Caring for someone with alzheimer s disease and dementia
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Caring for someone with Alzheimer’s Disease and Dementia. Michelle Cleary, Ivy Cawley, Laura Chisholm, Mary MacLeod, Leah MacDonnell and Laura MacArthur. Two Mothers I had two mothers.. Two mothers I claim Two different people… Yet with the same name Two separate women… Diverse by design

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Caring for someone with Alzheimer’s Disease and Dementia

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Caring for someone with alzheimer s disease and dementia

Caring for someone with Alzheimer’s Disease and Dementia

Michelle Cleary, Ivy Cawley, Laura Chisholm, Mary MacLeod, Leah MacDonnell and Laura MacArthur


Caring for someone with alzheimer s disease and dementia

Two Mothers

I had two mothers..

Two mothers I claim

Two different people…

Yet with the same name

Two separate women…

Diverse by design

But I loved the both

Because they were both mine

The first was the mother

Who carried me here

Gave birth and nurtured and

Launched my career

She was the who features I bear.

Complete with the facial expression I wear.

She gave me some music which follows me yet .

Along with examples in the life that she set:

Then as I got older she some younger grew.

And we’d laugh as just mothers and daughters do.

As quickly she changed and turned to the other

A stranger who dressed in the clothes of my mother

Oh she looked the same at least at arms length

But she was the child now and I was her strength

We’d come full circle we women three:

My mother the first, the second and me

And if my own children should come to a day

When a new mother comes and the old goes away

I’d ask of them nothing that I didn’t do

Love both of your mothers as both have loved you


Alzheimers dementia statistics

Alzheimers/ Dementia Statistics

  • 280 000 Canadians suffer with Alzheimer’s Disease

  • Dementias affect 8% of older Canadians, with an additional 16% having mild cognitive impairment

  • Risk of dementia increases greatly throughout the senior years, with 1 in 3 people 85 years and older

  • Women who typically live longer, are much more likely to develop dementia, they accounted for 68% of dementias.

  • 1- 10% of Alzheimers cases and occur in middle age


Dementia

Dementia

  • Dementia is a general term that refers to a variety of brain disorders. Physical changes in the brain cause dementia.

  • Is characterized by an uneven, downward decline in mental function


4 a s of dementia

4 A’s of Dementia

AGNOSIA: Inability to recognize common objects

APHASIA: impairment of language such as difficulty repeating a phrase or answering a question

APRAXIA: inability to carry out motor activities

AMNESIA: loss of memory


Diagnosis of dementia

Diagnosis of dementia

  • At least 2 domains of altered function must exist

    • Memory loss in at least one of cognitive disturbances

      • AGNOSIA: Inability to recognize common objects

      • APHASIA: impairment of language such as difficulty repeating a phrase or answering a question

      • APRAXIA: inability to carry out motor activities

      • EXECUTIVE FUNCTIONING: Inability to think abstractly and to be able to plan. Begin, monitor and complete a task


Risk factors for dementia

Risk Factors for Dementia

  • Age

  • Stroke

  • Hypertension

  • Alcohol abuse


Protective factors for dementia

Protective Factors for Dementia

  • Higher levels of education

  • Physical Activity

    - Moderate Alcohol intake


Non reversible dementias

Non Reversible Dementias

  • Alzheimer’s Disease

  • Vascular Disease (multi infarct)

  • Mixed Alzheimer’s and Vascular Demetia


Vascular dementia

Vascular Dementia

  • Defining Characteristics

    • Evidence of dementia

    • Evidence of cerebrovascular disease

    • 2 disorders must be reasonably related


Caring for someone with alzheimer s disease and dementia

Table 12-5 Behaviour Themes Related to the Phenomenon Sundowning


Sundowning

Sundowning


Alzheimer s disease

Alzheimer’s Disease

  • Chronic progressive and degenerative brain disorder accompanied by profound effects on memory, cognition and ability of self care

  • Oxidative stress primarily in the hippocampus and neocortex of people with this type of dementia


Stages of alzheimer s disease

Stages of Alzheimer's Disease

  • Stage 1 (Mild) - Forgetfulness

  • - Shows short-term memory loss; loses things, forgets

  • - Memory aids compensate; lists, routines, organization

  • - Aware of the problem; concerned about lost abilities

  • -Depression

  • Not diagnosable at this time


Stage 2 moderate confusion

Stage 2 (Moderate) - Confusion

  • - Shows progressive memory loss; short memory impaired; memory difficulties interferes with all abilities

  • - Withdrawn from social activities

  • -Show declines in instrumental activities of daily living, such as money management, housekeeping, cooking...

