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Dementia

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Dementia Understanding the Condition & Improving Quality of Life by Changing How We Do What We Do! How to Get Started Be Honest What is Going on NOW? – PowerPoint PPT presentation

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Title: Dementia


1
Dementia
  • Understanding the Condition Improving Quality
    of Life
  • by Changing How We Do What We Do!

2
  • Dementia is common
  • BUT
  • NOT NORMAL

3
Risk Factors
  • Increasing Age
  • Life Style Choices
  • No Exercise
  • Bad Diet
  • Cognitive stagnation
  • Social Isolation
  • Stress
  • Sleep Issues
  • Head injuries
  • Genetics
  • Can run in families
  • Certain types are dominant genes
  • Other types are risk factor genes
  • Some types are spontaneous mutations

4
Four Truths About Dementia
  • At least 2 parts of the brain are dying
  • One related to memory the one other
  • It is chronic cant be fixed
  • It is progressive it gets worse
  • It is terminal it will kill, eventually

5
Ten Early Warning Signs
  • Memory loss for recent or new information
    repeats self frequently
  • Difficulty doing familiar, but difficult tasks
    managing money, medications, driving
  • Problems with word finding, mis-naming, or
    mis-understanding
  • Getting confused about time or place - getting
    lost while driving, missing several appointments
  • Worsening judgment not thinking thing through
    like before
  • Difficulty problem solving or reasoning
  • Misplacing things putting them in odd places
  • Changes in mood or behavior
  • Changes in typical personality
  • Loss of initiation withdraws from normal
    patterns of activities and interests

6
Everyone deserves a Good Work-up
  • Not everything that looks like dementia is
    dementia

7
What Should the Doctor Do?
  • A thorough physical and medical history
  • Blood work
  • A neurological exam
  • A good history from the person and the family of
    the problem
  • A complete medication review
  • A CAT scan or MRI or PET scan
  • Neuropsychological testing screening for
    cognitive changes
  • Follow-up and counseling or at least a referral

8
Could It Just Be Getting Old?Not Really
  • There is a difference
  • At first it may be hard to tell
  • Then, you will start to notice patterns
  • One or more these things start to show
  • Memory
  • Word finding
  • Thinking Problem Solving
  • Behaviors

9
What is Dementia?...
  • It is BOTH
  • a chemical change in the brain
  • AND
  • a structural change in the brain
  • So
  • Sometimes they can and sometimes they cant

10
PET and Aging
ADEAR, 2003
11
Cognitive Changes with Aging
  • Normal changes more forgetful slower to learn
  • MCI Mild Cognitive Impairment
  • Immediate recall, word finding, or complex
    problem solving problems (½ of these folks will
    develop dementia in 5 yrs)
  • Dementia Chronic thinking problems in gt 2 areas
  • Delirium Rapid changes in thinking alertness
  • (seek medical help
    immediately )
  • Depression chronic unless treated, poor quality
    , I dont know, I just cant responses, no
    pleasure
  • can look like agitation confusion

12
DEMENTIA
Lewy Body Dementia
  • Alzheimers
  • Disease
  • Young Onset
  • Late Onset
  • Other Dementias
  • Genetic syndromes
  • Metabolic pxs
  • ETOH related
  • Drugs/toxin exposure
  • White matter diseases
  • Mass effects
  • Depression(?) or Other Mental conditions
  • Infections BBB cross
  • Parkinsons

Fronto- Temporal Lobe Dementias
13
PET and Aging
ADEAR, 2003
14
Positron Emission Tomography (PET) Alzheimers
Disease Progression vs. Normal Brains
Early Alzheimers
Late Alzheimers
Normal
Child
G. Small, UCLA School of Medicine.
15
Normal Brain
Alzheimers Brain
16
Learning Memory Center Hippocampus BIG CHANGE
17
Understanding Language BIG CHANGE
18
Hearing Sound Not Changed
19
Sensory Strip Motor Strip White Matter
Connections BIG CHANGES
Automatic Speech Rhythm Music Expletives PRESER
VED
Formal Speech Language Center HUGE CHANGES
20
Executive Control Center Emotions Behavior
Judgment Reasoning
21
Vision Center BIG CHANGES
22
A Positive Approach(To the Tune of Amazing
Grace)Come from the frontGo slowGet to the
side,Get lowOffer your handCall out the name
then WAITIf you will try, then you will seeHow
different life can be.For those youre caring
for!
23
Brain atrophy
  • the brain actually shrinks
  • cells wither then die
  • abilities are lost
  • with Alzheimers area of loss are fairly
    predictable
  • as is the progression
  • BUT the experience is individual

24
Memory Loss
  • Losses
  • Immediate recall
  • Attention to selected info
  • Recent events
  • Relationships
  • Preserved abilities
  • Long ago memories
  • Confabulation!
  • Emotional memories
  • Motor memories

25
Understanding
  • Losses
  • Cant interpret words
  • Misses some words
  • Gets off target
  • Preserved abilities
  • Can get facial expression
  • Hears tone of voice
  • Can get some non-verbals
  • Learns how to cover

26
Sensory Changes
  • Losses
  • Awareness of body and position
  • Ability to locate and express pain
  • Awareness of feeling in most of body
  • Preserved Abilities
  • 4 areas can be sensitive
  • Any of these areas can be hypersensitive
  • Need for sensation can become extreme

27
Self-Care Changes
  • Losses
  • initiation termination
  • tool manipulation
  • sequencing
  • Preserved Abilities
  • motions and actions
  • the doing part
  • cued activity

28
Language
  • Losses
  • Cant find the right words
  • Word Salad
  • Vague language
  • Single phrases
  • Sounds vocalizing
  • Cant make needs known
  • Preserved abilities
  • singing
  • automatic speech
  • Swearing/sex words/forbidden words

29
Impulse Emotional Control
  • Losses
  • becomes labile extreme
  • think it - say it
  • want it - do it
  • see it - use it
  • Preserved
  • desire to be respected
  • desire to be in control
  • regret after action

30
How You Look At Dementia MATTERS!
  • It is NOT all about LOSS
  • It is NOT untreatable
  • It is NOT unpredictable
  • Behaviors DONT come out of nowhere
  • Dementia DOESNT just affect the person with the
    disease it impacts all of us

31
Common Concerns
  • Not doing personal care
  • Paranoid/delusional thinking
  • Threatening caregivers
  • Seeking people and places from the past
  • Shadowing
  • Eloping or wandering
  • Seeing things and people
  • Getting into things
  • Undressing in public
  • Pxs w/intimacy and sexuality
  • Feeling sick c/o of pain
  • Striking out at others
  • Falls and injuries
  • Contractures and immobility
  • Infections and pneumonias
  • Pxs w/ eating or drinking
  • Not wanting F PoA or HC PoA
  • Not willing to go to the doctor
  • Losing important things
  • Getting lost
  • Unsafe task performance
  • Repeated calls and contacts
  • Refusing help
  • Being rude
  • Bad mouthing you to others
  • Making up stories
  • Resisting/refusing care
  • Use of drugs or alcohol to cope
  • Making 911 calls
  • Mixing day and night
  • No solid sleep time
  • Not following care/rx plans
  • No initiation - apathy
  • Perseveration
  • Emotional meltdowns

32
Why I Use What I Use
  • 3 systems all use numbers
  • Each has value together confusing
  • People are not numbers
  • Until we begin to the see the beauty and value in
    what the person is at this point in time we
    will never care for them as we should
  • Gems are precious and unique common language
    and characteristics

33
Gem Stones
  • Based on Allen Cognitive Levels
  • Cognitive Disability Theory OT based
  • Creates a common language approach to providing
  • Environmental support
  • Caregiver support cueing strategies
  • Setting expectations regarding retained abilities
    and lost skills
  • Promotes graded task modification for success

34
How Do the Gems Help?
  • Use familiar concepts to talk about a difficult
    subject.
  • Focus on what is valued.
  • Allow to us to get beyond the words dementia
    and Alzheimers disease.
  • Open the door to talking about changes.
  • Allow us to speak in a code to protect dignity.

