Simple solutions to reduce anxiety and improve sleep

Hello everyone,

Dailycaring.com named its number one article from 2017, showing that sometimes even the simplest ideas can have a significant impact. The article is about giving weighted blankets and lap pads to people with dementia to help reduce their anxiety and improve sleep.

According to the article, a 2008 study showed that weighted blankets were a safe and effective non-drug therapy for decreasing anxiety, and the results were confirmed in a 2012 study. How does it work? The heaviness of the blanket provides “deep pressure therapy”. When the body feels the gentle pressure of the blanket, it produces serotonin which improves mood and promotes calm. A typical weighted blanket for adults is about 15 to 30 pounds, but will depend on the person’s weight and physical condition. The standard guideline is that a blanket should be about 10% of the person’s body weight, plus 1 or 2 pounds (but lower if the person is frail). A lap pad is typically 2 to 5 pounds.

The article advises readers to ask a doctor before using a weighted blanket, since people with respiratory, circulatory, or temperature regulation problems, or people recovering from surgery, may not be able to safely use one.

To find out how to make your own weighted lap pad or blanket, or where to buy one, click on the link to the full article:

http://dailycaring.com/weighted-blankets-in-dementia-care-reduce-anxiety-and-improve-sleep/?utm_source=DailyCaring&utm_campaign=fa88c331a8-DC_Email_2018-01-09&utm_medium=email&utm_term=0_57c250b62e-fa88c331a8-123152321

Please let us know if you’ve tried this with any of your residents, and have a great week!

Preventing negative behaviors through resident engagement

Hello everyone,

It’s usually a lot simpler to prevent a problem than it is to deal with an issue once it’s already occurring. Unfortunately, nursing home staff is often so accustomed to “putting out fires” that they feel like they don’t have the time to prevent them from starting in the first place.

Much of what we’ve talked about these past few months is really this…prevention! Engaging residents in activities to keep them from feeling bored, agitated or useless; taking a closer look at the environment and habits of staff to see how it may result in negative behaviors; keeping residents active and taking them outside so they can enjoy the many benefits of physical activity and sunshine…all can lead to reduced negative behaviors related to dementia.

Take a moment to discuss with some staff or think about an incident that occurred recently that could have been prevented had it been handled differently. We’d love to hear some examples from you.

Have a great week!

Spontaneous activities

Hello everyone,

Many nursing homes have dedicated “activity personnel” who coordinate activity programs for residents, which include events such as bingo, trivia hour, musical entertainment and holiday crafts. Formal activities are important because they help residents socialize, get them out of their rooms, and sometimes (though we’d love to see more) encourage physical activity.

 Often though, scheduled activities occur at the same times each day and for some residents, these times don’t work well with their daily routines. Their sleep and energy patterns don’t always sync with what’s planned on the weekly calendar. Or they may not have the cognitive ability to participate in what’s planned. What then? Do they miss out on their only opportunity for activity, meaningful interaction and fun?

Encourage all staff to lead spontaneous activities throughout the day as their time permits and reward them when they do. Just 10 minutes here and there can make a big difference and prevent boredom and agitation in residents with dementia. Look around your environment…are there foam noodles, art supplies, and other things kept nearby that a GNA, nurse or even a family member can grab quickly? Have some music CD’s handy with a CD player in the common areas or near dining rooms. You’d be surprised at how quickly a dance party can start just by turning on some tunes! By providing GNA’s and other staff with these tools, they will have options to turn to when a resident could benefit from distraction and activity.

Have a great week, don’t forget to send us your short tidbits for our tidbit contest, and Happy New Year!

Coping strategies for evening agitation

Hello everyone,

“‘Twas the night before Christmas and all through the house, not a creature was stirring, not even a mouse…” But perhaps, some your residents are?

 People with dementia often struggle with restlessness, agitation, irritability or confusion that can begin or worsen in late afternoon and early evening, and can continue into the night. Commonly called “sundowning”, this phenomenon not only affects the person experiencing it, but can leave staff and other residents feeling frustrated and tired, and impact their mood and ability to function the next day.

