DIAMOND MODULE Early Dementia Why do we use the gems? The Senior Gems are based on the Allen Cognitive Disability Theory. Each gem represents a stage of dementia from normal aging through late stage dementia. We use the gems to help us understand the changes that are taking place and to know what our clients are still able to do in order to provide the best care possible. Dear Learner, This training guide was designed for you to complete as a self-study activity. Please do the following in order to ensure successful completion: First, read through EVERYTHING. There is a lot of important information through the guide. If you find something that will be helpful to you and your clients underline or highlight that information. If you have a question, please ask: Once you are finished take the quiz at the end and review these answers with your supervisor. You will need to answer 8 out of 10 questions correctly to pass. The packet will be yours to keep, but you must turn the quiz into your supervisor. Due Date: Taking the time to complete these learning guides show that you care about your clients and want to provide the best service possible. Thank you for your hard work and dedication! Pre-Quiz Test what you already know about Diamonds! 1. When working with a diamond, it is best to make as many changes as possible. 2. Diamonds are typically characterized by an easy-going, laid back disposition. 3. As a caregiver, you should lay down the ground rules and not be willing to change the way you do things. If you answered FALSE to all of these questions, you are well on your way to working effectively with Diamonds. 1
What s Inside? Introduction p. 1 Objective p. 2 Characteristics of Diamonds p. 2 Early Warning Signs p. 3 Normal Aging vs. Dementia p. 3-4 Diagnosing Dementia p. 4-5 Types of Dementia p. 6 Communication Techniques p. 7-8 Activities p. 9-11 Environment p. 12 Transitioning to the next Gem p. 12 Quiz p. 13 Caregivers completing this learning module will be able to identify the characteristics of diamonds, ways to promote effective communication, techniques for care and activities that work in order to create a more positive and fulfilling day for their clients. Fast Facts 1 in 8 people aged 65 or older have Alzheimer s disease. Nearly half of people aged 85 and older have Alzheimer s disease. Source: Alzheimer s Association Characteristics of Diamonds On the gem s scale diamond is the first stage of dementia meaning the cognitive changes that are happening are no longer normal. A diamond is the gem selected to represent this stage because diamonds are still clear, but they are very rigid. In other words, a diamond can still do things as they always have, but they are going to struggle with new information. Below are some basic characteristics of a diamond: Diamonds can be rigid, hard and totally inflexible, but they also shine and sometimes can be perfectly fine. They can do what they have always done; they often get upset when things change. They have many facets, so it is possible that different people see different sides of a diamond. The most important words you will use working with a diamond are I m sorry. Diamonds have trouble learning new information, but they can remember old stories. 2
10 Warning Signs of Dementia Since diamond is the first stage of dementia, it is a time when there may be some uncertainty about whether or not there is a problem. The Alzheimer s Association has created this list of early warning signs to help identify whether or not there is a need to see a doctor: Memory changes that disrupt daily life. Challenges in planning or solving problems. Difficulty completing familiar tasks at home, at Confusion with time or place. work or at leisure. Trouble understanding visual images and spatial New problems with words in speaking or writing. relationships. Misplacing things and losing the ability to retrace steps. Decreased or poor judgment. What should you do if you think your client has dementia? Based on your experience and education it may be clear to you that a client is having a problem with their cognitive functioning. As you understand, this may be extremely distressing to both the client and their family. If you feel that there is a problem, please contact the Senior Helpers office to let them know what you are noticing. That way you as the caregiver are not the one sharing this information and potentially causing your client to lose trust in you, or be angry with you. Withdrawal from work or Changes in mood and social activities. personality. Review of Normal Aging vs. Dementia Normal Aging Dementia Continues to be independent in daily activities. May complain of memory loss, but is still able to provide considerable details about incidents of forgetfulness. Occasional word finding difficulties. Person becomes dependent on others for key independent living activities. Will only complain of memory problems if specifically asked. Does not get lost in familiar areas. Memory problems worsen with time. Able to operate common appliances. Notable decline in memory for recent events. Maintains prior level of social skills. Frequent word-finding pauses and substitutions. Gets lost in familiar areas. Loss of interest in social activities. Unable to operate common appliances. 3
