Why are we leading with a definition of Person-Centered Care? We must know the individual before we can adequately and accurately understand symptoms of dementia. Too often, individuals and families look at symptoms they perceive as dementia and fear the worst. It is important to realize from the beginning of this training that there are over TWO DOZEN recognized types of dementia and that is without even looking at depression, delirium and other types of “pseudo-dementia.”Person-centered care is an evolved method of caregiving that transforms the way in which staff work with those they are caring for and with one another.Person-centered care is best achieved when residences move from centralized management with standardized procedures to a team environment with individualized responses at the resident level.We know the person’s needs by knowing the person.The team’s ability to respond individually to those for whom they are caring means the resident is able to live in an environment which supports the “normalcy of his or her life.”Consider showing the video: http://nursing.flinders.edu.au/comeintomyworld/media/video.php?video=8
Here is more information and terminology associated with PCC.What would you define as “purposeful living”?
Don’t go from baseline to a diagnosis of Alzheimer’s Disease immediately. Consider alternatives. Consult a specialist.
Speaker notes: Consider directly addressing the fallacy that “Alzheimer’s” and “Dementia” are entirely separate. Emphasize that Alzheimer’s is one form of dementia, and that there are several others. (e.g., “His doctor says he either has dementia or Alzheimer’s” is a common example of this misconception)Dementia is a term for a group of diseases that affect cognition and memory. Alzheimer’s Disease is the most common form of dementia and is typically associated with the gradual loss of memory, reasoning, orientation and judgment along with the progression of a number of behavioral disorders including confusion, depression and aggression.
Note that 43% of DRD (Dementia Related Disorders) are diagnosed as Alzheimer’s diseases in adults over the age of 65.Alzheimer disease: This is the most common cause of dementia, accounting for about half of all cases. Alzheimer disease is at least partly hereditary in that it tends to run in families. (Just because a relative has Alzheimer disease, however, does not mean that another family member will have the disease.) In this disease, abnormal protein deposits in the brain destroy cells in the areas of the brain that control memory and mental functions. People with Alzheimer disease also have lower-than-normal levels of brain chemicals called neurotransmitters that control important brain functions. Alzheimer disease is not reversible, and no known cure exists. However, certain medications can slow its progress.Vascular dementia: This is the second most common cause of dementia, accounting for as many as 40% of cases. This dementia is caused by atherosclerosis, or "hardening of the arteries," in the brain. Deposits of fats, dead cells, and other debris form on the inside of arteries, partially (or completely) blocking blood flow. These blockages cause multiple strokes, or interruptions of blood flow, to the brain. Because this interruption of blood flow is also called "infarction," this type of dementia is sometimes called multi-infarct dementia. One subtype whose origin is not well understood is Binswanger disease. Vascular dementia is related to high blood pressure, high cholesterol, heart disease, diabetes, and related conditions. Treating those conditions can slow the progress of vascular dementia, but functions do not come back once they are lost. Parkinson disease: People with this disease typically have limb stiffness (which causes them to shuffle when they walk), speech problems, and tremor (shaking at rest). Dementia may develop late in the disease, but not everyone with Parkinson disease has dementia. Reasoning, memory, speech, and judgment are most likely to be affected. Lewy body dementia: This is caused by abnormal microscopic deposits of protein, called Lewy bodies, which destroy nerve cells. These deposits can cause symptoms typical of Parkinson disease, such as tremor and muscle rigidity, as well as dementia similar to that of Alzheimer disease. Lewy body dementia affects thinking, attention, and concentration more than memory and language. Like Alzheimer disease, Lewy body dementia is not reversible and has no known cure. The drugs used to treat Alzheimer disease also benefit some people with Lewy body disease. Huntington disease: This inherited disease causes wasting of certain types of brain cells that control movement as well as thinking. Dementia is common and occurs in the late stages of the disease. Personality changes are typical. Reasoning, memory, speech, and judgment may also be affected. Creutzfeldt-Jakob disease: This rare disease occurs most often in young and middle-aged adults. Infectious agents called prions invade and kill brain cells, leading to behavior changes and memory loss. The disease progresses rapidly and is fatal. Pick disease (frontotemporal dementia): This is another rare disorder that damages cells in the front part of the brain. Behavior and personality changes usually precede memory loss and language problems. Parkinson disease and Huntington disease begin in subcortical areas. They cause the subcortical type of dementia.