 According to the National Institute on Aging (NIA), possible causes for sundowning include confused sleep-wake cycles due to disease-related brain changes, being overly tired, hunger, thirst, depression, pain and boredom. Signs of sundowning may include increased confusion or anxiety and behaviors such as pacing, wandering or yelling. The NIA has some helpful suggestions for coping with and preventing sundowning: https://www.nia.nih.gov/health/tips-coping-sundowningutm_source=20171219_sundowning&utm_medium=email&utm_campaign=ealert

Some of their tips include:

  • Try to determine the cause of the resident’s behavior and address it.
  • If person becomes agitated, listen calmly to his/her concerns and frustrations and try to reassure the person that everything is ok.
  • Reduce noise, clutter, or the number of people in a room.
  • Distract the person with a favorite snack, object or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar and fun TV show (not the news!).
  • Make early evening a quiet time. Play soothing music or encourage a family member or friend to call during this time.
  • Close curtains at dusk to minimize shadows and the confusion they may cause. Turn on lights to help minimize shadows.
  • Go outside (or at least site by a window) since sunlight exposure can help reset a person’s body clock
  • Participate in physical activity every day. This can be a formal exercise class, or simply going for walks and participating in self-care.
  • Keep naps short and not too late in the day.
  • Get enough rest at night.

Sundowning can be exacerbated by serving coffee, cola or other caffeinated drinks late in the day; serving alcoholic drinks, which can add to confusion and anxiety; and too many activities during the day.

Finally, if these approaches don’t help, a medical exam may be needed to rule out pain, a sleep disorder or other illness, or a medication side effect.

We wish you all a happy and healthy holiday, and don’t forget to send us your tidbits for our tidbit contest!!

Holiday tidbit contest

Hello everyone,

In order to get everyone into the holiday spirit, we are excited to announce our Holiday Tidbit Contest! As you celebrate the holidays with residents at your facility, consider person-centered approaches to help decrease behavioral and psychological symptoms of dementia.

 For example, music is a big part of the holidays, so try playing classic holiday songs during care activities or while writing out Christmas cards with residents. Ask visitors to take residents for walks around the facility to look at the holiday decorations. Do you have residents who liked to bake? Host a cookie decorating party for residents and their guests. You can supply the pre-baked cookies, and residents can add the icing and sprinkles. Messy, but fun! Keep in mind that for some residents, the extra “hustle and bustle” around the holidays can be too much stimulation for them, and they may need extra breaks throughout the day for quiet time and rest.

 This article from Daily Caring.com has some great tips and ideas too:

http://dailycaring.com/5-best-alzheimers-holiday-tips-for-an-enjoyable-season/?utm_source=DailyCaring&utm_campaign=e65bccd561-DC_Email_2017-12-11&utm_medium=email&utm_term=0_57c250b62e-e65bccd561-123152321

 Email your tidbit (it only has to be a paragraph!) to Erin Vigne (vigne1@verizon.net) by January 7th. Those who send in the winning tidbits will win a prize for their facility!

Have a great week, and we can’t wait to read YOUR tidbits!

Non-verbal communication techniques

Hello everyone,

DailyCaring.com has a great piece this week about non-verbal communication with people with dementia. Sometimes our words are misunderstood, and body language can say far more. Take a moment to read more (link to article is below) about the 6 nonverbal communication techniques that can make caregiving easier with your residents:

  • Be patient and calm
  • Keep voice, face and body relaxed and positive
  • Be consistent
  • Make eye contact and respect personal space
  • Use gentle touch to reassure
  • Observe their nonverbal reactions

Have a great week! 

 

Non-pharmacological approaches to BPSD

Hello everyone,

Last week we discussed some of the negative side effects of psychotropic drugs commonly used to treat behavioral and psychological symptoms of dementia (BPSD) and a 5-step approach to reduce their use. The next step is to explore alternatives to pharmacologic treatment to decrease these challenging behaviors. Educating staff and loved ones of residents about these alternatives is critical to successfully addressing BPSD for the long term.

 According to the IPA Complete Guides to BPSD , a large body of evidence supports the use of psychosocial interventions for BPSD and these approaches are indicated as first-line management. These interventions work best when they are tailored to people’s backgrounds, interests and capacity. See the PELI Tools. 

 Treatment Principles for BPSD (from the IPA Complete Guides to BPSD, Module 5):

  • Address one symptom at a time
  • Follow the ABC approach: Specify the Antecedent of Behaviors (circumstances that spark them) and their Consequences (what makes them better or worse)
  • Measure the symptom before an after making an intervention to confirm that it is effective
  • Start with a small achievable goal and proceed step by step
  • Apply the intervention consistently. Do not expect immediate change; improvement takes time
  • Continually evaluate and modify plans. Decide in advance what “success” means for this person
  • Think in advance of an alternative strategy if this one fails

 Researchers continue to conduct a variety of studies to determine the effectiveness of non-pharm treatments including:  activity and recreation, aromatherapy, family tape-recordings, music and sound, one-to-one interaction and physical activity. 

