Care of the Resident with Dementia

1
Care of the Resident with Dementia

• Time, place and location here

2
Types of Dementia

• Different types of dementia
• Alzheimers dementia
• Lewy Body dementia
• Stroke

3
Definition of dementia

• Dementia is a general term that describes a group
  of symptoms such as
• loss of memory
• judgment
• language
• complex motor skills
• other intellectual function-caused by the
  permanent damage or death of the brain's nerve
  cells, or neurons

4
Facts

• Alzheimer's disease is the most common cause of
  dementia in persons over the age of 65. It
  represents about 60 percent of all dementias.
• Dementia with Lewy bodies is the 2nd most common
  form of dementia after Alzheimers disease.
• Vascular dementia
• Alcohol dementia
• Trauma dementia
• Frontotemporal dementia

5
Twelve Ways to Boost Caregiver Success

• Educate yourself about the disease
• Learn caregiving techniques
• Understand the experience of your resident
• Avoid burnout
• Maintain your own physical and mental health
• Discuss the resident with nurses and family

6
Twelve Ways to Boost Caregiver Success, cont.

• Do cognitive stimulation activities with the
  resident
• Foster communication with nurse and physicians
• The social worker may help the family to take
  care of financial, legal and long-term care
  planning issues
• Smile
• Think positive
• Reach out for more education on dementia

7
Daily Routines

• Stick to a routine
• Structured schedule
• Involve the individual in daily tasks
• Be realistic about what the individual can do
• Bathing
• Repeating the same act
• Be consistent

8
Communication Techniques

• It's not what you say, but how you say it.
• Rely on the four Ss Simple, Slow, Show and Smile
• Speak in a tone that is calm and reassuring
• Approach the individual from the front
• Ask only one question at a time and allow time
  for an answer

9
Communication Techniques, cont.

• Allow the individual adequate time
• Eliminate distractions
• Use humor whenever possible
• Break down all tasks into simple steps
• Keep on talking

10
Eating Techniques

• Have the individual sit in an upright,
  comfortable position
• Have them eat with others to increase
  socialization and make mealtimes more pleasant
• Check that their mouth is empty, especially if
  they hoard food or cigarette butts
• Make sure they have their glasses, dentures,
  hearing aids or any other appliances they need
• Prompt or feed those who can't feed themselves
  (apraxia)

11
Eating Techniques, cont.

• Give the individual food they like and adequate
  snacks
• Provide nutritional supplements if there is
  significant weight loss
• Present one item at a time if the person seems
  confused by too much food in front of them
• Consider moving food to a different location on
  the tray or table
• Serve the drink last if the individual drinks too
  much and will not eat

12
Eating Techniques, cont.

• Serve pre cut or finger food, if using utensils
  becomes difficult
• Keep stressing that the food is safe if the
  individual believes it is poisoned
• Reassure the person that you will make sure they
  are well fed

13
Bathing Techniques

• Give one-step instructions in short, simple
  terms, and go slowly
• Communicate with non-verbal cues to help the
  individual understand
• Remember to provide privacy and ensure dignity
• Be reassuring since concern over modesty also may
  increase agitation
• Approach the individual from the front whenever
  possible

14
Bathing Techniques, cont.

• Make sure the room temperature is appropriate for
  disrobing
• Smile, speak calmly and do not express any
  frustration
• Remove the bathroom door lock for safety
• Do not leave the individual unattended in the
  bath area

15
Bathing Techniques, cont.

• Minimize safety risks by installing a no-skid
  surface and grab bars
• Try the shower instead of the tub, or vice versa,
  if someone becomes afraid of either
• Keep the individual in a bathrobe until they are
  in the bathing area
• Make sure the individual uses the toilet prior to
  bathing to prevent accidents during or after the
  bathing process

16
Bathing Techniques, cont.

• Secure soap, towels and other bathing items in
  advance
• Ensure appropriate water temperature, especially
  to prevent scalding
• Keep the individual in a warm room until they are
  completely dry and clothed
• Lay out clothing in advance to proceed quickly
  from drying to dressing

17
Dressing Techniques

• Encourage the individual to dress himself to
  whatever extent possible
• Intervene when attempts at self-dressing are not
  working
• Recognize the need for a sense of dignity
• Set a daily routine try to have the individual
  get dressed at the same time each day
• Do not rush the process

18
Dressing Techniques, cont.

• Give one-step instructions if the person needs
  prompting
• Limit the choice of outfits to two
• Clear closets and drawers of excess clothing to
  reduce confusion
• Provide loose-fitting, comfortable clothes with
  elastic waistbands
• Lay out the articles of clothing in the order
  they are to be put on

