Slide 1 - Arrowhead Area Agency on Aging

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  • The title of this module is Behavioral symtpoms of dementia: moving beyond redirection as an intervention. It was developed as a collaborative effort of Esther Gieschen of the Alzheimers association, Debra Laine of the Arrowhead agency on Aging, Margaret Hoberg a geriatric nurse practitioner who works in the Elder Care department and St. Mary’s Duluth clinic and Siobhan McMahon, also a geriatric nurse practitioner who works in the Elder Care department and teaches at the College of St. Scholastica. The impetus for the creation of the module was that caregivers in our Arrowhead region commonly shared concerns that their attempts to re-direct persons with dementia related behavior changes were not successful and at times were even met with resistance and anger. Thus, we explored the literature, and had conversations with experts in the field and discovered information that may help families and caregivers to better understand redirection as an intervention and to consider additional more effective interventions.
  • The learning objectives of this module I will focus on the first four objectives listed here. The last objective, Developing a plan whose non… , will be presented in module II of this dementia presentation.
  • Dementia is a common condition, but really an umbrella term for many different conditions, the most common being Alzheimers dementia. Vascular dementia, dementia of lewy bodies, and frontotemporal dementia also occur with some frequency. The diagnosis of dementia of any type involves ruling out other medical, metabolic or nutThere pathophysiology varied
  • Dementia is a persistent and, progressively changes a persons memory, abiliity to problem solve, ability to speak and use language, ability to interpret messages and other stimuli, and the ability to express and understand emotions. Combined together, all of these changes impair a persons ability to function as they once did; on physical, social and emotional levels.
  • Alzheimer’s disease is one type of dementia; it is the most common cause of dementia.
  • The pathophysiology behind Alzheimer’s dementia is thought to be from the development of amyloid plaques and neurofibrillary tangles. These changes typically are first seen in an area of the brain called the hippocampus and therefore typically cause changes in memory and orientation. These changes then spread to areas throughout the brain, causing additional changes in normal thought processes.
  • Vascular dementia, sometimes referred to as multi-infarct dementia, is another common cause of cognitive impairment. Changes in blood vessels, including small capillaries, from any systemic disease such as atherosclerosis, diabetes, irregular heart rhythms, changes circulation effectiveness to all parts of the body, including the brain.
  • Other common types of dementia include Dementia of Lewy Body and Frontotemperal dementia.In addition to primary dementia types, certain medical conditions contribute to dementia symtpoms. Examples of those medical conditions include Vitamin B 12 deficiency, Hypothyroidism, and medication side effects.
  • There are common primary symptoms of dementia. Many times people refer to memory loss as the primary symptom of dementia. Think back to the effects of dementia we talked about on many parts of the brain over time understand the multiple effects that dementia has on thinking, emotions and function. In addition to changes in memory, persons with dementia typically also have difficulty finding words, expressing thoughts and interpreting messages. Apraxia, ore the inablity to perform a well known task such as buttoning a button, is common. Other symptoms you will commonly see include the inability to recognize familiar objects. Impaired executive function refers to the inability to solve problems that occur throughout the course of a normal day.
  • The next two slides briefly review common symptoms of dementia in early, mid and late stages. In early stages symptoms include memory problems, getting lost or confused, having difficulty handling money or medications, taking a longer time than usual to complete every day tasks such as getting ready in the morning, poor judgment, having more frequent or more sever mood change, and losing things. In middle stages of progressive dementia, memory impairment worsens, individuals begin to have difficulty recognizing family and friends, have difficulty carrying out routine multi step tasks, more difficulty coping with new situations, and becoming more impulsive
  • The next two slides briefly review common symptoms of dementia in early, mid and late stages. In early stages symptoms include memory problems, getting lost or confused, having difficulty handling money or medications, taking a longer time than usual to complete every day tasks such as getting ready in the morning, poor judgment, having more frequent or more sever mood change, and losing things. In middle stages of progressive dementia, memory impairment worsens, individuals begin to have difficulty recognizing family and friends, have difficulty carrying out routine multi step tasks, more difficulty coping with new situations, and becoming more impulsive
  • Slide 1 - Arrowhead Area Agency on Aging