1. N 2. D 3. D 4. N 5. D 6. D The Diamond Module Normal Aging vs. Dementia: Review Activity For each statement below, identify N for normal aging and D for may have dementia. 1. Mr. Johnson got up to get a drink, once he got to the kitchen he forgot why he was there. After retracing his steps, he remembered. 3. When Mrs. Jackson s caregiver arrived at her house, the caregiver was shocked to find that Mrs. Jackson had tried to cook a frozen meal in the toaster. 5. Today you are scheduled to take Mr. Chin to the doctors. Every time you remind him about the appointment, he tells you he s never heard of having any appointment today. 2. Mrs. Morris has played bridge with a group of friends every Tuesday for ten years. Recently, she says she does not want to go anymore, she s done with bridge. 4. Mr. Thompson no longer likes to drive at night because he has problems with his night vision. 6. Mrs. Robinson is very agitated. She keeps asking to go home, but she is home. Answer Key: Diagnosing Dementia Diagnosing dementia requires a complete medical and neuropsychological examination. Getting a proper diagnosis is vital, because there are other diseases that may mimic dementia and can be treated. Although there is no cure for many forms of dementia, knowing what you are working with will make a difference in care. The following are usually included in the examination: Fast Fact A review of history and onset of symptoms Medical history and medications Neurological exam Laboratory tests Brain imaging Mental status testing 50% of those who meet the diagnostic criteria for dementia, never receive a diagnosis. Source: Alzheimer s Association 4
Diseases that Mimic Dementia As we noted before, getting a physician s diagnosis of dementia is important. There are many very treatable conditions that actually mimic the symptoms of dementia. So, for example, a family may be thinking their loved one has just gotten old and gotten dementia, when really, they have a nutritional deficiency which could easily be reversed. Examples of the diseases that can actually mimic dementia symptoms are: Fast Facts Alzheimer s disease is the 6th leading cause of death in the United States and the 5th leading cause of death for those aged 65 and older. Depression Side-effects from medication Substance abuse Nutritional deficiencies Thyroid Conditions Hypercalcemia (electrolyte imbalance) Alzheimer s is the only cause of death among the top 10 in America without a way to prevent, cure, or even slow its progression. Source: Alzheimer s Association How does dementia affect the brain? It is important to realize, dementia is not just a memory problem. There is a disease at work and the brain is physically changing. In fact the brain is dying, and shrinking. People with dementia can lose up to 2/3 of their brain mass through the course of the disease. The picture below shows a healthy brain on the left and the brain of someone who died from Alzheimer s on the right. Both of these individuals had the same head circumference in life, so the difference in size is due to the disease process. As you care for clients with dementia, keep in mind, their brains are undergoing major changes. Sometimes it is hard to remember that since we cannot see the way the brain is changing, we can only see the behaviors. The behaviors are not on purpose, they are the result of a very real disease. 5
because that person is aware that they re losing awareness. -Patti Davis The Diamond Module Types of Dementia Although most of us are familiar with Alzheimer s disease it is actually just one type of dementia. Knowing some of the other types of dementia may help you with caregiving. Below you will find a brief description of a few of the most common forms of dementia. Fast Fact Most common forms of dementia: 1. Alzheimer s Disease 2. Vascular Dementia Type Alzheimer s Disease Vascular Dementia Dementia with Lewy Bodies Mild Cognitive Impairment Frontotemporal Dementia Description Difficulty remembering names and recent events is often an early symptom. Later symptoms include impaired judgment, disorientation, confusion, behavior changes and difficulty talking, swallowing, and walking. Impairment is caused by decreased blood flow to parts of the brain, often due to a series of small strokes that block arteries. Symptoms often overlap those of Alzheimer s, although memory may not be as seriously affected. Pattern of decline may be similar to Alzheimer s, including problems with memory and judgment as well as behavior changes. Alertness and severity of cognitive symptoms may fluctuate daily. Visual hallucinations, muscle rigidity and tremors are common. A condition in which a person has problems with memory, language or other essential cognitive function that are severe enough to be noticeable to others and show up on tests, but not severe enough to interfere with daily life. Nerve cells in the front and side regions of the brain are especially affected. Typically symptoms include changes in personality and behavior and difficulty with language. 3. Mixed Dementia Source: Alzheimer s Association The early stages of Alzheimer s are the hardest Source: Alzheimer s Association 6
When working with Diamonds, learning effective communication techniques might be the most important factor in providing quality care. Remember, diamonds are rigid and inflexible. It is not their fault, it is the disease. You as the caregiver need to change the things you do, because the Diamond is not going to be able to change. Here are tips for successful communication: 1. I m sorry are the most important words you can use. It does not necessarily mean you did something wrong, but it is an opportunity for you to acknowledge that you have upset them and that they are still in control. 3. Never use the phrase don t you remember! The fact of the matter is, they don t remember. Pointing that out is not going to help anyone. 5. Ask permission. Diamonds want to still feel like they are the ones in control, so ask before you start a task. 2. Diamonds will enjoy talking about the past, because those are the memories they still have. Let them talk about the past, in fact encourage it! Those stories will help you as the disease progresses. 4. Accept that there is a change taking place. Don t pretend nothing is going on. 6. Don t be the person telling them no. If you are going to spending all day with them, it is better that the blame be on someone else. For example the doctor says 7. Don t take away their hope, present changes as temporary. For example, try the phrase just for right now Although the change may be permanent, they do not need to know that. R eality Orientation What is it? Does it work? Scenario: your client Mrs. Jones comes to you and tells you that she has to go pick up her child from school. You know that her child is now 45 years old, and no longer in school. Reality orientation means you tell your client But, Mrs. Jones your son is 45 years old. Does this help? NO! Correcting Mrs. Jones will not do anything to help the situation. Instead, try distracting Mrs. Jones by asking her questions about the memory your son is at school? He goes to New Town Elementary school, right? How is that school? This will allow your client to live their memory and reduce anxiety. 7
For each scenario below, circle which option would be the best way to communicate effectively with a Diamond. Scenario 1: Mrs. Turner has always been the one to make dinner in her household. Recently, however, she caused a small kitchen fire and her family does not want her cooking anymore. Option 1: Tell Mrs. Turner to go take a nap on the couch while you prepare dinner. Option 2: Ask Mrs. Turner if she would rather have chicken or beef for dinner and then ask if she might be able to give you a hand in the kitchen. Scenario 2: Mr. Mount s family is adamant that he cannot be allowed to drive anymore. Mr. Mount is furious because he s driven for 60 years! Option 1: Tell Mr. Mount the doctor thinks you (the caregiver) should take over the driving, for just a little while. Option 2: Hide his keys and tell him he s finished his driving career! Scenario 3: Mr. Martin has told you the same stories about his fishing trips with his father at least ten times today. Option 1: Tell Mr. Martin you already know that story and it is going to drive you insane if you hear it again. Option 2: Listen to Mr. Martin s story like it is the first time you have heard it. Maybe even write it down. Scenario 4: Mrs. Talbot has always maintained a beautiful house, now her family has asked that you take over some of the housework. Option 1: Ask Mrs. Talbot permission to complete household tasks. Option 2: Tell Mrs. Talbot she s too old to be cleaning, and you will take care of it now. 8
I f you want to lift yourself up, lift someone else. -Booker T. Washington The Diamond Module Fast Fact Women are more likely then men to get Alzheimer s disease. Source: Alzheimer s Association Keep Track of the Stories! One common attribute of diamonds is that they tell the same old stories over and over again. The reason they do this is that their long term memory is preserved as their recent memory declines. So those old stories are what they can still confidently remember. While it is understandable that hearing the same stories repeatedly might be wearing, these stories are actually a gift to caregivers. Hearing your client s story now and remembering it later will help you as their disease progresses. You might even consider writing the stories down. This could act both as a tool in the future and an activity for you and your client now. Encouraging Independence At the early stages of dementia, it is important that you encourage your clients to retain as much independence as is safely possible. This means you might have to make the activity a little simpler, but you should not be doing everything for them. For example, although you might have to remind your client that it is time to change their clothes, that does not mean you need to pick out their clothes for them. If they begin struggling picking out their clothes, you can simplify the task by offering them choices, do you want to wear your blue shirt or your red shirt. Even though you are adjusting the task, they are still the ones picking out their clothes. Feeling independent and productive will lead to more meaningful days. Even if they make a mistake, let it go, they don t need to know that. 9
Activities Make the Day Better! Planning activities throughout your day will help to make the day more meaningful for your client, establish a routine and make the day easier for you. Activities suggestions for diamonds are located in the chart below, and organized into the following four categories: Productive Provides a sense of value and purpose. Leisure Promotes having fun and interacting. Self-Care & Wellness Personal care of body and brain. Restorative Re-energizes and restores the spirit. Productive Category Activity Suggestions Getting the mail Setting the table Caring for Pets Finding, sorting, and cutting coupons Putting away dishes Wiping windows and mirrors Gardening/watering plants Doing laundry Preparing food Sorting and rolling coins Dusting Volunteering Grocery shopping 10
Category Leisure Self-Care & Wellness Restorative Activity Suggestions Watching t.v. Creating a family tree Reading Playing sports Shopping Cooking Going out to eat Arranging flowers Arts and crafts Music activities Playing games Walking Going to a place of worship Exercise/yoga Grooming Completing puzzles/crosswords Reading Applying lotion to self Getting medication reminders Choosing foods Playing Games Getting manicures/pedicures Taking naps Listening to relaxing music Getting a massage Going outside for a walk 11
For dementia clients, the environment is extremely important. Not only can an appropriate environment promote health and safety, but it can also help to provide effective cues to get through the day. Being able to maintain the same environment is one of the major benefits of remaining at home with dementia. When working with a diamond the key is to keep as much as is safely possible exactly how it is! Diamonds are good at old habits and routines, but struggle with new information. Changing around the set up of a room, the location of where items are stored or a daily routine will be difficult for them to adjust to and may cause distress. For example, if your client has always showered before bed, you should continue to plan showers for around bed time. Not only will this be familiar to them, but the shower will also be a cue that it is time for bed. Transitioning to the Next Gem The nature of dementia is that it is progressive. It is possible that you will see your client moving from one gem to the next. If you think your client has transitioned it is important to contact the Senior Helper s office. This may indicate that it is time for a reassessment and adjustment to the Service Plan or that it is time for your client to visit the doctor. If you start noticing any of these characteristics, it might be indicative that a transition is taking place: Having emotional moments as they become lost in time and place. Losing things and thinking someone stole them. Use your best judgment, if you think something is going on, it probably is. Not only could it be a transition to the next gem, it could be some other treatable problem. 12
Quiz The Diamond Module: Early Dementia Employee Name (Please Print): Date: I understand the information presented in this guide. I have completed this guide and answered at least 8 questions correctly. Employee Signature: Supervisor Signature: Directions: Circle the best answer choice, and then check your answers with your supervisor. 1. When working with a diamond it is best to take over all tasks and activities so they can rest. 2. Diamonds are good at old habits and routines. 3. What should you avoid when communicating with a diamond? A. Giving them options. B. Saying don t you remember. C. Allowing them to maintain control. 4. If someone is forgetting things, it is best to just assume they have dementia. 5. Going to get the mail, putting away dishes and folding clothes are examples of: A. Restorative Activities B. Leisure Activities C. Productive Activities 6. Ruby is the next gem after diamond. 7. When working with diamonds it is best to maintain things the way they are as much as possible. 8. When a diamond asks the same question repeatedly, they are doing it to frustrate you. 9. Reality orientation is not an effective means of communicating with diamonds. 10. Alzheimer s disease is the only form of dementia. 13