dementia diarties final lafl · the 500 piece puzzle…. leading age florida 2015 the 500 piece...

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LEADING AGE FLORIDA 2015

Dementia Diaries: It's Never Too LateHow does one truly walk in the shoes of another? How much do we

really know and understand about the first-hand experience of living

with dementia? Our team of senior living experts tackled this issue

"head on" by utilizing the Virtual Dementia Tour techniques and living as

memory care residents in communities across the country. Join us to

understand this unusual research project and explore the perceptions

and findings of these brave designers. We will discuss the physical

environment, perceptual changes, cognitive impacts and

psychological factors of this experience. In conclusion this team will

touch upon the future of memory care through emerging approaches,

programs and research studies.

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“You can’t pretend or observe your way into understanding dementia.”

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Addie Abushousheh, PhD• Gerontologist• Researcher• Culture Change Expert &

Consultant• Architect• Organizational Dynamics• NHA candidate



Dementia SimulationSome dementia simulations, such as the Virtual Dementia Tour® (VDT)

created by P.K. Beville of Second Wind Dreams, provide clients with a

“snap shot” of what it is like to experience dementia via a 12-minute

simulation exercise in a manipulated environment. Our goal was to, not

only simulate the symptoms of age-related

Alzheimer’s and dementia , but immerse

ourselves in a variety of care settings for 24-

hours in an effort to better identify and

understand residents’ behaviors and needs.


Project Approach Participants were fitted with gear that simulated the physical symptoms

of age as well as the cognitive effects of dementia. In order to evaluate

the effect of the training, there were pre and post-testing that included:

psychological, physiological, and behavioral analysis.

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ARCHITECTS RESEARCHER

Role: Participant Observer

Question: What is it like? What is happening?

Approach: ∙ Simulate∙ Immerse∙ Experience

∙ Identify∙Measure∙ Interpret

Research: ∙ Naturalistic∙ Perceived view∙ Descriptive (Qualitative)

∙ Empirical∙ Received view∙ Analytical (Quantitative)

Measures: ∙ Assume age‐related deficits∙ Dementia sensory stimulation

∙ Pre/post perceptions∙ Vital signs∙ Behavioral mapping

Additional: ∙ Sleep pattern records∙ Light measurements∙Writing in journals

∙ LTC consent for participation∙ Coordinate activities/agenda∙ Simulation validation

Rigorous, Authentic, Credible



Simulation EquipmentDeficit Equipment

Neuropathy ─ One small bag of uncooked popcorn kernels (not in a microwavable bag)

Decreased sensitivity ─ Several pairs of snug fitting latex gloves (or similar non‐latex glove if allergic)

Arthritis ─ Medical tape

Unaddressed need ─ Sand paper

Confusion ─ MP3 or CD player with headphones or ear buds (fully charged)

Yellowing of lens & diminished peripheral

vision

─ Glasses or goggles with yellow lenses (Global Vision Escort or similar)


Gearing Up

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Evaluation3-minute observations at 15-minute intervals• Vital signs (admission, sleep, bathing)

• Mini-Mental State Exam (admission)

• Activity & State of Arousal• Agitation

– Cohen & Mansfield Agitation Inventory

– Wisconsin Agitation Inventory Scoring

• Facial Affect• Behavioral Mapping


SITE #1 SITE #2 SITE #3

*Melissa Ambulatory, no assist ‐ ‐

*Amy WC, stand‐by assist Walker, no assist, WG Walker, no assist

*Curtis ‐ WC, no assist, WG Walker, no assist

Region North Central South East South Central

Context Urban Urban Urban

CCRC Yes Yes No

Ownership Non profit ‐ Church Non profit ‐ Other Non profit ‐ Church

MC Approach Integrated Isolated Specialized

MC Programming Personalized General Social & Sensory

Staffing (consistent) Team‐based (yes) Traditional (yes) Hybrid (yes)

Destinations Chapel, gym, café, restaurant, gardens

NA Central courtyard

Site Characteristics


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SITE #1 SITE #2 SITE #3

Configuration “T” Neighborhoods x2 “L” Unit “O” Households x2

# Residents (Beds) 22 (24) & 25 (26) 44 (50) 14 (20) & 17 (20)

Outdoor Access Unrestricted Extremely limited Loosely supervised

Amenities Per Nbhd: 2 dining, 3 living, activity

3 dining, gathering, activity, therapy

Per HH: Dining, 2 living, activity

Bedrooms Private Shared (side‐by‐side) Private

Bathroom (shower) Private (no) Shared (no) Private (no)

Public Outing Coffee shop NA NA

Site Characteristics


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The Dementia Experience

• Quality of Life, Sleep, Fun, Food, Communication

• Effects on Relationships

• Effects on Self-Esteem

• Autonomy


The Dementia Experience


The “Shared Room” Experience

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The Sleep Sagas….


Motion-Sensing Call System


Sleep…or lack thereof….

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Typical Sleep


The “night”-light…


The food…

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The food…



The “Starbucks” Experience

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The great escape….


The great escape….


We’re done!

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Confusion?

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The Napkin Test….


The 500 piece puzzle….


The 500 piece puzzle….

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Understanding & Misunderstandings


Cognitive Impacts

• Concentration• Focus• Engagement• Understanding• Sensory processing!• Prioritization!

