CREATING MEANING FOR PEOPLE WITH ADVANCED DEMENTIA: Stimulation of Senses. Maribeth Gallagher, DNP, Psych NP Hospice of the Valley

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1 CREATING MEANING FOR PEOPLE WITH ADVANCED DEMENTIA: Stimulation of Senses Maribeth Gallagher, DNP, Psych NP Hospice of the Valley Learning Objectives: Discuss the importance of sensory stimulation in persons with advanced dementia Demonstrate one intervention that can be used for each of the five senses Describe favorable responses following sensory stimulation for the person with advanced dementia DISCLOSURE OF COMMERCIAL SUPPORT Maribeth Gallagher, DNP, Psych NP does not have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and /or provider(s) of commercial services discussed in this presentation. 1

2 Creating Meaning for Persons with Advanced Dementia: Stimulation of Senses Maribeth Gallagher, DNP, Psych NP - BC Dementia Program Director Hospice of the Valley mgallagher@hov.org Learning Objectives: 1. Discuss the importance of sensory stimulation in persons with advanced dementia 2.Demonstrate one intervention that can be used for each of the 5 senses. 3. Describe favorable patient responses following sensory stimulation. Importance of Sensory Stimulation Increased risk of sensory deprivation due to: Deterioration of the senses with aging Diminished self-initiated engagement w/pleasures Lack of stimulation negative outcomes (agitation, anxiety, isolation, boredom) (Cohen-Mansfield, 2001;Cohen-Mansfield et al, 2006; Takeda et al, 2012) 2

3 Consider Environmental Stressors Over-stimulation Yelling from other residents, loud TV, bed alarms, glare, clutter Unpleasant stimulation Noises from pill crushers & PA system, unpleasant odors, soiled brief Lack of personally meaningful stimulation Institutions lack touches of home Absence of nurturing touch Bland food with unappealing color and texture (Cohen-Mansfield, 2001;Cohen-Mansfield et al, 2006; Takeda et al, 2012) Every interaction is an opportunity to affirm personhood & enhance quality of life. (Kitwood, 1997; Takeda et al., 2012) How do we individualize the SOS (Stimulation of Senses) approach? 3

4 24th Annual Fall Symposium The New Era of Alzheimer s Disease Arizona Geriatrics Society About Me Form To provide excellent care, we must Know the Person (Dougherty, Gallagher, Cabral, Long & McLean, 2007) Olfactory cues Familiar & Pleasant Scents Citrus essential oils and spray (energizing) Lavender essential oil and spray (calming) Responses to aromas vary. Explore personal favorites-vanilla, cinnamon, Old Spice, White Shoulders, rosemary, basil, baby oil, flowers, etc. 4

5 24th Annual Fall Symposium The New Era of Alzheimer s Disease Arizona Geriatrics Society Tactile Cues Combined with Pleasurable Experiences Human touch is a basic need, but most of the touch is related to bodily needs. Holding the hand can communicate love, warmth and safety. A gentle hand or foot massage can create a unique connection. Use in conjunction with conversation, music/singing, direct eye contact, smiling or simply by itself. Visual cues Mrs. T teaches us a lesson 5

6 24th Annual Fall Symposium The New Era of Alzheimer s Disease Visual Cues Arizona Geriatrics Society Visual cues can help recall memories of treasured experiences. The shared viewing of a book or photos can create a sense of joy, humor warmth and love. The Sunshine on My Face: A Read-Aloud Book for Memory-Challenged Adults (Burdick, 2004) Auditory Cues Music & Sounds of Nature Select songs with pleasant memories heard repeatedly over a lifetime. Focus on conveying comfort and tenderness. NO EXCUSES Success does not depend on the quality of your singing voice. (Gerdner, 2005) Taste Cues & Oral Stimulation Food continues to be enjoyed until the last days of life IF it provides pleasure and comfort for the PWD. Taste and texture are important considerations. Soft and sweet are usually preferred comfort foods (ice cream, shakes, yogurt, bananas, applesauce, peanut butter and jelly, potatoes and gravy). mashed 6

7 24th Annual Fall Symposium The New Era of Alzheimer s Disease Arizona Geriatrics Society Tactile and Kinesthetic Cues Tactile stimulation Squishy balls Baseball mitt Fabrics Stuffed animals Baby Dolls Kinesthetic stimulation Bubbles, balloons and inflatable beach balls provide motion cues and help raise the person s awareness of environment. Dr. Boo Boo to the rescue Cues for spiritual connections Explore which sensory approaches support and honor the person s spiritual preferences: The sights, sounds & smells of nature via fresh flowers or going outdoors can touch the soul. Smelling incense or candles can assist to sense the presence of God. 7

8 The sounds of short favorite passages from a book of faith or favorite sacred songs can bring comfort and awareness of the Divine. Touching & looking at religious symbols (rosary beads, prayer shawl, holy pictures) Preparation for the SOS Experience: Schedule for the person s best time of day. Be flexible. Create a calm, uninterrupted environment (turn off TV & radio) Assess & provide for any unmet needs that may cause distraction (pain, hunger, thirst, toileting, change of position, etc.) Use sensory aids as needed (glasses, hearing aids, etc.) Conducting the SOS Session Consult the About Me to customize sensory approaches for each person Baseline Assessment facial expressions, body language, muscle tension Determine goal: Stimulate? Calm? Connect? Gently encourage responses to the sensory activities Frequently reassess responses & stop if any negative effects are noted. 8

9 Key Points for Success Target lifelong preferences and pleasures (Consult the About Me ) Provide one-to-one attention Length of intervention is determined by person s ability to comfortably tolerate and pay attention (usually 5-10 minutes for PWAD) Examples CNAs report with bath/shower care: Decreased aggressive self-protective behaviors Increased positive interactions & verbalization Improved participation in self-care and social behaviors Family and Friends Visits Visitors report PWD is more alert and engages in more meaningful exchanges Frequent falling - Capt. Tommy Pacing/clinging to others - Walt s romantic rendezvous Aggressive/self-protective bxs - Nurse Margaret & her babies Emotional lability- Gail and lollipops Sensory Experiences & YOU Mental Floss Sensory experiences can be used to: Relax Increase energy Alter moods Express emotion Connect with Spiritual Source Time to play and experiment.. 9

10 Thank you. References Burdick, L. (2004). The Sunshine on My Face: A Read-Aloud Book for Memory-Challenged Adults. Health Professions Press Cohen-Mansfield J. Libin A. Marx M. (2006). Nonpharmacological Treatment of Agitation: A Controlled Trial of Systematic Individualized Intervention. Journals of Gerontology, 62 (8) Cohen-Mansfield, J, Marx M, Rosenthal A. (1990). Dementia and Agitation in Nursing Home Residents: How Are They Related? Psychology & Aging, 5(1), 3-8 Dougherty J, Gallagher M, Cabral D, Long CO, McLean A. (2007). About me: Knowing the person with advanced dementia. Alzheimer s Care Quarterly; 8(1): Gerdner LA. (2005). Use of individualized music by trained staff and family: translating research into practice. J Gerontol Nurs Jun;31(6):22-30 Kitwood, T.M. Dementia Reconsidered: The Person Comes First. (1997) University PressTakeda M, Tanaka T, Okochi M, Kazui H. (2012) Nonpharmacological intervention for dementia patients. Psych & Clin Neurosciences; 66: 1 7 Takeda M, Tanaka T, Okochi M, Kazui H. (2012)Non-pharmacological intervention for dementia patients.psych & Clin Neurosciences; 66: