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

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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.

• 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.)

De me ntia Sympto ms

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 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……

Main T ype s o f De me ntia

• 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

Alzheimer ’s type Dementia and the Br ain

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

De me ntia Pro gre ssio n in Stage s

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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 *

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 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 *

Mild Dementia

Mild Decline

• Assist with reminders
• Accept excuses as valid
• Celebrate abilities to use coping

mechanisms

• Cognitive Impairment will worsen

when tired, in pain, stressed, hungry, etc.

• Needs extra time to process and make

decisions (Be Patient!) Stage 4: Moderate Decline

• Help from others is needed, but can still perform

many activities independently

• Can still do personal care tasks, 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 and activities

• Difficulty with following all of the steps to

complete tasks, likes to be busy but not sure what to do, embarrassed about cognitive losses

*as developed by Dr. Barry Reisberg, M.D.

Se ve n Stage s o f Alzhe ime r’ s Dise ase *

Moderate Dementia

Moderate Decline

• Behavior can shift dramatically
• Personal preferences, likes/dislikes

will become more intense

• Respects authority figures
• Celebrate individuality
• Respect choices and routines
• Honor irritability as a symptom of

being aware of cognitive decline

• Do not quiz
• Offer information, needs

repetition

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• 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?”

T ips: Mo de rate Stage s

Stage 4: Moderate Decline

• Help from others is needed, but can still perform many

activities independently

• Can still do personal care tasks, 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 and activities

• Difficulty with following all of the steps to

complete tasks, likes to be busy but not sure what to do, embarrassed about cognitive losses *as developed by Dr. Barry Reisberg, M.D.

Se ve n Stage s o f Alzhe ime r’ s Dise ase *

Moderate Dementia

Moderately Severe

• Needs structured routine, step‐by‐step cuing
• Cannot make new short‐term memories
• Limited awareness of decreased abilities
• Uses vague words as communication skills are

diminishing, language skills are being lost

• Emotionally, very difficult stage for the person

with dementia; strong emotional reactions are normal ‐Be aware of signs of depression and/or anxiety

• Celebrate long‐term memories
• Join the reality of the person, apologize and

allow blame, help solve her problems (in her reality)

• 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

T ips: Mo de rate Stage s

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• Call the person by the name he or she

relates to

• Approach from the front, provide facial

expressions and use a direct, friendly tone

• f voice
• Make eye contact before communicating

Alte rnative s: Mo de rate Stage s

Stage 6: Severe Decline

• Notable personality and behavior changes,

physical changes and 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 *as developed by Dr. Barry Reisberg, M.D.

Se ve n Stage s o f Alzhe ime r’ s Dise ase *

Severe Dementia

Severe Decline

• Many changes will be made in abilities during this

stage

• Seeks to satisfy desires, limited social skills so

crosses boundaries, avoids what is disliked

• Very limited ability to communicate or understand

communication or cues in the environment

• Can copy gestures, large motions, struggles to

understand gestures as a form of communication

• Use music, rhythm, singing
• Provide moments of joy
• Limit expectations
• 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

Alte rnative s: Mo de rate and Se ve re Stage s

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• 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”

Alte rnative s: Mo de rate Stage s

Stage 6: Severe Decline

• Notable personality and behavior changes,

physical changes and 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 *as developed by Dr. Barry Reisberg, M.D.

Se ve n Stage s o f Alzhe ime r’ s Dise ase *

Severe Dementia

Very Severe Decline

• Comfort Care
• Use gentle, soothing touch
• End of life choices will need to be made
• Go Slow!
• Get the person’s attention before

beginning any communication

• Use gestures and facial expressions

more than words

Alte rnative s: Se ve re Stage s

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• Accuse someone
• Dress inappropriately
• Want to leave
• Go to the bathroom
• Refuse to bathe
• Refuse to take medications
• Touch others or self
• Say inappropriate things

Be havio r I nte rve ntio ns

So What?

• Dementia behaviors are coping behaviors
• Analyze the behavior and try to “become a

detective” in figuring out what the reason for the behavior

• Then help the person with dementia to solve

the problem

• The person with dementia cannot learn new

things or use judgment and reasoning to change the behavior

Abo ut De me ntia Be havio rs

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Re fle c t o n Change s to the Brain

• The person cannot try harder
• The person cannot purposefully change

behaviors

• The person is doing the best she can
• We must make accommodations for the

brain deterioration

• It’s not easy!
• Take care of YOURSELF

Remember the Symptoms: Problems with memory, thinking/attention, planning/problem solving, Difficulty with communication, changes in personality/behaviors and problems with spatial awareness