5 CRITICAL AREAS OF DEMENTIA CARE

Dementia care involves first and foremost, providing for the safety of the person with dementia. One of the major symptoms of dementia, is the loss of safety awareness. Hand in hand with that, is the loss of the ability to reason, or think your way out of a situation. A real problem, if the situation is dangerous.

Added to providing for safety, is having good dementia communication, knowing what a happy environment looks like for someone with dementia, providing for social and spiritual needs as well as addressing everything physical.

5 Critical Areas of Dementia Care:

  1. Safety – walking alone across a busy highway, putting something on a hot burner and walking away forgetting about it, going outside in sub-zero temperatures without a coat, and more. Protecting the confused elder without having him feel he is being controlled, is good dementia care.
  2. Communication – just having the most beautiful home, with the best security system, won’t lead to great dementia care. Especially if the caregiver doesn’t know how to effectively communicate with a confused person. Good communication involves the speaker and the listener. When the confused elder is no longer able to communicate well, the burden is on the caregiver. The caregiver must know how to communicate through touch, gestures, smiles, patience and kindness.
  3. Environment – the environment needs constant review, and may change over time. Thinking of the environment as a way to make the elder with dementia know where they are and what is expected, is great dementia care. Clutter needs to be eliminated as it contributes to confusion. A kitchen needs to be used for preparing and eating meals. Having a TV running at all times in a kitchen reduces the environmental cues, that are telling the confused person, where he is. Creating a happy environment involves using music, activities, creating enjoyable smells, like the smell of cookies baking.
  4. Social and spiritual needs – whether this means continuing in church attendance, or participating in social groups, these connections remain important.  When the elder can no longer play that card game they won at for years, continuing the activity, while changing the level of the game is what is important. Getting together with familiar people, playing a game, laughing together, watching a movie together, these are important parts of dementia care.
  5. Physical – involves really knowing the person physically. What are the physical problems the person is challenged with other than dementia? Does this person have a vision or hearing deficit? Also good dementia care means knowing when the confused person has had a physical change in condition, when they cannot tell you. Physical also literally means engaging in physical activity to keep the body strong.

Many of these areas crossover to other areas. The person with a hearing deficit, will have an added burden of communication, increasing their confusion. The person who may be diabetic, will no longer be able to understand, how unsafe it is to not follow their diet restrictions.

To provide over all wellness, only 5 areas of dementia care turns, into a very big job.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

WHAT IS THE E IN CTE? IS THAT THE SAME AS DELIRIUM? A CONCUSSION?

The C is for chronic, happening over and over. And the T is for traumatic, meaning this isn’t just a little bump on the head, it is a repeated injury.  But that E is a problem in healthcare. E is for enchephalopathy.  Since the movie Concussion came out more people are aware of the high cost of getting repeatedly hit in the head. This could be for any reason, where a person sustains head injury. From having epilepsy, and during seizures, hitting your head on hard surfaces, to boxing head injuries, sports injuries and now to the current focus of playing football.

The reason it is difficult to differentiate between delirium and enchephalopathy is because even the medical community seems to use these terms interchangeably. The common use of delirium is an altered mental state, well so is it for enchephalopathy. It is only when a person needs that diagnosis for reasons of medical insurance or healthcare intervention that things get more specific.

Much easier to see than a physical injury, is when delirium relates to the abuse of alcohol. The person who is drunk may be unsteady on their feet, having balance problems to the point of walking into things and even falling down. Their thinking will be foggy, unable to communicate their thoughts clearly. In fact their speech can be slurred as well. The next day they may have no memory of the events of the day before, while they were drunk.

If that person continues to abuse alcohol over a long period of time the damage to the brain would no longer be considered delirium. Those changes are no longer happening quickly, and no longer reverse, now they are a permanent change in the person’s brain.

