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Fundamentals of
Dementia Care for Health
Facility Personnel
Funded by:
Indiana State Department of Health
Co-sponsored by:
IAHSA
IHCA
HOPE
Module 1:
Understanding Memory Loss
In this section, we will cover:
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Definition of dementia and Alzheimer’s
disease
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Stages of the disease and the
expectations
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Current medications and treatments
What is Dementia?
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Dementia is a disease process
– Progressive decline in cognitive function
– Memory loss
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Over 170 irreversible dementias
– HIV, Vascular, Lewy Body, Parkinson’s,
Alzheimer’s
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Some forms are reversible (treatable)
– Thyroid disorders, drug interactions,
dehydration
Delirium, Depression, and
Dementia
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Delirium
– Acute onset, can be treated
– Altered state of consciousness
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Depression
– Gradual onset, can be treated
– Look for signs, such as low self-esteem
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Dementia
– Gradual onset, might be treated
– Memory loss and decline in cognitive function
Alzheimer’s Disease
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Most common form of irreversible
dementia
– Nearly 70% of all dementias are Alzheimer’s
– Over 4.5 million Americans have Alzheimer’s
– It is estimated that 60% of all nursing home
residents have Alzheimer’s disease
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Alzheimer’s is not normal aging
– Learning new information make take longer
– May be difficult to filter out noise
Brain Scan
The Diagnostic Process
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Multidisciplinary approach that is 8090% accurate
– Brain scan, blood and urine tests,
hearing/visual exams
– Neuropsychological testing and interview with
caregivers
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The only way to confirm diagnosis is
with an autopsy
Stages
Early
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Needs
reminders
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Daily
routines
difficult
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Concentrati
on-ion is
difficult
Middle
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May need
hands on
care
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May get lost
easily
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Changes in
personality
Late
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Severe
confusion
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Needs hand
on care for
most
personal
care
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May not
recognize
self or
family
Areas of the Brain Affected
Cognition
Behavior
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Memory
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Learning
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Language
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Praxic
Function
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Abstract
thinking
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Lapses in
clarity
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Psychomotor speed
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Hallucinations
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Delusions
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Communication
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Safety
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Personal
care
deteriorates
Emotion
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Disregulated
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Disorganized
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Apathy (loss
of energy,
willingness)
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Lability
(moods
change)
Medications
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Cholinesterase
Inhibitors
–
–
–
–
Cognex
Aricept
Exelon
Reminyl
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Glutamate Receptors
– Namenda
Module 2:
Person Centered Care
In this section, we will cover
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Understanding person centered care
and its characteristics
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Identifying strategies for implementing
person centered care
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Find ways to take care of the
professional caregiver
Person Centered Care
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Person centered care is truly putting the
PERSON first
Characteristics
– Behaviors are a desire to communicate
– We must maintain and uphold the value of the
person
– Promote positive health
– All action is meaningful
Person Centered Care, Cont.
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Core psychological needs must be met
to provide quality care
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–
–
–
–
Love
Inclusion
Attachment
Identity
Occupation
Comfort
Implementing
Person Centered Care
Recognition
Negotiation
Collaboration/
Facilitation
Play
Timalation
Celebration
Relaxation
Validation
Holding
Stress!
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Stress can lead to poor quality care,
quality of life, and abuse and neglect
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Signs of stress
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–
–
–
–
Too little or too much sleep, nightmares
Fatigue
Headaches, backaches, joint pain
Diarrhea/constipation
Frequent accidents
Module 3:
Communication
In this section, we will cover:
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The impact of verbal and non-verbal
communication
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Examine and demonstrate techniques
for promoting meaningful
communication
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Understand the correct use of validation
and reality orientation
Verbal and Non-verbal
Communication
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Each person is unique
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Behaviors are a form of communication
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Communication is only 10% verbal
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People with Alzheimer’s maintain the ability to
understand non-verbal long after verbal is forgotten
Verbal
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Tone
Pitch
Rate
Pause
Non-verbal
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Gestures
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Facial expressions
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Posture
Non-verbal Strategies
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Your mood will be mirrored
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Approach from the front
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Establish eye contact
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Speak at eye level
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Use gentle touch
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Point or demonstrate
Verbal Strategies
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Use calm, gentle voice
Call person by name
Identify yourself
Use short, simple sentences
Speak slowly and respectfully
Eliminate distracting noises
Use familiar words
Give simple choices
Give one instruction at a time
Allow time for the person to respond
Validation vs. Reality
Validation
Reality
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Become part of the
person’s reality
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Early stages, only if not
upsetting
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Acceptance
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Short explanations
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Feelings into words
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Acknowledgement
New information can be
frustrating
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Reality becomes based on
the past
Therapeutic Fibbing
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The use of telling fibs or lies in an effort
to calm
We are never sure how much
information a person may be able to
process or remember
Should only be used when absolutely
necessary, look for other ways to calm
and support, such as redirection
Module 4:
Understanding Behaviors
In this section, we will cover:
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Understanding of how and why
behaviors become challenging
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Ways to prevent behaviors
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Techniques for responding to
challenging behaviors
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Emotions a person with dementia is
likely to experience
Human Emotions
Joy
Anger
Pleasure, love,
happiness, sexuality
Rage, hate, displeasure
Fear
Sadness
Guilt, shame, anxiety
Misery, grief
Respond to Feelings
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Enter the person’s reality
Look for feelings behind the words
Empathize
Be non-judgmental
Respect their needs
Your emotions will be mirrored
Communicate comfort, warmth, and praise
Smile!
