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  1. 1. © 2013 Griswold International, LLC The Griswold Solutions SeriesTM
  2. 2. © 2013 Griswold International, LLC Our Goal for Today Empower people living with Dementia and their family/professional caregivers to: • Understand and manage Dementia symptoms • Improve quality of life through education, support and advocacy
  3. 3. © 2013 Griswold International, LLC Presented by: Rosemary Kane Family Caregiver, Support Group Facilitator Chris Kelly, MEd Director of Learning & Development Griswold Home Care
  4. 4. Thank you for your courage, energy, and dedication! Professional CaregiversHealthcare Providers Family Caregivers Clients Living with Dementia © 2013 Griswold International, LLC
  5. 5. Lit Review Social Media Advocacy Solutions Webinar & Toolkit © 2013 Griswold International, LLC
  6. 6. © 2013 Griswold International, LLC Brainwriting is… • a fun, engaging way to brainstorm • sharing as many ideas as possible within a short timeframe Brainwriting Process • Listen for our questions • When prompted, enter your solutions using the webinar chat function • Don’t overthink or agonize…There are no right or wrong answers Brainwriting Outcomes • Peer-to-peer learning and sharing • A publication that benefits others who are living with Dementia Important • Avoid sharing any information that you would not want others to see BRAIN WRITING Solutions Orange Arrow Button: Minimizes or expands the GoToWebinar control panel.
  7. 7. © 2013 Griswold International, LLC Dementia is an umbrella term used to describe a set of symptoms that can include changes in: …and must be severe enough to interfere with a person’s ability to function. THINKING ATTENTION/ CONCENTRATION JUDGEMENTLANGUAGEPERCEPTION REASONINGMEMORY About Dementia JUDGEMENT
  8. 8. © 2013 Griswold International, LLC Sources: n Alzheimer’s Disease n Vascular Dementia n Lewy Body Dementia n Parkinson’s Disease n Creutzfeldt-Jakob Disease aka Mad Cow Disease n Down Syndrome n Frontotemporal Dementia (FTD) n Huntington’s Disease n Mixed Dementia n Korsakoff’s Syndrome n AIDS Dementia Complex n Traumatic Brain Injury,, syndrome-symptoms.asp, The Many Forms of Dementia
  9. 9. © 2013 Griswold International, LLC Why Not Ask Me? Poetry by Norm - a person with Dementia Why Not Ask Me? I’m still here, I can still speak, I’m still strong, not frail and weak, So when you stand there in my house, Talking in whispers, just like a mouse, Just look this way and you will see, I’m still here, why not ask me? Instead of saying, oh he can wear that, And dressing me in some daft hat, Or making me eat food I hate, With me, why won’t you debate? I’m no different, can’t you see, I`m still here, I`m still me, All I want is to have a choice, All I want is to use my voice.
  10. 10. © 2013 Griswold International, LLC The questions come over and over all day and night…‘Where is my mother?’. I try to be patient, but I end up yelling…‘your mother died, remember???’. Afterwards, you feel horrible. Family caregiver quote Repetitive Symptoms
  11. 11. - Lou Gehrig © 2013 Griswold International, LLC What’s Behind Repetitive Symptoms? Changes in the brain can cause: Verbal Symptoms Physical Symptoms I want to go home. I want to go home. What time is it? What time is it? Tapping Feet Banging Rubbing Hands Rummaging Repeating the same question, story or statement over and over
  12. 12. © 2013 Griswold International, LLC Action Plan and Toolkit • Identify and respond to unmet emotional/physical needs • Divert to meaningful/repetitive past activity • For banging – Give clients a soft/meaningful object to hold Remember – a person with Dementia cannot control their symptoms Tools: NINDS Dementia Information Page Planning the Day for a Person with Dementia Memories in the Making
  13. 13. © 2013 Griswold International, LLC Wandering &Movement Issues I found myself lost, frightened and confused about where I was…and I didn’t even know where I was trying to go. Person with Dementia
  14. 14. © 2013 Griswold International, LLC What’s Behind Wandering? There are four types of wandering: n Exit Seeker Has a specific goal. Examples: “going home” or “going to work” n Pacer Has excess energy and a need to move n Explorer Interested in everything— likes to touch things n Follower Shadows caregiver for reassurance
  15. 15. © 2013 Griswold International, LLC • Enroll in an emergency response program (see links below) • Walk/pace with them, then gradually slow to a stop/sit • Resolve unmet needs: toileting, hunger, thirst, rest, pain, illness, emotions • Develop a wandering response plan • Provide a safe, clutter- free walking path • Ask your HCP about a home safety assessment MedicAlert® + Alzheimer's Assoc. Safe Return® Preparing for and Preventing Wandering Tools: Action Plan and Toolkit
