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Fundamentals of Dementia Care for Health Facility Personnel.

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Presentation on theme: "Fundamentals of Dementia Care for Health Facility Personnel."— Presentation transcript:

1 Fundamentals of Dementia Care for Health Facility Personnel

2 Funded by: Indiana State Department of Health Co-sponsored by: IAHSAIHCAHOPE

3 Module 1: Understanding Memory Loss In this section, we will cover: Definition of dementia and Alzheimers disease Definition of dementia and Alzheimers disease Stages of the disease and the expectations Stages of the disease and the expectations Current medications and treatments Current medications and treatments

4 What is Dementia? Dementia is a disease process Dementia is a disease process – Progressive decline in cognitive function – Memory loss Over 170 irreversible dementias Over 170 irreversible dementias – HIV, Vascular, Lewy Body, Parkinsons, Alzheimers Some forms are reversible (treatable) Some forms are reversible (treatable) – Thyroid disorders, drug interactions, dehydration

5 Delirium, Depression, and Dementia Delirium Delirium – Acute onset, can be treated – Altered state of consciousness Depression Depression – Gradual onset, can be treated – Look for signs, such as low self-esteem Dementia Dementia – Gradual onset, might be treated – Memory loss and decline in cognitive function

6 Alzheimers Disease Most common form of irreversible dementia Most common form of irreversible dementia – Nearly 70% of all dementias are Alzheimers – Over 4.5 million Americans have Alzheimers – It is estimated that 60% of all nursing home residents have Alzheimers disease Alzheimers is not normal aging Alzheimers is not normal aging – Learning new information make take longer – May be difficult to filter out noise

7 Brain Scan

8 The Diagnostic Process Multidisciplinary approach that is 80- 90% accurate 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 The only way to confirm diagnosis is with an autopsy

9 Stages Early Needs reminders Needs reminders Daily routines difficult Daily routines difficult Concentrati on-ion is difficult Concentrati on-ion is difficult Middle May need hands on care May need hands on care May get lost easily May get lost easily Changes in personality Changes in personality Late Severe confusion Severe confusion Needs hand on care for most personal care Needs hand on care for most personal care May not recognize self or family May not recognize self or family

10 Areas of the Brain Affected Cognition Memory Memory Learning Learning Language Language Praxic Function Praxic Function Abstract thinking Abstract thinking Psycho- motor speed Psycho- motor speedBehavior Communi- cation Communi- cation Safety Safety Personal care deteriorates Personal care deteriorates Lapses in clarity Lapses in clarity Hallucina- tions Hallucina- tions Delusions DelusionsEmotion Disregulated Disregulated Disorganized Disorganized Apathy (loss of energy, willingness) Apathy (loss of energy, willingness) Lability (moods change) Lability (moods change)

11 Medications Cholinesterase Inhibitors Cholinesterase Inhibitors – Cognex – Aricept – Exelon – Reminyl Glutamate Receptors Glutamate Receptors – Namenda

12 Module 2: Person Centered Care In this section, we will cover Understanding person centered care and its characteristics Understanding person centered care and its characteristics Identifying strategies for implementing person centered care Identifying strategies for implementing person centered care Find ways to take care of the professional caregiver Find ways to take care of the professional caregiver

13 Person Centered Care Person centered care is truly putting the PERSON first Person centered care is truly putting the PERSON first Characteristics Characteristics – Behaviors are a desire to communicate – We must maintain and uphold the value of the person – Promote positive health – All action is meaningful

14 Person Centered Care, Cont. Core psychological needs must be met to provide quality care Core psychological needs must be met to provide quality care – Love – Inclusion – Attachment – Identity – Occupation – Comfort

15 Implementing Person Centered Care RecognitionNegotiationCollaboration/Facilitation PlayTimalationCelebration RelaxationValidationHolding

16 Stress! Stress can lead to poor quality care, quality of life, and abuse and neglect Stress can lead to poor quality care, quality of life, and abuse and neglect Signs of stress Signs of stress – Too little or too much sleep, nightmares – Fatigue – Headaches, backaches, joint pain – Diarrhea/constipation – Frequent accidents

17 Module 3: Communication In this section, we will cover: The impact of verbal and non-verbal communication The impact of verbal and non-verbal communication Examine and demonstrate techniques for promoting meaningful communication Examine and demonstrate techniques for promoting meaningful communication Understand the correct use of validation and reality orientation Understand the correct use of validation and reality orientation

18 Verbal and Non-verbal Communication Verbal Tone Tone Pitch Pitch Rate Rate Pause Pause Non-verbal Gestures Gestures Facial expressions Facial expressions Posture Posture Each person is unique Each person is unique Behaviors are a form of communication Behaviors are a form of communication Communication is only 10% verbal Communication is only 10% verbal People with Alzheimers maintain the ability to understand non-verbal long after verbal is forgotten People with Alzheimers maintain the ability to understand non-verbal long after verbal is forgotten

19 Non-verbal Strategies Your mood will be mirrored Your mood will be mirrored Approach from the front Approach from the front Establish eye contact Establish eye contact Speak at eye level Speak at eye level Use gentle touch Use gentle touch Point or demonstrate Point or demonstrate

20 Verbal Strategies Use calm, gentle voice Use calm, gentle voice Call person by name Call person by name Identify yourself Identify yourself Use short, simple sentences Use short, simple sentences Speak slowly and respectfully Speak slowly and respectfully Eliminate distracting noises Eliminate distracting noises Use familiar words Use familiar words Give simple choices Give simple choices Give one instruction at a time Give one instruction at a time Allow time for the person to respond Allow time for the person to respond

