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Reaching Beyond the Shadows…An Overview of Dementia
Macomb County Department Senior Citizen Services
Presented by
Karen D. Bisdorf Kathryn Ann W. Kozlinski
10th Annual Michigan Traffic Safety Summit
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Aging In America
• 1 in 10 Americans have a family member with a cognitive impairment
• 1 in 3 knows someone with dementia
• 2002 - 4.5 million 2010 - 5.1 million
• Census now 65/85 85/105 105/115• 2030 the baby boomers will have turned 65
• 7.7 million persons will present with a dementia-related illness in the US
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What is Dementia?
• Dementia is an umbrella term • The loss of mental function
two or more areas of the brain Language, memory, judgement, personality, or visual–spatial comprehension.Severe enough to interfere with daily life.
• Damage causes the death/malfunction of brain cells.
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Dementia Related Illnesses
• Alzheimer’s Disease
• Lewy body dementia
• Vascular dementia
• Stroke - CVA
• Multi-infarct dementia
• Medication imbalance
• Alcohol/drugs
• Korsakoff’s Syndrome
• Parkinson’s Disease
• Tumors
• Head injury
• Nutritional
• Environmental
• If it affects the heartIt may affect the brain
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Prevalence of Dementia• Ages
– 10 percent
• Over 65 years
– 45 per cent
• Over 85 years
– 60 percent
• 90 years and over
• Phases– Beginning
• 3-5 years
– Middle
• 8-13 years
– Late
• 1-3 years
No cure – insidious - progressive disease2-21 years diagnosis to death8-12 years hands on caregiving needed
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Warning Signs
Profound memory loss
Misplacing things
Abstract thinking
Difficulty with routine tasks
Change in mood & behavior
Language skills
Loss of initiative
Disorientation time/ place
Poor or weak judgement
Personality changes
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Circumstances in Which You May Encounter a Person With Dementia
• Driving– Appearance of DUI– Traffic Violations– Traffic Accidents– Erratic Driving
• Wandering 60 – 20%– Lost and Confused– Walking & Driving
• Endangered Adult– Critical Incidence
• False Reports– Home Invasion– Theft– Misplaced items– Shoplifting
• Victimization– Scams, Schemes,
Swindles– Abuse & Neglect
• Sexual Misconduct– Indecent Exposure
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Macomb CountySenior Assessment Request
• Endangered adults
• False reports
• Victimization
• Abuse or neglect
• Unsupervised activities
• Community service referrals
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Communication Guidelines
• Approach from the front when possible
• Approach with respect – maintain their dignity
• Introduce yourself– call them by name if possible
• Maintain eye contact– establish some type of rapport
• Speak in slow distinct tones
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Encounter Tools
• Look for physical and medical needs first
• Look for a medical alert or ID bracelet
• Pay close attention to mood & emotion
• Easily redirected if not agitated
• Allow as much space as possible
• Avoid backing them into a corner
• Environmental noise & bright light areconfusing
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Communication Tools
• Be clear about your expectations– Project the feeling that you assume they can and will do
what you ask of them
• Request their assistance– Don’t order or demand
• Don’t push or pull – Walk beside– Direct with gestures – Instructions one at a time
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Communication Tools
• This is a disease of emotions– Control the emotional environment
– Maintain control-they will mimic you
– Don’t argue
– There is no logic- they can’t follow your reasoning
• Don’t try reorientation to time & place– Find out where they are in time
– Work at that level
– Do not lie
– Ask them non-threatening questions
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Signs of Unsafe Driving
• Forgetting how to locate familiar places
• Failure to observe traffic signals
• Slow or poor decisions in driving
• Driving at inappropriate speeds
• Becoming angry or confused while driving
• Night blindness
• Being uncomfortable on the road
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Restricting a Driver
• Family doctor may write a “do not drive” prescription• Family maintain control access to the car keys• Disable the car - remove the distributor cap or battery• Park the car on another block or in a neighbor’s
driveway• Discuss unsafe driving practices with insurance agent• Encourage family members to keep a record of their
observations to share with person, other family members and health care professionals
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Why Do People Wander
• Restless - Bored
• Confused about time and place
• Change in physical environment
• Over stimulated environment “getting away”
• Argument with caregiver
• Fear caused by delusions or hallucinations
• Medication side effects
• Sundowning a biological clock
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Endangered Person
• These persons are not “missing”
• They are “endangered”
• Time is of the essence
• Do they have an ID bracelet?