• Mental Fatigue!• Headaches• Disturbed Sleep!• Flashbacks• Task success


Psychological Factors

• Anxiety• Fear• Frustration• Confusion• Worry• Reduction of

Coping Skills

• Vulnerability• Helplessness• Dependency• Agitation• Self-doubt• Misperceptions• Paranoia

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Physical Environment

• Intuitive• Accessible• Comfortable• Aesthetics • Lighting• Acoustics• Destinations

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Privacy


Light levels


Safety/Security

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Safety/Security


Safety/Security

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Amy Carpenter• Private rooms!• Access to outdoor spaces!• Provide outlets for curiosity• Created empathy and

understanding• The staff makes a HUGE

difference!


Melissa Pritchard• Are “negative” behaviors

really “negative”• Is “wandering” a behavior of

being “lost”


Addie Abushousheh


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Pre/Post-QuestionnairePart 1a: Dementia Attitudes Scale (Melissa O’Connor, PhD & Susan McFadden, PhD)

• 20 statements (7-pt scale)• Validated questionnaire • Recommended by Alzheimer’s Association

Δ = 3‐pt avg. pre to post



Pre/Post-QuestionnairePart 1b: Dementia Attitudes Scale (Melissa O’Connor, PhD & Susan McFadden, PhD)

• 7 questions (5-pt scale + comments) – Understanding emotional needs

– Perceived capability

– State of relaxation

– Dementia sensitivity for care

– Completing ADLs

– Justified inappropriate behavior

– People with dementia receive the care they need

2‐3‐pt increase pre to post



Pre/Post-QuestionnairePart 2: Design for Dementia• 8 questions (comments, no scale)

– Wayfinding/Orientation

– Privacy/Socialization

– Personalization

– Safety/Security

– Self-Sufficiency

– Interior Décor

– Ambient Conditions

– Size & Scale

LEADING AGE VIRGINIA 2015

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Direct Observation3-minute observations at 15-minute intervals• Vital signs (admission, sleep, bathing)

• Mini-Mental State Exam (admission)

• Activity & State of Arousal• Agitation

– Cohen & Mansfield Agitation Inventory

– Wisconsin Agitation Inventory Scoring

• Facial Affect• Behavioral Mapping

Practical Advice• Communication & cues• Environmental Overstimulation• Are they talking about me??? Be

careful about what you say and don’t say

• Create a sleep supportive environment!• Lighting!• Do this!


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LeadingAge FloridaJune 30, 2015

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The Future of Memory Care:SAIDO Learning®

Eliza Jennings

Denise Gannon, RNVice President of Operations and COO

Sheryl L. SeredaVice President of Advancement and CAO

Eliza Jennings

• 125 years old

• Not-for-profit

• Full spectrum of service lines

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First U.S. Trial of SAIDO Learning

Primary Outcomes – MMSE*

5%

80%

15%

Intervention GroupEliza Jennings Home

65

25%

75%

Control GroupThe Renaissance

No Change

Improvement

Progression

*MMSE‐Mini Mental State Examination

Primary Outcomes – FAB*

26%

58%

16%


66

25%

40%

35%

Control GroupThe Renaissance No Change

Improvement

Progression

*FAB – Frontal Assessment Battery at Bedside

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Secondary Outcomes – MDS*Mental Status (C500)

17%

39%

44%


67

13%

12%

75%

Control GroupThe Renaissance No Change

Improvement

Progression

*MDS‐Minimum Data Set

Video: Mae & SAIDO Learning

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Positive Outcomes Related to Improved Prefrontal Cortex Function

• Decreased wandering in halls and others’ rooms

• Ability to locate their own rooms

• Regaining ability to use the bathroom and self-toilet

• Ability to remain seated and eat meals

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• Increasingly independent with grooming, bathing, dressing

• Spending less time isolated in room

• Attending more activities

• Resuming hobbies such as knitting

• Expressing preferences


• Participating in household chores such as setting the table

• Resuming pastimes such as gardening

• Spending more time interacting with family

• Initiating conversation

• Smiling more!

Eliza Jennings

• Cleveland, Ohio

• 600 employees

• Person-centered care leader

• 25 years specialized dementia care

• Full continuum of care

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What is SAIDO Learning?

• Learning Therapy=SAIDO• Non-pharmacological• 18,000 participants in 1600

nursing facilities• Proven to improve the

symptoms of Alzheimer’s and dementia (2005)

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Development of SAIDO Learning

KumonInstitute ofEducation

Eijuen(NursingHome)

TohokuUniversity

Learning Therapy

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Effective Tasks for Activating the Prefrontal Cortex

The tasks must 1. activate bilateral PFC2. be simple and easy

Reading aloud Hand writing Simple arithmetic

Materials design basisfor Brain Training

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SAIDO Learning Fundamentals

• Lead Supporters and Supporters

• Learners• 30-minute sessions• Scientifically developed,

multi-level worksheets• Praise &

encouragement• 5 times a week

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The Road Map to the Paradigm Shift

• SAIDO Learning is not a separate program

• It is the care that we provide to those we serve

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Resources

• Kawashima, Ryuta, MD et al. “SAIDO Learning as a Cognitive Intervention for Dementia Care: A Preliminary Study.” Journal of Medical Directors Association (JAMDA), January 2015.

• “The Gift of the Present.” Long-Term Living Magazine, Sept. 2013. http://www.ltlmagazine.com/SAIDO

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SAIDO LearningHope for the Future

Until now, we have focused on decline, caring for older adults with dementia and managing their symptoms.

Now, SAIDO Learning grants us the opportunity to provide hope and improved quality of life for those living with dementia.

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dementia diarties final lafl · the 500 piece puzzle…. leading age florida 2015 the 500 piece...

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