caregiving gems - alzheimer's association · diamonds emeralds ambers rubies pearls. 1/3/2017...
TRANSCRIPT
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Caregiving Gems
Teepa Snow, MS, OTR/L, FAOTA
Beliefs
• People with Dementia are Doing the BEST they can
• We must learn to DANCE with our partner• We are a KEY to make life WORTH living• What we choose to do MATTERS• We can change the WORLD with help• We must be willing to CHANGE ourselves• We must be willing to STOP & BACK OFF
How Can We Become Better Care Partners?
Be willing to try something newBe willing to learn something different
Be willing to see it through another’s eyesBe willing to fail & try again
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What Are the Most Common Issues That Come Up???
• No HC-POA or F-POA• ‘Losing’ Important Things• Getting Lost • Unsafe task performance• Repeated calls & contacts• Refusing• ‘Bad mouthing’ you to
others • Making up stories• Resisting care• Swearing & cursing• Making 911 calls• Mixing day & night
• Shadowing• Eloping or Wandering• No solid sleep time• Getting ‘into’ things• Threatening caregivers• Undressing• Being rude• Feeling ‘sick’• Striking out at others• Seeing things & people• Contractures• Stopping eating & drinking
How Do We Learn?
It’s a process!
Do Something
Think about what you did…
Try IT out…
Figure IT Out!?
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More Ideas
• We learn by doing and making mistakes• We learn with practice• We learn by being confronted by a
challenge and trying to figure it out• We each learn in a variety of ways• We are all SMART, in different ways• We learn better if we are having fun
Caring for Someone with Dementia…
What Works BEST?
The Basics for Success…
• Be a Detective NOT a Judge• Look, Listen, Offer, Think… • Use Your Approach as a Screening Tool• Always use this sequence for CUES
– Visual - Show– Verbal - Tell– Physical – Touch
• Match your help to remaining abilities
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Some Basic Skills
• Positive Physical Approach• Supportive Communication• Consistent & Skill Sensitive Cues
– Visual, verbal, physical• Hand Under Hand
– for connection– for assistance
• Open and Willing Heart, Head & Hands
First Connect – Then Do
• 1st – Visually• 2nd – Verbally• 3rd – Physically
• 4th – Emotionally• 5th – Spiritually - Individually
To ConnectStart with the
Positive Physical Approach
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Your Approach
• Use a consistent positive physical approach– pause at edge of public space– gesture & greet by name– offer your hand & make eye contact– approach slowly within visual range– shake hands & maintain hand-under-hand– move to the side– get to eye level & respect personal space– wait for acknowledgement
A Positive Approach(To the Tune of Amazing Grace)
Come from the frontGo slow
Get to the side,Get low
Offer your handCall out the name then WAIT…If you will try, then you will see
How different life can be.For those you’re caring for!
Supportive Communication
• Make a connection– Offer your name – ”I’m (NAME) ”… “and
you are…”– Offer a shared background – “I’m from
(place) …and you’re from…”– Offer a positive personal comment – “You
look great in that ….” or “I love that color on you…”
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Support to ‘Get it GOING!’
• Give SIMPLE & Short Info• Offer concrete CHOICES• Ask for HELP• Ask the person to TRY• Break the TASK DOWN to single steps
at a time
Give SIMPLE INFO• USE VISUAL combined VERBAL
(gesture/point)– “It’s about time for… “– “Let’s go this way…”– “Here are your socks…”
• DON’T ask questions you DON’T want to hear the answer to…
• Acknowledge the response/reaction to your info…
• LIMIT your words – Keep it SIMPLE• WAIT!!!!
Now for the GEMS…
DiamondsEmeraldsAmbersRubiesPearls
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Diamonds
Still ClearSharp - Can Cut
Hard - Rigid - InflexibleMany Facets
Can Really Shine
Emeralds
Changing colorNot as Clear or Sharp - Vague
Good to Go – Need to ‘DO’Flaws are HiddenTime Traveling
Ambers
Amber AlertCaution!
Caught in a momentAll about Sensation
Explorers
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Rubies
Hidden DepthsRed Light on Fine Motor
Comprehension & Speech HaltCoordination Falters
Wake-Sleep Patterns are Gone
Pearls
Hidden in a ShellStill & QuietEasily Lost
Beautiful - LayeredUnable to Move – Hard to ConnectPrimitive Reflexes on the Outside
Diamonds
Still ClearSharp - Can Cut
Hard - Rigid - InflexibleMany Facets
Can Really Shine
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Diamonds
Are Joiners or Are Loners
Use Old Routines & Habits
Control Important ‘Roles’ & ‘Territory’
Real? Fake? - Hard to Be Sure
• Uses Routines & Old Habits to function• Can complete personal care in ‘familiar place’• Follows simple prompted schedules - mostly• Misplaces things and can’t find them• ‘Resents takeover’ or bossiness • Notices other people’s mis-behavior & mistakes• Territorial – refusals!• Varies in lack of self-awareness
Diamonds – Level 5
Diamond Interests• What they feel competent at• What they enjoy & who they like• What makes them feel valued• Where they feel comfortable but
stimulated• What is familiar but intriguing• What is logical and consistent with
historic values & beliefs• Who is in charge – the boss
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Common Diamond Issues• IADLs
– Money management– Transportation -
Driving– Cooking– Home maintenance &
safety– Caring for someone
else– Pet maintenance– Med administration
• Unfamiliar settings or situations– Hospital stay– Housing change– Change in family– Change in support
system – MD visits– New diagnoses– Traveling or
vacations
Visual Cues that Help
• Personalized room • Way finding signs• Highlighted schedules• Familiar & inviting environments• Familiar set-ups for tasks or activities• Personal approach with a smile• Place cards at table settings• Wear name tags on right side
Verbal Cues that Help• Knock before entering• Use Sir and Ma’am, be respectful• Ask permission to do things in the room• Offer positive comments • Issue invitations not orders• Ask for help or input• Frame as a ‘RULE’ for everyone• Acknowledge their skill, ask for their
support or understanding --- a favor
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Watch how you talk…
• How you say it…• What you say…• How you respond…
Tactile Cues that Help
• Hand shake greetings• Return of friendly affection touches• Responsive hugs• Hand-under-hand comforting • Back rubs – with permission• Hand & foot massages – ‘pampering’
(getting used to us touching & doing)
So What Helps?
