WHAT DOES THE PERSON WITH DEMENTIA NEED?

The person with dementia needs to feel safe, but not in a way that they feel restricted. The person with dementia has a need to understand. The person with dementia has a need to be understood. The person with dementia has a need to be healthy and physically fit. The person with dementia has a need to be spoken to like an adult.

The need to feel safe, means feeling comfortable and accepted. Many times when a person with dementia moves into a nursing home, they will talk about “going home.” Home is where you are comfortable, accepted and you will not be forced into doing something. In the nursing home setting it takes about a month for many to no longer ask to go home. It is not that they are now resigned to being in the nursing home. It is that they finally feel that acceptance and feel at home.

The need to understand, and be understood. Persons with dementia have lost their normal forms of communication. They no longer can communicate verbally or non-verbally their needs. Even the person who still has words has trouble expressing their thoughts and feelings. Misinterpretation of their environment causes more misunderstanding and results in fear.

The person with dementia has a need for nutritious food and exercise.  Nutritious meals, no junk food, supplement with B vitamins for stress and brain health, fresh air and exercise results in better sleep. (B vitamins should only be taken in the morning so they do not disrupt sleep)

The person with dementia needs to be included in conversations. They need to be addressed by their preferred name or title.

The person with dementia struggles all day long to understand their world and make their needs known.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

THE HIGH COST OF DEMENTIA TO SOCIETY, FAMILIES AND MOST OF ALL TO THE INDIVIDUAL

There is a high cost of dementia both to society as well as the individual and family. The cost to society through Medicare payments is not only high it is skyrocketing. Currently 1 in every 5 dollars spent is on elderly with dementia. The per-person cost to Medicare for taking care of persons with dementia is 19 times higher than the average per-person cost for all other seniors together. The total spending by families is close to the same as the government spends.

The cost of dementia to society:

  • Alzheimer’s is the most expensive condition in the nation. In 2014 the cost to Medicare and Medicaid was $150 billion with an estimated total cost of $214 billion. Estimates are that 2050 costs will escalate to $1.2 trillion dollars.
  • In 2014 an estimated 5.2 million Americans had dementia.
  • Of the over 5 million people with dementia age 65 and older, 3.2 million are women and 1.8 million are men.

The cost of dementia to families:

  • In 2013, 15.5 million friends and family provided 17.7 billion hours of unpaid care to those with dementia. That care was valued at $220.2 billion dollars.
  • The emotional stress of care-giving for someone with dementia is so high it takes a devastating physical toll. Dementia caregivers, had $9.3 billion dollars in healthcare costs, of their own in 2013.
  • Women are more likely to be caregivers for those with dementia, more than 3 in 5 unpaid caregivers are women.
  • Because of their caregiving duties, nearly 19 percent of women caregivers had to quit work. This causes future consequences, when those women once again want to join the workforce.

The total cost to Medicare is $37 billion annually, and estimated to be $36 billion of cost to families. As staggering as these numbers are, the cost to the individual with dementia cannot be measured. The loss of memory, inability to concentrate, loss of social skills, deterioration in personal hygiene and appearance, difficulty communicating, disorientation and more, how are these costs calculated?

The high cost of dementia is shouldered by everyone.

Virginia Garberding RN

Certified in Gerontology and restorative Nursing

WHY YOU DON’T ARGUE WITH A PERSON WITH DEMENTIA OR DELUSIONS

The elderly person with dementia, who has a persistent fixed incorrect idea or delusion, is literally unable to change their mind. The idea might be harmless, as in the case of the elderly woman who insisted she was always on a train. Or it might be dangerous as the person who is insisting he has to leave and go to work, when he hasn’t worked for many years. Harmless or not, these ideas frighten the family or caregiver because it demonstrates irrational thinking.  Using rational explanations or arguing doesn’t work when the person is unable to change their mind.