  16. 16. © 2013 Griswold International, LLC Real Stories Rosemary Kane Family Caregiver, Support Group Facilitator
  17. 17. © 2013 Griswold International, LLC Aggression & Agitation If you don't understand what's happening because your brain is not functioning, it can be scary. It's normal human behavior. You might act out, become agitated, or violent if you don't know what's going on. Beth Kallmyer - Senior Director of Constituent Services at Alzheimer's Association
  18. 18. © 2013 Griswold International, LLC Understanding Aggression & Agitation Aggressive Symptoms can include: n Yelling n Cursing n Hitting n Biting n Throwing Things
  19. 19. © 2013 Griswold International, LLC What’s Behind Aggression? Aggression is often triggered by the inability to communicate an unmet need. Needs that often trigger aggression include: n Pain n Depression, anxiety & stress n Too little/much rest or sleep n Constipation n Soiled clothing n Change - location, routine or caregiver n Vision or hearing problems n Sense of loss (roles, hobbies, control family/friends, dignity, loneliness) n Noise n Being pushed to do things they don’t want to do n Reaction to medicine n Being too hot or too cold n Clothing does not fit
  20. 20. © 2013 Griswold International, LLC • Reassure the person that they are OK • Speak calmly/slowly and listen • Limit caffeine and sugar • Play soothing music • Divert to soothing/ meaningful activity • Identify and respond to unmet needs • Reduce noise, clutter or number of people • Don’t argue or reason • Walk away and return after a few minutes Coping with Agitation and Aggression Music and Memories Aggression and Anger Tools: Action Plan and Toolkit
  21. 21. © 2013 Griswold International, LLC Real Stories Rosemary Kane Family Caregiver, Support Group Facilitator
  22. 22. © 2013 Griswold International, LLC Hallucinations & Paranoia My mom has Alzheimer’s Disease and also has hallucinations. What I've learned is that if they aren't bothering her, let it be. Go along if she wants your opinion or interaction. If they upset her, then you need to try to divert her or possibly try medication.
  23. 23. © 2013 Griswold International, LLC What’s Behind Hallucinations and Paranoia Hallucinations/paranoia are very real for the person with Dementia. Examples are: n Seeing/feeling/hearing/ smelling/tasting things EXAMPLE: Seeing bugs n Illusions - Seeing objects in a distorted way EXAMPLE: Thinking that the drapes are a ghostly figure n Blaming or suspicion EXAMPLE: “You stole my keys”, “You took my money”
  24. 24. • Don’t correct the person or argue • Divert attention to relevant/ meaningful activity • Talk to your healthcare provider about treatment • Join their world and remove the problem Hallucinations and Alzheimer's Suspicion, Delusions and Alzheimer's © 2013 Griswold International, LLC Tools: Action Plan and Toolkit
  25. 25. © 2013 Griswold International, LLC Sundowning & Sleep Problems My father, who had Alzheimer’s Disease had sundowning syndrome. His late evening wandering, becoming demanding, and suspicions about me moving things made me want to scream each night. Even though I knew he had Alzheimer’s, it did not stop me from having caregiver burnout. Family caregiver quote
  26. 26. © 2013 Griswold International, LLC What’s Behind Sundowning? n Change in internal clock n Exhaustion Sundowning — when a person with dementia becomes more restless, anxious or agitated during the late afternoon and evening hours. Causes of sundowning can include: Late afternoon was always a time to “do something” or “go somewhere” n Inactivity and napping n Medication side effects n Anxiety During the day From lack of sleep n Lack of light n Depression Can be disorienting
  27. 27. © 2013 Griswold International, LLC • Involve the person in late- afternoon/evening activities • Stay active during the day • Avoid alcohol, caffeine and nicotine • Recognize and respond to unmet needs • Ask your HCP if you should avoid medicines before bedtime • Make sure the bedroom temperature is comfortable • When sleep problems persist, it is important to get support/respite Respite Care Griswold Home Care National Adult Day Services Assoc. Tools: Action Plan and Toolkit
  28. 28. © 2013 Griswold International, LLC It is agonizing. I see the word in my head, but I can’t say it. I try to avoid people so I don’t embarrass myself. Person with Dementia Communication Challenges
  29. 29. © 2013 Griswold International, LLC Types of Aphasia Expressive (Broca’s) Aphasia: non-fluent Speech is effortful and it is hard to convey thoughts through writing. The client knows what they want to say, but cannot find the words. Receptive (Wernicke’s) Aphasia: fluent The client speaks fluently, but the words often do not make sense. It is hard to process (receive) spoken or written words as well.