Apologize! - “I’m SORRY!” – “I didn’t mean to…”• Friendly NOT bossy – leader to leader• “Let’s try” – temporary…• Share responsibility not take over• Use as many ‘old habits’ as possible• Give up being ‘RIGHT’• Go with the FLOW• Give other ‘job’ when taking away another
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Be Prepared for REPEATS
• For repeated questions or requests– Don’t share so early
• be careful about emotional information– Make sure you are connected to respond– Repeat a few of their words in a ???– Answer their question– THEN
• Go to new words (use enthusiasm)• A new place• Add a new activity (possibly related)
For OLD Stories
• Use “Tell me about it” – to accept the story– To reduce risk of ‘paranoia-like’ thinking
• Store them for the future– Write them down– Share them with others– You will possibly need them for supportive
communication later• Learn several – prompt for ‘switch up’
Use empathy&
Go with the flow
Reality Orientation
Telling Lies
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BAD Helper Habits to BREAK
• Saying “Don’t you remember…”• Not recognizing or accepting differences• Trying to force changes in roles or
responsibilities• Trying to take over completely• Taking responsibility for saying “NO”• Accepting things at face value• Arguing
Emeralds
Changing colorNot as Clear or Sharp - Vague
Good to Go – Need to ‘DO’Flaws are HiddenTime Traveling
Emeralds
Two Kinds of DOINGDoers or Supervisors
Does What is Seen - Misses What is NotMust be in Control - Not able to do it Right Does tasks – Over and over OR Not at All
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Emerald Interests
• Doing familiar tasks• Doing visible tasks• Historic tasks and people and places• Engaging with or helping others• Finding important people or things• Having a ‘job’ or ‘purpose’• Being an ‘adult’• Getting finished & doing something else
Common Emerald Issues
• Doesn’t do care routinely – thinks did• Makes mistakes in sequence – unaware• Repeats some care routines over & over• Resists or refuses help• Gets lost – can’t find where to do care• Limited awareness of ‘real needs’ –
– Hunger, thirst, voiding, bathing, grooming…• Has other ‘stuff’ to do…
More Emerald Issues
• Afternoon or Evening – “Got to go home”• Daytime – “Got to go to work”• Looking for people/places from the past• Losing important things – thinking
others stole/took them • Doing private things in public places• Having emotional meltdowns• Treating strangers like friends and visa
versa
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Visual Cues that Help
• The environment– Overall look (friendly, fun, familiar, forgiving)– Surfaces to work on or do things on– Places to sit (paired chairs)– Set up Props (objects that ‘say’ what to do)– Highlighted areas (light, color contrast,
clutter reduction, organized)– Hidden – what is NOT to be done, what is
already done, what ‘triggers’ distress
More Visual Cues that Help
• You – Facial expression
• Friendly• Concerned
– Gestures• Invite with gestures and your face• Indicate next item to use, or options
– Offer items• Offer an item in correct orientation• Present two to pick from
Verbal Cues that Help
• Tone of Voice– Friendly– Interested– Concerned
• Reduce and Focused words– Use preferred name for attention– Match words with gestures or offering
• Listen and use their words to connect
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More Verbal Cues
• When becoming distressed– Use PPA – Let them come to you, if possible– Listen - Get emotionally connected to
where they are– Use empathic comments– Listen for key words– Go with their FLOW – don’t push for the
change– THEN Use redirection, NOT distraction
Physical Cues that Help
• Limit this form of helping! – Match it with a visual & verbal cue combo
• Offer objects – don’t put hands on• Share the task -
– Give them something to do while you do your part
• Do ‘it’ with/to someone else first, then approach them
More Physical Cues
• When distressed– Match your touch to their preferences– Hand-under-Hand FIRST– Back rub – if interested– Hug – show first– Increase space and distance, if cued– BACK OFF, if it is not working
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How to Help
• Learn about “SO WHAT!”… is it worth it?• Provide ‘subtle’ supervision for care • Provide visual prompts to do
– Gestures, objects, set-up, samples, show• Hide visual cues to ‘stop’/prevent
– Put away, move out of range, leave• Use the environment to cue – SHOW • Use ‘normal’, humor, friendliness, support
Connect• ID common interest• Say something nice about the person or their
place• Share something about yourself and encourage
the person to share back• Follow their lead – listen actively• Use some of their words to keep the flow going• Remember its the FIRST TIME! – expect
repeats• Use the phrase “Tell me ABOUT …”
Do’s• Go with the FLOW• Use SUPPORTIVE communication
techniques– Use objects and the environment– Give examples– Use gestures and pointing– Acknowledge & accept emotions– Use empathy & Validation– Use familiar phrases or known interests– Respect ‘values’ and ‘beliefs’ – avoid the negative
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DON’Ts
• Try to CONTROL the FLOW– Give up reality orientation and BIG lies– Do not correct errors– Offer info if asked, monitoring the
emotional state• Try to STOP the FLOW
– Don’t reject topics– Don’t try to distract UNTIL you are well
connected– Keep VISUAL cues positive
What NOT to DO…
• DO NOT point out errors – or focus on ‘wrong’
• DO NOT offer – physical assist 1st
• DO NOT offer “Let me HELP you”• DO NOT try to ‘go back and fix it…• DO NOT continue arguing about ‘reality’• DO NOT treat like children…• Do NOT react… remember to respond
BAD Helper Habits to Break!
• Noticing and pointing out errors• Telling not asking – “You need to…”• Too little or too much – talking, showing,
touching• Trying to take over – offering “HELP”• Putting hands on – ‘fussing’• Reality orientation or lying• Trying to use ‘distraction’
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Ambers
Amber AlertCaution!