And so, also for that football player who sustains a significant hit to the head, they might have a mild concussion. They might be unsteady on their feet and be confused for awhile. But after repeated abuse, just as with the alcoholic, the changes over the years may be subtle and develop slowly. But the end result could be the same. Poor judgement, poor coordination, gross distraction, tremors or muscle twitching and dementia.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology

HOW THE NURSING HOME PREVENTS FALLS

Every year the average nursing home will have between 100 to 200 patient falls. The people who fall the most often are men, and patients who are confused. Men fall almost twice as often as women because they are less likely to call for assistance, because it is more difficult for them to admit needing help. Patients with Alzheimer’s disease or another form of dementia fall frequently, because they no longer have safety awareness.  Statistics tell us that 35% of those patients who fall are unable to walk, yet they try.

Most patient falls happen in the patient’s room, when the person is attempting something without assistance. Few falls happen in places like a dining room or at a nurses station where many staff members are available to monitor for unsafe behaviors. The majority of those falls in patient rooms have to do with needing to go to the bathroom. Being incontinent of urine, having diarrhea, and having to urinate frequently at night all contribute to the high number of falls.

Added risk factors are poor vision, going bare foot, clutter on the floor, poor lighting and possible a slippery/wet floor from the patient becoming incontinent. As well as the patient forgetting to reach for their cane or walker in their rush to the bathroom.

A nursing home fall prevention program includes assessing each and every patient for their fall risk. All of the above mentioned problems are identified. A plan of care is developed and all staff members are informed of the plan. Safety devices are put in place, most of those devices are in the form of alarms. A good web site for safety devices is -www.Rehabmart.com. Their site is very user friendly and they have a large selection of safety alarms.

Looking at the environment, follows the assessment. Are the grab bars placed correctly? If the patinet is getting out of bed, is the bed in a low position, with an alarm? Is the lighting adequate, are there motion sensors in place? Is the patient on a regular toileting schedule before bed? How often does the staff check on them during the night?

A big deterrent for falls is a busy, engaged patient, a patient who has activities to go to that they enjoy. A patient who is really tired when it is time for bed, that they enjoy a good nights sleep.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology

MILD COGNITIVE IMPAIRMENT AND REASONING

Dorothy is 80 years old and anyone would say she looks just great. Today she is volunteering at her local nursing home, as she has done for the last 15 years. Her hair looks perfect, her clothes always matching and becoming. She has her usual great smile and good humor for all of the residents.

However there had been a particularly bad snow and ice storm the night before. A nurse seeing Dorothy remarked that she was surprised to see her out on such a bad day. Dorothy seemed unfazed by the weather. “Aren’t you afraid of falling?” the nurse asked. Oh no, Dorothy assured her she never falls. Looking down at Dorothy’s feet the nurse commented on the dress shoes with 2 inch heels,  Dorothy was wearing. Pointing to all of the snow and ice patches still on the driveway, the nurse asked why she was going out in those shoes. As the conversation continued it was clear that Dorothy was not connecting the dots between safety, caution, weather, common sense and those very pretty and impractical shoes. In fact, Dorothy showed signs of losing her good humor, if pressed on the subject.

Mild cognitive impairment is considered a condition that might indicate that the diagnosis of Alzheimer’s disease will be next. It is considered a condition that really doesn’t interfere with normal life or activities. Mild cognitive impairment may improve, stay the same or progress. Mild cognitive impairment involves issues like searching for words, losing your train of thought in a conversation, mild forgetfulness, feeling sad or overwhelmed. Many things can account for these such as poor diet, anxiety, depression and especially loss of sleep can cause many of these problems in the elderly.

But the decline in reasoning and judgement are particularly worrisome. Reason involves thinking through a problem and coming up with a solution. It involves higher thinking abilities such as applying logic, verifying facts and making sense of a situation. When the loss of judgement or reasoning skills is lost, this now does interfere with normal life and activities. The loss of reason can have consequences, like Dorothy in her pretty shoes sliding around on ice.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

SENIOR WITH ALZHEIMER’S DEMENTIA CHANGES TRYING TO COMMUNICATE

Of all of the changes the family sees in their loved one with Alzheimer’s dementia, the most frightening is personality and behavioral changes.  When the senior with dementia acts childish, irrational, stubborn, suspicious, paranoid, or becomes physically combative, the caregiver can be frightened.  The caregiver can feel that the relationship is over, this person is now a stranger.