Put the person’s feelings into words
Allow for negative feelings
Problem Solving Behaviors
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Task
– Too complicated, too many steps, not modified,
unfamiliar
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Environment
– Too large, too much clutter, excessive stimulation, no
clues, poor sensory, unstructured, unfamiliar
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Physical health
– Medications, impaired vision/hearing, acute illness,
chronic illness, dehydration, constipation, depression,
fatigue, physical discomfort
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Miscommunication
The 11 W’s
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Who has the behavior?
What is the specific behavior?
Why does it need to be addressed?
What happened just before?
Where does it occur?
What does the behavior mean?
When does the behavior occur?
What is the time, frequency?
Who is around?
What is the outcome?
What is the DESIRED change?
Preventing Behaviors
Diversion or distraction
Removal
Redirection
Task breakdown
Stimulus Control
Environmental
manipulation
Reassurance
Setting limits
Responding to Behaviors
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Anxiety/agitation
– Response to misinterpretation of environment
or people
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Aggressive reactions
– Usually directed at caregiver or another person
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Rummaging
– Looking for something meaningful
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Repetitive crying out
– Unresolved pain or discomfort
Module 5:
Activities of Daily Living
In this section, we will cover:
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Causes for resistance to ADL’s
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Strategies that promote participation
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Possible techniques for managing ADL’s
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Identifying signs of abuse and neglect
Causes for Resistance
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Memory loss
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Decreased attention span
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Impaired judgment
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Loss of ability to communicate
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Difficulty with motor skills
Strategies for Participation
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Anticipate problems or events
пЃ¬ Provide a routine
пЃ¬ Establish rapport
пЃ¬ Talk with a calm voice
пЃ¬ Do not attempt to use reason or logic
пЃ¬ Do not rush
пЃ¬ Avoid arguing
пЃ¬ Focus on abilities
Strategies for Participation, Cont
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Approach—knock, announce, privacy
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Encourage the person to do as much as
they can
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Praise for small successes
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Provide for privacy
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Do not keep person waiting
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Demonstrate what you want done
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Stop when frustration occurs
ADL Tips
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Dressing
– Layout clothes, limit choices, item to stroke
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Bathing
– Keep routine consistent, privacy, adequate lighting
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Toileting
– Evaluate!
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Eating and swallowing
– Ensure adequate intake, pleasurable experience,
independence
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Sleeping
– Reassure, speak softly, adequate lighting
Module 6:
Families
In this section, we will cover:
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Empathizing with feelings that a person with
Alzheimer’s and their families may experience
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Identifying and informing families of resources
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Identifying strategies for building a positive
relationship with families
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Understanding the unique opportunity for a
long term relationship
Family Feelings
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Denial
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Frustration
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Isolation
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Guilt
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Anger
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Loss/grief
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Letting go
Conflict Resolution
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Denial can be healthy
пЃ¬ Educate in small doses
пЃ¬ Do not push to hard
пЃ¬ Encourage support groups
пЃ¬ Acknowledge
пЃ¬ Listen
пЃ¬ Feedback
пЃ¬ Privacy
Internal Resources
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Staff members
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Library
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Administrator
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Family counsels
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Care plan meetings
Alzheimer’s Association
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Helpline
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Family Education
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Support Groups
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Care Consultation
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Safe Return
Strategies for Positive
Relationships
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Show support
– Family tours, communication processes
– Validate emotions, develop realistic
expectations, compliment, report good news
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Promote successful visits
– Offer suggestions and support
– Bring in family videos, pictures
– Activities
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