Caught in a momentAll about Sensation
Explorers
AmbersPrivate & Quiet OR Public & Noisy
All About Sensory Tolerance & NeedsTouching - Tasting – Handling – Exploring
Attraction – AvoidanceOver-stimulated – Under-stimulated
No safety awarenessEgo-centric
Level 3 - Amber• LOTS of touching, handling, mouthing,
manipulating• Focus on fingers and mouth• Get into things• All about sensation….• Invade space of others• Do what they like • AVOID what they do NOT
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Amber Interests
• Things to mess with (may be people)• Places to explore• Stuff to take, eat, handle, move…• Visually interesting things• People who look or sound interesting OR
places that are quiet and private• Textures, shapes, movement, colors,
numbers, stacking, folding, sorting…
Amber Issues
• Getting into stuff – taking stuff• Bothering others• Not able make needs known• Not understanding what caregivers are
doing• Not liking being helped/touched/handled• Not like showers or baths• Repetition of sounds/words/actions
Visual Cues that Help
• Automatic social greeting signals• Lighted work surfaces with strong props• Demonstrations – work along side• Model the actions• Do the action one time, then offer the
prop• Show one step at a time• Show a NEW item, then cover the old
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Verbal Cues that Help
• Call name• Use simple noun, verb, or noun + verb
– “Cookie?”– “Sit down”– “Let’s go” (with gesture)
• Give simple positive feedback• Listen for their words, then
– use a few and leave a blank at the end of the sentence
Physical Cues that Help
• Show the motion or action wanted• Touch the body part of interest• Position the prop for use – light touch• Show the motion on yourself• Use hand under hand guidance• Offer the prop once started –
encourage their use of the item
Hand-Under-Hand Assistance
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How to Help• Provide step-by-step guidance & help • Give demonstration – show• Hand-under-hand guidance after a few
repetitions, uses utensils (not always well) • Offer something to handle, manipulate,
touch, gather• Limit talking, noise, touch, other activities• SUBSTITUTE don’t SUBTRACT
To Connect with Ambers
• Make an Emotional Connection– Use props or objects– Consider PARALLEL engagement at first
• Look at the ‘thing’, be interested, share it over….
– Talk less, wait longer, take turns , COVER don’t confront when you aren’t getting the words, enjoy the exchange
– Use automatic speech and social patterns to start interactions
– Keep it short – Emphasize the VISUAL
BAD Helper Habits to Break!• Talking too much, showing too little• Keep on pushing• Doing for NOT with• Stripping the environment• Leaving too much in the environment• Getting in intimate space• Over or under stimulating• Getting loud and forceful
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Rubies
Hidden DepthsRed Light on Fine Motor
Comprehension & Speech HaltCoordination Falters
Wake-Sleep Patterns are Gone
RubiesBalance & coordination
Eating & drinkingWake time & sleep time
Level 2 - Ruby• Big movements – walking, rolling, rocking• Hand actions – not fingers• Tends toward movement unless ‘asleep’• Follows gross demonstration & big gestures
for actions• Limited visual awareness• Major sensory changes• Major movement skill loses• Fine motor skill lost – mouth & hands
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Ruby Interests
• Walking a routine path• Going forward• Watching others – checking them out• Being close or having space• Things to pick up, hold, carry, push,
wipe, rub, grip, squeeze, pinch, slap• Things to chew on, suck on, grind• Rhythmic movements and actions
Ruby Care Issues• Safe mobility – fatigue, wandering, & falls• Intake – amount and safety• Hydration – interest, amount, safety• Rest time & place – night time waking• Shadowing others – invading places• Not staying – not settling for meals• Reactions to hands on care – sensation• Identifying & meeting needs
More Ruby Issues
• Contractures• Skin well being – bruises, tears, rashes• Pressure or friction• Infections – UTI, yeast, URI,
pneumonias• Swallowing• Circulation
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Visual Cues that Help
• Demonstrate what you want• Give big movements to copy• Move slowly & with rhythm• Present cues in central visual field
about 12-18 inches out• Hold things still – allow exploration• Offer your hand• Smile while offering support
Verbal Cues that Help
• Call name to get attention – at 6’ out• Use ‘song’ to connect• Give 1-3 words only• Combine verbal direction with gesture
or demo• Give one ‘action’ cue at a time• Match tone/inflection to intent• Give positive ‘Strokes’ with attempts
Physical Cues that Help
• Hand-under-hand• Touch body part to be moved or used• Place hand/foot then gesture• Offer comfort touch as desired before
task attempt• Back rubs –
– Flat and slow – to calm– Finger tips and quick circles – to awake
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How to Help
• SLOW yourself DOWN• Hand under hand• Move with first – then guide• Learn about patterns of ‘needs’• Use music and rhythms – help get or stop
movement• Use touch with care• Combine cuing & do SLOW
BAD Helper Habits to Break!
• Touching too quickly – startling• Leaning in – intimate space invasion• Talking too loudly• ‘Baby-talking’• Not talking at all• Not showing by demonstrating• Trying to understand what is said, by
being confrontational
Pearls
Hidden in a ShellStill & QuietEasily Lost
Beautiful - LayeredUnable to Move – Hard to ConnectPrimitive Reflexes on the Outside
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Pearls• The end of the journey is near• Multiple systems are failing• Connections between the physical and
sensory world are less strong• We are often the bridge – the connection • Many Pearls need our permission to go –
– They are still our moms, dads, spouses, friends– They will go in their own time – IF we don’t try to change what is
Level 1 - Pearl• Immobile – can’t get started• Bed or chair bound – frequently falls to side or
forward• Has more time asleep or unaware• Has many ‘primitive’ reflexes present -Startles easily• May cry out or mumble ‘constantly’• Increases vocalizations with distress• Difficult to calm• Knows familiar from unfamiliar• Touch and voice make a difference in behaviors
Pearl Interests
• Internal cues • Pleasant and familiar sounds & voices• Warmth and comfort• Soft textures• Pleasant smells• ‘Good’ tastes• Smooth and slow movement• Just right touch and feel
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Primitive Reflexes to Consider • Startle reflex –
– Sudden movement causes total body motion• Grasp reflex–
– touch palm – grips hard can’t release• Sucking reflex –
– sucks on anything near mouth• Rooting reflex –
– Turns toward any facial touch and tries to eat
More Reflexes
• Bite reflex – Any touch in mouth causes bite down
• Tongue thrust– Anything in mouth causes tongue to push
forward and out • Withdrawal – rebound
– Pull away from stretch• Gag reflex –
– Any touch to tongue causes gag
Typical Positioning – Why?
• Constant muscle activity causes ‘contractures’ – shortening – can’t relax
• Stronger muscles cause typical ‘fetal’ positioning
• Pulling against contractures is painful• Shortened muscles cause some areas to:
– Not get air – become ‘raw’ or ‘irritated’– Rub or press against other body parts– Get too much pressure – can’t move off
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Pearl Care Issues
• Not interacting much• Crying out – can’t make needs known• Skin & hygiene problems• Weight loss• Reflexes make care challenging• Repeated infections• Not eating or drinking• Not able to sit up safely
Visual Cues to Help
• Get into supportive position• Place your face in the central field of
vision• Make sure light comes from behind the
person – into your face• Bring up lights carefully• Move slowly so they can follow you• Place items to be used in central field
Verbal Cues to Help• Keep your voice deep & calm• Put rhythm in your voice• Tell what you are doing and what is
happening while you give care• Reflect emotions you think you see• Offer positive comments & familiar
phrases as you offer care• Quiet down, if signaled to do so
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Touch Cues to Help
• Use firm, but gentle palm pressure at joints to make contact
• Always try to maintain contact with one hand while working with the other
• Once physically connected keep it• Use flats of fingers and palms for care• Always use hand under hand when doing
something ‘intense’
How to Help• Hand under hand help & care – or hand on
forearm, if hand/arm movement is poor• Check for reflexes – modify help &
approach to match needs• GO SLOW• Use calm, rhythmic movements & voice• Come in from back of extremities to clean• Stabilize with one hand & work with other
How to Help?
• Gather all supplies for the task before getting started
• Increase warmth of the room for bathing• Use warm towels & light weight blankets• GO SLOW• Use circular, rotational movements to
relax joints for care• Provide skin care – fragile & dry skin
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BAD Help Habits to BREAK
• Hurry - Get it done quickly• Don’t talk to – talk over or about• Don’t check for primitive reflexes prior
to helping• Use both hands to give care• Clean from the front – use prying motions• Focus on tasks not the relationship• Forget to look for the Pearl
Time to Practice
Typical Situations
• Going to the doctor• Having help come in or moving into a
more ‘protected’ environment• Managing a new medical condition • Not wanting to spend any money for
help or firing the help!• Giving away money or jewelry • What about driving?
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Typical Situations
• “What should I do now?”• “I need to get to work/find my mom/go
home… Can you help me?”• Clothes on wrong and they are dirty• I haven’t shaved in three days• I just ate, but I say I haven’t • Someone has taken my wallet/pocket
book – I want to call the police!
Typical Situations
• Face Sensitivity Issues –– Eating, Mouth care, Shaving
• Getting clean issues• Getting into things OR breaking things• Taking things• Annoying others – approach & touch• Exploring - invading space and place• Not wanting to do when it’s time to do
Typical Situations
• Won’t sit down for meals• Spits out meats and rice• Can’t settle down at night keeps coming
back out• Keeps following when you need to give
care to someone else• Grabs things and pulls on them• Won’t sit on the toilet
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Typical Situations
• Not knowing how to connect• Trying to get the person clean• Calling out, or grimacing• Won’t take a bite, or a drink• Won’t swallow or chokes or has wet voice• Is hard to move, gets rigid• Keeps eyes closed, doesn’t seem to
respond
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Memory CareSpirituality Matters
• Understand and identify the importance and value of faith for those with dementia symptoms.
• Identify the value of engaging friendships with those living with dementia symptoms.
• Understand how to integrate those with a neurocognitive disorder into the faith community.
Objectives
Challenges• Most feared illness• Challenging behaviors• Burden on others• Isolation • Threatens our identity• Memory
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The importance and value of
faith for those with dementia
symptoms.
No two people are the same…
In the Image of God
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Spirituality Matters
Meaning of Life
A sense of…• Identity• Relationship• Meaning and purpose
Tai Chi
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Outdoors
Optimal ConnectionsMusic
Nurture
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Children
Lifelong Learning
Prayer
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All things bright and beautiful…
The value of engaging
friendships
Utility, Pleasure, VirtueFriendships
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“The friend who can be silent with us in a moment of despair and confusion, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness… that is the friend who cares.”
~Nouwen, 1974
Integrating those with dementia
into the faith community
Pastoral Regard• Mutuality• A different way of thinking• Acceptance of the person• A different way of relating
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Organization of Worship• Favorite Bible readings• Well known and well
loved hymns• Patterned liturgical
responses• Prayer
• Memory cueing• Leadership style• Practicalities• The Lord’s supper
Organization of Worship
Best Practices• Attentive listening• Patience and kindness• Focus on the ability, not the
limitation• Provide needed practical
support• Environment free of stigma
and anxiety• Involve everyone• Speak about dementia
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II Corinthians 5:7
“For we walk by faith and not by sight.”
Closing Thoughts
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D A N I E L C U R L I K I I , P H . D .Y O R K C O L L E G E O F P E N N S Y L V A N I A
A M E L I OR AT I N G AG E - R E L AT E DC OG N I T I V E I M P AI R M E N T S BY AL T E R I N GF U N C T I ON OF H I P P OC AM P AL N E U R ON S
T H E A G I N G P O P U L A T I O N I S P R O J E C T E D T OD O U B L E O V E R T H E N E X T F I F T Y Y E A R S
An Aging Nation, 2014
I M P L IC IT M E M O R Y R E M A IN S M O S T L YU N A F F E C T E D B Y A G IN G
(declarative)
(non-declarative)
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D E C L A R A T IV E M E M O R Y IS O F T E NIM P A IR E D W IT H A G IN G
(declarative)
(non-declarative)
T H E H I P P O C A M P U S I S A B R A I N R E G I O NR E Q U I R E D F O R M A N Y F O R M S O F L E A R N I N G
T H E H I P P O C A M P U S I S A B R A I N R E G I O NR E Q U I R E D F O R M A N Y F O R M S O F L E A R N I N G
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W I T H O U T A H I P P O C A M P U S H . M . W A S U N A B L ET O F O R M N E W D E C L A R A T I V E M E M O R I E S
H O W E V E R , H . M W A S A B L E T O F O R M N E WI M P L I C I T M E M O R I E S
H O W E V E R , H . M W A S A B L E T O F O R M N E WI M P L I C I T M E M O R I E S
Luo 2014; adapted from Milner, Squire & Kandel 1998
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T H E H I P P O C A M P U S I S R E Q U I R E D F O RD E C L A R A T I V E L E A R N I N G
D O E S A L O S S O F H I P P O C A M P A LN E U R O N S C O N T R I B U T E T O A G E-
R E L A T E D C O G N I T I V E I M P A I R M E N T?