19
Dressing Techniques, cont.

• Use a consistent method of helping the individual
  dress each day. For example, first dress their
  upper body and then the lower body. If the
  individual can still dress himself, hand him one
  article of clothing at a time in the same order
  each day
• Use gestures to show the individual what to do
• Do not argue if they want to repeat the same
  outfit

20
Toileting Techniques

• Treat the individual with respect and dignity
• Be understanding and reassuring when accidents
  occur
• Establish a routine for example, take the person
  to the bathroom every two hours while they are
  awake
• Try to respond quickly to an individual's request
  for the bathroom
• Watch for non-verbal cues, such as facial
  expressions or tugging on clothing
• Put up signs (with illustrations) to indicate the
  bathroom door

21
Toileting Techniques, cont.

• Use easy-to-remove clothing, such as those with
  elastic waistbands
• Avoid caffeine and other stimulants in the
  evening
• Continue to let ambulatory individuals use the
  bathroom, even if they are managed with adult
  continence products, until such efforts are
  counter-productive, e.g., the individual fights
  during attempts to place them on the toilet
• Do not give liquids a few hours before bedtime
• Place a commode in the bedroom at night for easy
  access

22
Strategies

• Pay attention
• Think ahead and plan for situations
• Distract and divert attention
• Hold to the same routine.
• Keep things simple to avoid frustration
• Promote a sense of security and comfort

23
Strategies, cont.

• Use positive reinforcements
• Allow some sense of control
• Maintain a calm manner
• Assess the situation to protect you
• Practice ways to reduce stress
• Behavior problems result from the disease
• Be creative and use common sense.
• Try to keep a sense of humor

24
Anger Management

• Limit outside noise, clutter or the number of
  persons in a room
• Keep to the same routines
• Reduce caffeine intake
• Restrict choices to minimize confusion
• Keep objects and furniture in the same places

25
Anger Management, cont.

• Help orient the confused person with calendars
  and clocks
• Dot the environment with familiar objects and
  photographs
• Try gentle touch, soothing music, reading or
  walks
• Speak in a reassuring voice
• Distract the person with a snack or an activity

26
Anger Management, cont.

• Learn to recognize certain behaviors
• Do not try to restrain the person during a
  catastrophic reaction
• Keep dangerous objects out of reach
• If agitation increases at night, a nightlight may
  reduce confusion

27
Traveling

• Do not "negotiate" an outing. Do not ask, "Are
  you ready to go out?" Instead, use statements,
  such as, "Here's your coat" and "We're getting
  into the car now."
• Reassure the person
• Plan your route as carefully as possible, with
  attention to parking, elevators and other details
• Leave plenty of time so you do not have to rush
• Consider taking along another adult to assist you
• Bring items, such as snacks or books, to occupy
  the person if you must wait somewhere

28
Sundowning

• Plan activities or outings in the morning
• Do only simple, calming activities in the
  afternoon
• Keep individuals awake during the day
• Increase indoor lighting before dusk
• Ensure that the individual is not suffering from
  hunger, thirst, pain or fear

29
Sundowning, cont.

• Correct potential causes with basic interventions
  such as hydration and snacks
• Remove excess stimuli and clutter
• Watch for sundowning in early-stage dementia or
  rapidly worsening symptoms
• Be twice as patient and kind during these hours

30
Wandering

• Monitor and record the individual's wandering
  patternsfrequency, duration, time of day
• Provide recreational activities
• Ensure that the individual is well fed, well
  hydrated and using the bathroom
• Reduce environmental stimuli
• Outfit the individual with an identification
  bracelet
• Obtain a wristband transmitter

31
Wandering, cont.

• Identify bathrooms and other rooms with colorful
  signs to re-orient individuals
• Post a large sign that says "stop" or "do not
  enter" on exits
• Provide familiar objects, such as family
  photographs, slippers and a quilt
• Put away essential items
• Look for changes in patterns and report these

32
Other Strategies

• Music therapy
• Storytelling

33
Source

• The Alzheimers Foundation of America
• Web Site www.alzfdn.org
• This material was prepared by the Iowa Foundation
  for Medical Care, the Medicare Quality
  Improvement Organization for Iowa, under contract
  with the Centers for Medicare Medicaid Services
  (CMS), an agency of the U.S. Department of Health
  and Human Services. The contents presented do not
  necessarily reflect CMS policy.
• 8SoW-IA-PPT-NH-12/06-176