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Fundamentals of Dementia Care for Health Facility Personnel
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Indiana State Department of Health
Funded by: Indiana State Department of Health Co-sponsored by: IAHSA IHCA HOPE
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Module 1: Understanding Memory Loss
In this section, we will cover: Definition of dementia and Alzheimer’s disease Stages of the disease and the expectations Current medications and treatments
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What is Dementia? Dementia is a disease process
Progressive decline in cognitive function Memory loss Over 170 irreversible dementias HIV, Vascular, Lewy Body, Parkinson’s, Alzheimer’s Some forms are reversible (treatable) Thyroid disorders, drug interactions, dehydration
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Delirium, Depression, and Dementia
Acute onset, can be treated Altered state of consciousness Depression Gradual onset, can be treated Look for signs, such as low self-esteem Dementia Gradual onset, might be treated Memory loss and decline in cognitive function
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Alzheimer’s Disease Most common form of irreversible dementia
Nearly 70% of all dementias are Alzheimer’s Over 4.5 million Americans have Alzheimer’s It is estimated that 60% of all nursing home residents have Alzheimer’s disease Alzheimer’s is not normal aging Learning new information make take longer May be difficult to filter out noise
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Brain Scan
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The Diagnostic Process
Multidisciplinary approach that is 80-90% accurate Brain scan, blood and urine tests, hearing/visual exams Neuropsychological testing and interview with caregivers The only way to confirm diagnosis is with an autopsy
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Stages Middle Early Late May need hands on care May get lost easily
Changes in personality Early Needs reminders Daily routines difficult Concentration-ion is difficult Late Severe confusion Needs hand on care for most personal care May not recognize self or family
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Areas of the Brain Affected
Cognition Memory Learning Language Praxic Function Abstract thinking Psycho-motor speed Behavior Communi-cation Safety Personal care deteriorates Lapses in clarity Hallucina-tions Delusions Emotion Disregulated Disorganized Apathy (loss of energy, willingness) Lability (moods change)
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Medications Cholinesterase Inhibitors Glutamate Receptors Namenda
Cognex Aricept Exelon Reminyl Glutamate Receptors Namenda
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Module 2: Person Centered Care
In this section, we will cover Understanding person centered care and its characteristics Identifying strategies for implementing person centered care Find ways to take care of the professional caregiver
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Person Centered Care Person centered care is truly putting the PERSON first Characteristics Behaviors are a desire to communicate We must maintain and uphold the value of the person Promote positive health All action is meaningful
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Person Centered Care, Cont.
Core psychological needs must be met to provide quality care Love Inclusion Attachment Identity Occupation Comfort
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Implementing Person Centered Care
Recognition Negotiation Collaboration/ Facilitation Play Timalation Celebration Relaxation Validation Holding
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Stress! Stress can lead to poor quality care, quality of life, and abuse and neglect Signs of stress Too little or too much sleep, nightmares Fatigue Headaches, backaches, joint pain Diarrhea/constipation Frequent accidents
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Module 3: Communication
In this section, we will cover: The impact of verbal and non-verbal communication Examine and demonstrate techniques for promoting meaningful communication Understand the correct use of validation and reality orientation
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Verbal and Non-verbal Communication
Each person is unique Behaviors are a form of communication Communication is only 10% verbal People with Alzheimer’s maintain the ability to understand non-verbal long after verbal is forgotten Non-verbal Gestures Facial expressions Posture Verbal Tone Pitch Rate Pause
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Non-verbal Strategies
Your mood will be mirrored Approach from the front Establish eye contact Speak at eye level Use gentle touch Point or demonstrate
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Verbal Strategies Use calm, gentle voice Call person by name
Identify yourself Use short, simple sentences Speak slowly and respectfully Eliminate distracting noises Use familiar words Give simple choices Give one instruction at a time Allow time for the person to respond
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Validation vs. Reality Validation Reality
Become part of the person’s reality Acceptance Feelings into words Acknowledgement Reality Early stages, only if not upsetting Short explanations New information can be frustrating Reality becomes based on the past
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Therapeutic Fibbing The use of telling fibs or lies in an effort to calm We are never sure how much information a person may be able to process or remember Should only be used when absolutely necessary, look for other ways to calm and support, such as redirection
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Module 4: Understanding Behaviors
In this section, we will cover: Understanding of how and why behaviors become challenging Ways to prevent behaviors Techniques for responding to challenging behaviors Emotions a person with dementia is likely to experience
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Pleasure, love, happiness, sexuality
Human Emotions Joy Pleasure, love, happiness, sexuality Anger Rage, hate, displeasure Fear Guilt, shame, anxiety Sadness Misery, grief
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Respond to Feelings Enter the person’s reality
Look for feelings behind the words Empathize Be non-judgmental Respect their needs Your emotions will be mirrored Communicate comfort, warmth, and praise Smile! Put the person’s feelings into words Allow for negative feelings
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Problem Solving Behaviors
Task Too complicated, too many steps, not modified, unfamiliar Environment Too large, too much clutter, excessive stimulation, no clues, poor sensory, unstructured, unfamiliar Physical health Medications, impaired vision/hearing, acute illness, chronic illness, dehydration, constipation, depression, fatigue, physical discomfort Miscommunication
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The 11 W’s Who has the behavior? What is the specific behavior?
Why does it need to be addressed? What happened just before? Where does it occur? What does the behavior mean? When does the behavior occur? What is the time, frequency? Who is around? What is the outcome? What is the DESIRED change?
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Diversion or distraction Environmental manipulation
Preventing Behaviors Diversion or distraction Removal Redirection Task breakdown Stimulus Control Environmental manipulation Reassurance Setting limits
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Responding to Behaviors
Anxiety/agitation Response to misinterpretation of environment or people Aggressive reactions Usually directed at caregiver or another person Rummaging Looking for something meaningful Repetitive crying out Unresolved pain or discomfort
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Module 5: Activities of Daily Living
In this section, we will cover: Causes for resistance to ADL’s Strategies that promote participation Possible techniques for managing ADL’s Identifying signs of abuse and neglect
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Causes for Resistance Memory loss Decreased attention span
Impaired judgment Loss of ability to communicate Difficulty with motor skills
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Strategies for Participation
Anticipate problems or events Provide a routine Establish rapport Talk with a calm voice Do not attempt to use reason or logic Do not rush Avoid arguing Focus on abilities
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Strategies for Participation, Cont
Approach—knock, announce, privacy Encourage the person to do as much as they can Praise for small successes Provide for privacy Do not keep person waiting Demonstrate what you want done Stop when frustration occurs
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ADL Tips Dressing Bathing Toileting Eating and swallowing Sleeping
Layout clothes, limit choices, item to stroke Bathing Keep routine consistent, privacy, adequate lighting Toileting Evaluate! Eating and swallowing Ensure adequate intake, pleasurable experience, independence Sleeping Reassure, speak softly, adequate lighting
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Module 6: Families In this section, we will cover:
Empathizing with feelings that a person with Alzheimer’s and their families may experience Identifying and informing families of resources Identifying strategies for building a positive relationship with families Understanding the unique opportunity for a long term relationship
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Family Feelings Denial Frustration Isolation Guilt Anger Loss/grief
Letting go
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Conflict Resolution Denial can be healthy Educate in small doses
Do not push to hard Encourage support groups Acknowledge Listen Feedback Privacy
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Internal Resources Staff members Library Administrator Family counsels
Care plan meetings
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Alzheimer’s Association
Helpline Family Education Support Groups Care Consultation Safe Return
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Strategies for Positive Relationships
Show support Family tours, communication processes Validate emotions, develop realistic expectations, compliment, report good news Promote successful visits Offer suggestions and support Bring in family videos, pictures Activities
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