5 ways to address delusions without arguing:

  1. Let it go if at all possible. If the idea is not dangerous, doesn’t bother the person or others, let it go.
  2. If the idea or delusion is frightening, such as the woman who thought people were living on her patio, give reassuring , comforting words. “I am here and will stay with you,” while you use a distracting activity.
  3. A delusion might be an expression of some fear. Look to the environment. Are there shadows, do you need more light, are curtain or shades open at night creating reflections on a window?
  4. Support the feelings the person expresses, not the delusion.
  5. Ask the person to show you what they see. The shadow on a wall, when reality is distorted, may become a ghost to the confused.

Many delusions are just plain hurtful, as with the spouse who is no longer recognized and is accused of being an impostor. Some delusions are very embarrassing for the family, and require understanding and the education of others.  Well meaning friends and acquaintances may intercede and begin arguing the irrational  idea or delusion. Look at this as an opportunity to educate other people, so that they may support you, in creating your plan of care for this person.

When caring for the individual with irrational ideas, you never argue these thoughts away.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

DEMENTIA CARE – DECORATING FOR DEMENTIA – CREATING A SMART ENVIRONMENT

Lets face it we cannot get away from environment.  We are always in some kind of environment, but is it a healthy environment or troublesome environment? And for the person with dementia many things we take for granted in the environment are unhealthy as well as troublesome. These are environmental stressers that the person with dementia either hears, sees, or think they see.

Hearing stressors, are anything that is too loud. This can be the rattle and clink of utensils in a restaurant or even the voices when several people are talking at the same time, at the next table.  Anything that causes constant noise, like the TV or radio.  It will also be things that cause sporadic loud noises like a vacuum or landscapers.

A hearing stressor can also be when the person, who is trying to communicate with the confused person, just talks too fast. If the person is trying to understand, and can’t even catch the words, trying so hard will be stressful. And creates an environmental stress, where the person just seems to want to get away.

Things you commonly see in an environment can be very stressful for the confused person. When a person with advanced dementia looks at a shiny floor, it can appear as if there is water on the floor. Or even worse, that there is ice on the floor. A dark area of a carpet or tile can look like there is a big hole in the floor. Another frequent problem with flooring is small patterns. A carpet with obvious patterns will look like there is something on the floor. Many an elderly person has fallen trying to pick up something that wasn’t there.

The demented person does need contrast in color to be able to see the difference in surfaces. In a bathroom, if the tile floor is solid white and the toilet white, the person will have difficulty locating the toilet. He just doesn’t see white on white. In the same way when eating, a white plate on a white table, needs a colored place mat under the plate for the person to see it.

Keep this in mind, when walking around the house, think of contrast in doorways and furniture compared to wall color as well as floor color. Using the environment for great dementia care.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

DEMENTIA AND DELIRIUM INCREASE CHANCE OF FALLS

Confusion due to dementia and delirium are known risk factors for falls in healthcare. Researches have noted that persons with confusion have a risk of falling 1.8 times that of the elderly without dementia. Falls in the elderly are predictable when the elder has; balance problems, problems with dizziness or fainting, cardiac problems, arthritis, osteoporosis, vision problems, is weak from immobility or a recent infection, is taking numerous medications or a medication for anxiety, or depression.

But the risk of a fall increases to almost double the risk when the elderly have dementia or delirium as well as the other known risk factors.

Behavioral problems – the person with dementia or delirium will have decreased safety awareness and make poor decisions. The person with dementia or delirium are more likely to forget to use assistive devices such as canes and walkers, or stop and put on good safe footwear. If the person also experiences angry outbursts of a physical nature, this also greatly increases their risk of falling.

Dietary deficiency –  the person with dementia or delirium can suffer from a poor nutritional status due to bad food choices. Adequate protein, essential vitamins, and water are needed for good health.  And especially vitamin D and calcium are necessary for strong bones.

Vision changes – a person with dementia can experience a decline in the ability to sense where they are in space. This often results in sitting down and missing a chair. Added to that a decrease in visual accommodation to light and dark, glare intolerance, altered depth perception and possibly physical changes in eyes due to aging, increase the risk of falls to an even greater degree.

Chronic illness – arthritis causing stiffening of joints, osteoporosis and bone deterioration increases risk of injury related to a fall, stroke and Parkinson’s disease increase the risk of falls. These are known issues with aging, and the elder with dementia who has painful swollen joints from arthritis is at even more risk.

