Fundamentals of Dementia Care for Health Facility Personnel

1. Fundamentals of Dementia Care for Health Facility Personnel

2. Funded by: Indiana State Department of Health Co-sponsored by: IAHSA IHCA HOPE

3. 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

4. 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

5. Delirium, Depression, and Dementia • Delirium • 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

6. 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

7. Brain Scan

8. 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

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

10. 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)

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

12. 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

13. 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

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

15. Implementing Person Centered Care

16. 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

17. 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

18. Verbal Tone Pitch Rate Pause Non-verbal Gestures Facial expressions Posture 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

19. 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

20. 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

21. Validation 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 Validation vs. Reality

22. 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

23. 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

24. Human Emotions

25. 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

26. 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

27. 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?

28. Preventing Behaviors

29. 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

30. 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

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

32. 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

33. 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

34. ADL Tips • Dressing • 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

35. 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

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

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

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

39. Alzheimer’s Association • Helpline • Family Education • Support Groups • Care Consultation • Safe Return

40. 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