What we are doing is creating a more diverse menu of living options for older adults. We know that nine in ten older adults want to age in place (AARP, 2000). Here are options in addition to creating a more person centered approach among institutional models. And let me be clear that these are not solutions; just more options. It really is all about the person-environment fit.
To reduce both the risk of Legionnaire's disease and scalds, many experts recommend keeping the hot water heater set at higher temperatures (140°F+) and delivering safer, temperate water (110° – 120°) at the tap through the use of anti-scald valves. A severe burn can still occur at 120°F, but it takes 5 minutes, allowing the person and caregiver more time to react.These DIY anti-scald products are available as either separate valves that you screw onto existing faucets and showerheads or as replacement fixtures (tub spouts, showerheads, or hand held shower heads) with integral anti-scald valves.Special Note: Because persons with dementia may be unable to operate the faucet with the anti-scald valve installed, it may be best used with a live-in caregiver, given that the hot and cold water must be properly mixed or the water will not flow. Devices should be checked often to make sure they're working properly.
Always be person-centered in your approach. What did your loved one like in the past? What yields positive results now?
Remembering which meds to take, the right dosage, and at what times of the day can be difficult for anyone - and a daunting or impossible task for a person with dementia. Without a medication system in place, things can go desperately wrong for a person with declining memory and organizations skills. For example, he or she may take a medication, and then not know whether they've actually taken it. Pill bottle tops, difficult to remove, may be simply left off, allowing the bottles to spill. A person may sometimes take a medicine relying solely on the pill's color, leading to confusion with similar pills. And they may forget - is it one or two of the pink or blue pills? In addition, pills may be hidden under clutter.We all know how a person's health can suffer if they forget a medication, take the wrong one, or take too many. That's why it's essential that the person you care for gets assistance in managing their meds.The type of assistance needed depends on his/her stage of the disease, the complexity of their medication regimen, and whether or not they live alone. For example, in the early stages, he or she may be able to take medications independently, if you sort and organize their pills in a 7-day pillbox. But in the late stages, you'll need to administer all medications and keep them in a safe place to reduce the risk of an overdose.
It is important to review the many possible side effects of drugs. Many prescriptions for DRD’s can have GI side effects, which may lead to malnutrition or dehydration, that may quicken the disease progression.
Throughout our lives, we interact with friends, family, and strangers on a daily basis. It is important that persons with dementia continue to have these sort of meaningful encounters, even as their disease progresses. While it is true that your loved one may have trouble retaining memories or remembering his or her own loved ones, he or she can still recognize the attention, feelings, and moods of others.
Choose the Best Time and PlaceSocial visits should be planned for the times when your loved one is feeling their best. Visits should occur in environments that are not too crowded or busy.Plan AheadMake sure that friend and familiy have appropriate expectations by explaining the nature of the disease and what to expect as it progresses. Prepare visitors by informing them of how the mind and behavior of your loved one has changed. Prepare some sort of activity that can be shared during a visit, such as singing a song, looking through old photo albums, or taking a walk, as this can give your loved one something to focus upon. If there are pictures of the person(s), offer them to your loved one as a visual reminder to who is coming to visit.Know How to InteractMake sure that whoever is interacting with your loved one knows how he or she can best communicate with the person with dementia. Let visitors know that they should go with the flow and try to follow these guidelines:Avoid talking in loud voicesTalk slowly and avoid quick phrases.Be prepared for emotional outbursts and if there are some, speak calmlyKeep eye contactIdentify the person with dementia by name, so that he or she knows when someone addresses him or herBe prepared to repeat themselvesUse commonly used words or phrasesUse props and objects if neededBe prepared for the person with dementia to forget what he or she just said or get confused easilyLook interestedRemind them that they are not only important to you for their presence and support, but that they are still important and vital people in the life of your loved one.
Delight in the “small stuff”Accept help from “the village”. Family, friends, faith communities, in home care, adult day, long term careTreading Water…it will be increasingly difficult to tread water for two people. Know your limitations and reach out for support.The more you support your loved one’s ability to tread water, the easier it is for you.
Balancing maximum independence and home safety for individuals
Jay White, MSGerontologistVirginiaCommonwealthUniversityBALANCING MAXIMUMINDEPENDENCE AND HOMESAFETY FOR INDIVIDUALSWITH DEMENTIA
An increasedunderstandingof Home Safetyspecificallypertaining toadults with aDRDIncreasedawareness ofthe spectrum ofDementiaRelatedDisorders (DRD)A greaterunderstandingof the currentimpact ofDementia in theUnited StatesBasicIntroduction toPerson-CenteredCare and Agingin PlaceLEARNING OBJECTIVES
Person-Centered Care is an approach to care that respects andvalues the uniqueness of the individual, and seeks to maintain,even restore, the personhood of individuals. We do this bycreating an environment that promotes:WHY PERSON-CENTERED CARE?PersonalWorth &UniquenessSocialConfidenceRespectTruthfulnessIndependenceEngagementHope
WHAT IS PERSON-CENTERED CARE?Person-CenteredCareFosters optimal aging for theindividualEmpowersCare is driven--as much as possible--by the individual andsupported by the caregiverCore Values of•Choice•Dignity•Respect•Self-Determination•Purposeful Living
DEMENTIA: IT’S NOT JUST ALZHEIMER’SDementia affects 5% of people 65+5%and about 40% of adults over the age of 8540%This accounts for over 5,000,000 adults in the United StatesBetween 2000 and 2010 diagnoses of a Dementia Related Disorder has increased 68%
GENERAL WARNING SIGNSMemory lossthat disruptsdaily lifeChallenges inplanning orsolvingproblemsDifficultycompletingfamiliar orroutine tasksConfusion withtime or placeTroubleprocessingvisual imagesor spatialrelationshipsNew problemswith words inspeaking orwritingMisplacingthings andproblems withretracing yourstepsDecreased orpoor judgmentWithdrawalfrom work orsocial activitiesChanges inmood orpersonality
Do you work with adults with a Dementia Related Disorder: Yes NoSURVEY
Dementiais agroup ofillnessesDEMENTIA: A BRIEF OVERVIEWLate-onset (age 65+) is most common,slowest-progressingAverage course of Dementia of Alzheimer’s Type (DAT):6-20 years40%Alzheimer’s Disease isthe most common formof dementia
ALZHEIMER’S DISEASE IS ONE OF OVER TWODOZEN TYPES OF DEMENTIA
PROMINENT DEMENTIA SYNDROMESAlzheimer’sFrontotemporal dementiaLewy Body dementiaVascular dementiaHuntington’s diseaseParkinson’s dementia
WHY SUPPORT AGING IN PLACE FOR ADULTSWITH A DRD?
HOW CAN WE SUPPORT AGING IN PLACE?SUPPORTAGING INPLACEHOLISTICALLY= Person-CenteredBiologicallyPsychologically SociologicallySpirituallyEntering into areciprocalrelationship asa Care Partner
What do you consider the largest barrier to success for adultswith a DRD aging at home?1. Wandering2. Nutrition3. Agitation4. Isolation5. Care Partner Availability6. Others?BARRIERS TO SUCCESS
CHALLENGES FOR AGING IN PLACE9 out of 10 older adults prefer to live at home (AARP, 2006).This will not change with a diagnosis of Dementia.Homesthat areisolatedfromservicesLiving inhomesthat aretoo largeorunfamiliarHomesthat arenotfunctionalfor theagingHomesthat arerural
HOME SAFETY CHECKLIST: STAIRS, HALLSFalls can beprevented!Can you clearly seeall steps in yourhome as you go upand down? Free ofclutter?Handrails oninterior andexteriorstairways?Are all loose carpetsand runnersfastened to the flooror removed?Are therenight lights inthehallways?
Are your stove controls easy to see and use?Are flammable objects (towels or loose fitting clothing) keptaway from your stove?Can you reach items you regularly use without climbing on achair or stool? Or if you do have a stool, is it sturdy?Again, if you have mats or rugs, are they secured to the floor?KITCHEN SAFETY CHECKLIST
LOW TEMPERATURE SAFETY BURNERS Electric Safety Burners• 1/3 to 1/2 as hot as regular burners, but hot enough toboil water & cook a meal• Food, oil, & most household products will not catch fire• Attaches over existing burners• Assess persons cooking skills for safe usageKITCHEN: QUICK TIPS
DINING: QUICK TIPSSpeak slowly•it takes the person more time to understand andrespond.Encourage•Use encouraging words - Instead of "Dont", or "Sit down,you must eat!“, try to use "Look at this delicious food Imade especially for you!”Describe •Always tell the person what you’re serving.Orient•Use pointing, light touch, or an occasional tap on thetable to orient the person.Simple and specific•Use simple but specific verbal commands as in "Lift yourspoon!" or "Scoop the apple sauce!"•Avoid saying something like "Finish eating, Mom!"Move slowly andcalmly•Rushing a person can trigger agitation.Smile a lot•It can help reduce the persons stress (and yours) andmake for a more relaxing mealtime.•Ever heard of laughter yoga?
