Dementia and Stroke

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Dementia and Stroke

• Central South Regional Stroke Program
• September 2007
• Funded by the Ministry of
• Health and Long-Term Care

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Session Overview

• The types of stroke.
• The common changes that result from stroke.
• The connection between stroke and dementia.
• The behaviour changes that result from dementia
• Strategies to assist in working with residents
  with dementia

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What is a Stroke

• An interruption of the supply of blood and oxygen
  to an area of the brain.
• This causes the brain cells in an area to die,
  and reduces the brain function in that area.
• The area of the body controlled by the damaged
  area in unable to function properly.
• There are two types of stroke.

• http//www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/s
  troke-vasculaire_e.htmlef

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What is a Stroke?
A stroke can happen when a blood clot blocks a
blood vessel in the brain. 80 of strokes are
this type.
A Guide to Understanding Stroke, Heart and Stroke
Foundation of Canada, 1996
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What is a Stroke?

• A stroke can also happen when a blood vessel
  breaks and results in bleeding in the brain.
• 20 of strokes are this type.

A Guide to Understanding Stroke, Heart and Stroke
Foundation of Canada, 1996
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Risk factors you can do something about

• Being overweight
• Excessive alcohol use
• Physical inactivity
• Smoking
• Stress

• High blood pressure
• High blood cholesterol
• Heart disease
• Diabetes

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What does a resident who has had a stroke look
like in LTC?
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What are some of the losses due to stroke?

• paralysis or weakness on one side of the body
• vision problems (double vision)
• trouble speaking or understanding language

http//www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/s
troke-vasculaire_e.htmlef
9
What are some of the losses due to stroke?

• inability to recognize or use familiar objects
• tiredness
• depression

http//www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/s
troke-vasculaire_e.htmlef
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What are some of the losses due to stroke?

• exaggerated or inappropriate emotional responses
  
• difficulty learning and remembering new
  information and
• changes in personality.

http//www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/s
troke-vasculaire_e.htmlef
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Stroke Statistics

• There are between 40,000 and 50,000 strokes
  survivors in Canada each year.
• 10 (4-5,000) of strokes survivors each year
  require long-term care.
• 40 (16-20,000) of strokes survivors each year
  are left with a moderate to severe impairment.
• http//ww2.heartandstroke.ca/Page.asp?PageID33Ar
  ticleID1078SrcnewsFromSubCategory

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Dementia
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• Dementia is a syndromethat includes loss of
  memory, judgment and reasoning, and changes in
  mood, behaviour and communication abilities.

Alzheimers Society of Canada
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What is dementia?

• ? in memory
• And at least one of the following
• Difficulty with language
• Difficulty with voluntarily moving despite having
  normal muscle function
• Difficulty recognizing and identifying objects or
  persons
• Difficulty with planning, reasoning, problem
  solving and judgment.

The Diagnostic and Statistical Manual published
by the American Psychiatric Association
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Types of Dementia
Other (3.1)
Dementia with Lewy bodies (1.9) Frontotemporal
dementia (5.4)
Vascular Dementia 8.7
Alzheimers 47.2
Mixed Dementia 33.7
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 200322
265-274.
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How many people have dementia?
(Canadian Study of Health and Aging Working
Group, 1994).
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Vascular dementia is related to stroke and can
cause a loss in memory, reasoning, thinking,
attention span and independence with activities
of daily living.
Alzheimer Society of Canada
Health and Quality of Life Outcomes 2004, 252
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• Vascular dementia results when a critical part of
  the brain does not receive enough oxygen.
• http//www.emedicinehealth.com/stroke-related_deme
  ntia/article_em.htm

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What symptoms may be present in vascular
dementia?

• Problems concentrating and communicating
• Depression accompanying the dementia
• Symptoms of stroke, such as physical weakness or
  paralysis
• Seizures

http//www.alzheimers.org.uk/Facts_about_dementia/
What_is_dementia/info_vascular.htm
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What are the symptoms of vascular dementia?

• Memory problems (although this may not be the
  first symptom)
• A stepped progression, with symptoms remaining
  at a constant level and then suddenly
  deteriorating
• Periods of acute confusion

http//www.alzheimers.org.uk/Facts_about_dementia/
What_is_dementia/info_vascular.htm
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Other symptoms may include

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

http//www.alzheimers.org.uk/Facts_about_dementia/
What_is_dementia/info_vascular.htm
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Communication Strategies

• Eliminate distractions (e.g. TV, radio)
• Approach the person slowly and from the front
  establish and maintain eye contact
• Use short, simple sentences
• Speak slowly
• Give one instruction at a time
• Ask yes/no rather than open-ended questions
• Repeat messages using the same wording
• Paraphrase repeated messages
• Avoid interrupting the person allow plenty of
  time to respond
• Encourage the person to talk around or describe
  the word he is searching for.