    1. 1. Interventions to Minimize Behavioral Symptoms of Dementia: <br />Moving Beyond Redirection<br />Part I<br />Margaret Hoberg MSN, GNP-BC<br />Siobhan McMahon MSN MPH GNP-BC<br />
    2. 2. Objectives<br />Learning Objectives<br />Explain the effects of dementia on thinking, emotions and communication<br />Use a theory to help explain behavioral and communication changes associated with dementia and to guide interventions<br />Respond to behavioral changes with a calm, validating approach<br />Comprehensively assess verbal and nonverbal messages, including those that are associated with stress<br />Develop a plan whose non-pharmacological interventions reflect an understanding of and respect for the person and their preferences.<br />
    3. 3. Clara<br /><ul><li>91-year-old woman
    4. 4. AD (recent MMSE score 12)
    5. 5. “Severe agitation” per LPN who is passing meds A few hours ago she hit another resident.
    6. 6. CNA adds she has been irritable and pacing.
    7. 7. The night CNA also notes she has been having trouble sleeping and has expressed feelings that others
    8. 8. She has heart disease and mild COPD. She has a history of recurrent UTIs .
    9. 9. Clara cooperates at times, but when left in her room, she wanders the hall, seeming confused. When “redirected” to her room, she insists that she had to go home and would refuses assistance with care.</li></li></ul><li>What is the most appropriate next step in the care of Clara?<br />(A) Administer prn lorazepam .5mg-1 mg intramuscularly, sublingual or po<br />(B) Administer haloperidol 1 mg intramuscularly or po<br />(C) Ask family member, nurse or CNA to spend one-on-one time with her; begin a thorough assessment for acute illness and unmet physical need. <br />(D ) Restrain Clara to obtain a blood and urine work-up<br />
    10. 10. What is the most appropriate next step in the care of Clara?<br />(A) Administer lorazepam 1 mg intramuscularly, sublingual or po<br />(B) Administer haloperidol 1 mg intramuscularly or po<br />(C) Ask family member, nurse or CNA to spend one-on-one time with her; begin a thorough assessment for acute illness and unmet physical emotional or social needs. <br />(D) Restrain the patient to obtain a blood and urine work-up<br />
    11. 11. Dementia Statistics<br /><ul><li>5.3 million
    12. 12. 7th leading cause of death
    13. 13. Risk >65:
    14. 14. 9.1 % men/
    15. 15. 17.2% women
    16. 16. Risk: Over age 85
    17. 17. 12.1% men
    18. 18. 20.3% women
    19. 19. Long term care
    20. 20. AL 45-67 % with some dementia
    21. 21. 41 % with moderate to severe cognitive impairment</li></li></ul><li>Memory / Cognitive Changes<br /><ul><li>Normal aging
    22. 22. Mild cognitive impairment
    23. 23. Delirium (e.g. acute infection)
    24. 24. Other medical / health causes (B12 deficiency; thyroid dysfunction)
    25. 25. Depression
    26. 26. Alzheimer’s disease
    27. 27. Vascular (multi-infarct) dementia
    28. 28. Dementia associated with Lewy bodies
    29. 29. Other (alcohol, frontotemporal dementia, Parkinson’s Disease, Neurosyphilis)</li></li></ul><li>Dementia<br />persistent and progressive<br />
    30. 30. Alzheimer’s disease<br />Alzheimer’s disease (AD) is an irreversible, progressive brain disease that slowly destroys memory and thinking skills and the ability to carry out the simplest tasks of daily living. In most people with AD, symptoms first appear after age 60.<br />AD is the most common cause of dementia among older people, but it is not a normal part of aging.<br />
    31. 31. Cause of Alzheimer’s Dementia<br /><ul><li>Amyloidplaques and neurofibrillary tangles which start in area of brain affecting memory and spread to other areas
    32. 32. Gradual loss of connections between nerve cells (neurons) in the brain. This loss leads to diminished cell function and cell death.
    33. 33. Read more about Alzheimer’s Disease by connecting to this link:
    34. 34. Alzheimer's Association Web Page with Description of Alzheimer's Dementia</li></li></ul><li>Causes of Vascular Dementia<br />Complete blockage of blood vessels in the brain. The complete blockage of an artery in the brain usually causes a stroke, but some blockages don't produce stroke. These "silent brain infarctions" increase a person's risk of vascular dementia. The risk increases with the number of infarctions experienced over time. One variety of vascular dementia is called multi-infarct dementia. Heart disease and irregular heart rhythms, such as atrial fibrillation, can increase your risk of stroke. <br />Narrowing of the blood vessels in the brain. Vascular dementia also can occur without a complete blockage of an artery. Portions of the brain can be starved for oxygen and food by reduced blood flow from arteries narrowed by vascular disease. <br />Vascular dementia can also be caused by: very low blood pressure, bleeding brain, blood vessel damage from such disorders as lupus erythematosus or temporal arteritis <br />
    35. 35. Other conditions that cause memory loss or dementia <br />medication side effects <br />chronic alcoholism <br />certain tumors and infections in the brain <br />blood clots in the brain <br />vitamin B12 deficiency <br />dehydration <br />high fever <br />some thyroid, kidney, or liver disorders<br />
    36. 36. Dementia symptoms<br />Memory impairment- getting lost in familiar settings, forgetting previous conversations, names, faces<br />Language impairment- difficulty finding words or following conversation, inability to communicate needs and preferences through verbal means<br />Apraxia-unable to perform previously learned tasks such as not knowing how to drink from a cup even though person may have sensory and physical ability intact<br />Agnosia-unable to recognize objects or other sensory stimuli<br />Impaired executive function- poor planning and judgement, difficulty solving problems<br />
    37. 37. Mild<br />Moderate<br /><ul><li>Memory problems
    38. 38. Getting lost
    39. 39. Difficulty handling money or medications
    40. 40. Taking a longer time than usual completing a task
    41. 41. Poor judgment
    42. 42. Losing things
    43. 43. Mood changes
    44. 44. Increased memory loss
    45. 45. Problems recognizing family and friends
    46. 46. Inability to learn new things
    47. 47. Difficulty carrying out routine multi-step tasks
    48. 48. Problems coping with new situations
    49. 49. Impulsive
    50. 50. Delusions and paranoia</li></ul>Progressive Symptoms of AD<br />
    51. 51. Severe<br />Difficulty recognizing one self or family<br />Inability to verbally communicate<br />Weight loss<br />Seizures <br />Difficulty swallowing<br />Groaning<br />Moaning<br />Increased sleeping<br />Loss of bladder and bowel control<br />Progressive Symptoms of AD<br />

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