today’s training is supported by the nevada aging and ... 1 today’s training is supported by the...

12/22/2015

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Today’s training is

supported by the Nevada

Aging and Disability

Services Division

Nevada Geriatric Education Center

Dementia, Alzheimer’s

Disease and Memory Loss: A comprehensive guide for

family caregivers

Dolores M. Ward, M.S. Education Coordinator, NGEC Certified Gerontologist

12/22/2015

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Learning Objectives

Identify key factors of Alzheimer’s disease (AD) and other forms of dementia

Discuss best practices and positive approaches in understanding and accessing disruptive behaviors

Demonstrate techniques for personal care and hygiene

Learning Objectives

Apply strategies for keeping the person with the disease actively engaged

Describe various intervention approaches to improving caregiver burden, depression and quality of life

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10 Warning Signs

Memory changes that disrupts 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

[Know the 10 Warning Signs]. (n.d.). Retrieved from http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp]

10 Warning Signs

New problems with words in speaking or writing

Misplacing things and losing the ability to retrace steps

Decreased or poor judgement

Withdrawal from work or social activities

Changes in mood and personality

[Know the 10 Warning Signs]. (n.d.). Retrieved from http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp]

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What is Dementia?

Understanding Dementia

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What is Dementia?

Loss of cognitive functioning severe enough to interfere with activities of daily living

Is NOT a diagnosis

Causes changes in

◦ Memory

◦ Language

◦ Thought

◦ Behavior

◦ Mood

[Dementia Definition]. (n.d.). Retrieved from http://www.mayoclinic.org/diseases-conditions/dementia/basics/definition/con-20034399

Vascular Dementia

Second most common type of dementia

Occurs as a result of brain damage due to reduced blood flow to the brain

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Lewy Body Dementia

Parkinsonism

Pronounced variation in attention and alertness

Recurrent visual hallucinations

Frontotemporal Dementia (FTD)

Sometimes known as

Pick’s disease

Affects the frontal and

temporal lobes of the

brain

Occurs at a younger age

Progresses more quickly than AD

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Rare Forms of Dementia

Other types of dementias include:

Creutzfeldt-Jakob disease

Huntington’s disease

Parkinson’s disease

Wernicke-Korsakoffsyndrome

[Diseases and Conditions-Dementia]. (n.d.). Retrieved from http://www.mayoclinic.org/diseases-conditions/dementia/basics/definition/con-20034399

Alzheimer’s Disease (AD)

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What is Alzheimer’s Disease

A progressive, degenerative disease of the brain

Is the most common form of dementia

6th leading cause of death in the U.S.

Has no cure

Is eventually fatal

Dementia-like conditions that

may be reversed

Brain disease

Delirium

Depression

Eye and Ear Impairments

Infections

Metabolic or Endocrine Disorders

Malnutrition

Medication

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Stages of AD

The seven stage Global Deterioration Scale:

Stage 1 – No impairment

Stage 2 – Minimal Impairment/Normal Forgetfulness

Stage 3 – Early Confusional/Mild Cognitive Impairment

Stage 4 – Late Confusional/Mild Alzheimer’s

Stage 5 – Early Dementia/Moderate AD

Stage 6 – Middle Dementia/Moderately Severe AD

Stage 7 – Late or Severe Dementia and Failure to Thrive

[Diseases and Conditions-Dementia]. (n.d.). Retrieved from http://www.mayoclinic.org/diseases-conditions/dementia/basics/definition/con-20034399

Understanding and Responding

to Behavioral Symptoms in

Dementia

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New vs. Old Culture of

Dementia Care

Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993). “Acting Up and Acting Out: Assessment and Management of Aggressive and Acting Out Behaviors,

“The Geriatric Mental Health Training Series, for the Hartford Center of Geriatric Nursing Excellence, College of Nursing, University of Iowa


Dementia Care



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Dementia Care




Dementia Care



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A-B-C Approach to Dementia Care



Prevention is the “Best Medicine!” Remember to:

Identify the individuals who are “at risk”

Learn to recognize behaviors

Intervene early to defuse the situation

Create a comfortable environment




A is for Antecedent:

◦ the events or factors that PRECEDE the

behavioral symptom and contribute to its

occurrence

◦ are also called “triggers” because they “set off”

behaviors

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B is for Behaviors

◦ the specific behavioral symptom that is of

concern

◦ looking at ONE behavioral symptom at a time in

the problem-solving and care-planning process




C is for Consequences

◦ all the things that happen AFTER the behavior

occurs

◦ that includes all the reactions and responses to

the person, including those by other residents,

family, visitors, volunteers, AND staff caregivers

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Assessment: Checking it Out!