N O ! N E U R O N A L C E L L L O S S I S N O T A S S O C I A T E DW I T H A G E - R E L A T E D C O G N I T I V E D E C L I N E
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R E S E A R C H E R S S T U D Y R O D E N T S T O B E T T E RU N D E R S T A N D T H E H U M A N B R A I N
T H E H I P P O C A M P U S C A N B E D I V I D E DI N T O T H R E E M A I N R E G I O N S
Deng, Aimone & Gage 2010
N E U R O N S I N T H E C A1 R E G I O N A R ES E N S I T I V E T O A G E - R E L A T E D C H A N G E S
Deng, Aimone & Gage 2010
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N E U R O N S I N A R E A C A 1 O F A G E DH I P P O C A M P U S A R E M U C H L E S S E X C I T A B L E
200ms20
mV
Young
Aged
A C T I V I T Y O F C A 1 N E U R O N S I S R E D U C E D I NA G E D C O G N I T I V E L Y I M P A I R E D A N I M A L S
Disterhoft and Oh 2006
A C T I V I T Y O F C A 1 N E U R O N S I S I N A G E DU N I M P A I R E D A N I M A L S I S C O M P A R A B L E T OT H A T O F Y O U N G R A T S
Disterhoft and Oh 2006
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T H E M O R R I S W A T E R M A Z E I S C O M M O N L Y U S E DT O A S S E S S S P A T I A L L E A R N I N G A N D M E M O R Y
Target Quadrant
T H E M O R R I S W A T E R M A Z E I S C O M M O N L Y U S E DT O A S S E S S S P A T I A L L E A R N I N G A N D M E M O R Y
Target Quadrant
T H E M O R R I S W A T E R M A Z E I S C O M M O N L Y U S E DT O A S S E S S S P A T I A L L E A R N I N G A N D M E M O R Y
Target Quadrant
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A G E D R AT S D I S P L AY I M P AI R E DS P AT I AL L E AR N I N G
Curlik, Weiss, Nicholson and Disterhoft 2014
T H E M O R R I S W A T E R M A Z E C A N A L S O B E U S E DT O A S S E S S S P A T I A L M E M O R Y
A G E D R AT S D I S P L AY I M P AI R E DS P AT I AL M E M OR Y
Curlik, Weiss, Nicholson and Disterhoft 2014
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O N L Y H AL F OF AG E D R AT S D I S P L AYC OG N I T I V E I M P AI R M E N T S
Curlik, Weiss, Nicholson and Disterhoft 2014
RestoreNeuronal
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SuccessfulLearning
andMemory
ImpairedSynapticPlasticity
ImpairedLearning
and Memory
DecreasedNeuronal
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Adapted from Disterhoft & Oh 2007
CAN INCREASING T HEEXCIT ABILIT Y OF AGED
HIPPOCAMPAL NEURONSAMELIORAT E AGE-RELAT ED
COGNIT IVE DEFICIT S?
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R A T S U N D E R W E N T S T E R E O T A X ICS U R G E R Y
A N A D E N O - A S S O C I A T E D V I R U S W A S U S E DT O I N C R E A S E C R E B L E V E L S I N C A1
CA1
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A D E N O - A S S O C I A T E D V I R U S E S C A N B E U S E DT O M O D I F Y H I P P O C A M P A L N E U R O N S
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A N A D E N O - A S S O C I A T E D V I R U S W A S U S E DT O I N C R E A S E C R E B L E V E L S I N C A1
Yu, Curlik, Oh, Yin & Disterhoft, In Preparation
C E L L S F R O M A G E D C A 1 W E R E L E S SE X C I T A B L E T H A N T H O S E F R O M Y O U N G R A T S
Yu, Curlik, Oh, Yin & Disterhoft, In Preparation
A D M I N I S T R A T I O N O F V I R A L C R E B A M E L I O R A T E DA G E - R E L A T E D B I O P H Y S I C A L D E F I C I T S
Yu, Curlik, Oh, Yin & Disterhoft, In Preparation
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A L L A N I M A L S W E R E T R A I N E D W I T H T H EM O R R I S W A T E R M A Z E
Target Quadrant
Y O U N G R A T S H A D A R O B U S T M E M O R YF O R T H E P L A T F O R M L O C A T I O N
Yu, Curlik, Oh, Yin & Disterhoft, In Preparation
H A L F O F A G E D R A T S W E R EU N I M P A I R E D
Yu, Curlik, Oh, Yin & Disterhoft, In Preparation
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H A L F O F A G E D R A T S D I S P L A Y E DS P A T I A L M E M O R Y D E F I C I T S
Yu, Curlik, Oh, Yin & Disterhoft, In Preparation
I N C R E A S I N G C R E B L E V E L S A M E L I O R A T E DA G E - R E L A T E D S P A T I A L M E M O R Y D E F I C I T S
Yu, Curlik, Oh, Yin & Disterhoft, In Preparation
PHARMACO LOGI C ALMANIPUL AT IONS CAN ALSOAMELIORAT E AGE-RELAT ED
BIOPHYSICAL ANDBEHAVIORAL DEFICIT S
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A D M I N I S T R A T I O N O F N I M O D I P I N E I N C R E A S E ST H E A C T I V I T Y O F C A 1 N E U R O N S
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15
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Adapted from Disterhoft & Oh 2007
ACKNO WL E DG E M E NT SDr. John DisterhoftDr. Matthew OhDr. Jerry YinXiao-Wen YuDr. Craig WeissDr. Dan NicholsonDr. Tracey ShorsDr. Jennifer EnglerDr. Carla StrassleDr. Perri DruenDr. Randi Shedlosky-Shoemaker
This work was supported by:NIH AG13854 to D.M.C. NIH AG20506 to D.M.C. NIH AG008796 to J.F.D.NIH AG017139 to J.F.D.
Q U E S TI O N S?
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Under Construction:A Short Detour, A long Drive
JASON HALL PHARM.D., BCPS
Learning Objectives
üReview Alzheimer’s Dementia and possible causes
üDiscuss current memory treatment options, efficacy and usage
üDiscuss available medications that may help improve quality of life
http://fortune.com/2016/09/03/biogen-drug-alzheimers-disease/
What Is Dementia?
Broad term describing many symptoms caused by changes in the brain
May cause changes in: memory, communication, language, reasoning, judgment, visual perception and behavior
Alzheimer’s Disease accounts for 60-80% of dementia
http://alznet.org/lewy-body-dementia/
Alzheimer’s Disease Education and Referral Center. Alzheimer’s Disease: Fact Sheet. National Institute on Aging. NIH Publication No. 15-6423. Updated: May 2015. Accessed October 13, 2015.
