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8 Aging is not a disease It makes the body more vulnerable to disease Dementia is a physically based disease affecting brain cell dysfunction.

9 The secret to staying young is to live honestly, eat slowly, and lie about your age.

10 Gifts of Aging View at the top Encouraging others, volunteering Spiritual maturity Do not need outside approval to know we are acceptable Our core identity changes: deeper and with more wisdom Spend more time with family, friends

11 Best Evidence on Aging Our bodies reach maximum capacity prior or during early adulthood, and then begin to gradually decline. Age does not occur on a specific timetable Helplessness and dependency are not a characteristic of old age. Some 87% of older adults maintain a good lifestyle. There is no cure for the aging process. Beauty in a bottle does not exist.

12 Dementia: What is it? Progressive condition with two or more impairments in mental skills that infer with the person s ability to function Three main symptoms: Activities- Inability to perform activities of daily life Behaviors- Psychiatric symptoms/behavior disturbances Cognition- Short term memory problems Source: Medical Encyclopedia, Dementia: Current Science Group, 2008, Lectures on Dementia.

13 Dementia The disease process starts slowly affecting only small parts of the brain. Each type of dementia starts in a specific part of the brain Some dementia can be reversed As long as only one symptom exists, it is classified as mild cognitive impairment (MCI). Source: Shanklle, W., M.D. and Amen, Daniel G. M.D. Preventing Alzheimer s Disease, P. 27.

14 Causes of Dementia Metabolic Disorders: Thyroid, hypoglycemia Trauma: subdural hematoma Nutritional deficiency :Vitamin. B1,B6 and B12,severe dehydration Disease: stroke, anemia, heart attack, asthma Anoxia: Heart Attack, Asthma, lungs, anemia Infection: meningitis, encephalitis Medications: antipsychotic medications, side effects Brain Tumors Source: Lectures on Dementia, Part 1, Current Medicine Group, LTD 2008.

15 The Diagnosed Any diagnosis of Dementia brings a reordering of priorities of life Take stock of leaving a legacy More time to reflect of religion and spirituality Jon Stuckey and Lisa P. Gwyther, Dementia, Religion, and Spirituality, Dementia 2003, 2;291

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20 Alzheimer s Disease Discovered in 1906 by Alois Alzheimer- German Psychiatrist. Patient had died at age 54 years old with severe dementia. He examined nerve tissue under a microscope and found abnormal cellular changes.

21 Alzheimer s Disease Caused by the formation of plaques- abnormal deposits of protein called: beta- amyloid. Formation of neurofibillary tangles Begins an average of 30 years before the symptoms begin. Gradual decline in cognitive abilities usually over 7-10 years All brain functions are eventually effected. Later stages involve inability to perform ADL s or communicate. Source: Lectures on Dementia, Current Medicine Group LTd

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24 Lewy Body Disease Described by a neurologist, F.H. Lewy in 1912 Recognized only in recent years Accounts for % of dementia disorders. Usually occurs over 70 years old Twice as common in men than women Source: Lewy Body Disease: Signs, Symptoms, and treatment. Helpguide.org

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26 Cause Abnormal formation of protein, alpha-synuclein, in the brain cells The difference between Alzheimer s disease and Lewy Bodies is the physical decline, mental fluctuations daily, and hallucination Occurs sporadically in people with no known family history.

27 Symptoms 1 st. Symptoms are early short term memory loss where short term memory is stored. Later stages advances into other parts of the cerebral cortex. Affects level of consciousness including confusion and drowsiness during the daytime and sleep disturbances at night due to accumulations of lewy bodies in the brainstem. Severe attention and concentration difficulties.

28 Symptoms Visual Hallucinations Individuals have reduced dopamine levels in the brain extreme sensitivity to antipsychotic medications. Movement becomes rigid and slow. Fluctuations in cognition (attention span, alertness) day to day. Usually live 6-12 years after symptoms begin

29 Vascular Dementia Vascular or circulatory lesions leading to an ischemic attack or infarction suddenly Cause from 5-30% dementias Can sometimes be reversed if the clot can be eliminated.

30 Symptoms Sudden Trans-ischemic attacks Dizziness Blurred vision Confusion Maintain personality and emotional responsiveness Usually local in area vs. alzheimer s disease Source: Richard Stub, MD, Vascular Dementia, Southern Medical Journal, 5/13/03.

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32 Handling Troubled Behavior Behavior has a purpose: anger, frustration, confusion Behavior is triggered What works today, may not work tomorrow The person cannot be changed Use gentle touch Promote independence Distract with a snack, etc. Stay calm Keep dangerous objects out of reach Have a routine, structure in the person s life

33 10 Tips for Communicating with a Dementia Patient Set a positive mood for interaction. Get the person s attention Listen with your eyes, ears, and heart. Ask simple questions. State your message clearly. Break down activities into a series of steps. When the going gets tough, distract, redirect Respond with affection, reassurance Remember the old days Keep a sense of humor

34 Why include spirituality in health care? Many people have religious beliefs. Research indicates that a person s beliefs, comfort, and strength are gained from religion. Religious beliefs affect medical decisions which may conflict with medical treatment. Source: Harold Koenig, Spirituality in Patient care, P. 17.

