Today s training is supported by the Nevada Aging and Disability Services Division

Transcription

1 Today s training is supported by the Nevada Aging and Disability Services Division Nevada Geriatric Education Center Dementia, Alzheimer s Disease and Memory Loss: A comprehensive guide for family caregivers Dolores M. Ward, M.S. Education Coordinator, NGEC Certified Gerontologist 1

2 Learning Objectives Identify key factors of Alzheimer s disease (AD) and other forms of dementia Discuss best practices and positive approaches in understanding and accessing disruptive behaviors Demonstrate techniques for personal care and hygiene Learning Objectives Apply strategies for keeping the person with the disease actively engaged Describe various intervention approaches to improving caregiver burden, depression and quality of life 2

3 10 Warning Signs Memory changes that disrupts daily life Challenges in planning or solving problems Difficulty completing familiar tasks at home, at work or at leisure Confusion with time or place Trouble understanding visual images and spatial relationships [Know the 10 Warning Signs]. (n.d.). Retrieved from 10 Warning Signs New problems with words in speaking or writing Misplacing things and losing the ability to retrace steps Decreased or poor judgement Withdrawal from work or social activities Changes in mood and personality [Know the 10 Warning Signs]. (n.d.). Retrieved from 3

4 What is Dementia? Understanding Dementia 4

5 What is Dementia? Loss of cognitive functioning severe enough to interfere with activities of daily living Is NOT a diagnosis Causes changes in Memory Language Thought Behavior Mood [Dementia Definition]. (n.d.). Retrieved from Vascular Dementia Second most common type of dementia Occurs as a result of brain damage due to reduced blood flow to the brain 5

6 Lewy Body Dementia Parkinsonism Pronounced variation in attention and alertness Recurrent visual hallucinations Frontotemporal Dementia (FTD) Sometimes known as Pick s disease Affects the frontal and temporal lobes of the brain Occurs at a younger age Progresses more quickly than AD 6

7 Rare Forms of Dementia Other types of dementias include: Creutzfeldt-Jakob disease Huntington s disease Parkinson s disease Wernicke-Korsakoff syndrome [Diseases and Conditions-Dementia]. (n.d.). Retrieved from Alzheimer s Disease (AD) 7

8 What is Alzheimer s Disease A progressive, degenerative disease of the brain Is the most common form of dementia 6 th leading cause of death in the U.S. Has no cure Is eventually fatal Dementia-like conditions that may be reversed Brain disease Delirium Depression Eye and Ear Impairments Infections Metabolic or Endocrine Disorders Malnutrition Medication 8

9 Stages of AD The seven stage Global Deterioration Scale: Stage 1 No impairment Stage 2 Minimal Impairment/Normal Forgetfulness Stage 3 Early Confusional/Mild Cognitive Impairment Stage 4 Late Confusional/Mild Alzheimer s Stage 5 Early Dementia/Moderate AD Stage 6 Middle Dementia/Moderately Severe AD Stage 7 Late or Severe Dementia and Failure to Thrive [Diseases and Conditions-Dementia]. (n.d.). Retrieved from Understanding and Responding to Behavioral Symptoms in Dementia 9

10 New vs. Old Culture of Dementia Care New vs. Old Culture of Dementia Care 10

11 New vs. Old Culture of Dementia Care New vs. Old Culture of Dementia Care 11

12 A-B-C Approach to Dementia Care Prevention is the Best Medicine! Remember to: Identify the individuals who are at risk Learn to recognize behaviors Intervene early to defuse the situation Create a comfortable environment A-B-C Approach to Dementia Care A is for Antecedent: the events or factors that PRECEDE the behavioral symptom and contribute to its occurrence are also called triggers because they set off behaviors 12

13 A-B-C Approach to Dementia Care B is for Behaviors the specific behavioral symptom that is of concern looking at ONE behavioral symptom at a time in the problem-solving and care-planning process A-B-C Approach to Dementia Care C is for Consequences all the things that happen AFTER the behavior occurs that includes all the reactions and responses to the person, including those by other residents, family, visitors, volunteers, AND staff caregivers 13

14 Assessment: Checking it Out! Prevention requires that caregivers know the PERSON and the SITUATION well Think like a detective! Get all the facts: Observe Listen Identify Ask Assessment: Checking it Out! STOP and QUESTION the behavior Look for clues about WHAT is going on and WHY LISTEN and TALK to others to get the WHOLE picture Get EVERYONE involved in assessment 14

15 Describe the BEHAVIOR in detail What is the real concern? What is the person with dementia (PWD) doing? Where is it happening? How often does it happen? Does it seem to get worse over time? Who is it really a problem for? Is the behavior safe? Is it dangerous? Identify possible ANTECEDENTS and TRIGGERS Where does the behavior occur? What else is going on around the person? Who is there? What are they doing? What is going on in the environment? Did someone say or do something to the PWD? Does it happen at a certain time of day? What might be going on inside the PWD? 15