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Graying Of America
In 2012, 43.1 million Americans were aged 65 years and older
By 2040 this number is expected to increase to 79.7 million
Americans aged 85 years and older is the fastest growing group◦ 5.8 million in 2014◦ 14.1 million in 2040 expectedhttp://www.ymcasm.org
Administration On Aging Statistics. Available at:http://www.aoa.gov/Aging_Statistics/Profile/index.aspx.Accessed. May 5th 2015
The Healthy Brain o Adult weight: 3 pounds
o Adult size: medium sized cauliflower
o Number of neurons: 100 billion
o Number of synapses: 100 trillion
o Number of capillaries: 400 billion
https://www.wired.com/2012/12/the-next-warfare-domain-is-your-brain/
Rodgers, Anne B. Alzheimer’s Disease: Unraveling the Mystery. Alzheimer’s Disease Education and Referral (ADEAR) Center. National Institute on Aging. September 2008. Publication: 08-3782
Alzheimer’s Disease
Affects more than 5 million Americans
Most common cause of dementia
Generally appears during the sixth decade of life
Brain changes may start 10-20 years before any symptoms appear
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Alzheimer’s Disease
Genetics
Hallmarks of AD◦ Beta-amyloid◦ Tau
Oxidative damage
Vascular changes
Other diseases: heart disease, stroke and type II diabetes.
https://www.alz.org/braintour/healthy_vs_alzheimers.asp
Rodgers, Anne B. Alzheimer’s Disease: Unraveling the Mystery. Alzheimer’s Disease Education and Referral (ADEAR) Center. National Institute on Aging. September 2008. Publication: 08-3782
Treatment of Alzheimer’s Disease
Even with advanced medicine, Alzheimer’s CANNOT be cured, or stopped from progressing
Goals of treatment§Lessen symptoms§Improve quality of life
Prescription Medications
Acetylcholinesterase inhibitors (AChEI)§Aricept ® (donepezil)§ Exelon ® (rivastigmine)§Razadyne ® (galantamine)
NMDA antagonist§Namenda ® (memantine)
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Acetylcholinesterase inhibitors
How they work: § They block the enzyme (AChE)
responsible for the breakdown of acetylcholine §Decreased breakdown of
acetylcholine, leads to increased levels in the synapses between neurons
Higher levels of acetylcholine may lead to improved communication
Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015
Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015
Acetylcholinesterase inhibitors Aricept® (donepezil)
Starting dose: 5 mg daily
Usual dose: 10 mg daily
Max dose: 23 mg daily
Increase dose every 2-4 weeks to 10 mg daily.
May consider 23 mg daily if patient stable on 10 mg (generally after 3-6 months)
Exelon® (rivastigmine)
Starting dose: 1.5 mg daily (oral)
Usual dose: 6 mg daily (oral)
Max dose: 12 mg daily (oral)
Increase dose every 2 weeks
Exelon® (rivastigmine)
Starting dose: 4.6mg/24hr (patch)
Usual dose: 9.5mg/24hr (patch)
Max dose: 13.3mg/24hr (patch)
Increase dose every 4 weeks
May consider increasing to 13.3mg/24hr patch after 6 months
Aricept Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.Exelon Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.
Razyadyne Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015
.
Acetylcholinesterase inhibitors Razadyne® (galantamine)
Starting dose: 4 mg twice daily
Usual dose: 8-12 mg twice daily
Max dose: 12 mg twice daily
Increase dose after 4 weeks at current dose
Razadyne ER® (galantamine)
Starting dose: 8 mg daily
Usual dose: 8-24 mg daily
Max dose: 24 mg daily
Increase dose after 4 weeks at current dose
Aricept Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.Exelon Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.
Razyadyne Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015
.
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Acetylcholinesterase inhibitors Possible side effects:
§ Nausea, vomiting
§ Diarrhea
§Muscle cramps
§ Urinary incontinence
§ Syncope
§ Fatigue
§ Anorexia
§ Behavioral changes
Discontinue use if:
§ Bradycardia (slow heart rate)
§ Gastrointestinal ulcer
Reduce dose or discontinue if:
§ Intolerable side effects occur (nausea, vomiting, diarrhea, muscle cramps, insomnia, fatigue, dizziness)
Aricept Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.Exelon Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.
Razyadyne Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015
.
Acetylcholinesterase inhibitors § Initiate therapy for patients with mild to severe Alzheimer’s Disease when clinically indicated§ Benefits may include:§ Cognition§ Activities of daily living § Severity of dementia§ Behaviors§ Nursing home placement
§ Not all patients will respond§ Duration of benefit will vary based on the patient
California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.
Acetylcholinesterase inhibitors
§ Choose product based on:§Cost§ Patient specific characteristics §Adverse side effects§Concurrent medications
§ Discontinuing product is controversial and patient specific
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Acetylcholinesterase inhibitors
Important considerations:
§ Starting doses of galantamine and rivastigmine are not therapeutic
§ Donepezil and galantamine undergo hepatic metabolism
§ All three may interact with other anticholinergic agents
§ Should be discontinued prior to surgery, unless otherwise stated by surgeon
§ Be mindful of food recommendations
California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.
NMDA Receptor AntagonistHow Namenda® (memantine)
Blocks the excessive stimulation of the neuron by glutamate
Excessive stimulation by glutamine may result in neuronal injury or death
https://www.google.com/search?q=memantine+moa&safe=off&biw=1361&bih=921&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjyuIWR_IfQAhWm6oMKHUQ4CA4Q_AUIBygC#imgrc=s6Aq26NYsT6KHM%3A
Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015
NMDA Receptor AntagonistNamenda® (memantine)
Starting dose: 5 mg daily
Usual dose: 10 mg twice daily
Max dose: 10 mg twice daily
Increase by 5 mg twice daily after 1 week, then increase by 5 mg every 1 week until max dose of 10 mg twice daily is achieved
Namenda XR® (memantine)
Starting dose: 7 mg daily
Usual dose: 28 mg daily
Max dose: 28 mg daily
Increase by 7 mg twice daily each week until target dose of 28 mg daily is achieved
Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.
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NMDA Receptor Antagonist
Possible side effects:
§ Dizziness
§ Balance disorders
§ Hypertension
§ Constipation
§ Headache
Reduce dose or discontinue if:
§ Intolerable side effects occur
§ Severe confusion/altered mental status
Namenda. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015
NMDA Receptor Antagonist
§May be initiated upon diagnosis or later in disease course
§May be used as monotherapy or combined with acetylcholinesterase inhibitors
§Benefits may include:§Cognition §Activates of daily living§Behaviors
§Discontinuing product is controversial and patient specific
Behavioral and Psychological Symptoms of Dementia (BPSD)
“The Scream” –Edvard Munch
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BPSD BasicsBPSD effects 35-85% of all patient living with dementia
Symptoms may cause distress to the patient and care partners
Treatments include both non-pharmacological and pharmacological approaches
BPSD Symptoms
§Agitation
§Anxiety
§Irritability
§Depression
§Delusions
§Hallucinations
Cer ejeira J, LagartoL, Mukaetova-Ladinska E.B. Behavioral and Psychological Symptoms of Dementia. Front in Neuro. 2012. 3(73). 1-21.