  30. 30. © 2013 Griswold International, LLC Anomic Aphasia Global Aphasia Primary Progressive Aphasia (PPA) It is hard to find/use the correct name for particular objects, people, places, or events. The word is always on the “tip of the tongue.” The client cannot speak or understand speech, nor can they read or write. This is the most severe form of aphasia, typically seen right after injury to the brain. The client has a language disorder that gets worse over time, but maintains ability to take care of themselves, pursue hobbies, and, in some instances, remain employed. PPA is a clinical dementia syndrome.
  31. 31. © 2013 Griswold International, LLC Communication Action Plan & Toolkit • Approach the person from the front, smile and say who you are • Get on eye level and make eye contact • Use short, simple words and sentences • Ask one question at a time • Speak slowly • Use a gentle and relaxed tone — a lower pitch is more calming • Give visual cues • Avoid quizzing • Write things down • Avoid talking down to the person or talking as if he or she isn't there • Be aware of your feelings and facial expressions Communication and Alzheimer's Aphasia Aids
  32. 32. © 2013 Griswold International, LLC Real Stories Rosemary Kane Family Caregiver, Support Group Facilitator
  33. 33. Your care team should include: © 2013 Griswold International, LLC Family Doctor/ Nurse Practitioner/ Nurse Geriatric Care Manager/ Social Worker Occupational Therapist Physical Therapist Home Care Adult Day Care Residential Care/ Hospital Advocacy/ Support Group Neurologist/ Geriatrician Speech Therapist Area Agency on Aging Your Dementia Care Team
  34. 34. © 2013 Griswold International, LLC Dementia Treatment n Validation Therapy n Snoezelen - Sensory stimulation n Complementary Treatment n Medicine • Music/art/dance therapy/tai chi • Antioxidants • FDA-approved dementia medicines • Antipsychotics • Antidepressants • Anti-anxiety • Anti-convulsants
  35. 35. © 2013 Griswold International, LLC Support Groups Can Help The most practical Dementia symptom management tips can be found through support groups. Here are links that can help you to find support groups in your area: Alzheimer’s Association Alzheimer’s Foundation of America
  36. 36. © 2013 Griswold International, LLC Real Stories Rosemary Kane Family Caregiver, Support Group Facilitator
  37. 37. © 2013 Griswold International, LLC© 2013 Griswold International, LLC Key Takeaways People with Dementia cannot control their symptoms It is important to surround yourself with Dementia experts and peers You can fight back through advocacy, education and support Symptoms are often triggered by unmet needs  
  38. 38. © 2013 Griswold International, LLC Open Q&A 1. Click to expand if necessary 2. Type questions here
  39. 39. © 2013 Griswold International, LLC National 24x7 Care Line: 800-GRISWOLD Brought to you by: Extraordinary Home Care at Affordable Rates Since 1982 Griswold Home Care offers access to affordable non-medical care options to assist your loved one. CareAssure Screening System™ The Griswold Golden Rule: We only approve caregivers we would trust in our own homes. QuickCare Placement™ We give each family access to the most experienced caregivers available. ValueCare Commitment™ Simple Rates. Unmatched Value. Our all- inclusive rates are among the most affordable.