Small et.al., (2003) Effectiveness of
Communication Strategies Used by Caregivers of
Persons With Alzheimers Disease During
Activities of Daily Living, Journal of Speech,
Language and Hearing Research 46, 2353
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ADL Strategies
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Eating

• Offer one food at a time
• Use contrasting colours for food, plate, placemat
• Try lighter weight utensils cup
• Serve more finger foods
• Check for dentures, problems with chewing

http//depts.washington.edu/adrcweb/UnderstandingA
D/Strategies.shtmldressing
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Eating

• Provide a relaxing eating area
• Provide adequate fluids - serve jello,
  popsicles, juices, and ice cream to increase
  fluids
• If appetite is poor, contact your registered
  staff or doctor
• Some residents benefit from dietary supplements
  (Ensure)

http//depts.washington.edu/adrcweb/UnderstandingA
D/Strategies.shtmldressing
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Bathing

• Ensure privacy and respect
• Have the bath water ready beforehand.
• Ensure that the water is not cold.
• Let the resident touch the water.
• Use gentle touch and cueing

http//depts.washington.edu/adrcweb/UnderstandingA
D/Strategies.shtmldressing
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Bathing

• Save shampooing until last (avoid showering the
  face)
• Avoid bath oils that make the tub slippery
• Use coloured decals/mat to indicate the tub
  bottom
• Cover up mirrors if they disturb the patient

http//depts.washington.edu/adrcweb/UnderstandingA
D/Strategies.shtmldressing
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Dressing

• Lay articles of clothing out in sequence
• Pick clothes that fit easily
• Keep the dressing routine as consistent as
  possible
• If the patient wants to wear the same thing over
  and over, obtain duplicates

http//depts.washington.edu/adrcweb/UnderstandingA
D/Strategies.shtmldressing
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Toileting

• Make sure that the toilet is visible from the
  residents bed or hallway
• clearly mark the bathroom door with a sign
• Provide adequate lighting along the pathway to
  the bathroom

http//depts.washington.edu/adrcweb/UnderstandingA
D/Strategies.shtmldressing
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Toileting

• Encourage a toileting routine to avoid
  incontinence e.g. every 2 hours
• Continually evaluate the level of assistance
  needed
• Remember that urinary tract infections are common
  in elderly people if a fever persists for more
  than 24 hours, contact your doctor

http//depts.washington.edu/adrcweb/UnderstandingA
D/Strategies.shtmldressing
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Mobility

• Increase daily exercise activity level
• provide safe access to the outdoors
• decrease or increase the resident's stimulation
• add familiar items to the residents room

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Mobility

• Remind residents to use their walking aid due to
  memory problems,
• Remind/teach residents about the need to use
  walker brakes,
• It is important to use these strategies to
  decrease the risk of falls

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Always remember that you can request an OT
referral from CCAC if you need assistance with
finding the right strategy.
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Jerry

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

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Jerry

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

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Jerry

• Today when you entered Jerrys room he did not
  recognize who you were. You initially thought he
  was joking with you.
• What do you think is going on with Jerry?
• What else could be happening with Jerry?
• What are you going to do next?

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Next Steps

• You are the eyes, ears and voice of your
  facility.
• Be aware of the diagnosis of your residents
• Take this information and use it with your
  residents.
• Share this information with other staff.

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More Information

• Acute Changes and Stroke
• Continence and Stroke
• Dementia and Stroke
• Falls and Stroke
• Pain and Stroke

Please contact Rebecca Fleck or Kim
Young Community and Long Term Care
Specialist Central South Regional Stroke
Program 905-521-2100 x 44127
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Acknowledgements

• Best Practices long term care advisory group
• Best Practices long term care evaluation group
• Barb McCoy and Deb Bryson, Psycho geriatric
  consultants, Hamilton
• Mary-Lou Vander Horst, Regional Best Practice
  Coordinator Long-Term Care Central South Region
• Wendy McDougall, Regional Best Practice
  Coordinator Long-Term Care, Central West Region
• Central South Regional Stroke Program
• Maryann Watts, Hamilton Health Sciences, Clinical
  Manager Neuro-ambulatory Centre
• Melanie Fall Stratton, Regional Stroke Program,
  Program Manager,
• Kim Young, Regional Stroke Program, Community and
  Long-term Care Specialist
• Lisa Colizza, Regional Stroke Program, Regional
  Stroke Development Specialist
• Nancy van Essen, Regional Stroke Program, Stroke
  Rehabilitation Coordinator
• Carol Pereira, Regional Stroke Program, LTC
  Project Coordinator

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(No Transcript)