Acute illness – has been shown to be a factor in 10% to 20% of falls in the elderly. An acute infection will cause weakness, fatigue, even dizziness. But the person with dementia or delirium will have an increase in their confusion.

Continuous monitoring of the elder with dementia or delirium is necessary as well as monitoring for these increased risk factors.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

7 QUESTIONS TO ASK ABOUT YOUR PATIENT FOR GOOD DEMENTIA CARE

Yes, John has dementia but that really doesn’t tell a lot about the person of John. In order to take really good care of John, you will need a lot of information.

  1. How alert and aware is John? Does he know his name, does he recognize his family, does he know their names, does he know the name of his caregiver? Can he find his way around inside his home? Can he perform a simple task by himself? Can he follow one or two step directions? How does John respond to people?
  2. How is John’s communication? What language would John most likely speak and understand? Is John’s speech usually clear and easy to understand? Does he get words mixed up, or does he make sense when he speaks?
  3. How well does he function? Does John walk, how much support does he need walking? Does John wash himself? Brush his own teeth? Can John comb his hair, or wash his face? How much assistance does he need with these daily tasks? How does John respond to help with these tasks?
  4. Can John eat by himself or does he need help?  How is his appetite, is this a problem? How much help does he need? Can he use a fork and knife safely or does he eat with a spoon? Does he have any swallowing problems, with liquids or with solid food? Does he need a special diet or soft ground up foods?
  5. Does John go to the bathroom by himself? The activity of being able to go to the bathroom independently involves several steps.  You need to know if John is able to wipe himself after a bowel movement. Is John incontinent of bowel or bladder? If John was on timed toileting would he be continent, does he just not make it there in time? Does John always go to the bathroom in the appropriate place? Does he give signs that he needs to use the bathroom?
  6. What are the usual or possibly problematic behaviors you might encounter with John? Is John’s disposition usually happy, sad, does he get angry often or easily? If John does get angry, what if anything does he do, yelling, striking out, hitting, or grabbing? If he is inclined to negative outbursts what usually calms him down? Does John have inappropriate sexual behaviors?
  7. Is John a safety hazard? If John walks does he leave, has he gotten lost? Why, has he gotten lost was he looking for someone, or did he think that there is some place he needs to be? Has he ever harmed himself or anyone else?

Whether you are a paid caregiver or a member of the family, in order to take care of someone with a dementia for a short time or consistently you need information. Important information.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

DEMENTIA CARE – WHEN COMMUNICATION ISN’T ABOUT WHAT WE SAY

Attitude, facial expression, tone of voice, and especially body language many times are so much more important than the words, we actually speak. The nicest, and kindest words can sound mean and ugly, when used in a tone of voice that is sarcastic and demeaning. In order for those words to sound nice and kind they have to be accompanied by an equally kind facial expression and tone of voice.

The person with dementia is especially sensitive to these other ways of communication, when they have lost their words. When the person with dementia is no longer able to say a word, they no longer understand that word, when it is said to them. Saying something as simple as “Come with me,” now has to be accompanied by a smile, and gestures. By smiling and waving the person towards you, the caregiver indicates, come with me, more effectively than only using those three words.

Connecting to that inner actor in all of us, instead of just depending on words, provides great dementia care. Helping the person you care for through positive gestures such as a simple thumbs up, clapping, shaking a man’s hand, or a pat on the back. All gestures that demonstrate approval.

Concentrating and many times practicing positive body language will result in improved communication. Sitting or standing with arms crossed on your chest indicate judgment. Tapping your fingers, or shoes on a hard surface,  indicates impatience.

Instead practice open body language, having arms open, and even leaning forward slightly indicates interest and attention. The person with dementia will respond positively to someone he feels is showing him respect with their attention.

When providing dementia care for someone of another culture, make sure you know what gestures and body language are considered appropriate in their culture.

Add to these forms of non-verbal communication, some pleasant words that bless the elder, will always be beneficial for the caregiver as well.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing