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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

Caring for someone with Alzheimer’s Disease and Dementia

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

slide2

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
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.
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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
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