Prevention requires that caregivers know the PERSON and the SITUATION well

Think like a detective!

Get all the facts:

◦ Observe

◦ Listen

◦ Identify

◦ Ask

Assessment: Checking it Out!



STOP and QUESTION the behavior

Look for clues about WHAT is going on and WHY

LISTEN and TALK to others to get the WHOLE picture

Get EVERYONE involved in assessment

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Describe the BEHAVIOR in detail



What is the real concern?

What is the person with dementia (PWD) doing?

Where is it happening?

How often does it happen?

Does it seem to get worse over time?

Who is it really a problem for?

Is the behavior safe? Is it dangerous?

Identify possible ANTECEDENTS

and TRIGGERS



Where does the behavior occur?

What else is going on around the person?

Who is there? What are they doing?

What is going on in the environment?

Did someone say or do something to the PWD?

Does it happen at a certain time of day?

What might be going on inside the PWD?

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Describe REACTIONS and

RESPONSES



What happens after the behavior occurs?

Who responds?

What is said (in words and nonverbally)

What does the PWD do next?

What might be said or done to comfort, reassure or redirect the person?

Are automatic reactions “making it worse” instead of better?

Common “Unhelpful” Automatic

Reactions



Avoiding or ignoring the PWD

Becoming defensive

Being indifferent, cold or silent

Slow to respond to their calls and requests

Blaming the PWD, thinking that he or she is “doing it on purpose”

Trying to correct the PWD

Rationalizing, Arguing, Reasoning, Explaining

Threatening with facial expressions, gestures or tone of voice

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Interventions: Managing and

Modifying

Set BEHAVIORAL Goals



Can you eliminate the behavior? Or decrease the frequency?

Do you need to adjust your expectations?

What do you REALLY want the PWD to do?

Is that goal realistic?

Is it specific enough to know when it’s been reached?

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Change the ANTECEDENT and

TRIGGERS



Which antecedent can be eliminated or changed?

What new cues can you add?

For example:

◦ Does the person need a rest period to avoid

“sundown” in the afternoon?

◦ Should they be allowed to eat in their room to avoid

the noise and confusions of the dining room?

Change the CONSEQUENCES

and REACTIONS



Which automatic reactions can be eliminated?

What are some new, neutral or positive responses?

For example:

◦ Speak in simple, easy to understand language

Give one command or ask one question at a time

Wait for a response and listen carefully for meaning

Don’t try to reason with them

Monitor your tone of voice, facial expressions and body

language

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and REACTIONS



Reduce environmental stress

◦ Remove unnecessary people, turn off the TV, etc.

◦ Move to a quite place

◦ Lighting (e.g. is it too dark, bright?)

Don’t confront or challenge delusions or hallucinations

◦ Distract them to some other activity or topic

◦ Reassure them that they are “safe with you”


and REACTIONS



Check for internal stressors that may be contributing

◦ Are they hungry?

◦ Are they thirsty?

◦ Do they have to use the restroom?

◦ Are they cold, hot?

◦ Are they not feeling well? In pain? Symptoms of a UTI?

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EVALUTE



Did your plan work?

Why or why not?

What got in the way?

What made the difference?

What can be done differently?

