Reaching Beyond the Shadows. An Overview of Dementia


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  • United States population & poverty rates
    Michigan Counties 2003
  • Why have we chosen to support the Alzheimer’s Association Safe Return Program over other programs and services?
    A recent study A look at deaths occurring in persons with dementia lost in the community completed by Rowe and Bennett reported the that only 25% of the people in their study who wandered were found within 24 hours.
    The National Alzheimer’s Association reports that of the people enrolled in the Safe Return program 88.4% were found within 24 hours.
    50.7% were found within 4 hours
    19.2% were found in 4-8 hours
    8.3% were found in 8-12 hours
    10.2% were found in 12-24 hours
    Only Nationwide program
    Only program that registers both the Client and their Caregivers
    Most helpful to Law enforcement officers
    Will accept information from multiple reporting individuals or agencies
  • Reaching Beyond the Shadows. An Overview of Dementia

    1. 1. Reaching Beyond the Shadows… An Overview of Dementia Macomb County Department Senior Citizen Services Presented by Karen D. Bisdorf Kathryn Ann W. Kozlinski 10th Annual Michigan Traffic Safety Summit
    2. 2. Aging In America • 1 in 10 Americans have a family member with a cognitive impairment • 1 in 3 knows someone with dementia • 2002 - 4.5 million 2010 - 5.1 million • Census now 65/85 85/105 105/115 • 2030 the baby boomers will have turned 65 • 7.7 million persons will present with a dementia-related illness in the US
    3. 3. What is Dementia? • Dementia is an umbrella term • The loss of mental function two or more areas of the brain Language, memory, judgement, personality, or visual–spatial comprehension. Severe enough to interfere with daily life. • Damage causes the death/malfunction of brain cells.
    4. 4. Dementia Related Illnesses • Alzheimer’s Disease • Lewy body dementia • Vascular dementia • Stroke - CVA • Multi-infarct dementia • Medication imbalance • Alcohol/drugs • Korsakoff’s Syndrome • Parkinson’s Disease • Tumors • Head injury • Nutritional • Environmental • If it affects the heart It may affect the brain
    5. 5. Prevalence of Dementia • Ages – 10 percent • Over 65 years – 45 per cent • Over 85 years – 60 percent • 90 years and over • Phases – Beginning • 3-5 years – Middle • 8-13 years – Late • 1-3 years No cure – insidious - progressive disease 2-21 years diagnosis to death 8-12 years hands on caregiving needed
    6. 6. Warning Signs Profound memory loss Misplacing things Abstract thinking Difficulty with routine tasks Change in mood & behavior Language skills Loss of initiative Disorientation time/ place Poor or weak judgement Personality changes
    7. 7. Circumstances in Which You May Encounter a Person With Dementia • Driving – Appearance of DUI – Traffic Violations – Traffic Accidents – Erratic Driving • Wandering 60 – 20% – Lost and Confused – Walking & Driving • Endangered Adult – Critical Incidence • False Reports – Home Invasion – Theft – Misplaced items – Shoplifting • Victimization – Scams, Schemes, Swindles – Abuse & Neglect • Sexual Misconduct – Indecent Exposure
    8. 8. Macomb County Senior Assessment Request • Endangered adults • False reports • Victimization • Abuse or neglect • Unsupervised activities • Community service referrals
    9. 9. Communication Guidelines • Approach from the front when possible • Approach with respect – maintain their dignity • Introduce yourself – call them by name if possible • Maintain eye contact – establish some type of rapport • Speak in slow distinct tones
    10. 10. Encounter Tools • Look for physical and medical needs first • Look for a medical alert or ID bracelet • Pay close attention to mood & emotion • Easily redirected if not agitated • Allow as much space as possible • Avoid backing them into a corner • Environmental noise & bright light are confusing
    11. 11. Communication Tools • Be clear about your expectations – Project the feeling that you assume they can and will do what you ask of them • Request their assistance – Don’t order or demand • Don’t push or pull – Walk beside – Direct with gestures – Instructions one at a time
    12. 12. Communication Tools • This is a disease of emotions – Control the emotional environment – Maintain control-they will mimic you – Don’t argue – There is no logic- they can’t follow your reasoning • Don’t try reorientation to time & place – Find out where they are in time – Work at that level – Do not lie – Ask them non-threatening questions
    13. 13. Signs of Unsafe Driving • Forgetting how to locate familiar places • Failure to observe traffic signals • Slow or poor decisions in driving • Driving at inappropriate speeds • Becoming angry or confused while driving • Night blindness • Being uncomfortable on the road
    14. 14. Restricting a Driver • Family doctor may write a “do not drive” prescription • Family maintain control access to the car keys • Disable the car - remove the distributor cap or battery • Park the car on another block or in a neighbor’s driveway • Discuss unsafe driving practices with insurance agent • Encourage family members to keep a record of their observations to share with person, other family members and health care professionals
    15. 15. Why Do People Wander • Restless - Bored • Confused about time and place • Change in physical environment • Over stimulated environment “getting away” • Argument with caregiver • Fear caused by delusions or hallucinations • Medication side effects • Sundowning a biological clock
    16. 16. Endangered Person • These persons are not “missing” • They are “endangered” • Time is of the essence • Do they have an ID bracelet? • Are they registered in the Alzheimer’s associations safe return program?