These behaviors are not only frightening for the caregiver but even more so for the person with dementia.  Preventing behaviors is always the goal, and so much easier that dealing with a full burst of anger.

Preventing bad behaviors:

  • be alert and aware to what is going on in the environment – if the last time Grandpa became angry were there too many people, too much talking, too much noise, just too much stimulation?
  • arguing with a person with dementia never works, the person just doesn’t have the reasoning skills any longer to engage in finding solutions – divert attention and head off any confrontations
  • respect and protect the elder’s dignity , there is a real reason why bathing is such a hard task for someone with dementia – being undressed is a huge loss of control
  • make every task as simple as possible – breakdown the task into one step at a time – even though this slows progress – slow and happy is much better than fast and unhappy
  • reassure, and reassure again and again – the elder is very afraid of being abandoned – even the most demanding elder is basically afraid of abandonment

The elder with dementia doesn’t mean to be difficult. Difficult behaviors are a means of communication by the elder. The elder knows that they are missing something everyone else understands. The changes the elder feels they are no longer able to communicate with words. So the elder will try to gain control over their environment through – behaviors.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

ADULT COLORING BOOKS – GREAT ACTIVITY FOR SENIOR WITH DEMENTIA

Adult coloring books are everywhere, from the internet to your neighborhood craft or book store. The choices are suddenly endless from floral, to animals and even the chance to color the masters of the art world. In this fast paced, goal driven, digital age, opening a fresh new coloring book and colors is soothing in itself. Taking any individual to a place of quiet and relaxation, but especially so for the senior with dementia..

For the person with Alzheimer’s disease, or another related disease causing dementia, coloring brings many benefits.  Coloring is among other things, an activity of reminiscing. Everyone remembers the wonderful feeling of opening a new box of crayons. And if you were the fortunate child who had the set of 64 with the built in sharpener, the feeling was quite amazing.

Coloring, gives the senior with dementia an opportunity to be successful. When you color it gives you chances to make decisions about which picture to color, where to start and which color to use. For a person with dementia who makes many mistakes all day long, due to memory loss, coloring is very safe. Art is in the eye of the beholder and there is no way to be wrong.

Find a quiet place, avoid a cluttered kitchen table, instead pick a place where the supplies can be spread out and enjoyed as well. Do not have the distraction of a TV, or even a radio unless it offers soft background music, preferably without lyrics. Even if the person with dementia never cared for art or crafts before, this is an area where they can do well now. This activity doesn’t require remembering facts, people, places or use any language skills. Just the ability to hold onto a coloring pencil or crayon.

When a person does an activity mainly engaging the right side of the brain where art, music and the softer side of life resides, it becomes a little vacation for the mind. As almost a form of meditation it can bring mindfulness to the person and make them more focused. Distraction is a major problem with dementia and developing activities which bring greater focus are worth the effort.

Having many coloring books and colored pencils or crayons around is a great way for the senior to do an activity with a child. The child knows instinctively how to get to the right side of the brain where there is only color, choices to be made and those spaces to be filled in.

Not only is coloring a great activity for the senior with dementia, it is also great for his caregiver. Time can fly when you are engrossed only in choosing which page to color next or what color to use. And the companionship created while you compliment each others work of art creates a pleasant feeling of friendship for both. Feelings that can last long after the crayons are put away.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology

 

GRANDMA CAN’T FIND THE BATHROOM – WHEN THE ELDER IS INCONTINENT

Grandma Lucy always has a big smile on her face. She is already in the late stage of Alzheimer’s disease. Grandma no longer talks or seems to understand what others are saying to her. She now needs total assistance bathing, dressing and eating.  Yet, Grandma Lucy can still walk and while she cannot go through the many steps of dressing. Once dressed she is able to pull down her slacks, as well as  incontinent brief, and then go to the bathroom.

