Independence versus Safety in Early Dementia

1. Independence versus Safety in Early Dementia Addressing Independent Activities of Daily Living Virginia C. Oates Feb. 2011 Long Island Alzheimer Coping and Caring Conference

2. Autonomy/IndependenceversusDependence

3. Stage 3 Mild cognitive decline Noticeable problems coming up with right word or name/and introductions Difficulty with performing tasks Misplacing items Trouble with planning Stage 4 Moderate cognitive decline Forget recent events Trouble with mental math Trouble with complex task-paying bills Behavior changes- moody Alzheimer’s Association 2011 Stages of Alzheimer’s disease

4. Objectives • Address competency and skill level for each Independent Activity of Daily Living (IADL) • Identify possible pitfalls/problems with each IADL task • Discuss possible options with intervention with each IADL task • Address safety issues as it applies to IADL’s

5. Independent Activity of Daily Living (IADL) • Managing Finances • Handling investments • Checking accounts • Paying routine bills • Tipping • Credit cards • ATM’s • Cash • Scams

6. IADL-Financial Issues-potential problems • Forges to pay bills • Disregards bank statements • Miscalculations in checkbook • Forgets to turn over CD’s or manage investments • Tipping inappropriately • Making repeated withdrawals from ATM

7. Financial Issues-Strategies for Intervention • Copy of bank statements sent to adult child • Automatic bill paying with online sources • Limit number of bills that individual needs to pay • Leave individual with weekly cash to avoid ATM withdrawals • Involve a bi monthly bookeeper to go to house and pay bills • Divert bills and mail to another family home • Involve an accountant

8. Independent Activity of Daily Living (IADL) • Communication • Mail • Phone use • Articulating problems • Summoning help • Navigating the outside world

9. IADL-Communication Issues-potential problems • Misplaces mail in home- once it has arrived • Forgets familiar phone numbers • Forgets to relate messages • Forgets what has been previously been discussed • Appears to lie/cover up deficits • Wont ask/call for help (multiple reasons)

10. Communication Issues-Strategies for Intervention • Encourage individual to use reminder cues such as calendars, post its • Assist individual in updating phone book • Most frequently called phone numbers on automatic dial or posted next to phone • Encourage the use of a diary • Use of answering machine • Phone message record keeping- next to phone (string note pad to phone, if needed)

11. Independent Activities of Daily Living • Housekeeping • Cleaning • Cooking • Meal planning • Shopping • Food preparation • Cooking • Clean up

12. Independent Activities of Daily Living • Housekeeping • Laundry • Animal Care

13. IADL-Housekeeping Issues-potential problems • Becomes disinterested in housekeeping chores-may not even notice or acknowledge dirt • Forgets to put all needed items into familiar recipe • Difficulties in remembering or learning how to use kitchen appliances • May forget to use dials and settings appropriately on washing machine, etc • Animal care may pose an issue to outside help

14. Housekeeping Issues- Strategies for Intervention • Hire cleaning service or a “familiar” cleaning lady • Arrange for meal deliveries • Use written cues in kitchen to heat food in microwave • Purchase automatic turn off kettle • Assist in weekly shopping or hire helper to escort individual to store (rather than shopping for the individual)

15. Independent Activities of Daily Living • Shopping • Transportation • Navigating the store • Dealing with sales help • Shopping on “sale” • Payment

16. IADL-Shopping Issues-potential problems • Problems handling money within the store • Forgets familiar bus routes • Becomes lost with familiar routes • Repetitive purchases of not needed items • Becomes obstinate with sales help

17. Shopping Issues- Strategies for Intervention • Escort to shop- whenever possible • Avoid problematic stores • Arrange for taxi service- account established with company for local driving (include tips on monthly statement) • Encourage use of shopping list or check off list for needed items

18. IADL- Driving Issues • Driving • Assessing one’s capability to continue driving • Who are assessor’s- family? Professionals? • Liability

19. IADL- Driving Issues-potential problems • Not registering car properly • Not keeping up with insurance payments • Not maintaining car automotively • Getting lost • Driving on challenging roads • Driving out of local area • Driving at night

