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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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LEADING AGE FLORIDA 2015
“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
LEADING AGE FLORIDA 2015
LEADING AGE FLORIDA 2015
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.
LEADING AGE FLORIDA 2015
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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LEADING AGE FLORIDA 2015
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
LEADING AGE FLORIDA 2015
LEADING AGE FLORIDA 2015
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)
LEADING AGE FLORIDA 2015
Gearing Up
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LEADING AGE FLORIDA 2015
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
LEADING AGE FLORIDA 2015
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
LEADING AGE FLORIDA 2015
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LEADING AGE FLORIDA 2015
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
LEADING AGE FLORIDA 2015
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LEADING AGE FLORIDA 2015
The Dementia Experience
• Quality of Life, Sleep, Fun, Food, Communication
• Effects on Relationships
• Effects on Self-Esteem
• Autonomy
LEADING AGE FLORIDA 2015
The Dementia Experience
LEADING AGE FLORIDA 2015
The “Shared Room” Experience
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LEADING AGE FLORIDA 2015
The Sleep Sagas….
LEADING AGE FLORIDA 2015
Motion-Sensing Call System
LEADING AGE FLORIDA 2015
Sleep…or lack thereof….
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LEADING AGE FLORIDA 2015
Typical Sleep
LEADING AGE FLORIDA 2015
The “night”-light…
LEADING AGE FLORIDA 2015
The food…
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LEADING AGE FLORIDA 2015
The food…
LEADING AGE FLORIDA 2015
LEADING AGE FLORIDA 2015
The “Starbucks” Experience
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LEADING AGE FLORIDA 2015
The great escape….
LEADING AGE FLORIDA 2015
The great escape….
LEADING AGE FLORIDA 2015
We’re done!
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LEADING AGE FLORIDA 2015
Confusion?
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LEADING AGE FLORIDA 2015
The Napkin Test….
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The 500 piece puzzle….
LEADING AGE FLORIDA 2015
The 500 piece puzzle….
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LEADING AGE FLORIDA 2015
Understanding & Misunderstandings
LEADING AGE FLORIDA 2015
Cognitive Impacts
• Concentration• Focus• Engagement• Understanding• Sensory processing!• Prioritization!
• Mental Fatigue!• Headaches• Disturbed Sleep!• Flashbacks• Task success
LEADING AGE FLORIDA 2015
Psychological Factors
• Anxiety• Fear• Frustration• Confusion• Worry• Reduction of
Coping Skills
• Vulnerability• Helplessness• Dependency• Agitation• Self-doubt• Misperceptions• Paranoia
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LEADING AGE FLORIDA 2015
Physical Environment
• Intuitive• Accessible• Comfortable• Aesthetics • Lighting• Acoustics• Destinations
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LEADING AGE FLORIDA 2015
Privacy
LEADING AGE FLORIDA 2015
Light levels
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Safety/Security
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LEADING AGE FLORIDA 2015
Safety/Security
LEADING AGE FLORIDA 2015
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!
LEADING AGE FLORIDA 2015
Melissa Pritchard• Are “negative” behaviors
really “negative”• Is “wandering” a behavior of
being “lost”
LEADING AGE FLORIDA 2015
Addie Abushousheh
LEADING AGE FLORIDA 2015
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LEADING AGE FLORIDA 2015
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
LEADING AGE FLORIDA 2015
LEADING AGE FLORIDA 2015
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
LEADING AGE FLORIDA 2015
LEADING AGE FLORIDA 2015
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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LEADING AGE FLORIDA 2015
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!
LEADING AGE FLORIDA 2015
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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
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25%
75%
Control GroupThe Renaissance
No Change
Improvement
Progression
*MMSE‐Mini Mental State Examination
Primary Outcomes – FAB*
26%
58%
16%
Intervention GroupEliza Jennings Home
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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%
Intervention GroupEliza Jennings Home
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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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Positive Outcomes Related to Improved Prefrontal Cortex Function
• Increasingly independent with grooming, bathing, dressing
• Spending less time isolated in room
• Attending more activities
• Resuming hobbies such as knitting
• Expressing preferences
Positive Outcomes Related to Improved Prefrontal Cortex Function
• 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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