Every 67seconds, someone will develop Alzheimer's.

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1 We all need a purpose and responsibilities to live a healthy life. Dementia Care 101 Corrin Campbell BS, COTA/L & Michael Urban, MS, OTR/L, MBA Every 67seconds, someone will develop Alzheimer's. By 2050, an American will develop the disease every 33 seconds. 1

2 The first word I think of when I hear the word Dementia is Costs of Alzheimer's = $214 Billion Most dementias are progressive, eventually becoming severe enough to interfere with work performance, social activities and daily functioning. They are caused by some underlying neurodegenerative change affecting the brain. For some people, dementia can be inherited or familial. 2

3 Dementia is a general term for loss of memory and other mental abilities severe enough to interfere with daily life. It is caused by physical changes in the brain. Alzheimer s disease is the most common type of dementia, accounting for 60 to 80 percent of cases. Other causes of dementia are: Mild Cognitive Impairment (MCI) Vascular Dementia Mixed Dementia Dementia with Lewy Bodies Parkinson s Disease Frontotemporal Dementia Creutzfeldt-Jacob Disease (CJD) Normal Pressure Hydrocephalus Huntington s Disease Wernicke-Kosakoff Syndrome Many older persons fail to recognize memory impairment as a problem and attribute their memory dysfunction to old age. Myth: Memory loss is a natural part of aging. 3

4 Dementia is characterized by loss of or decline in memory and other cognitive abilities. It is caused by various diseases and conditions that result in damaged brain cells. The Challenge of Dementia Care: Focusing on Remaining Abilities, Not Deficits And Creating a Positive Foundation for Care 4

5 The Global Deterioration Scale (abbreviated as the GDS) is a seven stage rating scale used to determine whether a person has cognitive impairments that are related to dementia. Global Deterioration Scale Stage 3 A person in the early stages may experience mild changes in the ability to think and learn, but he or she continues to participate in daily activities and give-and-take dialogue. To others, the person may not appear to have dementia. The early stages of Alzheimer's can last for years. You are there to help with daily life, as needed. Since no two people experience Alzheimer's alike, the degree of assistance needed from a care partner in this stage varies. A person with early-stage Alzheimer's may need cues and reminders to help with memory. For example, he or she may need help with: Keeping appointments Remembering words or names Recalling familiar places or people Keeping track of medications Doing familiar tasks 5

6 Global Deterioration Scale Stage 4-5 The middle stages of Alzheimer's are typically the longest and can last for many years. As dementia progresses, the person with Alzheimer's will require a greater level of care. During the middle stages of Alzheimer's, damage to the brain can make it difficult to express thoughts and perform routine tasks. You may notice the person with Alzheimer's jumbling words, having trouble dressing, getting frustrated or angry, or acting in unexpected ways, such as refusing to bathe. Being a caregiver for someone in the middle stages of Alzheimer's requires flexibility and patience. Use a calm voice when responding to repeated questions. Respond to the emotion, instead of the specific question; the person may simply need reassurance. As a person progresses through stage 6, they slowly lose their peripheral vision. Central vision will remain; however side vision may become limited or non existent. By the end of stage 6, depth perception will be greatly affected. People begin to fall due to not knowing someone is approaching, secondary to their limited visual field, they are startled and fall. Others, due to lack of depth perception will overcompensate their step height when crossing thresholds or change in flooring pattern and again lose their balance and fall. Global Deterioration Scale Stage 6-7 The late stage of Alzheimer's disease may last from several weeks to several years. As the disease advances, intensive, around-the-clock care is usually required. A person with late-stage Alzheimer's usually: -Has difficulty eating and swallowing -Needs assistance walking and eventually is unable to walk -Needs full-time help with personal care -Is vulnerable to infections, especially pneumonia -Loses the ability to communicate with words During the late stages, your role as a caregiver focuses on preserving quality of life and dignity. Although a person in the late stage of Alzheimer's typically loses the ability to talk and express needs, research tells us that some core of the person's self may remain. 6

7 MY WAY (THE PLATINUM RULE) Alzheimer's disease and other dementias can cause a person to act in different and unpredictable ways. Some individuals with Alzheimer's become anxious or aggressive. Others repeat certain questions or gestures. Many misinterpret what they hear. These types of reactions can lead to misunderstanding, frustration and tension, particularly between the person with dementia and the caregiver. It is important to understand that the person is not trying to be difficult and that all behavior is communication. 7

8 People with dementia can become upset for reasons that may be difficult to understand. It can help to learn what tends to trigger this response by looking at the person's surroundings, the time of day, what has just occurred, and evaluating potential sources of pain, hunger, need for sleep and sudden changes that may have occurred. How to respond: Check for pain Pain can often trigger anxiety or agitation. Pain can result from being in an uncomfortable situation, injury, medication reactions or a urinary tract infection. Common Pain Behaviors in Cognitively Impaired Elderly Persons Facial expressions: slight frown, sad, frightened face, grimacing, wrinkled forehead, closed or tightened eyes, any distorted expression, rapid blinking Verbalizations: vocalizations, sighing, moaning, groaning, grunting, chanting, calling out, noisy breathing, asking for help, verbally abusive Body movements: rigid, tense body posture, guarding, fidgeting, increased pacing, rocking Restricted movement: Gait or mobility changes Changes in interpersonal interactions: aggressive, combative, resisting care Decreased social interactions: socially inappropriate, disruptive, withdrawn Changes in activity patters or routines: refusing food, appetite change, increase in rest periods, sleep/rest pattern changes, sudden cessation of common routines, increased wandering Mental status changes: crying or tears, increased confusion, irritability or visible distress The Journal of Pain, Vol 8, No 5 (May), 2007: pp Available online at Dementia Possible Care We believe, with your help, that persons with dementia can remain active participants in their lives, lives filled with joy. 8

9 Case Study Pleasant and cooperative elderly female referred to PT as a result of a fall and subsequent ankle fx. Client also has a diagnosis of moderate dementia. Supportive family currently has her living in 2 nd floor apartment with her son. Daughter lives on 1 st floor. Family provides all meals and manages meds in weekly pill boxes. She is alone for most of the day as her children still work. Hired caregiver is present 3 days a week, 2 hours per visit and performs housekeeping and meal prep, however provides no self-care assistance. References: The Journal of Pain, Vol 8, No 5 (May), 2007: pp My Past is Now my Future QUESTIONS? 9

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