20. Driving Issues- Strategies for Intervention • Designated family member or significant other to ensure that liability and running of car is taken care of • Driving assessment to be performed professionally- MD to recommend- assist MD in this resource • Escort individual in driving whenever possible • Mobile phone in car (minimal gadgets) • Identification and family contact #’s in glove compartment

21. Independent Activities of Daily Living • Restaurants and Traveling

22. IADL-Restaurant-potential problems • Dealing with restrooms-unable to find restroom • Prolonged period in restroom -? Unsure what is going on in there • Unable to escort individual into bathroom • Inpatient waitstaff • Difficulty in ordering from menu- overwhelmed

23. Restaurants- Strategies for Intervention • Select restaurants with familiar staff • Identify restaurant patron that may be willing to check on individual in restroom • Offer to go to restroom with individual and wait outside door • Allow individual to order their own food-assist in selection

24. IADL-Travel-potential problems • Inpatient/ignorant airline attendants • Frequent trips to bathroom on flight • Locking door on airplane • Missing needed announcements in airport, navigating airport etc. • Irritable with passing through security

25. Travel- Strategies for Intervention • Consider train, bus, car trips if possible to avoid excess problems in airports • Plan a trip to a familiar place, such as a family member’s home • Keep the trip shortened • Sleep in the same room as the individual • Expect that they may waken during the night and need reassurance

26. Independent Activities of Daily Living • Working

27. IADL- Working-potential problems • Unable to fulfill work obligations • Co workers starting to complain • Co workers/ peers make call family of individual • Worker may appear to lose interest in workplace responsibilities- coming home early • More irritable behaviors may be noted

28. Working- Strategies for Intervention • Discuss role in work and determine if work load can be lightened • Shorten work day • Involve assistant or administrative help with the needed information so that he/she can be of help • Determine whether the individual needs to retire • Replace work with another type of volunteer responsibility/activity

29. Independent Activities of Daily Living • Medications

30. IADL-Medications - potential problems • Usually takes medications at the wrong time or totally forgets to take it • Runs out of medications • Repeated use of medications that are “as needed medications,” without keeping time intervals correct • Doesn’t adhere to medication changes made by MD

31. Medication Management- Strategies for Intervention • Offer assistance with automatic refill system set up with local pharmacy or mail away • Determine problem with compliance- for ex. Storage of medications • How does the individual remember to take them- determine routine-may need time/automatic reminder system • Pillbox preparation by significant other, if needed--Pill count if pillbox is refused to assess safety in taking medications

32. Independent Activities of Daily Living • Introducing help into the home • When is it time? • How to do this? • Who can help? Independent Activitie

33. Introducing help into the home • When is it time? Once the need is recognized and accepted by family- NOT BY THE INDIVIDUAL • How to do this? Who can help? Gain support of others (SW, MD,Geriatric Care Manager,organizations that assist with dementia, friends,family) • Include involvement of the individual (whenever possible) • Move slowly but deliberately- despite resistance- cant fail-safety is at stake

34. IADL- Introducing Help into the Home-potential problems • Absolute denial to need • Expect resistance • Fear of strangers in home • How and who will pay-cant afford • If the help comes, they may never leave! • “What will others think if I have help?”

35. Introducing Help- Strategies for Intervention • Brief periods to start • Specific and meaningful chores to do • Individual needs to be seen doing something constructive ex driving, cooking, cleaning • Gradually build up to sufficient goal- may take months

36. Maintaining Independence in IADL’s-Summary • Losing independence means that one has to rely on others for assistance • Involves $ • Involves someone’s TIME • Involves an EMOTIONAL BURDEN on others

37. Maintaining bank accounts for future care Maintain finances from predators Maintain a clean and healthy home Maintain safety while away from home Maintain safe driving Maintain safe management of medications Maintain safe communication so that needs are met Maintain safety while bringing help into one’s home Safety in IADL’s

38. Conclusion • No one wants their independence stripped • Do not do for someone that they can do for themselves • Promote independence- look for ways to make things easier • Maintaining spirit and avoiding depression and despair • Keep the individual mentally and physically active – at all costs! • Keep safety in mind at all times!

39. Reaching out… Reach out and hold a hand lightly until such time that you need to have a firm grip!

40. Autonomy vs. DependenceSafety