the diamond module - homesteadneoshcaregivers.homestead.com/diamond_module__1_.pdf · brain is...

The Diamond Module

Senior Gems®

SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and developed by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC

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Early Dementia

DIAMOND MODULE Pre-Quiz

Test what you already know about

Diamonds!

1. When working with a diamond, it

is best to make as many changes

as possible.

True or False

2. Diamonds are typically

characterized by an easy-going,

laid back disposition.

True or False

3. As a caregiver, you should lay

down the ground rules and not

be willing to change the way you

do things.

True or False

If you answered FALSE to all of these

questions, you are well on your way

to working effectively with

Diamonds.

Why do we use the gems?

The Senior Gems™ are based on the Allen Cognitive Disability Theory. Each

gem represents a stage of dementia from normal aging through late stage

dementia. We use the gems to help us understand the changes that are

taking place and to know what our clients are still able to do in order to

provide the best care possible.

Dear Learner,

This training guide was designed for you to complete as a self-study

activity. Please do the following in order to ensure successful completion:

First, read through EVERYTHING. There is a lot of important in-

formation through the guide. If you find something that will be

helpful to you and your clients underline or highlight that infor-

mation.

If you have a question, please ask:

__________________________

Once you are finished take the quiz at the end and review these

answers with your supervisor. You will need to answer 8 out of

10 questions correctly to pass.

The packet will be yours to keep, but you must turn the quiz into

your supervisor.

Due Date: _________________

Taking the time to complete these learning guides show that you

care about your clients and want to provide the best service

possible. Thank you for your hard work and dedication!

The Diamond Module

Senior Gems®


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What’s Inside?

Introduction p. 1

Objective p. 2

Characteristics of Diamonds p. 2

Early Warning Signs p. 3

Normal Aging vs. Dementia p. 3-4

Diagnosing Dementia p. 4-5

Types of Dementia p. 6

Communication Techniques p. 7-8

Activities p. 9-11

Environment p. 12

Transitioning to the next Gem p. 12

Quiz p. 13

Caregivers completing this learning module will be able to

identify the characteristics of diamonds, ways to promote

effective communication, techniques for care and activities that

work in order to create a more positive and fulfilling day for

their clients.

Characteristics of Diamonds

On the gem’s scale diamond is the first stage of dementia meaning the cognitive changes that are

happening are no longer “normal.” A diamond is the gem selected to represent this stage because

diamonds are still clear, but they are very rigid. In other words, a diamond can still do things as they

always have, but they are going to struggle with new information. Below are some basic characteristics

of a diamond:

Diamonds can be rigid, hard and totally inflexible, but they also shine and sometimes can be

perfectly fine.

They can do what they have always done; they often get upset when things change.

They have many facets, so it is possible that different people see different sides of a diamond.

The most important words you will use working with a diamond are “I’m sorry.”

Diamonds have trouble learning new information, but they can remember old stories.

Fast Facts

1 in 8 people aged 65 or older have

Alzheimer’s disease.

Nearly half of people aged 85 and

older have Alzheimer’s disease.

Source: Alzheimer’s Association

The Diamond Module

Senior Gems®


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10 Warning Signs of Dementia

Since diamond is the first stage of dementia, it is a time when

there may be some uncertainty about whether or not there is

a problem. The Alzheimer’s Association has created this list of

early warning signs to help identify whether or not there is a

need to see a doctor:

Memory changes that

disrupt daily life.

Challenges in planning or

solving problems.

Difficulty completing

familiar tasks at home, at

work or at leisure.

Confusion with time or

place.

Trouble understanding

visual images and spatial

relationships.

New problems with words

in speaking or writing.

Misplacing things and

losing the ability to retrace

steps.

Decreased or poor

judgment.

Withdrawal from work or

social activities.

Changes in mood and

personality.

What should you do if you

think your client has

dementia?

Based on your experience and

education it may be clear to you that

a client is having a problem with their

cognitive functioning. As you

understand, this may be extremely

distressing to both the client and

their family. If you feel that there is a

problem, please contact the Senior

Helpers office to let them know what

you are noticing. That way you as the

caregiver are not the one sharing this

information and potentially causing

your client to lose trust in you, or be

angry with you.

Review of Normal Aging vs. Dementia

Normal Aging Dementia

Continues to be independent in daily activities.

May complain of memory loss, but is still able to provide

considerable details about incidents of forgetfulness.

Occasional word finding difficulties.

Does not get lost in familiar areas.

Able to operate common appliances.

Maintains prior level of social skills.

Person becomes dependent on others for key

independent living activities.