• Are they registered in theAlzheimer’s associations safe return program?
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Endangered Persons
• Won’t knock on doors Won’t flag you down
• They won’t answer if you call their name
• They don’t think they are lost
• They may not stand out in a crowd
• Will be drawn to water, ditches, culverts
• Will walk in the snow shoeless & coatless
• Check the immediate area first
• Then go to old familiar places
• They wander on foot, by car, and by boat
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Survival Rates
• 50% chance to find them alive in the first 16 hours
• That percentage drops by 10% each hour they are lost
• 46% of those found deaddied of hypothermia or dehydration
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Safe Return Program
• SRP provides identification products – ID bracelets/necklace /key chains
• 24 hour hotline
• Registration in National data base
• Access to law enforcement agencies
• Direct connect to nationwide Alzheimer’s Association offices
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Safety and Care Tips
• Impaired person’s can’t be left alone or unattended in waiting rooms, offices or vehicles
• Automatic car windows can be dangerous
• The person should sit next to the driver, not alone in the back seat of cars without protection locks
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Rapid Assessment Look, Listen and Test to determine the risk
• Look – Body Language:
• Clenched fist, staring or hyper-vigilance, inappropriate facial expressions, posture, red face
– Psychomotor Activity:• Pacing, wringing hands, rapid breathing, clenched
teeth, ballistic movements
– Physical Appearance• Blank facial expressions, Inappropriate clothing,
disheveled
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Rapid Assessment• Listen
– Speech content• What is the person talking about, who is the person
talking to, are they responding to real people and events. Do they have a legitimate gripe.
– Speech organization:
• Is the person fluent, does he/she jump from one topic to another, can he follow a conversation
• Test– Receptivity:
• Can you connect with the person, are they going to cooperate, do they react to their name, will they follow simple directions
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Good Judgement
• Rapid assessment is completed in a matter of moments and does not guarantee freedom from risk, or the potential for a catastrophic reaction
• Trust your gut• Get a history when possible
– What medications are being taken– History of child or spouse abuse– History of violence during disputes
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Referral Resources
• Michigan Department of State– Request for Driver Evaluation– Form OC88
• Elder Referral-Request for Individual/Family Assessment– Macomb County Senior Citizen Services
• Adult Abuse Hotline– Adult Protective Services (APS)– Request for Investigation – 800.996.6228
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Information or Assistance
Macomb Co. Department of Senior Citizen Services586-469-6313
Macomb Co. Adult Day Service Program586-466-6817 or 586-469-5579
Alzheimer's Association -Greater Michigan Chapter800-621-0379
Alzheimer’s Association 24/7 Helpline800-337-3827
Alzheimer’s Safe Return Nationwide Program888-572-8566
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Information or Assistance
State of Michigan Insurance Commission
Traffic Associations of Michigan Offer driving assessments and safe driver classes
Duke Family Support Program, Durham, NC 800-672-4213
North Carolina Division of Aging 919-733-0440
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Resources
At the Crossroads, A Guide to Alzheimer’s Disease, Dementia and Driving Publication # 105013 The Hartford, Hartford, CT. 06115
We Need to Talk, Family Conversations with Older Drivers Publication # 105924 AARP /The Hartford
Driving for Life, A Guide for Older Drivers and their Families Publication # BBBB 000 Michigan Secretary of Statewww.michigan.gov/sos
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Resources
Alzheimer’s AssociationSafe Return Program Law Enforcement Official Training bookPublication # PF 203zSafe Return Video Law Enforcement
Safe Return Program Applications– English Chinese
– Korean Polish
– Russian Spanish
– Vietnamese
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Resources
Michigan Area Agencies on AgingHandout
Michigan Directors of Services to AgingHandout
AARP www.aarp.org
AARP Life Answers www.aarplifeanswers.com
National Institute on AgingP.O. Box 8250 Silver Springs, MD 20907-8250
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Comments
Questions?
Concerns?
Thank you for the opportunity of speaking with you today