Attached is a pdf file with Module 5 of the IPA Guide to BPSD, which includes much more information on non-pharmacological treatments. Since these approaches need to be feasible in addition to being effective, the Nursing Home Toolkit includes practical guidance for nursing home providers who are trying to integrate non-pharmacological approaches to address BPSD.

 Have a great week!

IPA complete guide to BPSD: Non-Pharmacological treatments

Antipsychotic medication reduction and appropriate use

Hello everyone,

 The use of psychotropic drugs for people with dementia living in long term care facilities is common, but research continues to show that their risks often far outweigh their benefits, and they are effective for a limited number of symptoms. The Centers for Medicare and Medicaid Services’ national initiative to improve behavioral health and decrease antipsychotic use among nursing home residents with dementia has prompted the education of interdisciplinary healthcare teams, patients and their families about the use of psychotropic drugs and effective alternatives to them. Attached is a helpful tool developed by the American Medical Directors Association that you and your team can use to assess a dementia patient’s antipsychotic use.

 While research has shown short-term effectiveness of psychotropic drugs in the treatment of those with psychotic symptoms (hallucinations, delusions) and significant physical aggression, there is little evidence of efficacy of these drugs with restlessness, verbal outbursts and resistance to care. Rather, these issues can be better addressed through behavioral interventions, which we will discuss in next week’s tidbit.

 Risks of antipsychotic medications include:

  • Falls & fractures
  • Sedation, delirium, functional decline
  • Extrapyramidal symptoms
  • Anticholinergic side effects, e.g. orthostasis, constipation, blurry vision
  • Hyperglycemia
  • Hyperlipidemia
  • Drug interaction potential
  • Pneumonia
  • Cardiovascular risks
  • Death—morbidity is highest in first 30 to 40 days

 Psychotropic drugs, especially antipsychotic drugs, are often prescribed too often and for too long. Evidence has shown that psychotropic drugs can be safely discontinued in many cases. Consider this 5-step approach when determining the appropriateness of a psychotropic drug for a patient, and when it is time to reduce dosage.

 A Five-Step Approach to Antipsychotic Reduction & Appropriate Use

  1. Assess facility policies, environment and culture, and baseline data: what are your beliefs about antipsychotics? Is there adequate staff to support non-pharmacologic approaches? Are current activities appropriate and effective? Can the environment be altered to decrease symptoms? What is rewarded…i.e. is quiet and sleeping rewarded more than functional and moving?
  2. Staff and family education: Do family and staff understand the limits of the efficacy of the drugs, along with their risks? Are they aware of non-pharmacologic interventions and their benefits?
  3. Interdisciplinary team of champions: Partner with consultants; not just about filling out tracking forms; staff should communicate regularly with drug prescribers to help determine when it’s time for a gradual dose reduction
  4. Start with “low hanging fruit”: Start with a patient whose medication is not effective, or has negative side effects, or who is already on a low dose of a medication or PRN, with no clear history of aggressive behavior or psychosis, and no GDR in 6 months. Go slow, develop strategies with clinician prescribers, reassess, be mindful that this may not be successful, involve family and put a non-pharmacological plan in place.
  5. Ongoing motivation and mentoring: Assess for change in target symptom, evidence of adverse effects or functional decline; gradual dosage reduction should be considered in 3-6 months once symptoms have been effectively treated OR if adverse effects outweigh benefits.

 Next week, we’ll discuss non-pharmacological approaches to use in place of psychotropic medications to address behavioral and psychological symptoms of dementia.

Link to this document to assess antipsychotic medication use in persons with dementia- Multidisciplinary_Medication_Management

Have a great week!

Recreational activity ideas

Hello everyone,

With the holiday season upon us, we hope that many family and friends will be visiting their loved ones at your nursing homes. You and your staff may already be planning special holiday events for visitors to attend with the residents.

 But when there isn’t a specific event planned, visitors can sometimes feel unsure of what to do with their friend or family member, especially if their loved one has challenges with communication or mobility.

 A nursing home in Pennsylvania has a great solution for this! The Meadows developed a travel activity box, an open suitcase that sits in the foyer and is filled with activities for residents to do with friends and family. The box contains magazines, adult coloring pages with colored pencils and crayons, checkers, crossword puzzles, puzzles and decks of cards. Guests are encouraged to pick some activities, and then return the games and supplies to the box when they leave.

 Why not make one of these boxes for your facility in time for the holidays? Be creative with what you include in it! To encourage visitors to engage in more physical activity with residents, you might include resistance bands for exercise or balloons to blow up and toss back and forth. The grandkids will love it!

Have a great week!