35
Now for the GEMS
  • Sapphires
  • Diamonds
  • Emeralds
  • Ambers
  • Rubies
  • Pearls

36
Now for the GEMS
  • Sapphires True Blue Slower BUT Fine
  • Diamonds Repeats Routines, Cutting
  • Emeralds Going Time Travel Where?
  • Ambers In the moment - Sensations
  • Rubies Stop Go No Fine Control
  • Pearls Hidden in a Shell - Immobile

37
Sapphires
  • Brains are Still True Blue!
  • You and Me on a GOOD Day
  • Normal Aging No Dementia
  • Some are Stars Some are Not
  • Slower but still shining

38
Sapphires
  • Clear True No dementia
  • May feel blue over changes
  • Importance of time true to lifetime
  • Will like to shine at times
  • Can make their own setting right
  • Will set their own pace
  • Will still need us in their lives
  • They can CHOOSE

39
Diamonds
  • Still Clear
  • Sharp - Can Cut
  • Hard - Rigid - Inflexible
  • Many Facets
  • Can Really Shine

40
Diamonds
  • Know Whos in Charge Respect Authority
  • Can do OLD habits routines
  • Become more territorial OR less aware of
    boundaries
  • Like the familiar FIGHT CHANGE
  • Can pull it together to make you look bad
  • Know how to push your buttons
  • Want to keep roles the same
  • Tell the same stories ask the same ?s

41
Emeralds
  • Changing color
  • Not as Clear or Sharp - Vague
  • Good to Go Need to DO
  • Flaws are Hidden
  • Time Traveling

42
Emeralds
  • Think they are FINE
  • Get emotional quickly
  • Make mistakes dont realize it
  • Do over and over OR Skip completely
  • Ask What? Where? When?
  • Like choices
  • Get lost in past life, past places, past roles
  • Need help, DONT know it or like it!

43
Ambers
  • Amber Alert
  • Caution!
  • Caught in a moment
  • All about Sensation
  • Explorers

44
Ambers
  • Get into stuff
  • Fiddle, mess, touch, taste, dig, tear, fold..
  • Move toward action and noise OR away
  • Sensory tolerance
  • Sensory need
  • Mouth, fingers, feet, genitalia
  • Cant figure it out react physically

45
Rubies
  • Hidden Depths
  • Red Light on Fine Motor
  • Comprehension Speech Halt
  • Coordination Falters
  • Wake-Sleep Patterns are Gone

46
Rubies
  • Fine motor stops
  • Hard to stop and hard to get going
  • Limited visual awareness
  • One direction forward only
  • Cant figure out details but do copy us
  • SLOW to change
  • On the go or full stop
  • Use music and rhythm

47
Pearls
  • Hidden in a Shell
  • Still Quiet
  • Easily Lost
  • Beautiful - Layered
  • Unable to Move Hard to Connect
  • Primitive Reflexes on the Outside

48
Pearls
  • More Time WITHIN
  • Moments of awareness - LAYERS
  • Comfort sights, sounds, touch, smells, tastes,
    movements
  • GO SLOW Be CALM Stay in Touch

49
Pearls
  • Cant move
  • Not aware of the world around most of the time
  • Problems swallowing
  • Hard to get connected
  • How we touch and help matters
  • SLOW!!!!
  • Varies a LOT

50
Progression of the Condition
  • To the TUNE of This Old Man

51
  • SAPPHIRE true, you and me
  • The choice is ours, and we are free
  • To change our habits, to read, and think and do
  • Were flexible, we think it through!

52
  • DIAMOND bright, share with ME
  • RIGHT before, where I can be
  • I need routine and different things to do
  • Dont forget, I get to CHOOSE!

53
  • EMERALD GO, I like to DO
  • I make mistakes, but I am through!
  • Show me only one step at a time
  • Break it down and Ill be fine!

54
  • AMBER HEY!, I touch and feel
  • I work my fingers - rarely still
  • I can do things, once I copy you
  • What I see is what I do!

55
  • RUBY skill it just wont go
  • Changing something must go SLOW
  • Use your body to show me what you need
  • Guide, dont force me. Dont use speed!

56
  • Now a PEARL, Im near the end
  • But I still feel things through my skin
  • Keep your handling always firm and slow
  • Use your voice to calm my soul.

