Caring for someone with Alzheimer’s Disease and Dementia

1. Caring for someone with Alzheimer’s Disease and Dementia Michelle Cleary, Ivy Cawley, Laura Chisholm, Mary MacLeod, Leah MacDonnell and Laura MacArthur

2. Two Mothers I had two mothers.. Two mothers I claim Two different people… Yet with the same name Two separate women… Diverse by design But I loved the both Because they were both mine The first was the mother Who carried me here Gave birth and nurtured and Launched my career She was the who features I bear. Complete with the facial expression I wear. She gave me some music which follows me yet . Along with examples in the life that she set: Then as I got older she some younger grew. And we’d laugh as just mothers and daughters do. As quickly she changed and turned to the other A stranger who dressed in the clothes of my mother Oh she looked the same at least at arms length But she was the child now and I was her strength We’d come full circle we women three: My mother the first, the second and me And if my own children should come to a day When a new mother comes and the old goes away I’d ask of them nothing that I didn’t do Love both of your mothers as both have loved you

3. Alzheimers/ Dementia Statistics • 280 000 Canadians suffer with Alzheimer’s Disease • Dementias affect 8% of older Canadians, with an additional 16% having mild cognitive impairment • Risk of dementia increases greatly throughout the senior years, with 1 in 3 people 85 years and older • Women who typically live longer, are much more likely to develop dementia, they accounted for 68% of dementias. • 1- 10% of Alzheimers cases and occur in middle age

4. Dementia • Dementia is a general term that refers to a variety of brain disorders. Physical changes in the brain cause dementia. • Is characterized by an uneven, downward decline in mental function

5. 4 A’s of Dementia AGNOSIA: Inability to recognize common objects APHASIA: impairment of language such as difficulty repeating a phrase or answering a question APRAXIA: inability to carry out motor activities AMNESIA: loss of memory

6. Diagnosis of dementia • At least 2 domains of altered function must exist • Memory loss in at least one of cognitive disturbances • AGNOSIA: Inability to recognize common objects • APHASIA: impairment of language such as difficulty repeating a phrase or answering a question • APRAXIA: inability to carry out motor activities • EXECUTIVE FUNCTIONING: Inability to think abstractly and to be able to plan. Begin, monitor and complete a task

7. Risk Factors for Dementia • Age • Stroke • Hypertension • Alcohol abuse

8. Protective Factors for Dementia • Higher levels of education • Physical Activity - Moderate Alcohol intake

9. Non Reversible Dementias • Alzheimer’s Disease • Vascular Disease (multi infarct) • Mixed Alzheimer’s and Vascular Demetia

10. Vascular Dementia • Defining Characteristics • Evidence of dementia • Evidence of cerebrovascular disease • 2 disorders must be reasonably related

11. Table 12-5 Behaviour Themes Related to the Phenomenon Sundowning

12. Sundowning

13. Alzheimer’s Disease • Chronic progressive and degenerative brain disorder accompanied by profound effects on memory, cognition and ability of self care • Oxidative stress primarily in the hippocampus and neocortex of people with this type of dementia

14. Stages of Alzheimer's Disease • Stage 1 (Mild) - Forgetfulness • - Shows short-term memory loss; loses things, forgets • - Memory aids compensate; lists, routines, organization • - Aware of the problem; concerned about lost abilities • -Depression • Not diagnosable at this time

15. Stage 2 (Moderate) - Confusion • - Shows progressive memory loss; short memory impaired; memory difficulties interferes with all abilities • - Withdrawn from social activities • -Show declines in instrumental activities of daily living, such as money management, housekeeping, cooking... • -Denial; fears losing his or her mind • - Depression increasingly common; frightened because aware of deficits; covers up for memory loss through confabulation • - Problems intensified when stressed, fatigued, out of own environment, ill • - Commonly needs day care or in-home assistance