21 Validation vs. Reality Validation Become part of the persons reality Become part of the persons reality Acceptance Acceptance Feelings into words Feelings into words Acknowledgement AcknowledgementReality Early stages, only if not upsetting Early stages, only if not upsetting Short explanations Short explanations New information can be frustrating New information can be frustrating Reality becomes based on the past Reality becomes based on the past

22 Therapeutic Fibbing The use of telling fibs or lies in an effort to calm 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 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 Should only be used when absolutely necessary, look for other ways to calm and support, such as redirection

23 Module 4: Understanding Behaviors In this section, we will cover: Understanding of how and why behaviors become challenging Understanding of how and why behaviors become challenging Ways to prevent behaviors Ways to prevent behaviors Techniques for responding to challenging behaviors Techniques for responding to challenging behaviors Emotions a person with dementia is likely to experience Emotions a person with dementia is likely to experience

24 Human Emotions Joy Pleasure, love, happiness, sexuality Anger Rage, hate, displeasure Fear Guilt, shame, anxiety Sadness Misery, grief

25 Respond to Feelings Enter the persons reality Enter the persons reality Look for feelings behind the words Look for feelings behind the words Empathize Empathize Be non-judgmental Be non-judgmental Respect their needs Respect their needs Your emotions will be mirrored Your emotions will be mirrored Communicate comfort, warmth, and praise Communicate comfort, warmth, and praise Smile! Smile! Put the persons feelings into words Put the persons feelings into words Allow for negative feelings Allow for negative feelings

26 Problem Solving Behaviors Task Task – Too complicated, too many steps, not modified, unfamiliar Environment Environment – Too large, too much clutter, excessive stimulation, no clues, poor sensory, unstructured, unfamiliar Physical health Physical health – Medications, impaired vision/hearing, acute illness, chronic illness, dehydration, constipation, depression, fatigue, physical discomfort Miscommunication Miscommunication

27 The 11 Ws Who has the behavior? Who has the behavior? What is the specific behavior? What is the specific behavior? Why does it need to be addressed? Why does it need to be addressed? What happened just before? What happened just before? Where does it occur? Where does it occur? What does the behavior mean? What does the behavior mean? When does the behavior occur? When does the behavior occur? What is the time, frequency? What is the time, frequency? Who is around? Who is around? What is the outcome? What is the outcome? What is the DESIRED change? What is the DESIRED change?

28 Preventing Behaviors Diversion or distraction Removal Redirection Task breakdown Stimulus Control Environmental manipulation Reassurance Setting limits

29 Responding to Behaviors Anxiety/agitation Anxiety/agitation – Response to misinterpretation of environment or people Aggressive reactions Aggressive reactions – Usually directed at caregiver or another person Rummaging Rummaging – Looking for something meaningful Repetitive crying out Repetitive crying out – Unresolved pain or discomfort

30 Module 5: Activities of Daily Living In this section, we will cover: Causes for resistance to ADLs Causes for resistance to ADLs Strategies that promote participation Strategies that promote participation Possible techniques for managing ADLs Possible techniques for managing ADLs Identifying signs of abuse and neglect Identifying signs of abuse and neglect

31 Causes for Resistance Memory loss Memory loss Decreased attention span Decreased attention span Impaired judgment Impaired judgment Loss of ability to communicate Loss of ability to communicate Difficulty with motor skills Difficulty with motor skills

32 Strategies for Participation Anticipate problems or events Anticipate problems or events Provide a routine Provide a routine Establish rapport Establish rapport Talk with a calm voice Talk with a calm voice Do not attempt to use reason or logic Do not attempt to use reason or logic Do not rush Do not rush Avoid arguing Avoid arguing Focus on abilities Focus on abilities

33 Strategies for Participation, Cont Approachknock, announce, privacy Approachknock, announce, privacy Encourage the person to do as much as they can Encourage the person to do as much as they can Praise for small successes Praise for small successes Provide for privacy Provide for privacy Do not keep person waiting Do not keep person waiting Demonstrate what you want done Demonstrate what you want done Stop when frustration occurs Stop when frustration occurs

34 ADL Tips Dressing Dressing – Layout clothes, limit choices, item to stroke Bathing Bathing – Keep routine consistent, privacy, adequate lighting Toileting Toileting – Evaluate! Eating and swallowing Eating and swallowing – Ensure adequate intake, pleasurable experience, independence Sleeping Sleeping – Reassure, speak softly, adequate lighting

35 Module 6: Families In this section, we will cover: Empathizing with feelings that a person with Alzheimers and their families may experience Empathizing with feelings that a person with Alzheimers and their families may experience Identifying and informing families of resources Identifying and informing families of resources Identifying strategies for building a positive relationship with families Identifying strategies for building a positive relationship with families Understanding the unique opportunity for a long term relationship Understanding the unique opportunity for a long term relationship

36 Family Feelings Denial Denial Frustration Frustration Isolation Isolation Guilt Guilt Anger Anger Loss/grief Loss/grief Letting go Letting go

37 Conflict Resolution Denial can be healthy Denial can be healthy Educate in small doses Educate in small doses Do not push to hard Do not push to hard Encourage support groups Encourage support groups Acknowledge Acknowledge Listen Listen Feedback Feedback Privacy Privacy

38 Internal Resources Staff members Staff members Library Library Administrator Administrator Family counsels Family counsels Care plan meetings Care plan meetings

39 Alzheimers Association Helpline Helpline Family Education Family Education Support Groups Support Groups Care Consultation Care Consultation Safe Return Safe Return

40 Strategies for Positive Relationships Show support Show support – Family tours, communication processes – Validate emotions, develop realistic expectations, compliment, report good news Promote successful visits Promote successful visits – Offer suggestions and support – Bring in family videos, pictures – Activities


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