16 Describe REACTIONS and RESPONSES What happens after the behavior occurs? Who responds? What is said (in words and nonverbally) What does the PWD do next? What might be said or done to comfort, reassure or redirect the person? Are automatic reactions making it worse instead of better? Common Unhelpful Automatic Reactions Avoiding or ignoring the PWD Becoming defensive Being indifferent, cold or silent Slow to respond to their calls and requests Blaming the PWD, thinking that he or she is doing it on purpose Trying to correct the PWD Rationalizing, Arguing, Reasoning, Explaining Threatening with facial expressions, gestures or tone of voice 16

17 Interventions: Managing and Modifying Set BEHAVIORAL Goals Can you eliminate the behavior? Or decrease the frequency? Do you need to adjust your expectations? What do you REALLY want the PWD to do? Is that goal realistic? Is it specific enough to know when it s been reached? 17

18 Change the ANTECEDENT and TRIGGERS Which antecedent can be eliminated or changed? What new cues can you add? For example: Does the person need a rest period to avoid sundown in the afternoon? Should they be allowed to eat in their room to avoid the noise and confusions of the dining room? Change the CONSEQUENCES and REACTIONS Which automatic reactions can be eliminated? What are some new, neutral or positive responses? For example: Speak in simple, easy to understand language Give one command or ask one question at a time Wait for a response and listen carefully for meaning Don t try to reason with them Monitor your tone of voice, facial expressions and body language 18

19 Change the CONSEQUENCES and REACTIONS Reduce environmental stress Remove unnecessary people, turn off the TV, etc. Move to a quite place Lighting (e.g. is it too dark, bright?) Don t confront or challenge delusions or hallucinations Distract them to some other activity or topic Reassure them that they are safe with you Change the CONSEQUENCES and REACTIONS Check for internal stressors that may be contributing Are they hungry? Are they thirsty? Do they have to use the restroom? Are they cold, hot? Are they not feeling well? In pain? Symptoms of a UTI? 19

20 EVALUTE Did your plan work? Why or why not? What got in the way? What made the difference? What can be done differently? Personal Care and Hygiene 20

21 Personal Care Changes during each stage of AD At the early stage the person may: forget about personal care tasks lose interest in bathing forget which tap is for hot or cold water forget they had their hair combed and ask for it to be combed again ask repeatedly why they have to get dressed [Personal Care]. (n.d.). Retrieved from Personal Care Changes during each stage of AD At the middle stage, the person may: have trouble remembering they need to take care of themselves forget how to use personal care/grooming objects not know how to bathe and where to start feel fear of water or drowning feel embarrassed or humiliated may hide grooming items [Personal Care]. (n.d.). Retrieved from 21

22 Personal Care Changes during each stage of AD At the last stage, the person may: experience increased mental and physical deterioration need help with all aspects of care [Personal Care]. (n.d.). Retrieved from Strategies for Caregivers Learn about the disease Know the PWD Be mindful of the PWD s cognitive impairment Respect PWD s privacy and dignity Be flexible Keep things simple Establish a routine Reassure, encourage and be positive [Personal Care]. (n.d.). Retrieved from 22

23 Oral Care Remind the person to brush twice a day Give step by step instructions or hands-on guidance/gestures Try fluoride swabs if the toothbrush is refused Be prepared for the PWD to hide their dentures Remove dentures at bedtime If the PWD develops dry mouth, try sugarless candies or gum [Personal Care]. (n.d.). Retrieved from Hair Care Choose a hairstyle that is easy to care for Encourage the person to comb their own hair Use non-stinging baby shampoo Try a dry shampoo if washing their hair is difficult Try a scalp massage when washing A salon or barbershop can be a familiar and relaxed setting [Personal Care]. (n.d.). Retrieved from 23

24 Foot Care Check the person s feet on a regular basis Check nail length After bathing, make sure skin between the toes is clean and dry Give a foot massage A little of nail polish always brings about a smile [Personal Care]. (n.d.). Retrieved from Toileting Help the PWD: identify where the toilet is make their way easily to the toilet identify and use the toilet, making sure the toilet is easier for people with mobility problems undo, remove and replace clothing easily If necessary, the use of commode may be useful Be cautious of locks on doors [Managing toilet problems and incontinence]. (n.d.). Retrieved from file:///c:/users/dmward/downloads/managing_toilet_problems_and_incontinence_factsheet.pdf 24

25 Bathing Person-centered discussions Respect the PWD s privacy and modesty Remove or cover mirrors Keep bathroom neat and avoid excess objects Ensure good lighting Use colored rubber bath mat to judge the depth of water Check temperature of the room and water Ryden et al. & Beck et al. cited by Sloane et al. (2004) Dementia & Agitation in Nursing Home Residents: How are they related? Psychology and Aging 5(1), 3-8 Personal Care Studies Cognitive impairment and activity of daily living (ADL) impairment were strongly related to agitated behavior aggressive behaviors correlated positively with ADL impairment. Cohen-Mansfield, Marx & Rosenthal (1990). Dementia & Agitation in Nursing Home Residents: How are they related? Psychology and Aging 5 (1), 3-8 Aggressive behaviors during personal care reported By 65% of community caregivers By 86% of staff in nursing homes Ryden et al. & Beck et al. cited by Sloane et al. (2004) 25