§Disinhibition
§elation
§Repetitive behavior
§Sleep changes
§Appetite changes
§Others
BPSD BasicsChanges in mood and behaviors are generally not sudden (acute)
Any sudden (acute) changes may indicate another medical problem
Non-pharmacological interventions are considered ideal, and should be used first if possible
If non-pharmacological treatments fail, then pharmacological intervention may be necessary
Medication classes used for BPSD include:
§Antidepressants
§Antipsychotics
§Anticonvulsants
§Benzodiazepines
Califor nia Department of Health. Guideline For Alzheimer's Disease Management- Final Report. Apr il 2008.
Antipsychotics Some documentation supports antipsychotic effectiveness in the treatment of BPSD
Targeted symptoms:§Aggression
§Psychosis
§Hallucination
§Delusions
§Extreme agitation
Two main classes of antipsychotics:§Typical antipsychotics
§Atypical antipsychotics
California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.
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Antipsychotics
Antipsychotics with the most evidence for BPSD
Risperdal® (risperidone) “atypical”
Zyprexa® (olanzapine) “atypical”
Haldol® (haloperidol) “typical”
Other antipsychotics used for BPSD
Seroquel® (quetiapine) “atypical”
Abilify ® (aripiprazole) “atypical”
Clozaril ® (clozapine) “atypical”
Geodon® (ziprasidone) “atypical”
AntipsychoticsInitiate therapy after other interventions have failed, or when safety may be compromised
Dosing should be patient specific. Consider type of behavior, frequency, onset and predicating factors
Start low and go slow!
“At Eternity's Gate”-Vincent van Gough
Antipsychotics Black Box Warning
There is a documented increased risk of death in older adults taking these drugs for mental problems caused by dementia
Possible side effects:
§Sedation
§Falls
§Anticholinergic effects
§Glucose intolerance
§Elevated cholesterol
§Extrapyramidal symptoms
§Gait disturbances
§Tardive dyskinesia
§Increased mortality
§Neuroleptic malignant syndrome
§Seizures
§Weight gain
§QT prolongation
§Elevated liver enzymes
§Others
California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.Cerejeri J, Lagarto L, Mukaetova-Ladinska E.B. Beavhioral and psychological symptoms of dementia. Front In Neuro. Vol 3. May 2012. 1-21
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AntipsychoticsSummary:
Antipsychotics may be beneficial for some BPSD symptoms
Antipsychotics should be used as a last line option
Start at the lowest possible dose and treat for the shortest amount of time possible
Monitor for side effects and discontinue use if risks > benefits
AntidepressantsSome documentation supports antidepressants effectiveness in the treatment of BPSD
Targeted symptoms:
§ Depressions
§ Agitation
§ Psychosis
§ Disinhibition
§ Irritability
Main classes antidepressants used for BPSD
§ Tricyclic antidepressants
§ Selective serotonergic reuptake inhibitors
§ Serotonin/norepinephrine reuptake inhibitors
California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.Cerejeri J, Lagarto L, Mukaetova-Ladinska E.B. Beavhioral and psychological symptoms of dementia. Front In Neuro. Vol 3. May 2012. 1-21
AntidepressantsTricyclic antidepressants
Norpramin® (desipramine)Sinequan® (doxepin)Aventyl® (nortriptyline)
Selective serotonergic reuptake inhibitors
Celexa® (citalopram)Lexparo® (escitalopram)Prozac® (fluoxetine)Luvox® (fluvoxamine)Paxil® (paroxetine)Zoloft® (sertraline)
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Antidepressants
Serotonin/norepinephrine reuptake inhibitors
Cymbalta® (duloxetine)
Effexor® (venlafaxine)
Miscellaneous
Wellbutrin® (buproprion)
Lithium
Remeron® (mirtazapine)
Nefazodone
Desyrel® (trazodone)
AntidepressantsPotential side effects:
§Dizziness
§Blood pressure changes
§Gastrointestinal upset
§Sexual disturbances
§Nervousness
§Changes in sleep
§Sedation
§Dry mouth
§Changes in heart rhythm
§Fatigue
§Weight loss
§Weight gain
Benzodiazepine Comparison Chart. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.Lorazepam Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.c
AntidepressantsSummary:
May be a good alternative to antipsychotic use
Depression is main use, however, may show benefit to other BPSD symptoms
Choose product based on patient characteristics and intended use
Requires 4-8 weeks at current dose to see full results
Do not abruptly discontinue (taper dose over several weeks)
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BenzodiazepinesSome documentation supports benzodiazepine effectiveness in the treatment of BPSD
Targeted symptoms:
§Anxiety
§Agitation
§Insomnia
§Restlessness
Cerejeira J, Lagarto L, Mukaetova-Ladinska E.B. Behavioral and Psychological Symptoms of Dementia. Front in Neuro. 2012. 3(73). 1-21.Benzodiazepine Comparison Chart. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.
Lorazepam Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.cCalifornia Department of Health. Guideline For Alzheimer's Disease Management- Final Report. April 2008.
http://www.naturalstressreliefguide.com/image-files/anxiety_stress.jpg
BenzodiazepinesMay be used to manage acute or chronic agitation, anxiety or restlessness
Consider shorter acting benzodiazepines
Available benzodiazepines:
§Xanax® (alprazolam)
§Klonopin® (clonazepam)
§Valium® (diazepam)
§Ativan® (lorazepam)
§Serax® (oxazepam)
§Restoril® (temazepam)
§Halcion® (tiazolam)
Benzodiazepine Comparison Chart. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.Lorazepam Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.c
BenzodiazepinesPotential side effects:
§Changes in behavior
§Balances changes
§Confusion
§Dizziness
§Disinhibition
§Sedation
§Hallucination
§Lethargy
§Abnormal dreams
§Seizures
§Sexual changes
§Anorexia
§Changes in liver enzymes
§Blurred vision
§Gastrointestinal distress
§Drowsiness
Benzodiazepine Comparison Chart. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.Lorazepam Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.c
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Benzodiazepines
Summary
Often used to control acute or intermittent anxiety, agitation or restlessness
Recommend use at the lowest possible dose, for shortest time possible
Often using 30 to 50% of adult dose is sufficient
Monitor for changes in dizziness, vision and mental status
Monitor for increased risk of falls
On The Horizono Currently there are five FDA-approved Alzheimer’s drugs
o The function of the currently approved drugs are to help alleviate symptomso The target of drugs under current investigation will be to modify the disease
o Beta-amyloid
o Tau Proteino Inflammation
o Insulin resistanceo New imaging and diagnosing techniques are currently under investigation
o Many clinical trials available
Alzheimer’s Association. Treatment Horizon. Available at :http://www.alz.org/research/science/alzheimers_treatment_horizon.asp. Accessed October 14, 2015.