Will only complain of memory problems if specifically

asked.

Memory problems worsen with time.

Notable decline in memory for recent events.

Frequent word-finding pauses and substitutions.

Gets lost in familiar areas.

Loss of interest in social activities.

Unable to operate common appliances.

The Diamond Module

Senior Gems®


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Normal Aging vs. Dementia: Review Activity

For each statement below, identify N for “normal aging” and D for may have “dementia.”

Answer Key:

1. Mr. Johnson got up to get a drink,

once he got to the

kitchen he forgot why he was

there. After retracing his steps, he

remembered. _______

3. When Mrs. Jackson’s caregiver

arrived at her house, the

caregiver was shocked to find that

Mrs. Jackson had tried to cook a

frozen meal in the toaster.

________

5. Today you are scheduled to take

Mr. Chin to the doctors. Every time

you remind him about the

appointment, he tells you he’s

never heard of having any

appointment today. ________

2. Mrs. Morris has played bridge with

a group of friends every

Tuesday for ten years. Recently,

she says she does not want to go

anymore, she’s “done with bridge.”

________

4. Mr. Thompson no longer likes to

drive at night because he has

problems with his night vision.

________

6. Mrs. Robinson is very agitated. She

keeps asking to go home, but she is

home.

________

1. N 2. D 3. D 4. N 5. D 6. D

Diagnosing Dementia

Diagnosing dementia requires a complete medical and neuropsychological

examination. Getting a proper diagnosis is vital, because there are other

diseases that may mimic dementia and can be treated. Although there is no

cure for many forms of dementia, knowing what you are working with will

make a difference in care. The following are usually included in the

examination:

A review of history and onset of symptoms

Medical history and medications

Neurological exam

Laboratory tests

Brain imaging

Mental status testing

Fast Fact

50% of those who meet

the diagnostic criteria for

dementia, never receive

a diagnosis.


The Diamond Module

Senior Gems®


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Diseases that Mimic Dementia

As we noted before, getting a physician’s diagnosis of dementia

is important. There are many very treatable conditions that

actually mimic the symptoms of dementia. So, for example, a

family may be thinking their loved one has just “gotten old and

gotten dementia,” when really, they have a nutritional deficiency

which could easily be reversed.

Examples of the diseases that can actually mimic dementia

symptoms are:

Depression

Side-effects from medication

Substance abuse

Nutritional deficiencies

Thyroid Conditions

Hypercalcemia (electrolyte imbalance)

How does dementia affect the brain?

It is important to realize, dementia is not just a memory problem. There is a disease at work and the

brain is physically changing. In fact the brain is dying, and shrinking. People with dementia can lose up

to 2/3 of their brain mass through the course of the disease. The picture below shows a healthy brain

on the left and the brain of someone who died from Alzheimer’s on the right. Both of these

individuals had the same head circumference in life, so the difference in size

is due to the disease process. As you care for clients with dementia, keep in

mind, their brains are undergoing major changes. Sometimes it is hard to

remember that since we cannot see the way the brain is changing, we can

only see the behaviors. The behaviors are not on purpose, they are the

result of a very real disease.

Fast Facts

Alzheimer’s disease is

the 6th leading cause of

death in the United

States and the 5th

leading cause of death

for those aged 65 and

older.

Alzheimer’s is the only

cause of death among

the top 10 in America

without a way to

prevent, cure, or even

slow its progression.


The Diamond Module

Senior Gems®


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Types of Dementia

Although most of us are familiar with Alzheimer’s disease it is actually just one

type of dementia. Knowing some of the other types of dementia may help

you with caregiving. Below you will find a brief description of a few of the

most common forms of dementia.


Fast Fact

Most common forms of

dementia:

1. Alzheimer’s Disease

2. Vascular Dementia

3. Mixed Dementia


Type Description

Alzheimer’s

Disease

Difficulty remembering names and recent events is often an

early symptom. Later symptoms include impaired

judgment, disorientation, confusion, behavior changes and

difficulty talking, swallowing, and walking.

Vascular

Dementia

Impairment is caused by decreased blood flow to parts of

the brain, often due to a series of small strokes that block

arteries. Symptoms often overlap those of Alzheimer’s,

although memory may not be as seriously affected.

Dementia with

Lewy Bodies

Pattern of decline may be similar to Alzheimer’s, including

problems with memory and judgment as well as behavior

changes. Alertness and severity of cognitive symptoms may

fluctuate daily. Visual hallucinations, muscle rigidity and

tremors are common.

Mild Cognitive

Impairment

A condition in which a person has problems with memory,

language or other essential cognitive function that are

severe enough to be noticeable to others and show up on

tests, but not severe enough to interfere with daily life.

Frontotemporal

Dementia

Nerve cells in the front and side regions of the brain are

especially affected. Typically symptoms include changes in

personality and behavior and difficulty with language.

“The

ea

rly sta

ge

s of A

lzhe

ime

r’s are

the

ha

rde

st

be

ca

use

tha

t pe

rson

is aw

are

tha

t the

y’re

losin

g

aw

are

ne

ss.”

-Pa

tti Da

vis

The Diamond Module

Senior Gems®


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When working with Diamonds, learning effective communication techniques might be the most

important factor in providing quality care. Remember, diamonds are rigid and inflexible. It is not their

fault, it is the disease. You as the caregiver need to change the things you do, because the Diamond is

not going to be able to change. Here are tips for successful communication:

R eality Orientation

What is it? Does it work?

Scenario: your client Mrs. Jones comes to you and tells you that she has to

go pick up her child from school. You know that her child is now 45 years

old, and no longer in school. Reality orientation means you tell your client “But, Mrs.

Jones your son is 45 years old.”

Does this help? NO! Correcting Mrs. Jones will not do anything to help the

situation. Instead, try distracting Mrs. Jones by asking her questions about the

memory “your son is at school? He goes to New Town Elementary school, right?

How is that school?” This will allow your client to live their memory and reduce

anxiety.

1. “I’m sorry” are the most important words you can

use. It does not necessarily mean you did

something wrong, but it is an opportunity for you to

acknowledge that you have upset them and that

they are still in control.

2. Diamonds will enjoy talking about the past,

because those are the memories they still have. Let

them talk about the past, in fact encourage it! Those

stories will help you as the disease progresses.

3. Never use the phrase “don’t you remember…”!

The fact of the matter is, they don’t remember.

Pointing that out is not going to help anyone.

4. Accept that there is a change taking place. Don’t

pretend nothing is going on.

5. Ask permission. Diamonds want to still feel like

they are the ones in control, so ask before you start a

task.

6. Don’t be the person telling them “no.” If you are

going to spending all day with them, it is better that

the blame be on someone else. For example “the

doctor says…”

7. Don’t take away their hope, present changes as temporary. For example, try the phrase “just for right

now…” Although the change may be permanent, they do not need to know that.

The Diamond Module

Senior Gems®


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For each scenario below, circle which option would be the best way to

communicate effectively with a Diamond.

Scenario 1: Mrs. Turner has always been the one to make dinner in her household. Recently,

however, she caused a small kitchen fire and her family does not want her cooking anymore.

Option 1: Tell Mrs. Turner to go take a nap on the couch while you prepare dinner.

Option 2: Ask Mrs. Turner if she would rather have chicken or beef for dinner and

then ask if she might be able to give you a hand in the kitchen.

Scenario 2: Mr. Mount’s family is adamant that he cannot be allowed to drive anymore.

Mr. Mount is furious because he’s driven for 60 years!

Option 1: Tell Mr. Mount the doctor thinks you (the caregiver) should take over the

driving, for just a little while.

Option 2: Hide his keys and tell him he’s finished his driving career!

Scenario 3: Mr. Martin has told you the same stories about his fishing trips with his father at least

ten times today.

Option 1: Tell Mr. Martin you already know that story and it is going to drive you

insane if you hear it again.

Option 2: Listen to Mr. Martin’s story like it is the first time you have heard it. Maybe

even write it down.

Scenario 4: Mrs. Talbot has always maintained a beautiful house, now her family has asked that

you take over some of the housework.

Option 1: Ask Mrs. Talbot permission to complete household tasks.

Option 2: Tell Mrs. Talbot she’s too old to be cleaning, and you will take care of it

now.

The Diamond Module

Senior Gems®


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Keep Track of the Stories!

One common attribute of diamonds is that they tell the same old

stories over and over again. The reason they do this is that their

long term memory is preserved as their recent memory declines. So

those old stories are what they can still confidently remember.

While it is understandable that hearing the same stories repeatedly

might be wearing, these stories are actually a gift to caregivers.

Hearing your client’s story now and remembering it later will help

you as their disease progresses. You might even consider writing the

stories down. This could act both as a tool in the future and an

activity for you and your client now.

Encouraging Independence

At the early stages of dementia, it is important that you encourage your clients to

retain as much independence as is safely possible. This means you might have to

make the activity a little simpler, but you should not be doing everything for them.