35 Spirit Derived from Latin: spiritus, meaning soul. Courage, vigor, breath What makes a person unique

36 Spiritual Social Emotional Physical

37 Spirituality Philosophic- The search for the true meaning of life. The beliefs and values of how a person lives. Emotional Aspects- Feelings of hope, love, inner peace, comfort, and support. Behavior aspects- how a person externally manifests individual spiritual beliefs and innter spiritual state.. Source: Hay, MW, Principles in building spiritual assessment tools. Am J. Hospital care 1989;6:25-31.

38 Spirituality Interconnectedness: Past, present, future Environment Meaningful relationships Source: H. Koenig, Spirituality in Patient Care, p. 19.

39 Patients/Spiritual Issues 40% indicate that religion is what keeps them going 77 % of patients would like spiritual issues considered as part of their medical care. Only percent of physicians discuss these issues with their patients. 94% of patients admitted to hospitals believe that spiritual health is as important as physical health.

40 Reconciling to one s sense of physical and mental decline Dependency is difficult at any age Conditions that arise are inconvenient Loss of friends Loss of control Time of reflection Come to terms with end of life issues Our core identity changes, deeper, wiser Many people do not imbrace aging, bitter,

41 Spiritual Pain Loss of meaning, loss of hope Loss of identity Loss of independence Lack of sense of humor Despair Anger Conflict with family members

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43 The Spiritual Quest of Meaning with Aging As people grow older, they become more introspective Loss of meaning to life leading to depression, despair What lies in their deepest core of who they are, what they believe in. Assists with coping of their mental illness Provides meaning to life

44 How do people find spirituality? Religion Nature Music Art Individual values and beliefs Meditation Reading

45 Science of Spiritual Needs Studies conducted on elderly patients indicate that those who prayed or studied the Bible had significant decreases in blood pressure. Religious beliefs and practices enhances the patient s ability to cope with illnesses. Source: Susan J. Richardson, RN, M.S. CS & Verna Benner Carson, APRN/PMN, PhD., Making a Spiritual Assessment, Nurse. com CE: Course 249.

46 Spiritual Assessment

47 Spiritual Assessment comes from many disciplines: Nursing Psychology Psychiatry Pastoral Care Medicine Social Services Activities

48 Spiritual Assessments: Ongoing Establishing a relationship Intimate Trust A human dimension: Altrustic, interpretive, awareness

49 Emotional Memory Dementia patients have deep emotions, the spirit is expressed by: Music Singing Dancing Prayer Spiritual Verse Journaling

50 What are our spiritual responsibilities? Be honest, real, and human Listen to the resident s verbal ques Know how to respond to their spiritual needs: Word Presence Action

51 Word: Having a willingness to discuss spiritual/religious issues, the importance of dial Giving spiritual support and encouragement to spiritual beliefs Making a referral to minister, pastoral care Using religious literature Using prayer

52 Presence: Being at the bedside, showing up Holding a hand Active listening, gain a sense of who the person is. Offer a sense of security Limit tasks Showing humility, empathy, compassion

53 Action Addressing end of life issues: Living will Durable power of attorney Initiate a Care Plan Individual Needs/ Spiritual Expression Advocating Resources needed Evaluate Outcome: Achieve a state of personal comfort (emotional,physical, psychological) Provide spiritual support, connectiveness Build relationships Journaling, listening to their story Create meaning and understanding to their loves

54 Tools for Assessment S- Spiritual belief system P- Personal Spirituality I-Integration with a spiritual community R-Ritualized practices and restrictions I- Implications for care T- Terminal events planning Source: Janet S. Hickman, PhD, RN; Faith Community Nursing, pp. 57; Lippincott and Williams.

55 Using Health Models to Implement Spiritual Assessment Biomedical Biopsychological Social Source: Bruce D. Rumbold, PhD. A Review of spiritual assessment in health care practice, MJA 2007

56 Bio Medical WHO's definition of health: a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Attention to the Quality of Life Biology dominates: Diagnosis of disease

57 Biosocial Broad patterns of health and illness in a community Spirituality is usually treated as a culture Occupational class Level of education Sex Ethnicity Age

58 Biopsychological Emotional beliefs and behaviors What is important to individual values Individual motivation / responses Psychological tests

59 Spirituality and Medicine 95% of Americans believe in God 94% of patients admitted to hospitals believe that spiritual health is as important as physical health. Up to 77% believe that physicians should consider their patients spiritual needs as part of their medical care.

60 Greatest Barriers to Clinicians on Discussion of spiritual issues Lack of time (71%) Lack of training (59%) Difficulty in identifying patients who want a discussion (56%) Source: Anandarajah, Golwri, M.D., and Hight, Ellen, M.D.,M.P.H.. Spirituality and Medical Practice: Using HOPE Questions as a Practical Tool for Spiritual Assessment, Family Physician 2001;63:81-8,89. Brown University School of Medicine, Provence, Rhode Island.

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