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© Positive Approach to Care® – to be reused only w ith permission.


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without the expressed written consent of Teepa Snow and Positive Approach, LLC

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http://www.teepasnow.com/presentations

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Creating Days That

Have Meaning

for People Living with

Early Onset Dementia


Early Onset Dementia

Special Issues:

- Groups: genetic, Down, head injury, lifestyle

- Young family: kids often involved

- Mis-diagnosis and non–diagnosis is common

- Work may be first place to notice

- Relationships are strained early, misunderstood

- Services are usually a problem

- Finances are often problematic

- Executive decision making and sequencing

diminished


What Do People with Early

Onset Dementia Need?- Daily Routine!

- Help to fill their day with meaning

- A Balance of:

-Productive activity: feeling valued

-Leisure activity: having fun

-Self-care activity: wellness, health, personal care

-Restorative activity: sleep, rest, and re-energizing

- A Match-Up for Preferences:

-Large Group, Small Group, 1:1, Alone

-Active versus passive

-Sensory options: visual, auditory, tactile, olfactory,

gustatory

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Know each person!

Understand activities!

Make and use a

schedule!

Build staff skills!

Manage the environment!

Resources to succeed

What Does it Take to Have a

Day with Meaning and Joy?


Personal Preferences and

Values:

- Who have you been?

- What did you value?

- Who are you now?

- What do you value now?

- Why does it matter?

- Who gets a ‘say’?

- Who gets to set the priorities?


Personality Traits:

- Introvert - Extrovert

- Lots of Details - Big Picture Only

- Logical - Emotional

- Planning Ahead - Being in the Moment

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Life Story:

Family: past and

present

Living place(s)

Work history

Leisure History

Music history

People history

Plant history

Animal history

Plant history

Sensory environment preferences

Cultural history and concerns

Food likes and dislikes

Daily routines

Organizations and memberships

Roles and responsibilities

Comforts and Irritants


Design Each Day

8 am – coffee circle

8:30 – songs of joy

9 am – time to ‘go’9:15 – take a hike – walk’n’roll

10 am – cool down & stretch

10:30 – watering hole

11 am - ‘use your brains’games

11:30 - time to ‘go’ – wash up

11:45 – ‘set-‘em up’ crew

12 noon – let’s eat

12:30 – clean up crew

1 pm – music and meditation

1:30 – coupons clipping

2 pm – time to ‘go’2:15 – let’s dance

Make a

schedule and

follow it

Be structured

BUT allow

flexibility

Create a

FLOW for the

day

Build up and

then slow down

Circadian

rhythms

Offer a variety

of activities

every day

Leisure, work,

rest, self-care,

groups and 1:1,

passive and

active

Create Group

schedules

BUT

also build

individual

schedules

Not everything

is for

everybody!

Build a Foundation

of Familiar and Favorite

Activities

Add a few

special events and

something different© Teepa Snow, Positive Approach, LLC – to be reused only with permission.


Learn How To:

- Do something new

- Learn a new type of exercise or activity

- Simplify a dance

- Re-look at a old skill and make it easier

- Share a tasks

- Do something without touching things

- Get someone to do something without words

- Give positive feedback and say “thanks”

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Take a Look, Listen, Feel:

- Lighting: adequate, non-glare, focused

- Sounds: background, distracting, volume

- Feel:

-Temperature

-Space: crowded, intimate, personal, public

-Work surface

-Seating surface

-Walking surface

-Familiar? Friendly? Fun? Forgiving?


Key Activities to Consider:

Productive - Work

Enjoyment - Leisure

Wellness - Personal Care

Restorative - Rest


Productive Activities:

Helping another person

Helping family members/caregivers

Completing community tasks

Making something

Sorting things

Fixing things

Building things

Creating something

Caring for things

Counting things

Folding things

Marking things

Cleaning things

Taking things apart

Moving things

Cooking/baking

Setting up/breaking

down

Other ideas

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Two Options:

Doing:

Filling socks: rice socks,

bean socks, corn socks

Adding herbs: lavender,

citrus, eucalyptus, mint

Putting a sock inside

another sock

Heating the socks

Rubbing the socks over

muscles

Emptying socks out

Making:

Fruit salad: from fresh

Fruit salad: from canned

Fruit salad: from pre-cut

Fruit salad: one fruit and

yogurt

Fruit salad: dried fruit,

granola, and yogurt

Putting the fruit salad in

small cups or bowls

Serving the fruit salad


Two Examples:

Paying Bills:

Do it independently

Together – use a calculator

Together – do all of them

Together – do one at a time

You do most, they sign and

put in envelopes

You do all but the signature

They put on stamps

Both take them to the mail

box

Washing Dishes:

Do it independently only

after meals

Do it independently – when

needed to fill time

Together – one wash, one

dry

Do parts

Watch and guide

Carry dishes to/from sink


Active: Passive:

Socials

Sports

Games

Dancing

Singing

Visiting

Hobbies

Doing, Talking, Looking

Entertainers

Sport program/event

Presenters

Living room or lobby sitting

TV programs: watched

Activity watchers

Being done to

Leisure Activities:

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Cognitive: Physical:

Table top tasks

•Matching, sorting,

organizing, playing

Table top games

•Cards, board games,

puzzles

Group games

•Categories, crosswords,

word play, old memories

Exercise

Walking

Strengthening tasks

Coordination tasks

Balance tasks

Flexibility tasks

Aerobic tasks

Personal care tasks

Self-Care and Wellness

Activities:


Rest and Restorative

Activities:Sleep/naps

Listen to quiet music with lights dimmed

Look at the newspaper

Look at a calm video on TV screen

Rock in a chair

Swing in a porch swing

Walk outside

Listen to reading from a book of faith

Listen to poetry or stories

Listen to or attend a

worship service

Stroke a pet or animal

Stroke fabric

Get a hand or shoulder

massage

Get a foot soak and rub

Listen to wind chimes

Aromatherapy


Positive Action Starters:•Help: Be sure to compliment his or her skill in this area, then ask for help with something

“You are so good at baking, would you please help me?”

