How to Respond to What’s NOT There…

Hello everyone,

Many people with dementia (Lewy Body, Parkinson’s dementia and sometimes Alzheimer’s disease & other dementias) experience hallucinations, usually in the middle to later stages of the disease.

DailyCaring.com has a great article this week with 10 ways to respond when someone is experiencing dementia hallucinations. We encourage you to follow the link below and look through them, and discuss them with your staff. This is also helpful information to share with family and friends who are visiting their loved ones at your care center.

http://dailycaring.com/10-ways-to-respond-to-dementia-hallucinations-in-seniors/

Have a great week!

Breaking Down Language Barriers

Hello everyone,

If you’ve ever traveled to a foreign country where you don’t speak the language, you know how difficult it can be to get directions to a museum or order a meal.  Imagine how frightening and depressing it would if everyone around you spoke a different language, but instead of being on vacation, you were in your own home and needed to communicate more vital information, such as the fact that you were in pain or very confused.

Some of you have asked for tips on how staff can more effectively communicate with and engage residents who do not speak English. This can be challenging, especially with residents who have dementia. With some investment of time and extra effort, however, both staff and residents can benefit.

Here are some things to try:

If the resident has family or friends nearby, or if there is a staff member from the same culture who speaks the same language as the resident, they can be a valuable resource and can teach staff (and even other residents!) some basic phrases to use.

  • Create communication sheets or flashcards with simple phrases in the person’s language (Good morning, Please join us, Are you in pain?, etc.) and hang them in the resident’s room for staff to use.
  • Download a free translation application onto your phone to use when you or the resident have something important to communicate. There are apps that focus on medical terminology too.
  • Be mindful of body language. If a person cannot understand your words, they will rely on your body language and facial expression to help determine your intent. A smile and open stance can be a good start to help put the person at ease.
  • Take time to learn about the culture of the person, and invite family members to bring in food, music or activities from their culture to help entice the resident out of his/her room and get others—including staff and residents–involved.

Let us know if any of these suggestions help you, and have a great week!

 

Short Videos Provide Practical Tips for Staff

Hello everyone,

As you continue to work with the “Champions” at your care communities, we encourage you to show them these brief videos from the Function Focused Care website: http://www.functionfocusedcare.org/videocoaching

The six videos offer practical tips on how to engage residents with cognitive impairment and help them perform activities of daily living, which is when challenging behaviors often occur in people with dementia. There is a video on each of the following topics:

Dressing

Eating

Oral Care and grooming

Toileting

Encouraging group activity

Motivating people to go outside

You can even show the videos on a mobile device to GNA’s and other busy staff, as each video is only about 3 minutes long! Consider showing a different video at each of your next staff meetings, and discussing the ideas presented. Could some of the approaches shown work with your more challenging residents? Let us know how you use them at your community.

Have a great week!

Never Give Up…EVERYONE Can Find Something They Enjoy

Hello everyone,

How often do we see a group of residents participating in a recreational activity, but notice that at least a few of them are left out? Sitting in the corner looking on? Often, these more “challenging” residents are the people who most need to be active and engaged in activity so they avoid feelings of frustration, agitation and boredom.  

To help with this, here are some activity ideas that your nurses, nursing assistants and recreation staff can use to get residents with cognitive decline in on the fun: 

Flyswatter volleyball: Give residents plastic flyswatters have them hit a balloon back and forth to each other 

Dance, dance, dance! Turn off those televisions and turn on some music and dance. Have staff members take turns playing music from their iPods through a speaker. Fast or slow, old or new, music has the power to move everyone. 

Horseshoes: Now that Spring is (sort of) here, horseshoe games are everywhere. Look for the foam kind and play inside or outside on a patio. Residents can play while standing or sitting. 

Foam swim noodles: Get a bunch of these (you can find them at places like Five Below or WalMart and pools stores), cut them in half, and have residents hold one at each end and bend. The closer together their hands are, the harder it is to bend. These make for great resistance exercises! Leave them out in common areas for a safe, easy way to start spontaneous exercise. 

Movement scarves: These can be found on enasco.com, or you can make your own with a lightweight material. Toss these colorful scarves in the air and have residents try to catch them. These scarves can be better than throwing a ball back and forth, since people with slower reflexes and limited hand flexibility can catch them more easily.

One final note–never give up! Never stop asking a resident to participate. You never know…maybe on the 50th try, they’ll say “yes!” Here’s a great example…at Future Care Sandtown in Baltimore, one of the residents is blind. Staff said he usually stayed in his room all day and listened to the television. With a little extra coaxing from the staff, he came out of his room and they played music for him and he danced! Now he does it all the time. Great job, Sandtown!! Keep up the good work.

 

Have a great week!

Are Your Policies Helping or Hindering?

Hello everyone,

Policies are certainly a necessity in community care environments, but sometimes they can have unintended consequences. 

For example, is it your community’s policy (either written or unwritten) to have all exercise and activity items locked away when not being used during a scheduled activity so they aren’t “misplaced” by residents? While safety and security are important, we should keep in mind that putting these items away can prohibit spontaneous activity when it is most needed, such as in the evenings or when someone is wandering or agitated and could benefit from an activity to distract or expend excess energy. Items like foam swim noodles and foam horseshoe games can safely be left out in common areas, and are inexpensive to replace if they go missing.

If leaving these items out in the open is still frowned upon, having them out of sight but centrally located and easily accessible can also work. Make sure that all staff know where the items are kept so they can be quickly retrieved when needed and not locked away.

Communities often encourage staff to clean exercise and activity items after each use. Consider having antibacterial/antiviral wipes nearby so they can be quickly wiped down and ready to be used by others.

Have a great week!

Small Steps Lead to Steady Success

Hello everyone, 

When we consider integrating changes to a philosophy of care it is important to remember that small, gradual changes can lead to more lasting success. Attempting to take on too much, too quickly can result in frustration or a feeling of being overwhelmed. 

When it comes to managing behavioral symptoms related to dementia, consider having nursing staff choose a few residents with less challenging behavioral symptoms to begin. Staff can hold weekly “huddles” to discuss ideas, challenges and successes they have had with individual residents. This can help them build confidence in their abilities and foster teamwork as well as trust in the approach to care that we are encouraging. 

Have a great week!

 

Focus on Families

Hello Everyone,

Educating family members of your residents about your efforts to reduce the behavioral and psychological symptoms of dementia through person centered behavioral approaches is critical. Family members can support staff and be a useful resource when exploring their loved ones’ preferences and determining what may motivate a resident to participate in his/her own care and engage in activity, which can lead to decreased agitation, apathy and resistiveness to care.

 One of the ways you can educate family members is by including information on your facility’s social media, in your newsletter or other regular mailings/emails your residents’ loved ones. Below is a pre-written piece to help get you started: 

Research repeatedly shows that older adults can improve their physical and mental health, slow cognitive decline, and increase their ability to participate in personal care needs like bathing and dressing by engaging in regular physical activity. Physical activity can also help decrease symptoms of dementia such as agitation, aggression, resistiveness to care and depression. Even short spurts of 10 minutes of activity can result in significant physical and emotional benefits. Being able to care for oneself as much as possible also helps preserve the dignity and independence that we all hope for as we age.

With this in mind, our staff will be working with your loved one to participate as much as possible in personal care activities and to engage in physical activities such as walking or self-propelling in their wheelchair to the dining room or doing some stretching and strengthening exercises while waiting for meals. You can help too. Go for a walk with your loved one when you visit, or ask a staff member to show you some exercises you can do with them while you visit. Ask their caregiver what activity goals they have for them and encourage your loved one as they try to reach their goals. Finally, support your family member’s caregivers as they use their knowledge and skills to involve your loved one in their care and other activities in order to transform expressions of distress into expression of well-being—a goal we all share.

Feel free to contact us if you have any questions about working with family as we move forward.

Have a great week and Happy Easter!

Facebook Page Contest

Hello everyone,

Starting March 25th, in addition to emailing the weekly tidbits, we will also be posting them on the EIT-4-BPSD Facebook page at:

https://www.facebook.com/EIT-for-Behavioral-Psychological-Symptoms-of-Dementia-2012786125605006/ 

We invite you to “like” or “follow” our page, and post comments and photos! 

And while we’re on the topic of communicating ideas, consider doing what one smart group in Pennsylvania did at their community—they posted their BPSD goals and the DICE method on all the units to remind staff of their goals and the steps they can take to identify the causes of challenging behaviors and develop concrete plans to manage them. Great idea!

 

Have a wonderful week!

Involve Family Members in Dementia Care

Hello everyone, 

With the spring holidays like Easter and Passover just around the corner, your community may soon see an increase in visits from family and friends. Holidays can be a stressful time for your staff, with family members who may not often visit or be involved in care coming with high expectations for what their loved one can do, and unrealistic expectations of staff.

We can validate the feelings of loss and grief that family members experience as they miss the person that their loved one used to be. But if we also help them understand the disease process and learn how to meet their loved ones where they are, the end result can be a stronger, more trusting relationship between staff and family members.

This is a good time to gently remind family and friends that the goal is not a “perfect” visit with their loved one, but rather one where moments of happiness are shared. They may have to overlook that not-so-perfect hair-do, or spill on a shirt, and focus on the feelings of the person they are visiting. Changing priorities and re-aligning expectations are important as dementia progresses. Undoubtedly, this is a difficult adjustment for loved ones to make, and staff should be patient and understanding too.

 Finally, consider how much you and your staff involve the family members of your residents in their care, specifically when determining the need for antipsychotics. Do you ask family members for their input about managing the behaviors of their loved one, such as helping you identify the person’s preferences, motivations, and life experiences that may impact their behavior now that they have dementia? The attached research paper provides some insight on the benefits of involving family members at each step of care. 

Have a great week!

When a person with dementia has depression

Hello everyone,

Last week we discussed apathy in people with dementia, and approaches to use during care. Like apathy, depression is common in people with dementia, often in the early to middle stages of the disease.

According to a recent article by DailyCaring.com, depression symptoms in people with Alzheimer’s disease tend to be less severe than in those who are depressed but don’t have dementia, and people with both Alzheimer’s and depression may have noticeable irritability and social withdrawal but not many of the other common symptoms of depression.

 A person with dementia may also have depression if you observe:

  • Social withdrawal/isolation
  • Apathy or lack of interest in previously enjoyed activities
  • Irritability
  • Crying
  • Lack of appetite
  • Lethargy

For people who are living with dementia and depression, a combination of treatments can be effective, including non-pharmacologic approaches and anti-depressants if needed. Many experts identify inactivity as a major problem for people with dementia and depression, and keeping these people engaged in the world around them and participating in purposeful activities is crucial to their well-being. Practically speaking, if we keep someone engaged in activities that they find fulfilling, they have less time to be isolated and depressed.

Below is a link to full article by DailyCaring.com with more helpful information:

http://dailycaring.com/when-depression-and-dementia-collide/?utm_source=DailyCaring&utm_campaign=5a1e15d846-DC_Email_2018-02-20&utm_medium=email&utm_term=0_57c250b62e-5a1e15d846-123152321 

And here’s another link to a recent article about older adults with dementia needing MORE physical activity. The study shows that people with dementia who have good balance, muscular strength and mobility are less likely to suffer from depression. http://sciencenordic.com/elderly-people-dementia-need-more-physical-activity

Have a great week!