild Cognitive
Impairment
A condition in which a person has problems with memory,
language or other essential cognitive function that are
severe enough to be noticeable to others and show up on
tests, but not severe enough to interfere with daily life.
Frontotemporal
Dementia
Nerve cells in the front and side regions of the brain are
especially affected. Typically symptoms include changes in
personality and behavior and difficulty with language.
“The
ea
rly sta
ge
s of A
lzhe
ime
r’s are
the
ha
rde
st
be
ca
use
tha
t pe
rson
is aw
are
tha
t the
y’re
losin
g
aw
are
ne
ss.”
-Pa
tti Da
vis
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
7
When working with Diamonds, learning effective communication techniques might be the most
important factor in providing quality care. Remember, diamonds are rigid and inflexible. It is not their
fault, it is the disease. You as the caregiver need to change the things you do, because the Diamond is
not going to be able to change. Here are tips for successful communication:
R eality Orientation
What is it? Does it work?
Scenario: your client Mrs. Jones comes to you and tells you that she has to
go pick up her child from school. You know that her child is now 45 years
old, and no longer in school. Reality orientation means you tell your client “But, Mrs.
Jones your son is 45 years old.”
Does this help? NO! Correcting Mrs. Jones will not do anything to help the
situation. Instead, try distracting Mrs. Jones by asking her questions about the
memory “your son is at school? He goes to New Town Elementary school, right?
How is that school?” This will allow your client to live their memory and reduce
anxiety.
1. “I’m sorry” are the most important words you can
use. It does not necessarily mean you did
something wrong, but it is an opportunity for you to
acknowledge that you have upset them and that
they are still in control.
2. Diamonds will enjoy talking about the past,
because those are the memories they still have. Let
them talk about the past, in fact encourage it! Those
stories will help you as the disease progresses.
3. Never use the phrase “don’t you remember…”!
The fact of the matter is, they don’t remember.
Pointing that out is not going to help anyone.
4. Accept that there is a change taking place. Don’t
pretend nothing is going on.
5. Ask permission. Diamonds want to still feel like
they are the ones in control, so ask before you start a
task.
6. Don’t be the person telling them “no.” If you are
going to spending all day with them, it is better that
the blame be on someone else. For example “the
doctor says…”
7. Don’t take away their hope, present changes as temporary. For example, try the phrase “just for right
now…” Although the change may be permanent, they do not need to know that.
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
8
For each scenario below, circle which option would be the best way to
communicate effectively with a Diamond.
Scenario 1: Mrs. Turner has always been the one to make dinner in her household. Recently,
however, she caused a small kitchen fire and her family does not want her cooking anymore.
Option 1: Tell Mrs. Turner to go take a nap on the couch while you prepare dinner.
Option 2: Ask Mrs. Turner if she would rather have chicken or beef for dinner and
then ask if she might be able to give you a hand in the kitchen.
Scenario 2: Mr. Mount’s family is adamant that he cannot be allowed to drive anymore.
Mr. Mount is furious because he’s driven for 60 years!
Option 1: Tell Mr. Mount the doctor thinks you (the caregiver) should take over the
driving, for just a little while.
Option 2: Hide his keys and tell him he’s finished his driving career!
Scenario 3: Mr. Martin has told you the same stories about his fishing trips with his father at least
ten times today.
Option 1: Tell Mr. Martin you already know that story and it is going to drive you
insane if you hear it again.
Option 2: Listen to Mr. Martin’s story like it is the first time you have heard it. Maybe
even write it down.
Scenario 4: Mrs. Talbot has always maintained a beautiful house, now her family has asked that
you take over some of the housework.
Option 1: Ask Mrs. Talbot permission to complete household tasks.
Option 2: Tell Mrs. Talbot she’s too old to be cleaning, and you will take care of it
now.
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
9
Keep Track of the Stories!
One common attribute of diamonds is that they tell the same old
stories over and over again. The reason they do this is that their
long term memory is preserved as their recent memory declines. So
those old stories are what they can still confidently remember.
While it is understandable that hearing the same stories repeatedly
might be wearing, these stories are actually a gift to caregivers.
Hearing your client’s story now and remembering it later will help
you as their disease progresses. You might even consider writing the
stories down. This could act both as a tool in the future and an
activity for you and your client now.
Encouraging Independence
At the early stages of dementia, it is important that you encourage your clients to
retain as much independence as is safely possible. This means you might have to
make the activity a little simpler, but you should not be doing everything for them.
