Alzheimer’s and Dementia Care: Dealing With Difficult Behaviors

1. Alzheimer’s and DementiaCare:Dealing With Difficult Behaviors Angela Norman, DNP, GNP-BC, ACNP-BC Certified Dementia Practitioner South Arkansas Center on Aging Director

2. Why is this Important? “When You know better you do better”Maya Angelou

3. “A How To Program” • How to keep their dignity and your sanity • Caregiving 101 or….911

4. Normal Aging • Older adults may experience slower recall or forget only parts of an event. • Remains able to follow spoken and written instructions • Difficulty concentrating (requires fewer distractions, less noise, etc.) • Capacity to learn stays in tact, however, new info may take longer to absorb.

5. Dementia • Dementia is the loss of mental functioning that causes deficits in memory, language, learning ability, judgment, and orientation.

6. Dementia • Dementia is diagnosed when there are cognitive and behavioral symptoms that: • Interfere with the ability to function at work or usual activities, • Represent a decline from previous level of function • Are not explained by a delirium or other psychiatric disorder

7. Treatable or Reversible Causes of Dementia • D- drug reaction • E- Emotional disorders (depression, schizophrenia) • M- Metabolic and endocrine • E- Eyes and ears (sensory loss) • N- Nutritional deficits • T- Tumors or NPH • I- Infection (UTI, Pneumonia) • A- Arteriosclerosis

8. Irreversible Causes of Dementia • Alzheimer’s • Lewy Body • Vascular • Parkinson’s • Fronto-Temporal • Chronic Traumatic Encephalopathy

9. “Where do these behaviors come from?”

10. Behaviors • More positively referred to as “actions or reactions”

11. Lobes of the Brain

12. Physical changes in BRAIN • Frontal Lobe • Temporal lobe • Hippocampus • Occipital lobe • Sensory Center

13. Short Term Memory Loss • Usually first to go (Alzheimer’s) • As disease progresses, age regresses • Common behaviors seen • Remember…those things that irritate you today may be treasures tomorrow.

14. Communication • The single problem with communication is the illusion that it has taken place.” G.B. Shaw • When communication is impaired caregiving becomes a challenge

15. Benefits of Good Communication • Validates feelings • Creates reassurance and enhances cooperation • Enhances self esteem, reducing depression • Reduces isolation, loneliness • Diffuses power struggles, prevents catastrophic behaviors/abusive incidents

16. Communication • Stereotypic language “easier said than done,” “you got me” • Empty speech • Violations of conversation rules • Repeating stories • Windows of lucidity

17. Communication • Verbal • Nonverbal

18. Communication and Behavioral issues • Behind every behavior is an unmet need

19. Be a Good Detective • Listen • Observe what the patient is trying to tell you • Take time to figure out what they need • Begin with basics toileting , temperature, hunger and thirst • Develop trust by using good communication

20. Supportive Communication • 1. Greet before you Treat • 2. Focus on a positive greeting • 3. Give a compliment • 4. Bring a positive visual cue

21. Validation Therapy • Validation is a method of communicating with and helping the disoriented. • Validation is built on an empathetic attitude and a holistic view of individuals. Naomi Feil

22. Sensory Connections • Can bring comfort • Can cause agitation

23. Must Have:Skills and Techniques • 1. Visual- Must start with visual • 2. Verbal- has to match visual • 3. Touch- last, only use if above two are accomplished. • 4. Smell • 5. Taste.

24. Completing a Task:5 Steps • 1. Short simple information • 2. Provide Choices (1 or 2) • 3. Ask them for help (don’t command) • 4. Eliminate distractions • 5. Repeat same command and wait

25. You cannot control the disease.You can only control your reaction to it.

26. Creating Positive Outcomes • Remember their Greatness • Live their truth • Provide structure • Remove the word “No” • Removing an object • Identify favorites • Be like a duck • Be like the sun

27. Creating Positive Outcomes • Take Action • Kick start • Safe haven • Let go of expectations

28. Sundowning • Start the morning off right • Nap • Do something they love

29. Wandering • Problem solvers • Validate before redirecting

30. Hallucinations vs. Delusions • If this is new problem the patient needs an evaluation. • Don’t try to fix it, but Acknowledge… • Don’t use reality • Connect with the patient’s emotion regarding the situation • Meet their need • May need to change their environment • Go with the Flow!!!!!!

31. Patient Centered Care • When you have met one person with Alzheimer’s you have met one person with Alzheimer’s! • Listen to the words the staff/family use to describe the patient • Put the person first, not the characteristic

32. “People will forget what you said, people will forget what you did, but they will never forget how you made them feel.” Jolene Brackey

33. When we learn with pleasure we never forget, Alfred Mercier

34. Seek Support • Can be exhausting • Feelings of grief/relief • Ask for help • Be aware of care giver burden and burnout! • Resources are available: • South Arkansas Center on Aging 870-881-8969 • Local support groups

35. References • www.nia.nih.gov/alzheimers • www.alz.org • www.caregiving.org • Teepasnow.com • Jolene Brackey, “Creating moments of Joy”