For example, although you might have to remind your client that it is time to change

their clothes, that does not mean you need to pick out their clothes for them. If

they begin struggling picking out their clothes, you can simplify the task by offering

them choices, “do you want to wear your blue shirt or your red shirt.” Even though

you are adjusting the task, they are still the ones picking out their clothes. Feeling

independent and productive will lead to more meaningful days. Even if they make a

mistake, let it go, they don’t need to know that.

Fast Fact

Women are more likely

then men to get

Alzheimer’s disease.


“I f

you

wan

t to

lift

yo

urs

elf

up

, lift

som

eon

e el

se.”

-Bo

oke

r T.

Was

hin

gto

n

The Diamond Module

Senior Gems®


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Activities Make the

Day Better!

Planning activities throughout your day will help to make the day more meaningful for your client,

establish a routine and make the day easier for you. Activities suggestions for diamonds are located in

the chart below, and organized into the following four categories:

Productive—Provides a sense of value and purpose.

Leisure—Promotes having fun and interacting.

Self-Care & Wellness—Personal care of body and brain.

Restorative—Re-energizes and restores the spirit.

Category Activity Suggestions

Productive Getting the mail

Setting the table

Caring for Pets

Finding, sorting, and cutting coupons

Putting away dishes

Wiping windows and mirrors

Gardening/watering plants

Doing laundry

Preparing food

Sorting and rolling coins

Dusting

Volunteering

Grocery shopping

The Diamond Module

Senior Gems®


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Category Activity Suggestions

Leisure Watching t.v.

Creating a family tree

Reading

Playing sports

Shopping

Cooking

Going out to eat

Arranging flowers

Arts and crafts

Music activities

Playing games

Walking

Going to a place of worship

Self-Care & Wellness

Exercise/yoga

Grooming

Completing puzzles/crosswords

Reading

Applying lotion to self

Getting medication reminders

Choosing foods

Playing Games

Getting manicures/pedicures

Restorative Taking naps

Listening to relaxing music

Getting a massage

Going outside for a walk

The Diamond Module

Senior Gems®


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For dementia clients, the environment is extremely important.

Not only can an appropriate environment promote health and

safety, but it can also help to provide effective cues to get

through the day. Being able to maintain the same environment

is one of the major benefits of remaining at home with

dementia. When working with a diamond the key is to keep as

much as is safely possible exactly how it is! Diamonds are good

at old habits and routines, but struggle with new information.

Changing around the set up of a room, the location of where

items are stored or a daily routine will be difficult for them to

adjust to and may cause distress. For example, if your client has

always showered before bed, you should continue to plan

showers for around bed time. Not only will this be familiar to

them, but the shower will also be a cue that it is time for bed.

Transitioning to the Next Gem

The nature of dementia is that it is progressive. It is possible that you will see your

client moving from one gem to the next. If you think your client has transitioned it is

important to contact the Senior Helper’s office. This may indicate that it is time for a

reassessment and adjustment to the Service Plan or that it is time for your client to visit

the doctor. If you start noticing any of these characteristics, it might be indicative that a transition is

taking place:

Having emotional moments as they become lost in time and place.

Losing things and thinking someone stole them.

Use your best judgment, if you think something is going on, it probably is. Not only could it be a

transition to the next gem, it could be some other treatable problem.

The Diamond Module

Senior Gems®


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Employee Name (Please Print):

__________________________

Date: _____________________

I understand the infor-

mation presented in this

guide.

I have completed this guide

and answered at least 8

questions correctly.

Employee Signature:

__________________________

Supervisor Signature:

__________________________

Directions: Circle the best answer choice, and then check your answers

with your supervisor.

1. When working with a diamond it is best to take over all tasks and activities so they can rest.

True or False

2. Diamonds are good at old habits and routines. True or False

3. What should you avoid when communicating with a diamond? A. Giving them options. B. Saying “don’t you remember.” C. Allowing them to maintain control.

4. If someone is forgetting things, it is best to just assume they have dementia.

True or False

5. Going to get the mail, putting away dishes and folding clothes are examples of:

A. Restorative Activities B. Leisure Activities C. Productive Activities

6. Ruby is the next gem after diamond. True or False

7. When working with diamonds it is best to maintain things the way they are as much as possible.

True or False 8. When a diamond asks the same question repeatedly, they are doing

it to frustrate you. True or False

9. Reality orientation is not an effective means of communicating with diamonds.

True or False

10. Alzheimer’s disease is the only form of dementia. True or False

Quiz

The Diamond Module: Early Dementia

the diamond module - homesteadneoshcaregivers.homestead.com/diamond_module__1_.pdf · brain is...

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