powerpoint presentation · quality of life, “i don’t know ... lonely solitary –lonely – ......
TRANSCRIPT
7/5/2019
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
How to Communicate
With Someone Who is
Living With Dementia
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
PET Scan of 20-Year-Old Brain PET Scan of 80-Year-Old Brain
PET and Aging:
ADEAR, 2003
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As we age, we do not lose
function in our brains,
unless…
Something Goes Wrong with
Our Brains
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Normal vs. Not Normal
Normal Aging:
Slower to think
Slower to do
Hesitates more
More likely to ‘look before
leaping’
Know the person but not the
name
Pause to find words
Reminded of the past
Harder
Not Normal Aging:
Can’t think the same
Can’t do like before
Can’t get started
Can’t seem to move on
Doesn’t think it out at all
Can’t place the person
Words won’t come – even later
Confused about past versus now
Very different
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Cognitive Changes with Aging:- Normal changes: more forgetful and slower to learn
- MCI: Mild Cognitive Impairment: Immediate recall, word
finding, or complex problem-solving problems
-Half these folks will develop dementia in 5 years
- Dementia: Chronic thinking problems in > 2 areas
- Delirium: Rapid changes in thinking and alertness, seek
medical help immediately
- Depression/anxiety: Chronic unless treated, poor
quality of life, “I don’t know” or “I just can’t”responses, no pleasure, can look like agitation and
confusion
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Ten Early Warning Signs:
1. Memory loss for recent or new
information, repeats self
frequently
2. Difficulty doing familiar but
difficult tasks: managing money,
medications, driving
3. Problems with word finding,
mis-naming, or misunderstanding
4. Getting confused about time or
place, getting lost while driving,
missing several appointments
5. Worsening judgment, not
thinking thing through like before
6. Difficulty problem-
solving or reasoning
7. Misplacing things or
putting them in ‘odd’ places
8. Changes in mood or
behavior
9. Changes in typical
personality
10. Loss of initiation:
withdraws from normal
patterns of activities and
interests
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Four Truths About
Dementia:
1. At least 2 parts of the brain are dying-
one related to memory and another part
2. It is chronic – can’t be fixed
3. It is progressive – it gets worse
4. It is terminal – it will kill, eventually
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The person’s brain is dying
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Normal Brain Alzheimers BrainUsed with permission from Alzheimers:The Broken Brain, 1999 University of Alabama
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Dementia
does not equal
Alzheimers
does not equal
Memory Problems
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
How Can We Become Better
Communicators?
Let go of the past to be in the moment
Go with their flow
Be willing to try something new
Be willing to learn something different
Be willing to see it through another’s eyes
Be willing to fail and try again
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Getting The Person
to Do Something:
Form a relationship first,
then work on task attempt!
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To Connect:
- Use the Positive Physical Approach™ to
get started
- Make a Visual Connection:
-Look interested and friendly
- Make a Verbal Connection:
-Sound enthusiastic, keep responses short
- Make a Physical Connection:
-Hold Hand-under-Hand®, or use flat open
hand on forearm or knee
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Positive Physical
Approach™:
-Pause at edge of public space (6 feet)
-Gesture and greet by name
-Offer your hand and make eye contact
-Approach slowly within visual range
-Shake hands and then maintain Hand-under-Hand®
-Move to the side
-Get to eye level and respect intimate space
-Wait for acknowledgement
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Then, Connect Emotionally:
- 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.”
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Connecting Emotionally:
-Identify 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 and listen actively
-Use some of their words back to keep
the flow going
-Remember it’s often the ‘first time’ for
them, so expect repeats
-Use the phrase “Tell me about…”
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
To Communicate:
Just Having a Conversation-The more you know, the better it will go
-Take it slow and go with the flow
-Later in the disease:
-Use props or objects
-Consider parallel engagement at first: look at the
‘thing,’ be interested, share it
-Talk less, wait longer, take turns
-Cover, don’t confront when you aren’t getting
their words and just enjoy the exchange
-Use automatic speech and social patterns to
start interactions
-Keep words short and emphasize the visual
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Then, Get it Going!