For example, although you might have to remind your client that it is time to change
their clothes, that does not mean you need to pick out their clothes for them. If
they begin struggling picking out their clothes, you can simplify the task by offering
them choices, “do you want to wear your blue shirt or your red shirt.” Even though
you are adjusting the task, they are still the ones picking out their clothes. Feeling
independent and productive will lead to more meaningful days. Even if they make a
mistake, let it go, they don’t need to know that.
Fast Fact
Women are more likely
then men to get
Alzheimer’s disease.
Source: Alzheimer’s Association
“I f
you
wan
t to
lift
yo
urs
elf
up
, lift
som
eon
e el
se.”
-Bo
oke
r T.
Was
hin
gto
n
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
10
Activities Make the
Day Better!
Planning activities throughout your day will help to make the day more meaningful for your client,
establish a routine and make the day easier for you. Activities suggestions for diamonds are located in
the chart below, and organized into the following four categories:
Productive—Provides a sense of value and purpose.
Leisure—Promotes having fun and interacting.
Self-Care & Wellness—Personal care of body and brain.
Restorative—Re-energizes and restores the spirit.
Category Activity Suggestions
Productive Getting the mail
Setting the table
Caring for Pets
Finding, sorting, and cutting coupons
Putting away dishes
Wiping windows and mirrors
Gardening/watering plants
Doing laundry
Preparing food
Sorting and rolling coins
Dusting
Volunteering
Grocery shopping
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
11
Category Activity Suggestions
Leisure Watching t.v.
Creating a family tree
Reading
Playing sports
Shopping
Cooking
Going out to eat
Arranging flowers
Arts and crafts
Music activities
Playing games
Walking
Going to a place of worship
Self-Care & Wellness
Exercise/yoga
Grooming
Completing puzzles/crosswords
Reading
Applying lotion to self
Getting medication reminders
Choosing foods
Playing Games
Getting manicures/pedicures
Restorative Taking naps
Listening to relaxing music
Getting a massage
Going outside for a walk
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
12
For dementia clients, the environment is extremely important.
Not only can an appropriate environment promote health and
safety, but it can also help to provide effective cues to get
through the day. Being able to maintain the same environment
is one of the major benefits of remaining at home with
dementia. When working with a diamond the key is to keep as
much as is safely possible exactly how it is! Diamonds are good
at old habits and routines, but struggle with new information.
Changing around the set up of a room, the location of where
items are stored or a daily routine will be difficult for them to
adjust to and may cause distress. For example, if your client has
always showered before bed, you should continue to plan
showers for around bed time. Not only will this be familiar to
them, but the shower will also be a cue that it is time for bed.
Transitioning to the Next Gem
The nature of dementia is that it is progressive. It is possible that you will see your
client moving from one gem to the next. If you think your client has transitioned it is
important to contact the Senior Helper’s office. This may indicate that it is time for a
reassessment and adjustment to the Service Plan or that it is time for your client to visit
the doctor. If you start noticing any of these characteristics, it might be indicative that a transition is
taking place:
Having emotional moments as they become lost in time and place.
Losing things and thinking someone stole them.
Use your best judgment, if you think something is going on, it probably is. Not only could it be a
transition to the next gem, it could be some other treatable problem.
The Diamond Module
Senior Gems®
SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC
13
Employee Name (Please Print):
__________________________
Date: _____________________
I understand the infor-
mation presented in this
guide.
I have completed this guide
and answered at least 8
questions correctly.
Employee Signature:
__________________________
Supervisor Signature:
__________________________
Directions: Circle the best answer choice, and then check your answers
with your supervisor.
1. When working with a diamond it is best to take over all tasks and activities so they can rest.
True or False
2. Diamonds are good at old habits and routines. True or False
3. What should you avoid when communicating with a diamond? A. Giving them options. B. Saying “don’t you remember.” C. Allowing them to maintain control.
4. If someone is forgetting things, it is best to just assume they have dementia.
True or False
5. Going to get the mail, putting away dishes and folding clothes are examples of:
A. Restorative Activities B. Leisure Activities C. Productive Activities
6. Ruby is the next gem after diamond. True or False
7. When working with diamonds it is best to maintain things the way they are as much as possible.
True or False 8. When a diamond asks the same question repeatedly, they are doing
it to frustrate you. True or False
9. Reality orientation is not an effective means of communicating with diamonds.
True or False
10. Alzheimer’s disease is the only form of dementia. True or False
Quiz
The Diamond Module: Early Dementia