July 7, 2005 Rev/tlt

1. Alzheimer’s and Environmental Strategies for the Consumer with Alzheimer’s DiseasePresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU) July 7, 2005 Rev/tlt

2. Disclaimer Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

3. Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.

4. Objectives • The Participant will be able to: • Identify 3 possible safety hazards in the home • State 3 ways to make the home a safer place • List 2 risk factors that could put the consumer at risk to wander • Understand the concept of Snoezelen Therapy

5. Brief Review of Alzheimer's • Progressive disorder that attacks the brain’s nerve cells • This results in • Loss of memory • Decreased ability to think • Loss of language skills • Behavioral problems • Can affect all senses

6. Alzheimer's and Dementia • Alzheimer's is the most common cause of dementia for those age 65 and up • Dementia • General term used to describe a group of symptoms

7. Some Facts About AD • This is NOT a normal part of aging • Discovered in early 1900s • Affects 4.2-5.8 million Americans • Disease can last 2-20 years • 8th leading cause of death • There are ‘good’ days and ‘bad’ days

8. General Safety Principles • “An ounce of prevention….” • Adapt the environment • Minimize danger

9. Before Making any Adaptations… • Check with agency policy/regulations • Ask the consumer for input-it’s THEIR home • Always think SAFETY! • Remember…every consumer is unique

10. Can the Consumer with AD be Left Alone? • Some things to take into consideration • What is stated in their plan of care/ISP? • Do they easily become confused? • Can they recognize a dangerous situation? • Can they react in an emergency situation? • Does the consumer wander? • Are signs of depression evident?

11. Who is at Risk for Wandering? • Any Consumer Who • Returns from a walk/task later than usual • Disoriented to person, place, time • Tries to “go home” • Is restless and/or paces

12. What Can the Caregivers Do? • Be aware of who is at risk • Try to notice a pattern • Keep the consumer busy • Limit daytime naps • Schedule routine bathroom visits • Have door alarms installed

13. What Else Can the Caregivers Do? • Decrease excessive environmental stimuli • Do not leave consumer alone in a car • Keep recent photo of consumer handy • Make sure the consumer carries a form of ID • Keep pathways clutter-free

14. Did You Know…? • A person who wanders tends to follow the direction of their dominant hand

15. Helpful Resource for Consumers Who Wander “Safe Return” Sponsored by Alzheimer’s Association 1-888-572-8566 Price includes: ID Tag AND Registration into a national database to help locate a person who has wandered

16. Another Helpful Resource for Wandering Wherify Wireless Wristwatch device that contains a global positioning device Once a person is lost, location can be found by staff making a phone call or logging onto the Internet 1-877-LOCATE1

17. Home Adaptations • Outlet covers • Cover fish tanks/aquariums • Lock up poisonous substances • Lower water temperature to prevent scalding • Eliminate throw rugs

18. Home Adaptations (cont’d) • Remove large mirrors • Simplify furniture arrangements • Watch cords/eliminate use of extension cords • Remove low lying furniture

19. Home Adaptations (cont’d) • Bathroom safety • Grab bars • Shower chair • Non-slip surfaces • Contrasting color for toilet and floor • Eliminate distractions • Raised toilet seat

20. Home Adaptations (cont’d) • Contrasting Colors • Doors/Doorways • Walls • Steps • “Caution” colors • Plates/Place mats • Lighting/Noise • Keep environment familiar

21. Home Adaptations (cont’d) • Display emergency information by the phone • Have light switch at top and bottom of steps • Keep night light on • Keep environment “Clutter-Free” • Avoid dark colored rugs

22. Home Adaptations (cont’d) • Monitor smoking • Remove objects that look edible • Unplug appliances when not in use • Make sure refrigerator does not contain spoiled food • Keep thawing food out of consumer’s sight

23. Home Adaptations (cont’d) • Assess for agitating situations • Use pictures on • Cabinets • Bedroom doors • Drawers • Bathroom door

24. Home Adaptations (cont’d) • Use solid colored floor coverings • Be careful if pets are present • Secure sharp objects • Make sure fireplace is secured • Keep candles out of consumer’s reach

25. Yard Adaptations • Remove poisonous plants/bushes with thorns • Construct a walkway in a “Figure 8” pattern • Adequate outside lighting • Consider a “No Soliciting” sign

26. Snoezelen Therapy • “Linked to the Senses” • Based on theory • Persons with AD may suffer from sensory deprivation • Goal • Provide stimulating environment • Must be done under supervision

27. Visual Stimulation SUGGESTIONS • Borders around doors • Outline objects with tape • Holiday lights around door frames • Use of contrasting, bright colors

28. Textures • Textured objects can be glued to a board for the consumer to experience • Textures can include • Sandpaper • Cotton • Silk • Feathers

29. Auditory Stimulation SUGGESTIONS • Music • Find out what the consumer finds soothing • Nature sounds • Sing-A-Longs

30. Olfactory Stimulation • Use of the sense of smell • Use cotton balls dipped in various pleasant aromas • Use of aromatherapy oils • Vanilla • Lavender • Use Mild Scents

31. Making an Inexpensive Snoezelen Room… • Electric tart burner • Lava lamps • “Disco Ball” lamps • Texture board • CD player

32. References • Warner, M. A.I.A., NCARB and Ellen Warner, M.ED. Solutions for Living with Alzheimer's-The Caregiver's Guide to Home Modification. Retrieved 3-31-05 from World Wide Web: http://www.agelessdesign.com/artsolutions2living.htm • Information used from the following HCQU presentations: • “Psychosocial Aspects of AD” • “Alzheimer’s Disease”

33. Local Support Alzheimer’s Association Greater Pennsylvania Chapter Regional Office 100 West Station Square Drive, Suite 500 Pittsburgh, PA 15219 / Phone 412-261-5040 Chapter Helpline: 1-800-272-3900 available 24 hours a day for families dealing with AD & Dementia Greater PA Chapter Website: www.alzpa.org

34. References • Alzheimer's Disease Education & Referral Center. Home Safety for People with Alzheimers Disease. September 2002. Retrieved 3-31-05 from World Wide Web: http://www.alzheimers.org/pubs/homesafety.htm • Senior Link. Home Safety and Dementia. Retrieved 4-1-05 from World Wide Web: http://www.seniorlink.com/articles/A22_N5_DementiaSafety.html

35. References • Alzheimer’s Association. Safe Return. Updated 1-20-05. retrieved 4-1-05 from World Wide Web: http://www.alz.org/Resources/FactSheets/FS_SR_Family%20Caregivers.pdf • Full Circle of Care. Home Safety and Safety Issues. Retrieved 4-1-05 from World Wide Web: http://www.fullcirclecare.org/caregiverissues/general/safety.htm • Virtual House Tour – http://novartis.com./diseases_conditions/en/virtual_house.shtml

36. To register for future trainings,orfor more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com

38. EvaluationPlease take a few moments to complete the evaluation form found in the back of your packets.Thank You!

39. Test Review There will be a test review after all tests have been completed and turned in to the Instructor.