•Try: Hold up or point to the item you would like to use, possibly sharing in the dislike of the item or task

“Could we just try this?”

•Choice: Try using visual cues to offer two possibilities or one choice with something else as the other option

“This, or that?”

•Short and Simple: Give only the first piece of information, maybe offer a time frame of 1-5 minutes

“It’s about time to brush teeth.”

•Step by Step: Only give a small part the task at first

“Lean forward.”

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Progression of

Dementia: The GEMS®Sapphires

Diamonds

Emeralds

Ambers

Rubies

Pearls

As part of the disease people with dementia tend to

develop typical patterns of speech, behavior, and

routines.

These people will also have skills and abilities that are

lost while others are retained or preserved.


Sapphires:

- Us on a good day

- Clear and true to ourselves

- May feel ‘blue’ over changes

- Can typically choose our behavior

- May have other health issues that affect

behaviors

- Recognize life experiences, achievements

and values

- Can follow written info and hold onto it


Diamonds:-Sharp, hard, rigid, inflexible, can cut

-Many facets, still often clear, can really shine

-Are usually either Joiners or Loners

-Can complete personal care in familiar place

-Usually can follow simple prompted schedules

-Misplace things and can’t find them

-Resent takeover or bossiness

-Notice other people’s misbehavior and mistakes

-Vary in lack of self-awareness

-Use old routines and habits

-Control important roles and territories, use refusals

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Diamond Interests:

- What they feel competent at

- What they enjoy

- Who they like

- What makes them feel valued

- Where they feel comfortable but stimulated

- What is familiar but intriguing

- What is logical and consistent with historic

values and beliefs

- Whoever is in charge


Emeralds:

-Changing color

-Not as clear or sharp, more vague

-On the go, need to ‘do’

-Flaws may be hidden

-Time traveling is common

-Are usually Doers or Supervisors

-Do what is seen, but miss what is not seen

-Must be in control, but not able to do it correctly

-Do tasks over and over, or not at all


Emerald Interests:

- Doing familiar tasks

- Doing visible tasks

- Historic tasks and people and places

- Engaging with or helping others

- Finding important people or things

- Having a ‘job’ or ‘purpose’

- Being an ‘adult’

- Getting finished and doing something else

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Ambers:-Amber Alert- Caution!

-Caught in a moment

-All about sensation and sensory tolerance, easily

over or under stimulated

-May be private and quiet or public and noisy

-No safety awareness

-Ego-centric

-Lots of touching, handling, tasting, mouthing,

manipulating

-Explorers, get into things, invade others’ space

-Do what they like and avoid what they do not


Amber Interests:

- Things to mess with (may be people!)

- Places to explore

- Stuff to take, eat, handle, move

- Visually interesting things

- People who look or sound interesting, or

places that are quiet and private

- Textures, shapes, movement, colors,

numbers, stacking, folding, sorting


Rubies:-Hidden depths

-Major loss of fine motor finger and mouth skills, but

can do gross motor skills like walking, rolling,

rocking

-Comprehension and speech halted

-Wake-sleep patterns very disturbed

-Balance, coordination, and movement losses

-Eating and drinking patterns may change

-Tends toward movement unless asleep

-Follows gross demonstration and big gestures

-Limited visual awareness

-Major sensory changes

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Ruby Interests:

- Walking a routine path

- Going forward

- Watching others

- Being close or having space

- Things to pick up, hold, carry, push, wipe,

rub, grip, squeeze, pinch, slap

- Things to chew on, suck on, grind

- Rhythmic movements and actions


Pearls:-Hidden in a shell: still, quiet, easily lost

-Beautiful and layered

-Spends much time asleep or unaware

-Unable to move, bed or chair bound, frequently fall

forward or to side

-May cry out or mumble often, increases vocalizations

with distress

-Can be difficult to calm, hard to connect

-Knows familiar from unfamiliar

-Primitive reflexes

-The end of the journey is near, multiple systems are

failing

-Connections between the physical and sensory world

are less strong but we are often the bridge


Pearl Interests:

- Internal cues

- Pleasant and familiar sounds and voices

- Warmth and comfort

- Soft textures

- Pleasant smells

- ‘Good’ tastes

- Smooth and slow movement

- Just right touch and feel

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The content contained in this presentation is strictly for informational purposes. Therefore, if you wish to

apply concepts or ideas contained from this presentation you are taking full responsibility for your

actions. Neither the creators, nor the copyright holder shall in any event be held liable to any party for

any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly

or indirectly from any use of this material, which is provided as is, and without warranties.

Any links are for information purposes only and are not warranted for content, accuracy or any other

implied or explicit purpose.

This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright

Act of 1976 and all other applicable international, federal, state and local laws, with ALL rights reserved.

No part of this may be copied, or changed in any format, sold, or used in any way other than what is

outlined within this under any circumstances without express permission from Positive Approach to Care.

Copyright 2017, All Rights Reserved

Teepa Snow and Positive Approach to Care

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© positive approach to care® to be reused only with ... · -lots of details - big picture...

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