16. Stage 3 (Moderate to severe) - Ambulatory dementia • - Shows ADL losses in order; willingness and ability to bathe, grooming, choosing clothing, dressing, gait and mobility, toileting, communication, reading and writing skills • -Shows loss of reasoning ability, safety planning and verbal communication • - Frustration common; become more withdrawn and self-absorbed • - Depression resolves as awareness of losses diminishes • -Has difficulty communicating; shows increasing loss of language skills • - Shows evidence of reduced stress threshold; institutional care usually needed

17. Stage 4 (Late) - End stage • - Family recognition disappears; does not recognize self in mirror • -Non- ambulatory; shows little purposeful activity; often mute; may scream spontaneously • - Forgets how to eat, swallow; chew; commonly loses weight; emaciation common • - Has problems associated with immobility e.g. pneumonia, pressure ulcers • - Incontinence common; seizures may develop • -Often in long term care at this time • - Return of primitive (infantile) reflexes

18. Diagnosing - Venereal Disease Research Laboratories (VDRL), HIV virus tests - Serum creatinine assay - Electrolyte assessment - Vitamin B12 level - Liver function tests - Vision and hearing evaluation - Neuroimaging • - Chest and skull radiographic studies • - Electrocardiography • - Urinalysis • - Sequential multiple analyzer 12-test serum profile • - Thyroid function tests • -Folate level

19. Common problems • - Memory impairment • - Disorientation • - Need for physical help • - Risks in the home • - Risks outside the home • - Apathy • - Repetitiveness • - Uncontrolled emotion • - Uncontrolled behaviour • - Incontinence • - Emotional reaction • - Other reactions • - Mistaken beliefs • Decision making • Burden on family

21. Services that may be available to people Dementia and their families • Family/caregiver • Community services • Home care

22. Nursing Management of People with Alzheimer’s Disease and other Dementia • Nursing Interventions are aimed at • maintaining the patients safety, • reducing stress and anxiety and agitation, • improving communication • Promoting independence in self- care activities • Providing for the patients needs for socialization, self esteem and intimacy • Maintaining adequate nutrition • Managing sleep pattern disturbances • Supporting and educating family caregivers

23. Supporting Cognitive Function • Nurses role to provide calm, predictable environment which helps person interpret his or her surroundings and activities • Environment • Stimuli is limited • Regular Rountine Speech • Quiet • Pleasant manner • Clear and Simple Explanation • Use of memory aids and cues

24. Promoting Physical Safety • This allows the patient to move about as freely as possible and relieves the family of constant worry • Nightlights • Hazards for tripping are removed • Intake of food and medication is monitored • Smoking when supervised • Do not use restraints can increase agitation • Doors leading from the house need to be secured • All activities need to be supervised • Person should where ID bracelet or chain incase of getting away from family/ caregiver

25. Reducing Anxiety and Agitation • Constant emotional support • Reinforce a positive self- image • Environment kept uncluttered, familiar and noise free

26. Improving Communication • Remain calm and nonhurried • Reduce noise and distractions • Clear, easy to understand sentences to convey messages • - Always identify yourself and call person by name • - Speak slowly • - Use short, simple words and phrases • - Maintain face-to-face contact • - Be near by the person when talking • - Focus on one piece of information at a time • - Talk with the person about familiar and meaningful things • -Encourage reminiscing about happy times in life • - Have the person wear prescription eyeglasses or hearing aid • - Keep the person's room well lit • - Reinforce person's pictures

27. Promoting Independence in Self Care Activities • Simplify daily activities • Assist Person with activities, allow independence when possible

28. Providing for Socialization and Intimacy Needs • Visits should be short and non- stressful • Pets can often be therapeutic for people • Sexual activity between person and dementia may become difficult and may cause concerns to the spouse.

29. Promoting Adequate Nutrition • One dish or item of food is offered at a time • Food is cut up in small pieces • Fluids may need to be thickened • Diets may need to change to pureed or soft diet • Assist in feeding if necessary • Assess feeding ability independently • Ensure beverages and food are not too hot

30. SUNDOWNING