Tablet Engaged Active Minds Empowering Your Care Team
alzheimer’s association | Greater PA Chapter 2016 York County Education & Resource Conference Nov. 30, 2016 @ Wyndham Garden York
PRESENTED BY GENERATION CONNECT WEAREGENERATIONCONNECT.COM
What is your definition of “team”?
What is the common goal of your care team?
How do you empower members of your care team?
Keys to teamwork?
TEAMS
YOUR CARE TEAM
DEBBY’S CARE TEAM
STORIES
How does your care team use photographs, stories and reminiscing?
How can technology help?
APPS FOR STORIES
Camera
Adobe Spark Video
Swaha
RELAXATION
How does your care team use relaxation techniques?
How can technology help?
APPS FOR RELAXATION
Virtual Active
Relax HD
MUSIC
How does your care team use music and singing?
How can technology help?
APPS FOR MUSIC
YouTube iTunes
Spotify SingFit
GAMES
How does your care team use games?
How can technology help?
APPS FOR GAMES
Traditional Games
Tangram Colorfy
DIGITAL MEMORY BOX
What is a digital memory box?
How can I create one?
QUESTIONS & CONTACT
WeAreGenerationConnect.com
Michael:
Debby:
Stations #1 - Stories
Station #2 - SingFit
Station #3 - Virtual Active
Station #4 - Tangram
STATIONS
5/11/2016
1
Hope with PURPOSE Presented by:
Good News Consulting, Inc
140 Roosevelt Ave. Suite 210 York, PA 17403
(717)843-1504
www.goodnewsconsulting.com
Like us on FACEBOOK!
Objectives
• Take Care of You
• Taking Care of THEM
•Have PURPOSE
DO the BEST you can until you know better.
Then, when you know BETTER, DO better!
Maya Angelou
5/11/2016
2
Who are Caregivers?
• Family or friends providing a range of assistance from a few to 40+ hours per week and activities ranging from providing transportation or running errands to direct physical care including feeding, bathing, toileting, dressing, and 24 hour monitoring. -AARP
According to an AARP Study
• 1:4 caregivers report that they are living with the person cared for and most caregivers fulfill multiple roles, they live with a partner, work and manage caregiving responsibilities at the same time and are primarily women.
2016 Alzheimer’s Disease Facts & Figures
• In 2015, 15.9 million family & friends provided 18.1 billion hours of unpaid care to those with Alzheimer’s and other dementias. That care had an estimated economic value of $221.3 billion.
• Approximately 2/3 of caregivers are women. 34% are age 65 or older. 41% of caregivers have a household income of $50,000 or less.
• On average, care contributors lose over $15,000 in annual income as a result of reducing or quitting work to meet the demands of caregiving.
5/11/2016
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STRESS-What is it?
• Stress- body’s natural reaction to tension, pressure and change
• It effects us physically and emotionally
• Everybody experiences stress
• Prolonged stress can lead to serious health problems
• Stress means different things to different people.
10 symptoms of Caregiver stress
• Denial
• Anger
• Withdrawal
• Anxiety
• Depression
• Exhaustion
• Sleeplessness
• Irritability
• Lack of Concentration
• Health Problems
Tips to Manage Stress
• Know what resources are available
• Get help
• Use relaxation techniques
• Get moving
• Take time for yourself
• Become an educated caregiver
• Take Care of Yourself
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Why You’re important • You’ll be able to better take care of others.
• You’ll be able to manage daily responsibilities more effectively and efficiently.
• You’ll be happier and healthier.
• Your stamina, insight, and thinking abilities will be better.
• You’ll get along with others more effectively.
• You’ll be better able to think up solutions to your problems.
Caregiver Resources
• Alzheimer’s Association-www.alz.org
• AARP-www.aarp.org
• Adult Day Programs
• In-Home Assistance
• Visiting Nurses
• Meals on Wheels
• Senior Resource Directory
Taking Care of Them
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Positive Approach
1. Approach from the _______________
2. Go_____________________________
3. Move to the ____________________
4. Get ___________________________
5. Offer your______________________
6. Call them by ____________________
Use this EVERTIME!
COMMUNICATION SKILLS
• HOW YOU
SPEAK
• WHAT YOU SAY
• HOW TO
RESPOND
• TONE – Friendly
• PITCH – LOW
• SPEED - SLOW
Have Purpose
• What was their purpose?
• What can this look like today?
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THE CHALLENGE
• People with Dementia lose the ability to plan
• People with Dementia lose the ability to self-initiate
• People with Dementia lose the ability to follow-through with daily routine (comfort zone)
THE SOLUTION
• We help them create a meaningful day through their interaction with us.
• We help them gain a sense of control.
• We help them be successful no matter what their level of ability
***** ENGAGEMENT *****
ENGAGEMENT – what is it? • Interactive 1:1
– Conversing
• Reminiscing
• Discussions
– Giving / Following Directions
– Techniques for helping with life skills
• Therapeutic
– Planned intervention
– Spontaneous intervention
• Areas of Interest – nurturing center; office; kitchen etc.
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ENGAGEMENT – why?
RESEARCH SHOWS:
• Benefit of repetition – practice what is retained (ability left)
• Benefit of exercising the brain regardless of cognitive level
• Minimizing behavior by creating opportunities for success
• Relationships are KEY to all people
• Consistency creates familiarity (comfort zone)
PLAN SUCCESSFUL ENGAGEMENT
• KNOWLEDGE OF THE PERSON
• PLAN TO USE PERSON’S ABILITIES
and MEMORIES
• INDIVIDUALIZED TOOLS TO USE
ENGAGEMENT Intellectual, Spiritual, Social, Physical, & Sensory
RESEARCH SHOWS:
• Consistency creates familiarity – same types daily
• Benefit of exercising the brain regardless of cognitive level with variety of content
• Benefit of repetition – practice what is retained (ability left)
• Minimizing behavior by creating opportunities for success in areas of familiarity
WE DO THESE TO CREATE “NORMALCY”
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You can make a difference!
An old man walked up a shore littered with
thousands of seashells and starfish,
beached and dying after a storm. A
young man was picking them up and
flinging them back into the ocean. “Why
do you bother?” the old man scoffed.
“You’re not saving enough to make a
difference.” The young man picked up
another starfish and sent it spinning back
to the water.
“Made a difference to that one,” he said.