presents The I m Still Here Approach to Dementia Care www.thehearth.org 888 422 CARE
1 2 I m Still Here : Activity Programming for Persons with Dementia Presented by Hearthstone Alzheimer Care I m Still Here is an expression of Hearthstone s founding belief that every person living with dementia is truly still there and can experience a high quality of life regardless of the severity of their memory loss. 3 4 Why I m Still Here? I m Still Here is an invitation to a different world view. How partners see the illness both positively and negatively has a major impact on the partner with the illness. The greatest source of discouragement is the conviction that one is unable to do something. ~~ Maria Montessori 5 6 7 8 9 10 Respect and Dignity These techniques give care partners helpful tools to adapt activities and allow persons with memory loss to SUCCEED! Why do this? Therapeutic Nihilism The belief that because a person has dementia, he or she cannot learn, cannot improve, cannot be helped. All that is possible is to be patient and deliver palliative care. Just keep them busy They are too far gone to do anything These interventions can be utilized to successfully treat the 4 A s of Alzheimer s: Apathy Anxiety Agitation Aggression Additional benefit: better quality of life! 11 12 13 Key: Focus on Engagement Different people engage in different ways Specialized scales are used to measure a person s level of engagement and how they engage. written permission. 1
14 15 16 17 Signs of ACTIVE engagement Participant is discussing the activity Participant is holding materials related to the activity Participant is asking questions related to the activity Participant is smiling or exhibiting positive emotion Signs of PASSIVE engagement Participant is holding materials related to the activity Participant is actively watching the activity Participant is smiling or exhibiting positive emotion Signs of NON-engagement Participant is talking to other people Participant is manipulating things not related to the activity (clothing) Participant exhibits negative emotions Participant exhibits problematic behaviors (verbal aggression, interrupting activity) Participant is sleeping How can we know what activities might be interesting to a person? Investigate past interests Ask the person what they would like to do! 18 19 Examples: three adaptation methods 1. Utilization of Montessori-inspired methodology to identify and build on remaining strengths 20 2. Decreased reliance on impaired Memory Systems 3. 3. Use of effective communication techniques #1 Utilization of Montessori-inspired methodology to identify and build on remaining strengths 21 22 23 Who was Maria Montessori? Worked with the unteachable children of lower economic status in Rome in the 1920 s First person to adapt environment and teaching methods to the physical and mental capabilities of children What does an MMSE tell us? Assessment tools are used identify skills and adapt activities written permission. 2
24 Examples of skills that generally remain. 25 26 27 28 Reading Ability to categorize Motor Skills #2 Decreased reliance on impaired memory systems 29 30 31 32 Alzheimer s Long Term vs. Short Term Memory Loss Declarative Memory Systems are often impaired in Dementia Episodic memory Personal experiences (autobiographical information) Semantic memory General factual knowledge, separate from personal experiences (world knowledge, concepts, vocabulary) But some Memory Systems are NOT. Procedural Memory Habits of a lifetime Location learning Muscle / motor learning Unconscious Learning 33 Emotional Memories Linking positive feelings to: People Places Objects 34 35 36 37 38 39 By using these functioning systems, the I m Still Here Approach enables people to succeed and make use of skills that remain. KEYS TO SUCCESS Use familiar materials Account for deficits Use large, bold, san serif fonts when creating reading materials for visually impaired participants Hearing impaired persons may need an adaptive device to enjoy an activity (head phones for music appreciation). Create activities that are meaningful to the person Always offer an invitation written permission. 3
40 41 42 43 44 45 46 47 48 49 Offer a choice Match your speed to theirs (Start slowly and speed up) Each participant should have something to hold: manipulatives Use external memory cues: templates Prepare Remove distraction (sounds, clutter) Be sure there is ample lighting Be mindful of glare Adapt familiar activities Adaptive devices create success! Talk less, demonstrate more Build on success Group Activities: think of ways for everyone to have a role 50 51 Create meaning through social roles Utilize a participant s cognitive, social, and physical strengths written permission. 4