- Give Simple and short information
- Offer concrete choices
- Ask for help
- Ask the person just to try
- Break the task down to single steps at a time
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Give Simple Information:
- Use Visual Cue (gesture/point) combined
with a Verbal Cue:
-“Its about time for… “-“Lets 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
information
- Limit your words and keep it simple
- Wait!!!!
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
To Communicate
When They’re Distressed:
First - Connect
Then - Use Supportive Communication
Finally - Move Together to Something New
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Be a Detective, Not a Judge!
Try to figure out what is being communicated:
•Words
•Thoughts
•Actions
•Needs
•Beliefs
Don’t assume or presume
Don’t discount the message because of how it
is delivered
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Top Five Human Needs and
Emotional Indicators of
DistressFive Human Needs:
IntakeHydration, nourishment, meds
Energy Flowtired or revved up
directed inward or outward
OutputUrine, feces, sweat, saliva,
tears
Comfort4 Fs and 4 Ss
PAIN Free!!!Physical, emotional, spiritual
Five Expressions of Emotional Distress:
Angryirritated – angry – furious
Saddissatisfied – sad – hopeless
Lonelysolitary – lonely –
abandoned/trapped
Scaredanxious – scared – terrified
Lacking Purposedisengaged – bored – useless
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
To Communicate and Figure
It Out:Connect:
•Visually
•Verbally
•Physically
•Emotionally
•Spiritually
How?
•PPA™
•Supportive Communication
Supportive Communication:
•Empathy
•Validation
•Exploration
•Acknowledgement
Move Forward:
•New words
•New place
•New Activity/Focus
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
To Connect When They’re
Distressed:
- Send Visual Signal of connection:
-Look concerned
- Send a Verbal Signal of connection:
-Use the right tone of voice
- Send a physical signal of connection:
-Give a light squeeze or sandwich the hand
-Offer an open palm on shoulder or back
-Offer a hug if the person is seeking more
contact
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
What is Supportive
Communication?• Repeat a few of their words with a question at
the end
• Avoid confrontational questions
• Use just a few words
• Go slow
• Use examples
• Fill in the blanks
• Listen, then offer empathy:
“Sounds like…” or “Seems like…” or “Looks
like…”
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
More Supportive
Communication:• Validate their emotions
• Early Stage: “It’s really (label emotion) to
have this happen” or “I’m so sorry this is
happening to you!”
• Mid Stage: Repeat their words with emotion:
-Listen for added information, ideas, thoughts
-Explore the new info by watching and listening
-Late Stage: Check out the whole body:
-Face, posture, movement, gestures, touching,
looking
-Look for the need under the words or actions
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Once You’re Connected and
Communicating:
Move Forward:
•Add new words
•Move to a new place
or location
•Add a new activity
Early Stage: Redirection
•Same subject, different
focus
Later Stage: Distraction
•Different subject,
unrelated but
enjoyed
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For All Communication:
If what you are trying is not working:
- Stop!
- Back off
- Think it through, then:
- Re-approach
- Try something slightly different
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Use empathy
and
go with the flow!
Reality
OrientationTelling
Lies
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Do:- Go with the flow
- Use supportive communication techniques
-Use objects and the environment
-Give examples
-Use gestures and pointing
-Acknowledge and accept emotions
-Use empathy and validation
-Use familiar phrases or known interests
-Respect values and beliefs and avoid the negative
-Offer info if asked, monitoring the emotional state
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Don’t:- Try to control the flow
- Argue with them or correct their errors
- Ignore problem behaviors
-Use reality orientation and big lies
-Try a possible solution only once
- Try to stop the flow
-Reject topics
-Try to distract until you are well-connected
-Use negative visual cues
-Give up
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
So What Should We Do???
Remember
who
has the healthy brain!
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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Copyright 2017, All Rights Reserved
Teepa Snow and Positive Approach to Care
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