Personal Care and Hygiene

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Personal Care Changes during

each stage of AD

At the early stage the person may: ◦ forget about personal care tasks

◦ lose interest in bathing

◦ forget which tap is for hot or cold water

◦ forget they had their hair combed and ask for it to be combed again

◦ ask repeatedly why they have to get dressed

[Personal Care]. (n.d.). Retrieved from http://www.alzheimer.ca/~/media/Files/national/brochures-day-to-day/day_to_day_personal_care_e.pdf


each stage of AD

At the middle stage, the person may:◦ have trouble remembering they need to take

care of themselves

◦ forget how to use personal care/grooming objects

◦ not know how to bathe and where to start

◦ feel fear of water or drowning

◦ feel embarrassed or humiliated

◦ may hide grooming items


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each stage of AD

At the last stage, the person may:◦ experience increased mental and physical

deterioration

◦ need help with all aspects of care


Strategies for Caregivers

Learn about the disease

Know the PWD

Be mindful of the PWD’s cognitive impairment

Respect PWD’s privacy and dignity

Be flexible

Keep things simple

Establish a routine

Reassure, encourage and be positive


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Oral Care

Remind the person to brush twice a day

Give step by step instructions or “hands-on” guidance/gestures

Try fluoride swabs if the toothbrush is refused

Be prepared for the PWD to hide their dentures

Remove dentures at bedtime

If the PWD develops “dry mouth,” try sugarless candies or gum


Hair Care

Choose a hairstyle that is easy to care for

Encourage the person to comb their own hair

Use non-stinging baby shampoo

Try a dry shampoo if washing their hair is difficult

Try a scalp massage when washing

A salon or barbershop can be a familiar and relaxed setting


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Foot Care

Check the person’s feet on a regular basis

Check nail length

After bathing, make sure skin between the toes is clean and dry

Give a foot massage

A little of nail polish always brings about a smile


Toileting

Help the PWD:

◦ identify where the toilet is

◦ make their way easily to the toilet

◦ identify and use the toilet, making sure the toilet is

easier for people with mobility problems

◦ undo, remove and replace clothing easily

If necessary, the use of commode may be useful

Be cautious of locks on doors

[Managing toilet problems and incontinence]. (n.d.). Retrieved from file:///C:/Users/dmward/Downloads/Managing_toilet_problems_and_incontinence_factsheet.pdf

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Bathing

Person-centered discussions

Respect the PWD’s privacy and modesty

Remove or cover mirrors

Keep bathroom neat and avoid excess objects

Ensure good lighting

Use colored rubber bath mat to judge the depth of water

Check temperature of the room and water

Ryden et al. & Beck et al. cited by Sloane et al. (2004) Dementia & Agitation in Nursing Home Residents: How are they related? Psychology and Aging 5(1), 3-8

Personal Care Studies

“Cognitive impairment and activity of daily living (ADL) impairment were strongly related to agitated behavior … aggressive behaviors correlated positively with ADL impairment.”Cohen-Mansfield, Marx & Rosenthal (1990). Dementia & Agitation in

Nursing Home Residents: How are they related? Psychology and

Aging 5 (1), 3-8

Aggressive behaviors during personal care reported◦ By 65% of community caregivers

◦ By 86% of staff in nursing homes

Ryden et al. & Beck et al. cited by Sloane et al. (2004)

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What are the implications?

Assistance with personal care may elicit agitation or aggressive behaviors

Person may feel humiliated, frustrated, etc.

Person may not recognize the need for help

Care partners’ (staff or family) frustration an impatience may increase


Why is this important?

Help caregivers understand the link between assistance with ADLs and increased agitation

Teach ways of decreasing possible agitation during ADL care


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Bathing Study

Evidence-based intervention study by Sloane et al. (2004)

Compared person-centered bathing, no rinse towel bed bath, and control groups – 69 NH residents with dementia and agitation/aggression during bathing

Bed bath group = 60% decrease in behaviors


Person-centered bathing

Focus on person rather than task

Relationship building

Choices provided

Person kept partially covered

Modifying temperature of room and shower spray

Using distractions (music, food)

Using products familiar to the PWD


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No-rinse towel bed bath

Individuals bathed in bed with warm no-rinse soap towels

Remain partially covered at all times

Staff training in person-centered bathing techniques


Activities for Persons with

Dementia

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Benefits of Activities

Improves one’s quality of life and sense of wellbeing

Can lessen agitation an depression

Helps maintain motor skills

Provides a sense of autonomy and independence for the PWD

Keeps the PWD stimulated and engaged

Relieves caregiver, family member, staff member frustration

10 Quick Tips for Activities at Home

Be flexible and patient

Encourage involvement in daily life

Avoid correcting the person

Help the person remain as independent as possible

Offer opportunities for choice

[Activities at home]. (n.d.). Retrieved from https://www.alz.org/national/documents/brochure_activities.pdf

