Managing Behaviors: Start with Yourself!

Transcription

1 Slide 1 Managing Behaviors: Start with Yourself! Teepa Snow, Positive Approach, LLC to be reused only with permission. Slide 2 Time Out Signal copyright - Positive Approach, LLC 2012 Slide 3 REALIZE It Takes TWO to Tango or tangle

2 Slide 4 Being right doesn t necessarily translate into a good outcome for both of you Slide 5 It s the relationship that is MOST critical NOT the outcome of one encounter Slide 6 As part of the disease people with dementia tend to develop typical patterns of speech, behavior, and routines. These people will also have skills and abilities that are lost while others are retained or preserved.

3 Slide 7 Dementia What is it really? AND How can we help? Slide 8 NORMAL Aging What is it NOT Slower to think Slower to do Hesitates more More likely to look before you leap Know the person but not the name Pause to find words Reminded of the past For you, its HARDER NOT Normal Aging Can t think the same Can t do like before Can t get started Can t seem to move on Doesn t think it out at all Can t place the person Words won t come even later Confused about past versus now Copyright Positive Approach, For LLC you it s DIFFERENT Slide 9 But BE Careful! It Could Be Another medical condition Medication side-effect Undetected hearing loss or vision loss Depression Delirium Pain related Other things

4 Slide 10 Drugs that can affect cognition Anti-arrhythmic agents Antibiotics Antihistamines - decongestants Tricyclic antidepressants Anti-hypertensives Anti-cholinergic agents Anti-convulsants Anti-emetics Histamine receptor blockers Immunosuppressant agents Muscle relaxants Narcotic analgesics Sedative hypnotics Anti-Parkinsonian agents Washington Manual Geriatrics Subspecialty Consults edited by Kyle C. Moylan (pg 15) published by Lippencott, Wilkins & Williams, 2003 Slide 11 Mimics of Dementia Depression can t think can t remember not worth it loss of function mood swings personality change change in sleep Delirium swift change hallucinations delusions on & off responses infection toxicity dangerous Slide 12 Could It Just Be Getting Old? There is a difference At first it may be hard to tell Then you start to notice patterns One of these things starts to show Problems with new info or recent memory Problems with finding words or mis-speaking Problems with logic or reasoning Problems with mis-behavior or new personality

5 Slide 13 Cognitive Changes with Aging Normal changes = more forgetful & slower to learn MCI Mild Cognitive Impairment = Immediate recall, word finding, or complex problem solving problems (½ of these folks will develop dementia in 5 yrs) Dementia = Chronic thinking problems in > 2 areas Delirium =Rapid changes in thinking & alertness (seek medical help immediately ) Depression = chronic unless treated, poor quality, I don t know, I just can t responses, no pleasure can look like agitation & confusion Slide 14 DEMENTIA Alzheimer s Disease Young Onset Late Life Onset Vascular Dementias (Multi-infarct) Lewy Body Dementia Fronto- Temporal Lobe Dementias Other Dementias Genetic syndromes Metabolic pxs ETOH related Drugs/toxin exposure White matter diseases Mass effects Depression(?) or Other Mental conditions Infections BBB cross Parkinson s Slide 15 The person s brain is dying

6 Slide 16 PET and Aging PET Scan of 20-Year-Old Brain PET Scan of 80-Year-Old Brain ADEAR, 2003 Slide 17 Positron Emission Tomography (PET) Alzheimer s Disease Progression vs. Normal Brains Normal Early Alzheimer s Late Alzheimer s Child G. Small, UCLA School of Medicine. Slide 18 Normal Brain Copyright Positive Approach, Alzheimers LLC Brain

7 Slide 19 Learning & Memory Center Hippocampus BIG CHANGE Slide 20 Understanding Language BIG CHANGE Slide 21 Hearing Sound Not Changed

8 Slide 22 Sensory Strip Motor Strip White Matter Connections BIG CHANGES Automatic Speech Rhythm Music Expletives PRESERVED Formal Speech & Language Center HUGE CHANGES Slide 23 Executive Control Center Emotions Behavior Judgment Reasoning Slide 24 Vision Center Copyright Positive Approach, BIG CHANGES LLC

9 Slide 25 Memory Loss Losses Immediate recall Attention to selected info Recent events Relationships Preserved abilities Long ago memories Confabulation! Emotional memories Motor memories Slide 26 Understanding Losses Can t interpret information Can t make sense of words Gets off target Preserved abilities Can get facial expression Hears tone of voice Can get some non-verbals Slide 27 Language Losses Can t find the right words Word Salad Vague language Single phrases Sounds & vocalizing Can t make needs known Preserved abilities singing automatic speech Swearing/sex words/forbidden words

10 Slide 28 Impulse & Emotional Control Losses becomes labile & extreme think it - say it want it - do it see it - use it Preserved desire to be respected desire to be in control regret after action Slide 29 So what is happening to them? Memory damage Can t learn new things Forgets immediate past Does time & space travel Uses old memories like new May not ID self or others correctly CONFABULATES Follows visual cues Seeks out the familiar Can get stuck on an old emotional memory track Language damage Has very concrete understanding of words Misses 1 our of 4 words may miss Don t Word finding problems Word salad problems COVERS Follows your cues Gets very vague & repeats Uses automatic responses Mis-speaks Slide 30 So what is happening to them? Impulse Control Problems Say whatever they are thinking Swear easily Use sex words or racial slurs when stressed Act impulsively Not think thru consequences Can t hold back on thoughts or actions Responds quickly & strongly to perceived threats Flight, fight, fright Performance Problems Thinks they can do better than they can Can sometimes DO BETTER under pressure sometimes worse Uses old habits Attempts can be dangerous or fatal They will tell you one thing and then do another Families may over or under limit activities

11 Slide 31 REALLY Ask Yourself Who Started It? Can they change their behavior? Can I try something different? Can I learn to let it go? What else can be changed? Slide 32 How can we help better? It all starts with your approach! Slide 33 How you help Sight or Visual cues Verbal or Auditory cues Touch or Tactile cues

12 Slide 34 Believe - People with dementia Are doing The BEST they can! Slide 35 What shouldn t we do??? Argue Tell WHOPPERS that relate to emotions Ignore problem behaviors Try a possible solution only once Give up Let them do whatever they want to Force them to do it Slide 36 What NOT to DO DO NOT point out errors or focus on wrong DO NOT offer physical assist 1 st DO NOT offer Let me HELP you DO NOT try to go back and fix it DO NOT continue arguing about reality DO NOT treat like children

13 Slide 37 What to Do? Use a Positive Physical Approach Use a consistent positive physical approach pause at edge of public space gesture & greet by name offer your hand & make eye contact approach slowly within visual range shake hands & maintain hand-under-hand move to the side get to eye level & respect intimate space wait for acknowledgement Slide 38 How to Help Provide step-by-step guidance & help Give demonstration show Hand-under-hand guidance after a few repetitions, uses utensils (not always well) Offer something to handle, manipulate, touch, gather Limit talking, noise, touch, other activities SUBSTITUTE don t SUBTRACT Slide 39 Hand-Under-Hand Assistance

14 Slide 40 So WHAT should we do??? Remember who has the healthy brain! Slide 41 Behave Yourself! AND Take Time for YOU!