The problem arises because Grandma no longer can identify the correct place to toilet. When she feels the urge to go to the bathroom, any flat surface she can sit on, will do. She no longer plans or anticipates that she will be needing a bathroom. In the moment when she feels the urge, she answers the call in a public place, secret place, anywhere she finds an opportunity to sit.

Missing the toilet, and using either another object such as a waste basket, or a flat surface such as a chair, sofa, or recliner is common, in a dementia unit, in a nursing home setting. Especially common, for those elderly who continue to be able to walk independently. Grandma Lucy always was a great walker, and has continued to be able to walk, even though now she walks without a destination. She just appears to be wandering as she keeps retracing her steps, all day long.

But contrary to the many who are no longer this active, she has no problems with constipation. On the contrary, Grandma is as regular as clock work. And this fact provides the solution for Grandma’s problem.

When a confused elder like Grandma Lucy can’t plan or anticipate needing to use a toilet, the caregiver needs to provide this service. Her caregiver knows that Grandma Lucy has a bowel movement everyday, about a half hour after breakfast.  As many people know, having a cup of hot coffee in the morning, and chewing breakfast, stimulates the colon and bowel.

Now the caregiver keeps a close eye on Grandma Lucy after breakfast, and right on time walks her to the bathroom. Grandma Lucy is now greeted with smiles and welcome during her wanderings instead of looks of suspicion.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

EARLY SIGN OF DEMENTIA – GRANDPA WEARS SWEAT SUIT TO HOLIDAY DINNER

Where is grand-pa? All the family were comparing notes, before dinner, on Thanksgiving. “Did you talk to Dad?” “Did he seem to understand where to go and what time?”  And so the conversation went, while the sisters were getting ready to put the dinner on the table. Then right before dinner time, there was the door bell, and the sound of Grandpa letting himself in.

There was Grandpa, smiling, joking and also sporting his old grey sweat suit. On closer inspection he hadn’t shaved, his hair looked greasy, and he was covered in dog hair. When asked by one of his son-in-laws why he was wearing a sweat suit for Thanksgiving, he gave his now customary response. “This is so comfortable,” “This is so warm,” and ” I am afraid of catching cold.”

When asked why he didn’t go to church that morning, it became clear that it was just too hard to get out of that sweat suit, too much trouble. Once again it is just too comfortable, and warm.

Once dressed the confused elder has a sense of security, feeling put together. And more mentally together as well, as the favorite outfit now becomes a security blanket. And what could be more secure than the feel of  fleece, the feel of a sweat suit. So the confused elder then begins to resist bathing, getting into pajamas or even changing that sweat suit for a clean one.

This chosen outfit is then worn everyday, to eat in, sleep in, work in, relax in, for every season, and on every occasion. Grand-pa doesn’t know that he is wearing his confusion out there, for everyone to see.

So for this family as well as for many families during the holidays, the private conversations turn to “how bad is Dad?” “Should we be doing something?” “Is it time for him to go to a nursing home?”

No, its not time yet. Grand-pa drove himself over, seems to only drive with-in a few miles of his home, and has had no accidents. He is able to monitor his gas, and maintain his very old car. He appears well fed, so he must still be able to get his own food.

What can be done now, is to keep in close touch with him. Get in the habit of calling frequently, asking what he has eaten, where he has gone, and what he is doing. Make sure that he is able to use his telephone and that it is user friendly. Go to his house and make sure he has an adequate amount of fire alarms, especially one in the kitchen and by the clothes drier. Get in a schedule of checking the batteries for those alarms. Look at his kitchen items for any signs of burning.

Look carefully around the house for tripping hazards and move furniture to create clear walk ways. If clutter is beginning to be a problem, ask for some of the things instead of suggesting throwing things away.

