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Mindful Dementia-Caregiving – A Brief Introduction

Elisabeth Drance &

Donna Martin

BCPGA April 24, 2015

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Roadmap

• Mindfulness – a brief review• Health related benefits of mindfulness• Mindful caregiving• Mindfulness Practice – experiential practice• Q&A

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Supporting people with dementia ….

• Is often stressful for both family members and health care professionals.

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Consequences of Family Caregiver Stress

• Consequences to the caregiver– Physical, Emotional, Social, Work-related

• Consequences to the person with dementia– Premature placement– Diminished enjoyment of relationship– ?More rapid cognitive decline– Acceleration of Behavioural Symptoms– Elder Abuse

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Consequences of Health Care Professionals’ (HCP) Stress

• Consequences to the HCP– Physical, Emotional– Compassion Fatigue– Burnout– Increased injury rates

• Consequences to the person with dementia– Decreased patience for person’s behavior– Less interest in person-centered care– Increased outpacing, ignoring, infantilizing, task-orientation– Increased responsive behaviours

• Consequences for Health Care System– Increased sick time– Increased job turnover– Increased complaints from families

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Stress leads to “Mindlessness”

• Operating on “autopilot”• Being lost in fantasies of the past &

future• Rushing through activities without

attending to them• Breaking or spilling things because we’re

not paying attention.• Ron Siegel

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Variable Interventions

Family Caregivers• Psycho-education• Peer Support• Relaxation Therapy• Ambiguous Grief Work

Health Care Workers• Improving work-place

wellness• Improving job

satisfaction• Employee Assistance

Programs

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Relatively new approach to supporting dementia caregivers….

Mindfulness Training

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Mindfulness – the concept• Most frequently used western

definition –“Mindfulness is the awareness that arises by paying attention on purpose to the present moment, nonjudgmentally.”

- Jon Kabat-Zinn

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Mindfulness

1. Paying attention on purpose

2. To the present moment

3. Nonjudgmentally (accepting attitude)

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• Life is only available in the present moment. --Thich Nhat Hanh.

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Developing Mindfulness

• Formal mindfulness practice – mindfulness meditation

• Informal mindfulness practice

• eg. MBSR,MBCT

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How can mindfulness help professional and family caregivers?

• To see and accept things as they are• To loosen our preoccupation with ‘self’• To experience the richness of the

moment• To become free to act skillfully

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Benefits of Mindfulness for Dementia Caregivers

• Decrease in stress– Good for the brain– Improved physical health

• Improved Care outcomes

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How does Mindfulness Decrease Stress?

• Improves brain function– Increases attentional focus & choice of what we attend to– Decreases emotional reactivity– Decreases attachment to negative thoughts & feelings– Increased self-compassion

• Improves physical well-being– Strengthens the immune system– Improves treatment of/prevents illness where stress clearly plays a

role (cancer, hypertension, diabetes, heart disease etc)

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• “Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and freedom.”

• Viktor Frankl

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How does Mindfulness Practice Improve Quality of Care?

• Helps us to meet the person we are supporting in the present moment, exactly where they are.– Strengthens connection– Increases empathy, compassion– Less erosion of self-esteem for people we support

• Increases wise response to behaviour– Slows us down– Early recognition of distress in person with dementia

and myself– Decreased reactivity– Pulls us out of auto-pilot task-focused care– Choice of words

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• “I have discovered it isn’t so much about what I did or did not say or do that was key to pass on to professionals and family members – it was more about the way in which I was being with the persons with dementia that seemed important to communicate. Each person with dementia has taught me the importance of relaxing into being in the present moment. That moment may be perceived by her to be in a different place or time, but it is her very real and present moment”.

» Nancy Pearce

Inside Alzheimers

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• Mindfulness Practice– It’s your turn….

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• “Caring for someone with dementia is made up of an infinite number of small moments where we can go either way, adding more stress or bringing more ease.”

– Marguerite Rao

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References• Paller, K. A., Creery, J. D., Florczak, S. M., Weintraub, S., Mesulam, M. M., Reber, P. J., ... &

Maslar, M. (2014). Benefits of Mindfulness Training for Patients With Progressive Cognitive Decline and Their Caregivers. American journal of Alzheimer's disease and other dementias, 1533317514545377.

• Whitebird, R. R., Kreitzer, M., Crain, A. L., Lewis, B. A., Hanson, L. R., & Enstad, C. J. (2013). Mindfulness-based stress reduction for family caregivers: a randomized controlled trial. The Gerontologist, 53(4), 676-686.

• Lavretsky, H., Epel, E. S., Siddarth, P., Nazarian, N., Cyr, N. S., Khalsa, D. S., ... & Irwin, M. R. (2013). A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity. International journal of geriatric psychiatry, 28(1), 57-65.

• Irving, J. A., Dobkin, P. L., & Park, J. (2009). Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR). Complementary therapies in clinical practice, 15(2), 61-66.

• Zeller, J. M., & Lamb, K. (2011). Mindfulness meditation to improve care quality and quality of life in long-term care settings. Geriatric Nursing, 32(2), 114-118.

• Zeller, J. M., & Levin, P. F. (2013). Mindfulness Interventions to Reduce Stress among Nursing Personnel An Occupational Health Perspective. Workplace health & safety, 61(2), 85-89.

• Rao, Marguerite, How to Best Help Alzheimer Caregivers? Teach them Mindfulness, Huffington Post May 21, 2012

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Picture slide

• Bullet 1• Bullet 1