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10 Quick Tips for Activities at Home

Simplify instructions

Establish a familiar routine

Response to the person’s feelings

Simplify, structure and supervise

Provide encouragement and support


101 Things to do

Listen to music

Bake cookies

Look at photos

Reminisce

Water house plants

Put a simple puzzle together


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Take Care of Yourself

What is “Respite” Care

Respite care:

◦ provides the caregivers a “temporary” break from

caregiving

◦ can be provided through community or private

organizations

◦ can be provided at home or care setting

◦ can be provided by a friend, family member,

volunteer

[Respite Care]. (n.d.). Retrieved from http://www.helpguide.org/articles/caregiving/respite-care.htm

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Types of Respite Care Services

[Respite Care]. (n.d.). Retrieved from http://www.helpguide.org/articles/caregiving/respite-care.htm

10 Common Signs of Caregiver

Stress

[Take Care of Yourself]. (n.d.). Retrieved from https://www.alz.org/national/documents/brochure_caregiverstress.pdf

Denial Anger Social Withdrawal Anxiety Depression Exhaustion Sleeplessness Irritability Lack of Concentration Health Problems

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10 Ways to Manage Caregiver

Stress


Find time for yourself Know what community resources are

available Become an educated caregiver Get help and find support Take care of yourself

10 Ways to Manage Caregiver

Stress


Manage your level of stress Accept changes as they occur Make legal and financial plans Know you’re doing your best Visit your doctor regularly

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References

[Activities at home]. (n.d.). Retrieved from

https://www.alz.org/national/documents/brochure_activities.pdf

Barrick et al. (2008) Bathing without a Battle. Spring Publishing

[Dementia Definition]. (n.d.). Retrieved from

http://www.mayoclinic.org/diseases-

conditions/dementia/basics/definition/con-20034399

[Diseases and Conditions-Dementia]. (n.d.). Retrieved from

http://www.mayoclinic.org/diseases-

conditions/dementia/basics/definition/con-20034399

[Know the 10 Warning Signs]. (n.d.). Retrieved from

http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp

References

[Managing toilet problems and incontinence]. (n.d.).

Retrieved from

file:///C:/Users/dmward/Downloads/Managing_toilet_pro

blems_and_incontinence_factsheet.pdf

[Personal Care]. (n.d.). Retrieved from

http://www.alzheimer.ca/~/media/Files/national/brochure

s-day-to-day/day_to_day_personal_care_e.pdf

Revised by M. Smith (2005) from M. Smith & K.C.

Buckwalter (1993). “Acting Up and Acting Out:

Assessment and Management of Aggressive and Acting

Out Behaviors, "The Geriatric Mental Health Training

Series, for the Hartford Center of Geriatric Nursing

Excellence, College of Nursing, University of Iowa.

https://www.alz.org/national/documents/brochure_activities.pdf

http://www.mayoclinic.org/diseases-conditions/dementia/basics/definition/con-20034399

http://www.mayoclinic.org/diseases-conditions/dementia/basics/definition/con-20034399

http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp

http://www.alzheimer.ca/~/media/Files/national/brochures-day-to-day/day_to_day_personal_care_e.pdf

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References

[Respite Care]. (n.d.). Retrieved from

http://www.helpguide.org/articles/caregiving/respite-

care.htm


Dementia & Agitation in Nursing Home Residents: How

are they related? Psychology and Aging 5(1), 3-8

[Stages of Alzheimer’s Disease]. (n.d.). Retrieved from

http://www.alz.org/national/documents/topicsheet_stage

s.pdf

[Take Care of Yourself]. (n.d.). Retrieved from

https://www.alz.org/national/documents/brochure_careg

iverstress.pdf

THANK YOU!

http://www.helpguide.org/articles/caregiving/respite-care.htm

http://www.alz.org/national/documents/topicsheet_stages.pdf

https://www.alz.org/national/documents/brochure_caregiverstress.pdf

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