Slide 1 Dementia and Stroke Central South Regional Stroke Program September 2007 Funded by the...

Dementia Dementia and Stroke and Stroke

Central South Regional Stroke Central South Regional Stroke ProgramProgram

September 2007September 2007

Funded by the Ministry of Funded by the Ministry of Health and Long-Term CareHealth and Long-Term Care

Session OverviewSession Overview

The types of stroke. The types of stroke. The common changes that result from The common changes that result from

stroke.stroke.The connection between stroke and The connection between stroke and

dementia.dementia.The behaviour changes that result from The behaviour changes that result from

dementiadementiaStrategies to assist in working with residents Strategies to assist in working with residents

with dementiawith dementia

What is a StrokeWhat is a Stroke

An An interruption of the supply of blood and interruption of the supply of blood and oxygen to an area of the brain.oxygen to an area of the brain.

This causes the brain cells in an area to die, This causes the brain cells in an area to die, and reduces the brain function in that area.and reduces the brain function in that area.

The area of the body controlled by the The area of the body controlled by the damaged area in unable to function properly.damaged area in unable to function properly.

There are two types of stroke.There are two types of stroke.

http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#efhttp://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

What is a Stroke?What is a Stroke?

A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996

A stroke can A stroke can happen when a happen when a blood clotblood clot blocks blocks a blood vessel in a blood vessel in the brain.the brain.

80% of strokes are 80% of strokes are this type.this type.

What is a Stroke?What is a Stroke?

A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996

A stroke can also A stroke can also happen when a happen when a blood vessel blood vessel breaksbreaks and results and results in in bleedingbleeding in the in the brain.brain.

20% of strokes are 20% of strokes are this type.this type.

Risk factors you can do Risk factors you can do something about…something about…

High blood pressureHigh blood pressureHigh blood High blood

cholesterolcholesterolHeart diseaseHeart diseaseDiabetesDiabetes

Being overweightBeing overweightExcessive alcohol Excessive alcohol

useusePhysical inactivityPhysical inactivitySmokingSmokingStressStress

What does a What does a resident who has resident who has had a stroke look had a stroke look

like in LTC?like in LTC?

What are some of the losses What are some of the losses due to stroke?due to stroke?

paralysis or weakness on one side of paralysis or weakness on one side of the body; the body;

vision problems (double vision); vision problems (double vision); trouble speaking or understanding trouble speaking or understanding

language; language;



inability to recognize or use familiar inability to recognize or use familiar objects;objects;

tiredness; tiredness; depression; depression;



exaggerated or inappropriate emotional exaggerated or inappropriate emotional responses; responses;

difficulty learning and remembering new difficulty learning and remembering new information; and information; and

changes in personality. changes in personality.


Stroke StatisticsStroke Statistics

There are between 40,000 and 50,000 There are between 40,000 and 50,000 strokes survivors in Canada each year.strokes survivors in Canada each year.

10% (4-5,000) of strokes survivors each year 10% (4-5,000) of strokes survivors each year require long-term care.require long-term care.

40% (16-20,000) of strokes survivors each 40% (16-20,000) of strokes survivors each year are left with a moderate to severe year are left with a moderate to severe impairment.impairment.

http://ww2.heartandstroke.ca/Page.asp?http://ww2.heartandstroke.ca/Page.asp?PageID=33&ArticleID=1078&Src=news&From=SubCategoryPageID=33&ArticleID=1078&Src=news&From=SubCategory

Dementia is a syndrome…that Dementia is a syndrome…that includes loss of memory, includes loss of memory,

judgment and reasoning, and judgment and reasoning, and changes in mood, behaviour and changes in mood, behaviour and

communication abilities. communication abilities.

Alzheimer’s Society of Canada

What is dementia?What is dementia?

1111 in memoryin memory

2.2. And at least one of the following:And at least one of the following:a)a) Difficulty with languageDifficulty with languageb)b) Difficulty with voluntarily moving despite having Difficulty with voluntarily moving despite having

normal muscle functionnormal muscle functionc)c) Difficulty recognizing and identifying objects or Difficulty recognizing and identifying objects or

personspersonsd)d) Difficulty with planning, reasoning, problem Difficulty with planning, reasoning, problem

solving and judgment.solving and judgment.

The Diagnostic and Statistical Manual published by the American Psychiatric Association

Types of DementiaTypes of Dementia

Adapted from Feldman H, Levy A, Hsiung G, et al. A Canadian Cohort Study of Cognitive Impairment and Related Dementias (ACCORD): Study Methods and Baseline Results.

Neuroepidemiology 2003;22: 265-274.

Alzheimer’s Alzheimer’s 47.2%47.2%

Mixed Dementia Mixed Dementia 33.7%33.7%

Vascular Vascular Dementia Dementia

8.7%8.7%

Dementia with Lewy bodies Dementia with Lewy bodies (1.9%) (1.9%)

Frontotemporal dementia Frontotemporal dementia (5.4%)(5.4%)

Other Other (3.1%)(3.1%)

How many people have How many people have dementia?dementia?

(Canadian Study of Health and Aging Working Group, 1994)(Canadian Study of Health and Aging Working Group, 1994)..

Age Community Institution

≥ 65 8% 15%

≥ 75 11% 48%

≥ 85 35% 65%

Vascular dementia is related Vascular dementia is related to stroke and can cause a to stroke and can cause a loss in memory, reasoning, loss in memory, reasoning, thinking, attention span and thinking, attention span and independence with activities independence with activities

of daily livingof daily living..

Alzheimer Society of CanadaAlzheimer Society of Canada

Health and Quality of Life Outcomes 2004, 2:52Health and Quality of Life Outcomes 2004, 2:52

Vascular dementia results Vascular dementia results when a critical part of the when a critical part of the

brain does not receive brain does not receive enough oxygen.enough oxygen.

http://www.emedicinehealth.com/stroke-related_dementia/http://www.emedicinehealth.com/stroke-related_dementia/article_em.htmarticle_em.htm

What symptoms may be present in What symptoms may be present in vascular dementia?vascular dementia?

Problems Problems concentrating and concentrating and communicating communicating

Depression Depression accompanying the accompanying the dementia dementia

Symptoms of stroke, Symptoms of stroke, such as physical such as physical weakness weakness or paralysis or paralysis

SeizuresSeizures

http://www.alzheimers.org.uk/Facts_about_dementia/What_is_dementia/info_vascular.htm

What are the symptoms of vascular What are the symptoms of vascular dementia?dementia?

Memory problems Memory problems (although this may (although this may not be the first not be the first symptom) symptom)

A ‘stepped’ A ‘stepped’ progression, with progression, with symptoms remaining symptoms remaining at a constant level at a constant level and then suddenly and then suddenly deteriorating deteriorating

Periods of acute Periods of acute confusionconfusion


Other symptoms may include:Other symptoms may include:

Hallucinations (seeing things that do not exist) Hallucinations (seeing things that do not exist) Delusions (believing things that are not true) Delusions (believing things that are not true) ‘‘Wandering’ and getting lost Wandering’ and getting lost Physical or verbal aggression Physical or verbal aggression Restlessness Restlessness IncontinenceIncontinence


Communication StrategiesCommunication Strategies

Eliminate distractions (e.g. TV, radio)Eliminate distractions (e.g. TV, radio) Approach the person slowly and from the front; establish Approach the person slowly and from the front; establish

and maintain eye contactand maintain eye contact Use short, simple sentencesUse short, simple sentences Speak slowly Speak slowly Give one instruction at a timeGive one instruction at a time Ask “yes/no” rather than “open-ended” questionsAsk “yes/no” rather than “open-ended” questions Repeat messages using the same wordingRepeat messages using the same wording Paraphrase repeated messagesParaphrase repeated messages Avoid interrupting the person; allow plenty of time to Avoid interrupting the person; allow plenty of time to

respondrespond Encourage the person to “talk around” or describe the word Encourage the person to “talk around” or describe the word

he is searching for.he is searching for.

Small et.al., (2003) Effectiveness of Communication Strategies Used by Caregivers of Small et.al., (2003) Effectiveness of Communication Strategies Used by Caregivers of Persons With Alzheimer’s Disease During Activities of Daily Living, Persons With Alzheimer’s Disease During Activities of Daily Living, Journal of Speech, Journal of Speech,

Language and Hearing Research; 46, 2:353Language and Hearing Research; 46, 2:353

ADLADL StrategiesStrategies

EatingEating

Offer one food at a Offer one food at a time time

Use contrasting colours Use contrasting colours for food, plate, for food, plate, placematplacemat

Try lighter weight Try lighter weight utensils & cuputensils & cup

Serve more finger Serve more finger foods foods

Check for dentures, Check for dentures, problems with chewing problems with chewing

http://depts.washington.edu/adrcweb/UnderstandingAD/Strategies.shtml#dressing

EatingEating

Provide a relaxing Provide a relaxing eating area eating area

Provide adequate fluids Provide adequate fluids - serve jello, popsicles, - serve jello, popsicles, juices, and ice cream juices, and ice cream to increase fluids to increase fluids

If appetite is poor, If appetite is poor, contact your registered contact your registered staff or doctorstaff or doctor

Some residents benefit Some residents benefit from dietary from dietary supplements (Ensure)supplements (Ensure)


BathingBathing

Ensure privacy and Ensure privacy and respectrespect

Have the bath water Have the bath water ready beforehand. ready beforehand.

Ensure that the water Ensure that the water is not cold.is not cold.

Let the resident touch Let the resident touch the water.the water.

Use gentle touch and Use gentle touch and cueingcueing


BathingBathing

Save shampooing until Save shampooing until last (last (avoid showering avoid showering the face)the face)

Avoid bath oils that Avoid bath oils that make the tub slipperymake the tub slippery

Use coloured Use coloured decals/mat to indicate decals/mat to indicate the tub bottomthe tub bottom

Cover up mirrors if they Cover up mirrors if they disturb the patientdisturb the patient


DressingDressing

Lay articles of clothing Lay articles of clothing out in sequence out in sequence

Pick clothes that fit Pick clothes that fit easilyeasily

Keep the dressing Keep the dressing routine as consistent routine as consistent as possible as possible

If the patient wants to If the patient wants to wear the same thing wear the same thing over and over, obtain over and over, obtain duplicatesduplicates


ToiletingToileting

Make sure that the Make sure that the toilet is visible from the toilet is visible from the resident’s bed or resident’s bed or hallwayhallway

clearly mark the clearly mark the bathroom door with a bathroom door with a signsign

Provide adequate Provide adequate lighting along the lighting along the pathway to the pathway to the bathroom bathroom


ToiletingToileting

Encourage a toileting Encourage a toileting routine to avoid routine to avoid incontinence e.g. every 2 incontinence e.g. every 2 hourshours

Continually evaluate the Continually evaluate the level of assistance needed level of assistance needed

Remember that urinary Remember that urinary tract infections are tract infections are common in elderly people; common in elderly people; if a fever persists for more if a fever persists for more than 24 hours, contact your than 24 hours, contact your doctordoctor


MobilityMobility

Increase daily Increase daily exercise & activity exercise & activity levellevel

provide safe access to provide safe access to the outdoors the outdoors

decrease or increase decrease or increase the resident's the resident's stimulationstimulation

add familiar items to add familiar items to the resident’s room the resident’s room

MobilityMobility

Remind residents to use Remind residents to use their walking aid due to their walking aid due to memory problems,memory problems,

Remind/teach residents Remind/teach residents about the need to use about the need to use walker brakes, walker brakes,

It is important to use It is important to use these strategies to these strategies to decrease the risk of fallsdecrease the risk of falls

Always remember that you Always remember that you can request an OT referral can request an OT referral

from CCAC if you need from CCAC if you need assistance with finding the assistance with finding the

right strategy.right strategy.

JerryJerry

Jerry is a 68 year old man who has been living Jerry is a 68 year old man who has been living at Cozy Acres for the last 6 months. Jerry at Cozy Acres for the last 6 months. Jerry entered the nursing home after his wife was entered the nursing home after his wife was admitted to hospital. Jerry has had episodes admitted to hospital. Jerry has had episodes of forgetfulness (left the stove on, and tap of forgetfulness (left the stove on, and tap running) and impulsivity and needs help running) and impulsivity and needs help completing multi-step activities since his completing multi-step activities since his stroke 2 years ago. Jerry is well-liked by stroke 2 years ago. Jerry is well-liked by everyone and gets around Cozy Acres everyone and gets around Cozy Acres independently with his walker.independently with his walker.

JerryJerry

Recently Jerry has been found wandering Recently Jerry has been found wandering around the facility. He usually finds his way around the facility. He usually finds his way back but sometimes needs staff to bring him back but sometimes needs staff to bring him back to his unit. Jerry at times forgets to use back to his unit. Jerry at times forgets to use his walker and becomes angry when staff his walker and becomes angry when staff reminds him that he needs to use it at all reminds him that he needs to use it at all times. Jerry has said that he feels that they times. Jerry has said that he feels that they are just trying to “boss him around” and that are just trying to “boss him around” and that he really does not need the walker, even he really does not need the walker, even though he has had 2 falls in the last week.though he has had 2 falls in the last week.

JerryJerry

Today when you entered Jerry’s room he did Today when you entered Jerry’s room he did not recognize who you were. You initially not recognize who you were. You initially

thought he was joking with you.thought he was joking with you.

What do you think is going on with Jerry?What do you think is going on with Jerry?What else could be happening with Jerry?What else could be happening with Jerry?

What are you going to do next?What are you going to do next?

Next Steps…Next Steps…

You are the eyes, ears and voice of your You are the eyes, ears and voice of your facility.facility.

Be aware of the diagnosis of your residentsBe aware of the diagnosis of your residentsTake this information and use it with your Take this information and use it with your

residents.residents.Share this information with other staff.Share this information with other staff.

More InformationMore Information

Acute Changes and StrokeAcute Changes and Stroke Continence and StrokeContinence and Stroke Dementia and StrokeDementia and Stroke Falls and StrokeFalls and Stroke Pain and StrokePain and Stroke

Please contact: Please contact:

Rebecca Fleck or Kim YoungRebecca Fleck or Kim YoungCommunity and Long Term Care Specialist Community and Long Term Care Specialist Central South Regional Stroke ProgramCentral South Regional Stroke Program905-521-2100 x 44127905-521-2100 x 44127

AcknowledgementsAcknowledgements Best Practices long term care advisory groupBest Practices long term care advisory group Best Practices long term care evaluation groupBest Practices long term care evaluation group Barb McCoy and Deb Bryson, Psycho –geriatric consultants, HamiltonBarb McCoy and Deb Bryson, Psycho –geriatric consultants, Hamilton Mary-Lou Vander Horst, Regional Best Practice Coordinator Long-Term Mary-Lou Vander Horst, Regional Best Practice Coordinator Long-Term

Care Central South RegionCare Central South Region Wendy McDougall, Regional Best Practice Coordinator Long-Term Care, Wendy McDougall, Regional Best Practice Coordinator Long-Term Care,

Central West RegionCentral West Region Central South Regional Stroke ProgramCentral South Regional Stroke Program Maryann Watts, Hamilton Health Sciences, Clinical Manager Neuro-Maryann Watts, Hamilton Health Sciences, Clinical Manager Neuro-

ambulatory Centreambulatory Centre Melanie Fall Stratton, Regional Stroke Program, Program Manager,Melanie Fall Stratton, Regional Stroke Program, Program Manager, Kim Young, Regional Stroke Program, Community and Long-term Care Kim Young, Regional Stroke Program, Community and Long-term Care

SpecialistSpecialist Lisa Colizza, Regional Stroke Program, Regional Stroke Development Lisa Colizza, Regional Stroke Program, Regional Stroke Development

SpecialistSpecialist Nancy van Essen, Regional Stroke Program, Stroke Rehabilitation Nancy van Essen, Regional Stroke Program, Stroke Rehabilitation

CoordinatorCoordinator Carol Pereira, Regional Stroke Program, LTC Project CoordinatorCarol Pereira, Regional Stroke Program, LTC Project Coordinator

Slide 1 Dementia and Stroke Central South Regional Stroke Program September 2007 Funded by the...

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