57
Early -
  • Get good long term care insurance!
  • Then - check out the possibility that something
    IS WRONG
  • See someone who is interested in DEMENTIA and
    ALZHEIMERS DISEASE
  • Consider a specialist

58
Mid-Way
  • Use other forms of transportation no driving
  • Manage safely
  • Manage Meds
  • Provide support DAILY
  • Monitor for task initiation completion
  • Put things out that need to be done
  • Secure put away things that should NOT be used
  • Secure exits monitor for elopements
  • Give lots of things to DO.. That have meaning

59
End of the Journey
  • Nutrition safe intake when it stops?
  • Hands on care hand under hand, slow steady
  • Meet needs control pain
  • Music and environments that are friendly
  • Things to touch and handle
  • Safe areas to move around in
  • Places times to rest
  • Comfortable temperature places

60
Intervention Programming to
  • physical activity
  • mental activity
  • social activity
  • spiritual involvement
  • well-being and self-worth
  • minimize risky, challenging, or dangerous
    behaviors
  • reduce anxiety or distress

61
Key Issues
  • Early Diagnosis
  • Medications Treatment
  • Legal Issues
  • Financial Issues
  • Care Options Funding
  • Family Support Education
  • Staff Support and Education

62
GET HELP!
  • Support for YOU
  • Help with the person
  • Check out options home care, day care,
    residential care
  • Check out places visit, observe, reflect
  • Plan ahead when NOT if
  • Act before it is a crisis
  • Watch yourself for signs of burn-out
  • Set limits Its a marathon!

63
Latest Thinking About Risk ReductionThis Is For
US!
  • Help
  • Mental activity
  • Aerobic activity
  • Vitamin E C in food
  • Heart Smart Diet
  • Omega 3 fatty acids (fish, canola, flaxseed oils)
  • Lower weight
  • Not smoking
  • Enough sleep
  • De-stressing
  • Help
  • Keeping iron in limits
  • Keeping homocysteine right Vitamin Bs
  • Staying socially active
  • Getting depression treated
  • Control diabetes better
  • Control hypertension better
  • Statins (if needed)
  • NSAIDS (if needed)
  • Prevent head injuries

64
So What is Dementia?
  • It changes everything over time
  • It is NOT something the person can control
  • It is NOT always the same for every person
  • It is NOT a mental illness
  • It is real
  • It is hard at times

65
Dementia can be treated
  • With knowledge
  • With skill building
  • With commitment
  • With flexibility
  • With practice
  • With support
  • With compassion

66
How to Get Started
  • Be Honest
  • What is Going on NOW?
  • Get someone to help you look at it
  • Talk about what is
  • The GOOD
  • The BAD
  • The UGLY!

67
Take Some Time To
  • Figure out WHO you are
  • And
  • WHO your partner is
  • Similarities Differences
  • And
  • Respect Both Partners Needs

68
How can we help better?
  • It all starts with
  • your approach!

69
How you help
  • Sight or Visual cues
  • Verbal or Auditory cues
  • Touch or Tactile cues

70
What shouldnt we do???
  • Argue
  • Tell WHOPPERS that relate to emotions
  • Ignore problem behaviors
  • Try a possible solution only once
  • Give up
  • Let them do whatever they want to
  • Force them to do it

71
So WHAT should we do???
  • Remember
  • who
  • has the healthy brain!

72
I Will Change! (to the tune of This Little
Light of Mine) By Teepa Snow
73
I am gonna meet and greetBefore I start to
treatI am gonna meet and greetBefore I check
your feetI am gonna meet and greetBefore I help
you eatHow I start sets us up to succeed!
74
No more just Getting it DoneIm gonna DO with
youNo more just Getting it DoneIm gonna
help you thruNo more just Getting it
DoneWere gonna work, we twoCause if I do it
ALL, we BOTH LOSE!
75
Im gonna laugh and dance with you Not just
watch and frownIm gonna laugh and dance with
youNot just stand aroundIm gonna laugh and
dance with youWell really go to townFor the
POWER of JOY I have found!
76
Your Guide to Support Family Members with
Dementia DVD
77
DVD
  • DVDs for review purchase -
  • www.pinesofsarasota.org or Amazon
  • E-mail -
  • teepas_at_posapproach.com
  • Web-site
  • www.teepasnow.com
  • Free DVD to get started
  • www.seniorhelpers.com/seniorgems
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