9/8/2017 Judi Kelly Cleary, CDP, ALFA Executive Director, Branchlands - PDF document

9/8/2017 Judi Kelly Cleary, CDP, ALFA Executive Director, Branchlands What Dementia is, and the types of Dementia • The stages of an Alzheimer’s Disease Type of Dementia • Effective Support Strategies at the Various Stages • Objectives: • You will be able to implement one or more practical techniques to interact with a person with dementia to lower stress and improve quality of life. De me ntia Sympto ms ● Problems with memory ● Problems with thinking, attention, planning and problem solving ● Difficulty with communication ● Changes in personality/behaviors ● Problems with spatial awareness (visual perceptions, depth perception, etc.) 1

9/8/2017 Main T ype s o f De me ntia  Up to 70 ‐ 80% of dementia cases are caused by Alzheimer’s Disease  Another 20 ‐ 30% are caused by Lewy Body Dementia, Vascular Dementia or Mixed Dementia Other types or causes of Dementia: Frontal ‐ Temporal Dementia, Normal Pressure Hydrocephelus, Parkinson’s Disease, Syphilis, Creutzfeldt ‐ Jakob Disease, Pick’s Disease, Multiple Sclerosis, Celiac Disease, Lupus, Lyme Disease, Hypothyroidism, Vitamin B12 deficiency, Dehydration, Malnutrition, Excessive alcohol use, Infections, chronic stress, and more…… Alzheimer ’s type Dementia and the Br ain ● Brain failure causes the symptoms of dementia ● The hippocampus, which is the part of the brain that creates MEMORIES out of EXPERIENCES, is one of the most severely affected by Alzheimer’s disease. ● As brain cells die, the brain actually shrinks and ceases to operate effectively De me ntia Pro gre ssio n in Stage s Early Stages (MILD) ● Begins to show symptoms that are noticeable to others ● “Something is wrong, but we aren’t talking about it” Middle Stages (MODERATE) ● Behaviors and personality begin to change ● Will need help with daily tasks ● “I don’t know what I don’t know” Late Stages (SEVERE) ● Basic functions are difficult or impossible to complete ● Final stages, will not survive without assistance from others 2

9/8/2017 Se ve n Stage s o f Alzhe ime r’ s Dise ase * as de ve lope d by Dr. Barry Re isbe rg, M.D. Stage 1: No Impairment ~ Cell damage is occurring Stage 2: Very Mild Decline ~ Difficult to tell from normal aging Stage 3: Mild Decline ~ Difficulty with complicated tasks; uses coping mechanisms (lists, excuses) Stage 4: Moderate Decline ~ Help from others is needed, but can still perform many activities independently, can do personal care, becomes more rigid about routines and time, likes to keep same patterns Stage 5: Moderately Severe Decline ~ Gaps in memory and thinking, needs help with daily tasks, difficulty following steps to complete tasks, likes to be busy but unsure what to do, embarrassed Stage 6: Severe Decline ~ Notable personality and behavior changes, inability to perform self ‐ care activities, Like to touch things, gather things, trouble finding right words, trouble using devices, unable to control impulses, Difficulty with verbal communications, not able to relate to others, losing weight, but may still be able to walk Stage 7: Very Severe Decline Final stage, loss of verbal abilities, loss of continence, eating abilities, and responsiveness to environments. Reflexive behavior, rocking, flexion, and making noises. Se ve n Stage s o f Alzhe ime r’ s Dise ase * Stage 1: No Impairment Mild Decline ● Cell damage is occurring • Assist with reminders Stage 2: Very Mild Decline • Accept excuses as valid Mild Dementia ● Difficult to tell from normal • Celebrate abilities to use coping aging mechanisms • Cognitive Impairment will worsen Stage 3: Mild Decline when tired, in pain, stressed, hungry, ● Difficulty with complicated etc. • Needs extra time to process and make tasks decisions (Be Patient!) ● Uses coping mechanisms such as lists, talking to self, making excuses. *as developed by Dr. Barry Reisberg, M.D. Se ve n Stage s o f Alzhe ime r’ s Dise ase * Stage 4: Moderate Decline Moderate Decline Moderate Dementia ● Help from others is needed, but can still perform many activities independently • Behavior can shift dramatically ● Can still do personal care tasks, becomes more rigid about routines and time, likes to keep same • Personal preferences, likes/dislikes patterns will become more intense • Respects authority figures Stage 5: Moderately Severe Decline • Celebrate individuality ● Gaps in memory and thinking, needs help with daily tasks and activities • Respect choices and routines ● Difficulty with following all of the steps to • Honor irritability as a symptom of complete tasks, likes to be busy but not sure being aware of cognitive decline what to do, embarrassed about cognitive losses • Do not quiz • Offer information, needs *as developed by Dr. Barry Reisberg, M.D. repetition 3

9/8/2017 T ips: Mo de rate Stage s ● The person is aware that she is SUPPOSED to understand, but doesn’t ● To be socially appropriate will pretend to understand ● The person will pretend to remember by confabulating (making things up that make sense, or giving vague answers) ● Do not quiz the person by asking questions such as “do you remember such and such?” or “what is my name?” Se ve n Stage s o f Alzhe ime r’ s Dise ase * Moderately Severe Stage 4: Moderate Decline Moderate Dementia ● Help from others is needed, but can still perform many Needs structured routine, step ‐ by ‐ step cuing • activities independently Cannot make new short ‐ term memories ● Can still do personal care tasks, becomes more • rigid about routines and time, likes to keep same Limited awareness of decreased abilities • patterns Uses vague words as communication skills are • Stage 5: Moderately Severe Decline diminishing, language skills are being lost ● Gaps in memory and thinking, needs help with daily Emotionally, very difficult stage for the person • tasks and activities with dementia; strong emotional reactions are ● Difficulty with following all of the steps to complete tasks, likes to be busy but not sure what normal ‐ Be aware of signs of depression and/or to do, embarrassed about cognitive losses anxiety Celebrate long ‐ term memories • Join the reality of the person, apologize and • *as developed by Dr. Barry Reisberg, M.D. allow blame, help solve her problems (in her reality) T ips: Mo de rate Stage s ● Do not ask the person questions that require detailed answers ● Offer (simple) choices. Show rather than using words or at the same time , because the person may answer “yes” or “no” but is really not sure what you were asking 4

9/8/2017 Alte rnative s: Mo de rate Stage s ● Call the person by the name he or she relates to ● Approach from the front , provide facial expressions and use a direct, friendly tone of voice ● Make eye contact before communicating Se ve n Stage s o f Alzhe ime r’ s Dise ase * Severe Decline Stage 6: Severe Decline ● Notable personality and behavior changes, Severe Dementia physical changes and inability to perform Many changes will be made in abilities during this self ‐ care activities • Like to touch things, gather things, ● stage trouble finding right words, trouble Seeks to satisfy desires, limited social skills so using devices, unable to control • impulses crosses boundaries, avoids what is disliked ● Difficulty with verbal communications, Very limited ability to communicate or understand not able to relate to others, losing • weight, but may still be able to walk communication or cues in the environment Can copy gestures, large motions, struggles to • Stage 7: Very Severe Decline understand gestures as a form of communication ● Final stage, loss of verbal abilities, loss of continence, eating abilities, and Use music, rhythm, singing • responsiveness to environments Reflexive behavior, rocking, flexion, and Provide moments of joy ● • making noises Limit expectations • *as developed by Dr. Barry Reisberg, M.D. Alte rnative s: Mo de rate and Se ve re Stage s ● Give TIME for the person to receive your message and communicate a response ● If no response is given, try the same phrase again ● If this does not help, try to use different words to send the same message 5

9/8/2017 Alte rnative s: Mo de rate Stage s ● Use the sound of your voice (volume, inflection, tone, rhythm) to communicate feelings and be aware that the words are secondary ● Do not ask someone a yes or no question if you don’t want the answer to be “no” ● Keep it very simple , such as “come with me” or “Let’s stand up” Se ve n Stage s o f Alzhe ime r’ s Dise ase * Very Severe Decline Stage 6: Severe Decline ● Notable personality and behavior changes, Severe Dementia Comfort Care • physical changes and inability to perform self ‐ Use gentle, soothing touch care activities • ● Like to touch things, gather things, trouble End of life choices will need to be made • finding right words, trouble using devices, unable to control impulses ● Difficulty with verbal communications, not able to relate to others, losing weight, but may still be able to walk Stage 7: Very Severe Decline ● Final stage, loss of verbal abilities, loss of continence, eating abilities, and responsiveness to environments Reflexive behavior, rocking, flexion, and ● making noises *as developed by Dr. Barry Reisberg, M.D. Alte rnative s: Se ve re Stage s ● Go Slow ! ● Get the person’s attention before beginning any communication ● Use gestures and facial expressions more than words 6