BATHROOM: QUICK TIPSDo the tub and/or showerhave a non-skid surface?Do you have a grab barinstalled in your tub orshower? Or what about abath seat?Watch those mats and rugs!Are you able to get on andoff the toilet easily?Consider purchasing araised toilet seat or considerhaving a grad bar installed.Does your bathroom have anightlight?Is your hot water heater settoo high (keep under 120degrees)
Solution: Anti-Scald Valves installed on faucets, shower heads ortub spoutsSCALD RISKS: QUICK TIPSLower water heater temperatures canincrease bacterial growth.For example, 120°F has been the standardrecommended water heater temperature forreducing hot water scalding risk. This lowertemperature, however, can increase healthrisks, as bacteria can thrive at temperaturesbelow 140º F, especially in electric heaters.Older adults with weakened immunesystems are at increased risk for Legionellabacteria (which causes pneumonia) whenwater heater temperatures are reduced.Most homes and apartmentshave water heaters set at 140°For above.A severe burn can occur in 5seconds at 140º F or in 1 secondat 150º F.
BATHROOMS: QUICK TIPSBathing Chairs Showering a person who is sitting is easier and saferthan lowering a person into and lifting them out of atub. The right bath chair or transfer bench can increase thecomfort, safety, and hygiene of the person you care forand - as a bonus – is back-friendly for you. Weve sorted through a lot of information to give you acondensed "things you need to know" list. Not all bathchairs are equal. For example, some features are saferor more comfortable than others and some chairs aretoo large to fit into every tub.TIPA colorful towel on the seat that contrasts with the tub floor can help reduce fear offalling for those who have dementia-related problems with depth perception or for thosewith low vision.
DEMENTIA-FRIENDLY ACTIVITIES• Increase positive feelings• Bring out hidden memories• Reduce challenging behaviorsLIVING ROOM: QUICK TIPSSuggestions:Listening to or signing favorite songs, watching short, soothing videos, looking atmagazine or photo albums, aromatherapy hand massage, pet therapy
LIVING ROOM NEEDS• Good lighting• Comfortable seating• Quiet - reduce distracting sounds• Places to store items (table, armoire, etc.)LIVING ROOM: QUICK TIPS
MEDICATIONS: QUICK TIPS•Coordinate with all care providers to ensure each knows what the other hasprescribed (including OTC, PRN and Herbals)COORDINATION•Ask/Look for possible drug-drug interactions or drug-food interactionsDRUG INTERACTIONS•If swallowing becomes a problem, see if the medication is available in anotherformat (compounding pharmacies may be an option)INGESTING•Keep a journal!JOURNAL•Invest in a pill box organizerORGANIZATION•Develop a routine or invest in alarm remindersROUTINE AND REMINDERS•Use simple language with clear instructions when administeringSIMPLE AND CONCISE•Keep even PRN’s, OTC’s, Herbals and Vitamins in a locked drawerLOCK•Make sure emergency numbers are easily accessibleEMERGENCIES•Review protocol on a regular basis with the progression of the DRDREVIEW
http://www.alzpossible.org/wordpress-3.1.4/wordpress/webinars-2/medication-related-issues/BIOLOGICAL WELLNESS: ISSUES OFPOLYPHARMACY AND AGING IN PLACE
The plagues of loneliness, helplessness and boredom accountfor the bulk of suffering among our older adults.--“The Eden Alternative”. www.edenalt.orgSOCIALIZATION INSIDE AND OUTSIDE OF THEHOME
Choose the BestTime and PlacePlan AheadKnow How toInteractMake sure thatwhoever isinteracting with yourloved one knowshow he or she canbest communicatewith the person withdementia.Remind them thatthey are not onlyimportant to you fortheir presence andsupport, but thatthey are stillimportant and vitalpeople in the life ofyour loved one.SOCIALIZATION: QUICK TIPS
FOR THE CARE PARTNERFull timeLong hoursNo vacationApplicants are chosen atrandom without consent!Recharge your batteriesTreading Water
www.thiscaringhome.org www.alz.org www.dementiacarecentral.com www.liftcaregiving.com My91yearoldmom.com www.dcrinc.org Your Area Agency on Agency Communities of FaithRESOURCES