26 What are the implications? Assistance with personal care may elicit agitation or aggressive behaviors Person may feel humiliated, frustrated, etc. Person may not recognize the need for help Care partners (staff or family) frustration an impatience may increase Ryden et al. & Beck et al. cited by Sloane et al. (2004) Why is this important? Help caregivers understand the link between assistance with ADLs and increased agitation Teach ways of decreasing possible agitation during ADL care Ryden et al. & Beck et al. cited by Sloane et al. (2004) 26

27 Bathing Study Evidence-based intervention study by Sloane et al. (2004) Compared person-centered bathing, no rinse towel bed bath, and control groups 69 NH residents with dementia and agitation/aggression during bathing Bed bath group = 60% decrease in behaviors Ryden et al. & Beck et al. cited by Sloane et al. (2004) Person-centered bathing Focus on person rather than task Relationship building Choices provided Person kept partially covered Modifying temperature of room and shower spray Using distractions (music, food) Using products familiar to the PWD Ryden et al. & Beck et al. cited by Sloane et al. (2004) 27

28 No-rinse towel bed bath Individuals bathed in bed with warm no-rinse soap towels Remain partially covered at all times Staff training in person-centered bathing techniques Ryden et al. & Beck et al. cited by Sloane et al. (2004) Activities for Persons with Dementia 28

29 Benefits of Activities Improves one s quality of life and sense of wellbeing Can lessen agitation an depression Helps maintain motor skills Provides a sense of autonomy and independence for the PWD Keeps the PWD stimulated and engaged Relieves caregiver, family member, staff member frustration 10 Quick Tips for Activities at Home Be flexible and patient Encourage involvement in daily life Avoid correcting the person Help the person remain as independent as possible Offer opportunities for choice [Activities at home]. (n.d.). Retrieved from 29

30 10 Quick Tips for Activities at Home Simplify instructions Establish a familiar routine Response to the person s feelings Simplify, structure and supervise Provide encouragement and support [Activities at home]. (n.d.). Retrieved from Things to do Listen to music Bake cookies Look at photos Reminisce Water house plants Put a simple puzzle together [Activities at home]. (n.d.). Retrieved from 30

31 Take Care of Yourself What is Respite Care Respite care: provides the caregivers a temporary break from caregiving can be provided through community or private organizations can be provided at home or care setting can be provided by a friend, family member, volunteer [Respite Care]. (n.d.). Retrieved from 31

32 Types of Respite Care Services [Respite Care]. (n.d.). Retrieved from 10 Common Signs of Caregiver Stress Denial Anger Social Withdrawal Anxiety Depression Exhaustion Sleeplessness Irritability Lack of Concentration Health Problems [Take Care of Yourself]. (n.d.). Retrieved from 32

33 10 Ways to Manage Caregiver Stress Find time for yourself Know what community resources are available Become an educated caregiver Get help and find support Take care of yourself [Take Care of Yourself]. (n.d.). Retrieved from 10 Ways to Manage Caregiver Stress Manage your level of stress Accept changes as they occur Make legal and financial plans Know you re doing your best Visit your doctor regularly [Take Care of Yourself]. (n.d.). Retrieved from 33

34 References [Activities at home]. (n.d.). Retrieved from Barrick et al. (2008) Bathing without a Battle. Spring Publishing [Dementia Definition]. (n.d.). Retrieved from [Diseases and Conditions-Dementia]. (n.d.). Retrieved from [Know the 10 Warning Signs]. (n.d.). Retrieved from References [Managing toilet problems and incontinence]. (n.d.). Retrieved from file:///c:/users/dmward/downloads/managing_toilet_pro blems_and_incontinence_factsheet.pdf [Personal Care]. (n.d.). Retrieved from s-day-to-day/day_to_day_personal_care_e.pdf Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993). Acting Up and Acting Out: Assessment and Management of Aggressive and Acting Out Behaviors, "The Geriatric Mental Health Training Series, for the Hartford Center of Geriatric Nursing Excellence, College of Nursing, University of Iowa. 34

35 References [Respite Care]. (n.d.). Retrieved from Ryden et al. & Beck et al. cited by Sloane et al. (2004) Dementia & Agitation in Nursing Home Residents: How are they related? Psychology and Aging 5(1), 3-8 [Stages of Alzheimer s Disease]. (n.d.). Retrieved from s.pdf [Take Care of Yourself]. (n.d.). Retrieved from iverstress.pdf THANK YOU! 35