  • -Denial; fears losing his or her mind

  • - Depression increasingly common; frightened because aware of deficits; covers up for memory loss through confabulation

  • - Problems intensified when stressed, fatigued, out of own environment, ill

  • - Commonly needs day care or in-home assistance


Stage 3 moderate to severe ambulatory dementia

Stage 3 (Moderate to severe) - Ambulatory dementia

  • - Shows ADL losses in order; willingness and ability to bathe, grooming, choosing clothing, dressing, gait and mobility, toileting, communication, reading and writing skills

  • -Shows loss of reasoning ability, safety planning and verbal communication

  • - Frustration common; become more withdrawn and self-absorbed

  • - Depression resolves as awareness of losses diminishes

  • -Has difficulty communicating; shows increasing loss of language skills

  • - Shows evidence of reduced stress threshold; institutional care usually needed


Stage 4 late end stage

Stage 4 (Late) - End stage

  • - Family recognition disappears; does not recognize self in mirror

  • -Non- ambulatory; shows little purposeful activity; often mute; may scream spontaneously

  • - Forgets how to eat, swallow; chew; commonly loses weight; emaciation common

  • - Has problems associated with immobility e.g. pneumonia, pressure ulcers

  • - Incontinence common; seizures may develop

  • -Often in long term care at this time

  • - Return of primitive (infantile) reflexes


Diagnosing

Diagnosing

- Venereal Disease Research Laboratories (VDRL), HIV virus tests

- Serum creatinine assay

- Electrolyte assessment

- Vitamin B12 level

- Liver function tests

- Vision and hearing evaluation

- Neuroimaging

  • - Chest and skull radiographic studies

  • - Electrocardiography

  • - Urinalysis

  • - Sequential multiple analyzer 12-test serum profile

  • - Thyroid function tests

  • -Folate level


Common problems

Common problems

  • - Memory impairment

  • - Disorientation

  • - Need for physical help

  • - Risks in the home

  • - Risks outside the home

  • - Apathy

  • - Repetitiveness

  • - Uncontrolled emotion

  • - Uncontrolled behaviour

  • - Incontinence

  • - Emotional reaction

  • - Other reactions

  • - Mistaken beliefs

  • Decision making

  • Burden on family


Services that may be available to people dementia and their families

Services that may be available to people Dementia and their families

  • Family/caregiver

  • Community services

  • Home care


Nursing management of people with alzheimer s disease and other dementia

Nursing Management of People with Alzheimer’s Disease and other Dementia

  • Nursing Interventions are aimed at

    • maintaining the patients safety,

    • reducing stress and anxiety and agitation,

    • improving communication

    • Promoting independence in self- care activities

    • Providing for the patients needs for socialization, self esteem and intimacy

    • Maintaining adequate nutrition

    • Managing sleep pattern disturbances

    • Supporting and educating family caregivers


Supporting cognitive function

Supporting Cognitive Function

  • Nurses role to provide calm, predictable environment which helps person interpret his or her surroundings and activities

  • Environment

    • Stimuli is limited

    • Regular Rountine

      Speech

  • Quiet

  • Pleasant manner

  • Clear and Simple Explanation

  • Use of memory aids and cues


Promoting physical safety

Promoting Physical Safety

  • This allows the patient to move about as freely as possible and relieves the family of constant worry

  • Nightlights

  • Hazards for tripping are removed

  • Intake of food and medication is monitored

  • Smoking when supervised

  • Do not use restraints can increase agitation

  • Doors leading from the house need to be secured

  • All activities need to be supervised

  • Person should where ID bracelet or chain incase of getting away from family/ caregiver


Reducing anxiety and agitation

Reducing Anxiety and Agitation

  • Constant emotional support

  • Reinforce a positive self- image

  • Environment kept uncluttered, familiar and noise free


Improving communication

Improving Communication

  • Remain calm and nonhurried

  • Reduce noise and distractions

  • Clear, easy to understand sentences to convey messages

  • - Always identify yourself and call person by name

  • - Speak slowly

  • - Use short, simple words and phrases

  • - Maintain face-to-face contact

  • - Be near by the person when talking

  • - Focus on one piece of information at a time

  • - Talk with the person about familiar and meaningful things

  • -Encourage reminiscing about happy times in life

  • - Have the person wear prescription eyeglasses or hearing aid

  • - Keep the person's room well lit

  • - Reinforce person's pictures


  • Promoting independence in self care activities

    Promoting Independence in Self Care Activities

    • Simplify daily activities

    • Assist Person with activities, allow independence when possible


    Providing for socialization and intimacy needs

    Providing for Socialization and Intimacy Needs

    • Visits should be short and non- stressful

    • Pets can often be therapeutic for people

    • Sexual activity between person and dementia may become difficult and may cause concerns to the spouse.


    Caring for someone with alzheimer s disease and dementia

    • Promoting Adequate Nutrition

      • One dish or item of food is offered at a time

      • Food is cut up in small pieces

      • Fluids may need to be thickened

      • Diets may need to change to pureed or soft diet

      • Assist in feeding if necessary

      • Assess feeding ability independently

      • Ensure beverages and food are not too hot


    Sundowning1

    SUNDOWNING


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