New 8/4/2016 - The Carolinas Centercchospice.org/wp-content/uploads/2016/08/A3-The-Real... · 2016....
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8/4/2016 1
Transcript of New 8/4/2016 - The Carolinas Centercchospice.org/wp-content/uploads/2016/08/A3-The-Real... · 2016....
8/4/2016
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THE REEL WORLD OF DEMENTIAPLACES EVERYONE
Dr. Macie P. Smith, Gerontologist
TAKE 1
Reel World of Dementia
http://previews.123rf.com/images/flippo/flippo0907/flippo090700025/5193092-Hollywood-movie-items-including-a-clapboard-and-a-movie-reel-and-tin-on-a-white-background-Stock-Photo.jpg
ALZHEIMER’S DISEASE
o A progressive disease
o Nerve cells in the brain are destroyed
o Affects a person’s ability to carry out basic living
skills
o Causes a loss of mental abilities such as
memory , communication, and learning
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DEMENTIA
o A group of symptoms that evolve as a result
of having a medical condition that impairs
brain functioning
o Symptoms inhibit a person’s ability to
appropriately use his or her intellectual
abilities
o The loss of intellectual abilities interfere
with social and/or occupational functioning
CAUSES OF DEMENTIA
SC Alzheimer’s Registry, 2015
ALZHEIMER’S DISEASE CHARACTERISTICS
o Onset is 60-90 years of age
o Progressive
o Average 4-8 years (can last up to 20 years)
o 6th leading cause of death in the US
o 5th leading cause of death in US (for 65+)
o Cannot be prevented, cured, or even slowed
o May be further compromised by depression
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PATHOLOGY OF ALZHEIMER’S
o Plaques- a protein build up outside the nerve cell of the brain which interrupts information flow
o Tangles- a protein build up inside the nerve cell of the brain which short circuits the information flow
o Neurotransmitters (chemicals which help carry information from one nerve cell to another in the brain)-are prevented from doing their work.
CREDIT: REUTERS/DENIS BALIBOUSE
Normal Alzheimer’s
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REVERSIBLE DEMENTIA
o Possible causes:
o Infection
o Poor Nutrition
o Medication
o Alcohol
o Depression
o Isolation
o Dehydration
AAMI VS IMPAIRED
(AGE ASSOCIATED MEMORY IMPAIRMENT)
AAMI
Gradual sensory loss
Mild forgetfulness
Able to use reminders
Delayed recall
May forget parts of experience
Dementia
Gradual sensory loss
Progressive memory loss
Unable to use reminders
No recall
Forgets whole experience
AAMI VS IMPAIRED
(AGE ASSOCIATED MEMORY IMPAIRMENT)
AAMI
Able to follow directions
Some Paranoia / Hallucinations
Dementia
Loss of thinking skills
Loss of ability to make decisions/choices
Loss of ability to follow directions
Paranoia/Hallucinations will vary for each person
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RISK FACTORS
o Age
o Family History
o Genetics
o MCI (biomarker)
o Cardiovascular
o TBI
o Socioeconomic status
o Social Engagement
o Education
BRAIN PRESERVATION
o Antioxidants, C&E, B vitamins
o Fish (Omega -3 fatty acid)
o Exercise
o Low fat diet
o Mental activity
o Stay social
o Line Dancing
o Active Management
ACTIVE MANAGEMENT
o Appropriate use of available treatment
o Effective management of co-existing conditions
o Coordination of care among physicians
o Participation in social and stimulating activities
o Taking part in support groups and services
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DRUG THERAPY
o Pharmacologic Treatment
o Aricept
o Exelon
o Razadyne
o Memantine
o Non-pharmacologic Treatment
o Physical therapy
o Reminiscence therapy
TAKE 2
Reel World of Dementia
http://previews.123rf.com/images/flippo/flippo0907/flippo090700025/5193092-Hollywood-movie-items-including-a-clapboard-and-a-movie-reel-and-tin-on-a-white-background-Stock-Photo.jpg
CHARACTERISTICS OF DEMENTIA
www.rncasemanager.com
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THE FUNCTIONS OF THE BRAIN
http://theaddium.com/wp-content/uploads/2015/06/addium-functions.jpg
PSYCHOSOCIAL CHARACTERISTICS
o Personality changes
o Mood swings
o Depression
o Delusions
o Anxiety
o Agitation
BEHAVIORAL CHARACTERISTICS
o Wandering
o Misplacing items
o Aggressive behavior
o Inability to perform basic tasks (ADL’s):
Bathing
Dressing
Grooming
Eating
Toileting
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COGNITIVE CHARACTERISTICS
o Memory (recent) loss
o Confusion
o Disorientation to time and place
o Poor judgement
o Unable to make decisions
o Concrete thinkers
o Difficulty with abstract thinking
3 stages
Middle Stage
Early Stage
No concerns
Late Stage
EARLY SIGNS
o Memory loss PLUS
o Word find problems
o Poor decision making
o Disorientation
o Depression
o Apathy
o Unable to perform familiar tasks
o Need reminders
o Less spontaneity
o Decreased concentration
o Misplacing things
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MIDDLE SIGNS
o Risk to be left alone
o Increase in memory loss
o Mood disturbances
o Increased word find difficulties
o Problems tracking conversations
o Calculation difficulty
o Reading stops
o Visual-spatial perception problems
o Repetitive behaviors
o Inability to recognize self in mirror
LATER SIGNS
o Behavioral outbursts
o Paranoia/Hallucination
o Lost in familiar places
o Increased risk for falls
o Incontinence
o Assistance with ADL’s
o Simplification instructions
o Loss of inhibitions
o Limited communication
TAKE 3
Reel World of Dementia
http://previews.123rf.com/images/flippo/flippo0907/flippo090700025/5193092-Hollywood-movie-items-including-a-clapboard-and-a-movie-reel-and-tin-on-a-white-background-Stock-Photo.jpg
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COMMUNICATION CHALLENGES
o Difficulty interpreting conversation
o Difficulty understanding written communication
o Hiding what can’t remember
o Repeating stories
o Word-find difficulty
o Vocabulary shrinks
o Over use familiar words
COMMUNICATION STRATEGIES
o Assist with word-find
o Evaluate for hearing loss
o Reduce distractions
o Use one step directions or requests
o Therapeutic fib
o Validate / Comfort / Redirect (VCR)
OFFER ASSISTANCE BY
o Interpreting “their” facial expression
o Respond to “their” emotional tone
o Read “their” body language
o Understand generational barriers
o Understand cultural barriers
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VERBAL COMMUNICATION
o Take into consideration your actions
Tone of voice
Words
Facial expressions
Emotional state
Body position
Gestures
Touch
o Sensitive to non-verbal cues
o May mimic your actions
COMMUNICATION STRATEGIES
o Do not confront
o Assist with word-find
o Speak slowly
o Allow plenty of time to process
o Demonstrate visually
o Drop it / change subject
o Chat before asking to do task
o Be direct
o Approach from the front, but at an angle
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CAUSES OF CHALLENGING BEHAVIOR
o Pain
o Medical / Medication
o Fear
o Low vision/hearing
o Impaired problem solving skills
o Loss of control
o Don’t want to do, but being forced
o Difficulty communicating needs
o Feelings of isolation
o Under stimulation / Over stimulation
o Environment not desirable
TIPS TO AVOID CHALLENGING BEHAVIORS
o Use appropriate communication
o Use pictures
o Don’t surprise, communicate task first
o Watch for non-verbal communication
o Give choices, try to assist NOT control
o Keep environment simple and calm
o Establish routine/ minimize change
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ADDITIONAL TIPS
o Do not take actions personally
o If necessary, try later
o Explore medication for agitation/anxiety
o Engage in appropriate exercise, regularly
o Validate / Comfort / Redirect (VCR)
o Patience, Patience, Patience
CREDITS
o Alzheimer’s Association. (2015). Alzheimer’s facts and figures. Retrieved from www.alz.org
o University of South Carolina. (2015). Dementia Dialogues. Office for the Study of Aging. Pdf.
o Glisky, E. (2007). Brain aging: Models, methods, and mechanisms. Boca Raton, FL: CRC Press.
o Vockell, E. (n.d.) Educational psychology: A practical approach. Retrieved from http://education.purduecal.edu/Vockell/EdPsyBook/
