DEMENTIA CARE EDUCATION

Wait

Wait, Pause, Slow Down

What is dementia then?

brain failure

Validate emotions: EARLY stage

"It's really (label emotion) to have this happen"or "I'm sorry this is happening to you"

The person with dementia is focused on how we lookvisually, and they are notprocessing the content. (head nodding without comprehension)

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When engaged in activity...

Do 'With', not 'to' Give SIMPLE and Short Pieces of Information Offer concrete CHOICES Ask them to HELP you do something Ask the person to TRY Break the TASK DOWN to single steps at a time

Five ways to say "I'm sorry"

-I'm sorry, I was trying to help. -I'm sorry I made you feel (name the emotion.... angry, irritated, frustrated, sad, isolated). -I'm sorry I made you feel (name the experience you created....diminished, relationally unequal-like a child, stupid, or incompetent). -I'm sorry that happened (their perspective). -I'm sorry, this is HARD (for both of you)!

Dementia umbrella: Different types

-VascularDementias(Multi-infarct) -Lewy Body Dementia -Fronto-Temporal Lobe Dementias •Genetic syndromes •Metabolic •ETOH related •Drugs/toxin exposure •White matter diseases •Mass effects •Depression or Other Mental conditions •Infections -BBB cross •Parkinson's

What changes in dementia? Chemical changes

-variable Cells are producing and sending less chemicals Can 'shine' when least expected -chemical rush

HUGE CHANGES: brain

Formal Speech & LanguageCenter

What changes in dementia? Structural changes

=permanent ◦Cells are shrinking and dying

Acknowledge

Acknowledge the response/ reaction to your information...

PRESERVED: brain

Automatic Speech Rhythm -Music Expletives

Understanding Language

BIG change

Validate emotions: Late stage

Check out their 'whole' body - üObserve face, posture, movement, gestures, touching, looking üLook for NEED under the words or actions

Don't

DON'T ask questions you DON'T want to hear the answer to...

Executive Control Center

Emotions Behavior Judgment Reasoning

Hearing of Sound

NO change

Validate emotions: MIDWAY stage

Repeat/reflect their words (with emotion) üLISTEN for added information, ideas, thoughts üEXPLORE the new information by 'watching and listening' (wonder what they are trying to communicate)

If what you are trying is NOT working...

STOP Back off THINK IT THROUGH... Then, re-approach Try something slightly different

BIG CHANGES: brain

Sensory Strip Motor Strip White Matter Connections

Sensory change: Preserved Ability

•4 areas can be sensitive (mouth, hands, feet, genitalia) •Any of these areas can be hypersensitive •Need for sensation can become extreme

Four truths about Dementia

•At least 2 parts of the brain are dying •It is chronic and can't be fixed •It is progressive and will get worse •It is terminal

Sensory Changes: loss

•Awareness of body and position •Ability to locate and express pain •Awareness of feeling in most of body

Limit

•LIMIT your words -SIMPLE is better, always

Brain Atrophy

•The brain physically shrinks •Cells wither and die •Abilities are lost •With Alzheimer's, area of loss is somewhat predictable •BUT the experience is individual...

Use

•USE VISUAL combined VERBAL (gesture/point) •"It's about time for... " •"Let's go this way..." •"Here are your socks..."

Hand-under-Hand

•Uses established nerve pathways •Allows the person to feel in control •Connects you to the person •Allows you to DOwithnot to •Gives you advance notice of 'possible problems' •Connects eye-hand skills •Use the dominant side of the person

Alzheimer's Disease

•Young Onset •Late Life Onset

Vision: Preserved

◦'See'things in middle field ◦Looking at...curious

Understanding: Preserved Ability

◦Can get facial expression ◦Hears tone of voice ◦Can get some non-verbals ◦Learns how to cover

Language: Loss

◦Can't find the right words ◦Word Salad ◦Vague language ◦Single phrases ◦Sounds & vocalizing ◦Can't make needs known

Understanding: Loss

◦Can't interpret words ◦Misses some words ◦Gets off target

Vision: Losses

◦Edges of vision -peripheral field ◦Depth perception ◦Object recognition linked to purpose ◦SLOWER to process -scanning & shifting focus

Memory Loss

◦Immediate recall ◦Attention to selected info ◦Recent events ◦Relationships

Self-Care Changes: Loss

◦Initiation & termination ◦Tool manipulation ◦Sequencing

Dementia -What is it?

◦It is BOTH a chemical change in the brain ◦AND a structural change in the brain

Memory: Preserved Ability

◦Long ago memories ◦Confabulation! ◦Emotional memories ◦Motor memories

Self-Care Changes: Preserved Ability

◦Motions and actions ◦The "doing" part ◦Cued activity

Language: preserved

◦Singing ◦Automatic speech ◦Swear words, sex talk, forbidden words

Visual Information

◦The most powerful sensory input -People with dementia pay more attention to what they seethan what they hear.

Challenges for a person living with dementia

◦Unable to understand what is being said ◦Difficulty with word finding ◦Describing an object rather than naming ◦Loses train of thought ◦Revert to native language ◦Repeats same thing ◦Gestures rather than speaks