    17. 17. Endangered Persons • Won’t knock on doors Won’t flag you down • They won’t answer if you call their name • They don’t think they are lost • They may not stand out in a crowd • Will be drawn to water, ditches, culverts • Will walk in the snow shoeless & coatless • Check the immediate area first • Then go to old familiar places • They wander on foot, by car, and by boat
    18. 18. Survival Rates • 50% chance to find them alive in the first 16 hours • That percentage drops by 10% each hour they are lost • 46% of those found dead died of hypothermia or dehydration
    19. 19. Safe Return Program • SRP provides identification products – ID bracelets/necklace /key chains • 24 hour hotline • Registration in National data base • Access to law enforcement agencies • Direct connect to nationwide Alzheimer’s Association offices
    20. 20. Safety and Care Tips • Impaired person’s can’t be left alone or unattended in waiting rooms, offices or vehicles • Automatic car windows can be dangerous • The person should sit next to the driver, not alone in the back seat of cars without protection locks
    21. 21. Rapid Assessment Look, Listen and Test to determine the risk • Look – Body Language: • Clenched fist, staring or hyper-vigilance, inappropriate facial expressions, posture, red face – Psychomotor Activity: • Pacing, wringing hands, rapid breathing, clenched teeth, ballistic movements – Physical Appearance • Blank facial expressions, Inappropriate clothing, disheveled
    22. 22. Rapid Assessment • Listen – Speech content • What is the person talking about, who is the person talking to, are they responding to real people and events. Do they have a legitimate gripe. – Speech organization: • Is the person fluent, does he/she jump from one topic to another, can he follow a conversation • Test – Receptivity: • Can you connect with the person, are they going to cooperate, do they react to their name, will they follow simple directions
    23. 23. Good Judgement • Rapid assessment is completed in a matter of moments and does not guarantee freedom from risk, or the potential for a catastrophic reaction • Trust your gut • Get a history when possible – What medications are being taken – History of child or spouse abuse – History of violence during disputes
    24. 24. Referral Resources • Michigan Department of State – Request for Driver Evaluation – Form OC88 • Elder Referral-Request for Individual/Family Assessment – Macomb County Senior Citizen Services • Adult Abuse Hotline – Adult Protective Services (APS) – Request for Investigation – 800.996.6228
    25. 25. Information or Assistance Macomb Co. Department of Senior Citizen Services 586-469-6313 Macomb Co. Adult Day Service Program 586-466-6817 or 586-469-5579 Alzheimer's Association -Greater Michigan Chapter 800-621-0379 Alzheimer’s Association 24/7 Helpline 800-337-3827 Alzheimer’s Safe Return Nationwide Program 888-572-8566
    26. 26. Information or Assistance State of Michigan Insurance Commission Traffic Associations of Michigan Offer driving assessments and safe driver classes Duke Family Support Program, Durham, NC 800-672-4213 North Carolina Division of Aging 919-733-0440
    27. 27. Resources At the Crossroads, A Guide to Alzheimer’s Disease, Dementia and Driving Publication # 105013 The Hartford, Hartford, CT. 06115 We Need to Talk, Family Conversations with Older Drivers Publication # 105924 AARP /The Hartford Driving for Life, A Guide for Older Drivers and their Families Publication # BBBB 000 Michigan Secretary of State
    28. 28. Resources Alzheimer’s Association Safe Return Program Law Enforcement Official Training book Publication # PF 203z Safe Return Video Law Enforcement Safe Return Program Applications – English Chinese – Korean Polish – Russian Spanish – Vietnamese
    29. 29. Resources Michigan Area Agencies on Aging Handout Michigan Directors of Services to Aging Handout AARP AARP Life Answers National Institute on Aging P.O. Box 8250 Silver Springs, MD 20907-8250
    30. 30. Comments Questions? Concerns? Thank you for the opportunity of speaking with you today