Get more people involved. Start having food delivered, especially grocery staples. Start having a cleaning service come in  on a regular schedule. The important thing is to start these services, so the confused elder gets used to having these people around. Then, over time, these services can be increased as needed.

As annoying as the Thanksgiving sweat suit can be, it is really just a sign of things to come, and a sign it is time to plan.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

EXERCISE FOR PARKINSON’S DISEASE AND THE BRAIN – CROSSING THE MID-LINE

Boxing and Parkinson’s Disease

I recently saw a news show on television that highlighted the benefits of boxing, for persons with Parkinson’s disease. While everyone interviewed identified positive results, all the way from; moving better, to being motivated and at times being pushed to participate.  Those who strongly recommended boxing never really hit the nail on the head, and told us why this sport would work so well.

Boxing and Crossing the Mid-line

Picture an imaginary line from your head to your feet cutting your body in half. Every time you do something with your right hand and arm, swinging to your left and therefore crossing your mid-line you also increase the right-left connection in your brain. Watching the show and seeing the participants either hitting a punching bag, or in a ring hitting an instructor, you can easily see the therapy involved. When they punched with their right hand they frequently crossed over their body and hit the opponent on the right side of his body.

The brains two sides coordinate with their opposite side of the body. All of the connections happen in the middle of the brain called the limbic system. Exercises that cross the mid-line, reinforce and support  the connections in the limbic system. The limbic system is also the site of emotional intelligence, explaining why people feel happy after exercise.

Creating exercises that cross the mid-line

A simple balance exercise turned into a brain exercise can include swinging arms across the body. Kicking a leg across the mid-line while holding on to a chair is a simple brain movement. Bouncing a ball in front of you, with your right hand and then switching to your left hand, crosses the mid-line. Starting with a larger bouncing ball and then scaling down to a smaller and smaller ball also improves balance.

Great games with small children such as a bean bag toss when done crossing the mid-line, is a fun way to exercise the brain. Older children enjoy playing catch, and can start by just bouncing a large ball back and forth. Till they then can catch a ball in midair and switch up to a smaller ball.

Take that even further by hitting a tennis ball, volley ball, anything that provides that movement of crossing the body. Especially so for the confused elder who enjoys just throwing a beach ball around the family circle, or maybe a wild game of balloon toss. The easiest mid-line exercise for just about everyone, is to cross your arms and give yourself a big hug. The limbic system, is why that feels so good!

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

THE CHANGING PERSONALITY AND THE ELDER WITH DEMENTIA

A person’s personality may change dramatically as they go through the stages of dementia. The once very dominant father may become the passive, cheerful confused old man that the nursing home staff just loves and the family hardly recognizes.

Just as the quiet, and always agreeable old aunt you remember might now be the most difficult and uncooperative person in the dementia unit. When the elder with dementia becomes difficult consider the following:

  • An inability to communicate. When the confused elder knows what they want, or more likely what they don’t want and the caregiver doesn’t understand. Or the caregiver didn’t take that crucial time before the activity to make a connection.
  • If the elder is asked to do something that is too difficult the stress could very well trigger an angry outburst.
  • PAIN can cause a change in personality. Some elderly act out from pain and some retreat. The pain may come from an acute condition such as a urinary infection, or a chronic condition such as arthritis.
  • A personality change can be a side effect of medication. The once active and engaged elder might now suffer from extreme fatigue due to a medication side effect.
  • An elder with dementia may have a problem with their emotional well-being due to changes in the environment. The environment is too noisy and over stimulating or just the opposite and too quiet with little to do. There may be a change in the direct caregiver causing the elder to feel anxious.

While the elder with dementia may display a personality quite different from their former self, he has the same needs as everyone else. The need to feel a sense of control, the need to feel included in whatever is going on, the need for positive self- esteem, the need to feel purposeful, the need to feel secure and the need to be loved.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing