Caregiving Gems - Alzheimer's Association · Diamonds Emeralds Ambers Rubies Pearls. 1/3/2017 7...

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Caregiving Gems

Teepa Snow, MS, OTR/L, FAOTA

Beliefs

• People with Dementia are Doing the BEST they can

• We must learn to DANCE with our partner• We are a KEY to make life WORTH living• What we choose to do MATTERS• We can change the WORLD with help• We must be willing to CHANGE ourselves• We must be willing to STOP & BACK OFF

How Can We Become Better Care Partners?

Be willing to try something newBe willing to learn something different

Be willing to see it through another’s eyesBe willing to fail & try again

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What Are the Most Common Issues That Come Up???

• No HC-POA or F-POA• ‘Losing’ Important Things• Getting Lost • Unsafe task performance• Repeated calls & contacts• Refusing• ‘Bad mouthing’ you to

others • Making up stories• Resisting care• Swearing & cursing• Making 911 calls• Mixing day & night

• Shadowing• Eloping or Wandering• No solid sleep time• Getting ‘into’ things• Threatening caregivers• Undressing• Being rude• Feeling ‘sick’• Striking out at others• Seeing things & people• Contractures• Stopping eating & drinking

How Do We Learn?

It’s a process!

Do Something

Think about what you did…

Try IT out…

Figure IT Out!?

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More Ideas

• We learn by doing and making mistakes• We learn with practice• We learn by being confronted by a

challenge and trying to figure it out• We each learn in a variety of ways• We are all SMART, in different ways• We learn better if we are having fun

Caring for Someone with Dementia…

What Works BEST?

The Basics for Success…

• Be a Detective NOT a Judge• Look, Listen, Offer, Think… • Use Your Approach as a Screening Tool• Always use this sequence for CUES

– Visual - Show– Verbal - Tell– Physical – Touch

• Match your help to remaining abilities

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Some Basic Skills

• Positive Physical Approach• Supportive Communication• Consistent & Skill Sensitive Cues

– Visual, verbal, physical• Hand Under Hand

– for connection– for assistance

• Open and Willing Heart, Head & Hands

First Connect – Then Do

• 1st – Visually• 2nd – Verbally• 3rd – Physically

• 4th – Emotionally• 5th – Spiritually - Individually

To ConnectStart with the

Positive Physical Approach

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Your Approach

• Use a consistent positive physical approach– pause at edge of public space– gesture & greet by name– offer your hand & make eye contact– approach slowly within visual range– shake hands & maintain hand-under-hand– move to the side– get to eye level & respect personal space– wait for acknowledgement

A Positive Approach(To the Tune of Amazing Grace)

Come from the frontGo slow

Get to the side,Get low

Offer your handCall out the name then WAIT…If you will try, then you will see

How different life can be.For those you’re caring for!

Supportive Communication

• Make a connection– Offer your name – ”I’m (NAME) ”… “and

you are…”– Offer a shared background – “I’m from

(place) …and you’re from…”– Offer a positive personal comment – “You

look great in that ….” or “I love that color on you…”

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Support to ‘Get it GOING!’

• Give SIMPLE & Short Info• Offer concrete CHOICES• Ask for HELP• Ask the person to TRY• Break the TASK DOWN to single steps

at a time

Give SIMPLE INFO• USE VISUAL combined VERBAL

(gesture/point)– “It’s about time for… “– “Let’s go this way…”– “Here are your socks…”

• DON’T ask questions you DON’T want to hear the answer to…

• Acknowledge the response/reaction to your info…

• LIMIT your words – Keep it SIMPLE• WAIT!!!!

Now for the GEMS…

DiamondsEmeraldsAmbersRubiesPearls

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Diamonds

Still ClearSharp - Can Cut

Hard - Rigid - InflexibleMany Facets

Can Really Shine

Emeralds

Changing colorNot as Clear or Sharp - Vague

Good to Go – Need to ‘DO’Flaws are HiddenTime Traveling

Ambers

Amber AlertCaution!

Caught in a momentAll about Sensation

Explorers

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Rubies

Hidden DepthsRed Light on Fine Motor

Comprehension & Speech HaltCoordination Falters

Wake-Sleep Patterns are Gone

Pearls

Hidden in a ShellStill & QuietEasily Lost

Beautiful - LayeredUnable to Move – Hard to ConnectPrimitive Reflexes on the Outside

Diamonds

Still ClearSharp - Can Cut

Hard - Rigid - InflexibleMany Facets

Can Really Shine

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Diamonds

Are Joiners or Are Loners

Use Old Routines & Habits

Control Important ‘Roles’ & ‘Territory’

Real? Fake? - Hard to Be Sure

• Uses Routines & Old Habits to function• Can complete personal care in ‘familiar place’• Follows simple prompted schedules - mostly• Misplaces things and can’t find them• ‘Resents takeover’ or bossiness • Notices other people’s mis-behavior & mistakes• Territorial – refusals!• Varies in lack of self-awareness

Diamonds – Level 5

Diamond Interests• What they feel competent at• What they enjoy & who they like• What makes them feel valued• Where they feel comfortable but

stimulated• What is familiar but intriguing• What is logical and consistent with

historic values & beliefs• Who is in charge – the boss

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Common Diamond Issues• IADLs

– Money management– Transportation -

Driving– Cooking– Home maintenance &

safety– Caring for someone

else– Pet maintenance– Med administration

• Unfamiliar settings or situations– Hospital stay– Housing change– Change in family– Change in support

system – MD visits– New diagnoses– Traveling or

vacations

Visual Cues that Help

• Personalized room • Way finding signs• Highlighted schedules• Familiar & inviting environments• Familiar set-ups for tasks or activities• Personal approach with a smile• Place cards at table settings• Wear name tags on right side

Verbal Cues that Help• Knock before entering• Use Sir and Ma’am, be respectful• Ask permission to do things in the room• Offer positive comments • Issue invitations not orders• Ask for help or input• Frame as a ‘RULE’ for everyone• Acknowledge their skill, ask for their

support or understanding --- a favor

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Watch how you talk…

• How you say it…• What you say…• How you respond…

Tactile Cues that Help

• Hand shake greetings• Return of friendly affection touches• Responsive hugs• Hand-under-hand comforting • Back rubs – with permission• Hand & foot massages – ‘pampering’

(getting used to us touching & doing)

So What Helps?

Apologize! - “I’m SORRY!” – “I didn’t mean to…”• Friendly NOT bossy – leader to leader• “Let’s try” – temporary…• Share responsibility not take over• Use as many ‘old habits’ as possible• Give up being ‘RIGHT’• Go with the FLOW• Give other ‘job’ when taking away another

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Be Prepared for REPEATS

• For repeated questions or requests– Don’t share so early

• be careful about emotional information– Make sure you are connected to respond– Repeat a few of their words in a ???– Answer their question– THEN

• Go to new words (use enthusiasm)• A new place• Add a new activity (possibly related)

For OLD Stories

• Use “Tell me about it” – to accept the story– To reduce risk of ‘paranoia-like’ thinking

• Store them for the future– Write them down– Share them with others– You will possibly need them for supportive

communication later• Learn several – prompt for ‘switch up’

Use empathy&

Go with the flow

Reality Orientation

Telling Lies

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BAD Helper Habits to BREAK

• Saying “Don’t you remember…”• Not recognizing or accepting differences• Trying to force changes in roles or

responsibilities• Trying to take over completely• Taking responsibility for saying “NO”• Accepting things at face value• Arguing

Emeralds

Changing colorNot as Clear or Sharp - Vague

Good to Go – Need to ‘DO’Flaws are HiddenTime Traveling

Emeralds

Two Kinds of DOINGDoers or Supervisors

Does What is Seen - Misses What is NotMust be in Control - Not able to do it Right Does tasks – Over and over OR Not at All

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Emerald Interests

• Doing familiar tasks• Doing visible tasks• Historic tasks and people and places• Engaging with or helping others• Finding important people or things• Having a ‘job’ or ‘purpose’• Being an ‘adult’• Getting finished & doing something else

Common Emerald Issues

• Doesn’t do care routinely – thinks did• Makes mistakes in sequence – unaware• Repeats some care routines over & over• Resists or refuses help• Gets lost – can’t find where to do care• Limited awareness of ‘real needs’ –

– Hunger, thirst, voiding, bathing, grooming…• Has other ‘stuff’ to do…

More Emerald Issues

• Afternoon or Evening – “Got to go home”• Daytime – “Got to go to work”• Looking for people/places from the past• Losing important things – thinking

others stole/took them • Doing private things in public places• Having emotional meltdowns• Treating strangers like friends and visa

versa

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• The environment– Overall look (friendly, fun, familiar, forgiving)– Surfaces to work on or do things on– Places to sit (paired chairs)– Set up Props (objects that ‘say’ what to do)– Highlighted areas (light, color contrast,

clutter reduction, organized)– Hidden – what is NOT to be done, what is

already done, what ‘triggers’ distress

More Visual Cues that Help

• You – Facial expression

• Friendly• Concerned

– Gestures• Invite with gestures and your face• Indicate next item to use, or options

– Offer items• Offer an item in correct orientation• Present two to pick from

Verbal Cues that Help

• Tone of Voice– Friendly– Interested– Concerned

• Reduce and Focused words– Use preferred name for attention– Match words with gestures or offering

• Listen and use their words to connect

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More Verbal Cues

• When becoming distressed– Use PPA – Let them come to you, if possible– Listen - Get emotionally connected to

where they are– Use empathic comments– Listen for key words– Go with their FLOW – don’t push for the

change– THEN Use redirection, NOT distraction

Physical Cues that Help

• Limit this form of helping! – Match it with a visual & verbal cue combo

• Offer objects – don’t put hands on• Share the task -

– Give them something to do while you do your part

• Do ‘it’ with/to someone else first, then approach them

More Physical Cues

• When distressed– Match your touch to their preferences– Hand-under-Hand FIRST– Back rub – if interested– Hug – show first– Increase space and distance, if cued– BACK OFF, if it is not working

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How to Help

• Learn about “SO WHAT!”… is it worth it?• Provide ‘subtle’ supervision for care • Provide visual prompts to do

– Gestures, objects, set-up, samples, show• Hide visual cues to ‘stop’/prevent

– Put away, move out of range, leave• Use the environment to cue – SHOW • Use ‘normal’, humor, friendliness, support

Connect• ID common interest• Say something nice about the person or their

place• Share something about yourself and encourage

the person to share back• Follow their lead – listen actively• Use some of their words to keep the flow going• Remember its the FIRST TIME! – expect

repeats• Use the phrase “Tell me ABOUT …”

Do’s• Go with the FLOW• Use SUPPORTIVE communication

techniques– Use objects and the environment– Give examples– Use gestures and pointing– Acknowledge & accept emotions– Use empathy & Validation– Use familiar phrases or known interests– Respect ‘values’ and ‘beliefs’ – avoid the negative

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DON’Ts

• Try to CONTROL the FLOW– Give up reality orientation and BIG lies– Do not correct errors– Offer info if asked, monitoring the

emotional state• Try to STOP the FLOW

– Don’t reject topics– Don’t try to distract UNTIL you are well

connected– Keep VISUAL cues positive

What NOT to DO…

• DO NOT point out errors – or focus on ‘wrong’

• DO NOT offer – physical assist 1st

• DO NOT offer “Let me HELP you”• DO NOT try to ‘go back and fix it…• DO NOT continue arguing about ‘reality’• DO NOT treat like children…• Do NOT react… remember to respond

BAD Helper Habits to Break!

• Noticing and pointing out errors• Telling not asking – “You need to…”• Too little or too much – talking, showing,

touching• Trying to take over – offering “HELP”• Putting hands on – ‘fussing’• Reality orientation or lying• Trying to use ‘distraction’

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Ambers

Amber AlertCaution!

Caught in a momentAll about Sensation

Explorers

AmbersPrivate & Quiet OR Public & Noisy

All About Sensory Tolerance & NeedsTouching - Tasting – Handling – Exploring

Attraction – AvoidanceOver-stimulated – Under-stimulated

No safety awarenessEgo-centric

Level 3 - Amber• LOTS of touching, handling, mouthing,

manipulating• Focus on fingers and mouth• Get into things• All about sensation….• Invade space of others• Do what they like • AVOID what they do NOT

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Amber Interests

• Things to mess with (may be people)• Places to explore• Stuff to take, eat, handle, move…• Visually interesting things• People who look or sound interesting OR

places that are quiet and private• Textures, shapes, movement, colors,

numbers, stacking, folding, sorting…

Amber Issues

• Getting into stuff – taking stuff• Bothering others• Not able make needs known• Not understanding what caregivers are

doing• Not liking being helped/touched/handled• Not like showers or baths• Repetition of sounds/words/actions


• Automatic social greeting signals• Lighted work surfaces with strong props• Demonstrations – work along side• Model the actions• Do the action one time, then offer the

prop• Show one step at a time• Show a NEW item, then cover the old

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• Call name• Use simple noun, verb, or noun + verb

– “Cookie?”– “Sit down”– “Let’s go” (with gesture)

• Give simple positive feedback• Listen for their words, then

– use a few and leave a blank at the end of the sentence


• Show the motion or action wanted• Touch the body part of interest• Position the prop for use – light touch• Show the motion on yourself• Use hand under hand guidance• Offer the prop once started –

encourage their use of the item

Hand-Under-Hand Assistance

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How to Help• Provide step-by-step guidance & help • Give demonstration – show• Hand-under-hand guidance after a few

repetitions, uses utensils (not always well) • Offer something to handle, manipulate,

touch, gather• Limit talking, noise, touch, other activities• SUBSTITUTE don’t SUBTRACT

To Connect with Ambers

• Make an Emotional Connection– Use props or objects– Consider PARALLEL engagement at first

• Look at the ‘thing’, be interested, share it over….

– Talk less, wait longer, take turns , COVER don’t confront when you aren’t getting the words, enjoy the exchange

– Use automatic speech and social patterns to start interactions

– Keep it short – Emphasize the VISUAL

BAD Helper Habits to Break!• Talking too much, showing too little• Keep on pushing• Doing for NOT with• Stripping the environment• Leaving too much in the environment• Getting in intimate space• Over or under stimulating• Getting loud and forceful

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Rubies

Hidden DepthsRed Light on Fine Motor

Comprehension & Speech HaltCoordination Falters

Wake-Sleep Patterns are Gone

RubiesBalance & coordination

Eating & drinkingWake time & sleep time

Level 2 - Ruby• Big movements – walking, rolling, rocking• Hand actions – not fingers• Tends toward movement unless ‘asleep’• Follows gross demonstration & big gestures

for actions• Limited visual awareness• Major sensory changes• Major movement skill loses• Fine motor skill lost – mouth & hands

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Ruby Interests

• Walking a routine path• Going forward• Watching others – checking them out• Being close or having space• Things to pick up, hold, carry, push,

wipe, rub, grip, squeeze, pinch, slap• Things to chew on, suck on, grind• Rhythmic movements and actions

Ruby Care Issues• Safe mobility – fatigue, wandering, & falls• Intake – amount and safety• Hydration – interest, amount, safety• Rest time & place – night time waking• Shadowing others – invading places• Not staying – not settling for meals• Reactions to hands on care – sensation• Identifying & meeting needs

More Ruby Issues

• Contractures• Skin well being – bruises, tears, rashes• Pressure or friction• Infections – UTI, yeast, URI,

pneumonias• Swallowing• Circulation

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• Demonstrate what you want• Give big movements to copy• Move slowly & with rhythm• Present cues in central visual field

about 12-18 inches out• Hold things still – allow exploration• Offer your hand• Smile while offering support


• Call name to get attention – at 6’ out• Use ‘song’ to connect• Give 1-3 words only• Combine verbal direction with gesture

or demo• Give one ‘action’ cue at a time• Match tone/inflection to intent• Give positive ‘Strokes’ with attempts


• Hand-under-hand• Touch body part to be moved or used• Place hand/foot then gesture• Offer comfort touch as desired before

task attempt• Back rubs –

– Flat and slow – to calm– Finger tips and quick circles – to awake

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How to Help

• SLOW yourself DOWN• Hand under hand• Move with first – then guide• Learn about patterns of ‘needs’• Use music and rhythms – help get or stop

movement• Use touch with care• Combine cuing & do SLOW

BAD Helper Habits to Break!

• Touching too quickly – startling• Leaning in – intimate space invasion• Talking too loudly• ‘Baby-talking’• Not talking at all• Not showing by demonstrating• Trying to understand what is said, by

being confrontational

Pearls

Hidden in a ShellStill & QuietEasily Lost

Beautiful - LayeredUnable to Move – Hard to ConnectPrimitive Reflexes on the Outside

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Pearls• The end of the journey is near• Multiple systems are failing• Connections between the physical and

sensory world are less strong• We are often the bridge – the connection • Many Pearls need our permission to go –

– They are still our moms, dads, spouses, friends– They will go in their own time – IF we don’t try to change what is

Level 1 - Pearl• Immobile – can’t get started• Bed or chair bound – frequently falls to side or

forward• Has more time asleep or unaware• Has many ‘primitive’ reflexes present -Startles easily• May cry out or mumble ‘constantly’• Increases vocalizations with distress• Difficult to calm• Knows familiar from unfamiliar• Touch and voice make a difference in behaviors

Pearl Interests

• Internal cues • Pleasant and familiar sounds & voices• Warmth and comfort• Soft textures• Pleasant smells• ‘Good’ tastes• Smooth and slow movement• Just right touch and feel

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Primitive Reflexes to Consider • Startle reflex –

– Sudden movement causes total body motion• Grasp reflex–

– touch palm – grips hard can’t release• Sucking reflex –

– sucks on anything near mouth• Rooting reflex –

– Turns toward any facial touch and tries to eat

More Reflexes

• Bite reflex – Any touch in mouth causes bite down

• Tongue thrust– Anything in mouth causes tongue to push

forward and out • Withdrawal – rebound

– Pull away from stretch• Gag reflex –

– Any touch to tongue causes gag

Typical Positioning – Why?

• Constant muscle activity causes ‘contractures’ – shortening – can’t relax

• Stronger muscles cause typical ‘fetal’ positioning

• Pulling against contractures is painful• Shortened muscles cause some areas to:

– Not get air – become ‘raw’ or ‘irritated’– Rub or press against other body parts– Get too much pressure – can’t move off

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Pearl Care Issues

• Not interacting much• Crying out – can’t make needs known• Skin & hygiene problems• Weight loss• Reflexes make care challenging• Repeated infections• Not eating or drinking• Not able to sit up safely

Visual Cues to Help

• Get into supportive position• Place your face in the central field of

vision• Make sure light comes from behind the

person – into your face• Bring up lights carefully• Move slowly so they can follow you• Place items to be used in central field

Verbal Cues to Help• Keep your voice deep & calm• Put rhythm in your voice• Tell what you are doing and what is

happening while you give care• Reflect emotions you think you see• Offer positive comments & familiar

phrases as you offer care• Quiet down, if signaled to do so

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Touch Cues to Help

• Use firm, but gentle palm pressure at joints to make contact

• Always try to maintain contact with one hand while working with the other

• Once physically connected keep it• Use flats of fingers and palms for care• Always use hand under hand when doing

something ‘intense’

How to Help• Hand under hand help & care – or hand on

forearm, if hand/arm movement is poor• Check for reflexes – modify help &

approach to match needs• GO SLOW• Use calm, rhythmic movements & voice• Come in from back of extremities to clean• Stabilize with one hand & work with other

How to Help?

• Gather all supplies for the task before getting started

• Increase warmth of the room for bathing• Use warm towels & light weight blankets• GO SLOW• Use circular, rotational movements to

relax joints for care• Provide skin care – fragile & dry skin

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BAD Help Habits to BREAK

• Hurry - Get it done quickly• Don’t talk to – talk over or about• Don’t check for primitive reflexes prior

to helping• Use both hands to give care• Clean from the front – use prying motions• Focus on tasks not the relationship• Forget to look for the Pearl

Time to Practice

Typical Situations

• Going to the doctor• Having help come in or moving into a

more ‘protected’ environment• Managing a new medical condition • Not wanting to spend any money for

help or firing the help!• Giving away money or jewelry • What about driving?

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Typical Situations

• “What should I do now?”• “I need to get to work/find my mom/go

home… Can you help me?”• Clothes on wrong and they are dirty• I haven’t shaved in three days• I just ate, but I say I haven’t • Someone has taken my wallet/pocket

book – I want to call the police!

Typical Situations

• Face Sensitivity Issues –– Eating, Mouth care, Shaving

• Getting clean issues• Getting into things OR breaking things• Taking things• Annoying others – approach & touch• Exploring - invading space and place• Not wanting to do when it’s time to do

Typical Situations

• Won’t sit down for meals• Spits out meats and rice• Can’t settle down at night keeps coming

back out• Keeps following when you need to give

care to someone else• Grabs things and pulls on them• Won’t sit on the toilet

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Typical Situations

• Not knowing how to connect• Trying to get the person clean• Calling out, or grimacing• Won’t take a bite, or a drink• Won’t swallow or chokes or has wet voice• Is hard to move, gets rigid• Keeps eyes closed, doesn’t seem to

respond

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Memory CareSpirituality Matters

• Understand and identify the importance and value of faith for those with dementia symptoms.

• Identify the value of engaging friendships with those living with dementia symptoms.

• Understand how to integrate those with a neurocognitive disorder into the faith community.

Objectives

Challenges• Most feared illness• Challenging behaviors• Burden on others• Isolation • Threatens our identity• Memory

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The importance and value of

faith for those with dementia

symptoms.

No two people are the same…

In the Image of God

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Spirituality Matters

Meaning of Life

A sense of…• Identity• Relationship• Meaning and purpose

Tai Chi

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Outdoors

Optimal ConnectionsMusic

Nurture

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Children

Lifelong Learning

Prayer

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All things bright and beautiful…

The value of engaging

friendships

Utility, Pleasure, VirtueFriendships

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“The friend who can be silent with us in a moment of despair and confusion, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness… that is the friend who cares.”

~Nouwen, 1974

Integrating those with dementia

into the faith community

Pastoral Regard• Mutuality• A different way of thinking• Acceptance of the person• A different way of relating

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Organization of Worship• Favorite Bible readings• Well known and well

loved hymns• Patterned liturgical

responses• Prayer

• Memory cueing• Leadership style• Practicalities• The Lord’s supper

Organization of Worship

Best Practices• Attentive listening• Patience and kindness• Focus on the ability, not the

limitation• Provide needed practical

support• Environment free of stigma

and anxiety• Involve everyone• Speak about dementia

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II Corinthians 5:7

“For we walk by faith and not by sight.”

Closing Thoughts

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D A N I E L C U R L I K I I , P H . D .Y O R K C O L L E G E O F P E N N S Y L V A N I A

A M E L I OR AT I N G AG E - R E L AT E DC OG N I T I V E I M P AI R M E N T S BY AL T E R I N GF U N C T I ON OF H I P P OC AM P AL N E U R ON S

T H E A G I N G P O P U L A T I O N I S P R O J E C T E D T OD O U B L E O V E R T H E N E X T F I F T Y Y E A R S

An Aging Nation, 2014

I M P L IC IT M E M O R Y R E M A IN S M O S T L YU N A F F E C T E D B Y A G IN G

(declarative)

(non-declarative)

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D E C L A R A T IV E M E M O R Y IS O F T E NIM P A IR E D W IT H A G IN G

(declarative)

(non-declarative)

T H E H I P P O C A M P U S I S A B R A I N R E G I O NR E Q U I R E D F O R M A N Y F O R M S O F L E A R N I N G

T H E H I P P O C A M P U S I S A B R A I N R E G I O NR E Q U I R E D F O R M A N Y F O R M S O F L E A R N I N G

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W I T H O U T A H I P P O C A M P U S H . M . W A S U N A B L ET O F O R M N E W D E C L A R A T I V E M E M O R I E S

H O W E V E R , H . M W A S A B L E T O F O R M N E WI M P L I C I T M E M O R I E S

H O W E V E R , H . M W A S A B L E T O F O R M N E WI M P L I C I T M E M O R I E S

Luo 2014; adapted from Milner, Squire & Kandel 1998

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T H E H I P P O C A M P U S I S R E Q U I R E D F O RD E C L A R A T I V E L E A R N I N G

D O E S A L O S S O F H I P P O C A M P A LN E U R O N S C O N T R I B U T E T O A G E-

R E L A T E D C O G N I T I V E I M P A I R M E N T?

N O ! N E U R O N A L C E L L L O S S I S N O T A S S O C I A T E DW I T H A G E - R E L A T E D C O G N I T I V E D E C L I N E

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R E S E A R C H E R S S T U D Y R O D E N T S T O B E T T E RU N D E R S T A N D T H E H U M A N B R A I N

T H E H I P P O C A M P U S C A N B E D I V I D E DI N T O T H R E E M A I N R E G I O N S

Deng, Aimone & Gage 2010

N E U R O N S I N T H E C A1 R E G I O N A R ES E N S I T I V E T O A G E - R E L A T E D C H A N G E S

Deng, Aimone & Gage 2010

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N E U R O N S I N A R E A C A 1 O F A G E DH I P P O C A M P U S A R E M U C H L E S S E X C I T A B L E

200ms20

mV

Young

Aged

A C T I V I T Y O F C A 1 N E U R O N S I S R E D U C E D I NA G E D C O G N I T I V E L Y I M P A I R E D A N I M A L S

Disterhoft and Oh 2006

A C T I V I T Y O F C A 1 N E U R O N S I S I N A G E DU N I M P A I R E D A N I M A L S I S C O M P A R A B L E T OT H A T O F Y O U N G R A T S

Disterhoft and Oh 2006

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T H E M O R R I S W A T E R M A Z E I S C O M M O N L Y U S E DT O A S S E S S S P A T I A L L E A R N I N G A N D M E M O R Y

Target Quadrant


Target Quadrant


Target Quadrant

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A G E D R AT S D I S P L AY I M P AI R E DS P AT I AL L E AR N I N G

Curlik, Weiss, Nicholson and Disterhoft 2014

T H E M O R R I S W A T E R M A Z E C A N A L S O B E U S E DT O A S S E S S S P A T I A L M E M O R Y

A G E D R AT S D I S P L AY I M P AI R E DS P AT I AL M E M OR Y


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O N L Y H AL F OF AG E D R AT S D I S P L AYC OG N I T I V E I M P AI R M E N T S


RestoreNeuronal

Excitability

IncreaseSynapticPlasticity

SuccessfulLearning

andMemory

ImpairedSynapticPlasticity

ImpairedLearning

and Memory

DecreasedNeuronal

Excitability

Adapted from Disterhoft & Oh 2007

CAN INCREASING T HEEXCIT ABILIT Y OF AGED

HIPPOCAMPAL NEURONSAMELIORAT E AGE-RELAT ED

COGNIT IVE DEFICIT S?

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R A T S U N D E R W E N T S T E R E O T A X ICS U R G E R Y

A N A D E N O - A S S O C I A T E D V I R U S W A S U S E DT O I N C R E A S E C R E B L E V E L S I N C A1

CA1

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A D E N O - A S S O C I A T E D V I R U S E S C A N B E U S E DT O M O D I F Y H I P P O C A M P A L N E U R O N S

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A N A D E N O - A S S O C I A T E D V I R U S W A S U S E DT O I N C R E A S E C R E B L E V E L S I N C A1

Yu, Curlik, Oh, Yin & Disterhoft, In Preparation

C E L L S F R O M A G E D C A 1 W E R E L E S SE X C I T A B L E T H A N T H O S E F R O M Y O U N G R A T S


A D M I N I S T R A T I O N O F V I R A L C R E B A M E L I O R A T E DA G E - R E L A T E D B I O P H Y S I C A L D E F I C I T S


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A L L A N I M A L S W E R E T R A I N E D W I T H T H EM O R R I S W A T E R M A Z E

Target Quadrant

Y O U N G R A T S H A D A R O B U S T M E M O R YF O R T H E P L A T F O R M L O C A T I O N


H A L F O F A G E D R A T S W E R EU N I M P A I R E D


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H A L F O F A G E D R A T S D I S P L A Y E DS P A T I A L M E M O R Y D E F I C I T S


I N C R E A S I N G C R E B L E V E L S A M E L I O R A T E DA G E - R E L A T E D S P A T I A L M E M O R Y D E F I C I T S


PHARMACO LOGI C ALMANIPUL AT IONS CAN ALSOAMELIORAT E AGE-RELAT ED

BIOPHYSICAL ANDBEHAVIORAL DEFICIT S

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A D M I N I S T R A T I O N O F N I M O D I P I N E I N C R E A S E ST H E A C T I V I T Y O F C A 1 N E U R O N S

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RestoreNeuronal

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IncreaseSynapticPlasticity

SuccessfulLearning

andMemory

ImpairedSynapticPlasticity

ImpairedLearning

and Memory

DecreasedNeuronal

Excitability

Adapted from Disterhoft & Oh 2007

ACKNO WL E DG E M E NT SDr. John DisterhoftDr. Matthew OhDr. Jerry YinXiao-Wen YuDr. Craig WeissDr. Dan NicholsonDr. Tracey ShorsDr. Jennifer EnglerDr. Carla StrassleDr. Perri DruenDr. Randi Shedlosky-Shoemaker

This work was supported by:NIH AG13854 to D.M.C. NIH AG20506 to D.M.C. NIH AG008796 to J.F.D.NIH AG017139 to J.F.D.

Q U E S TI O N S?

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Under Construction:A Short Detour, A long Drive

JASON HALL PHARM.D., BCPS

Learning Objectives

üReview Alzheimer’s Dementia and possible causes

üDiscuss current memory treatment options, efficacy and usage

üDiscuss available medications that may help improve quality of life

http://fortune.com/2016/09/03/biogen-drug-alzheimers-disease/

What Is Dementia?

Broad term describing many symptoms caused by changes in the brain

May cause changes in: memory, communication, language, reasoning, judgment, visual perception and behavior

Alzheimer’s Disease accounts for 60-80% of dementia

http://alznet.org/lewy-body-dementia/

Alzheimer’s Disease Education and Referral Center. Alzheimer’s Disease: Fact Sheet. National Institute on Aging. NIH Publication No. 15-6423. Updated: May 2015. Accessed October 13, 2015.

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Graying Of America

In 2012, 43.1 million Americans were aged 65 years and older

By 2040 this number is expected to increase to 79.7 million

Americans aged 85 years and older is the fastest growing group◦ 5.8 million in 2014◦ 14.1 million in 2040 expectedhttp://www.ymcasm.org

Administration On Aging Statistics. Available at:http://www.aoa.gov/Aging_Statistics/Profile/index.aspx.Accessed. May 5th 2015

The Healthy Brain o Adult weight: 3 pounds

o Adult size: medium sized cauliflower

o Number of neurons: 100 billion

o Number of synapses: 100 trillion

o Number of capillaries: 400 billion

https://www.wired.com/2012/12/the-next-warfare-domain-is-your-brain/

Rodgers, Anne B. Alzheimer’s Disease: Unraveling the Mystery. Alzheimer’s Disease Education and Referral (ADEAR) Center. National Institute on Aging. September 2008. Publication: 08-3782

Alzheimer’s Disease

Affects more than 5 million Americans

Most common cause of dementia

Generally appears during the sixth decade of life

Brain changes may start 10-20 years before any symptoms appear

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Alzheimer’s Disease

Genetics

Hallmarks of AD◦ Beta-amyloid◦ Tau

Oxidative damage

Vascular changes

Other diseases: heart disease, stroke and type II diabetes.

https://www.alz.org/braintour/healthy_vs_alzheimers.asp

Rodgers, Anne B. Alzheimer’s Disease: Unraveling the Mystery. Alzheimer’s Disease Education and Referral (ADEAR) Center. National Institute on Aging. September 2008. Publication: 08-3782

Treatment of Alzheimer’s Disease

Even with advanced medicine, Alzheimer’s CANNOT be cured, or stopped from progressing

Goals of treatment§Lessen symptoms§Improve quality of life

Prescription Medications

Acetylcholinesterase inhibitors (AChEI)§Aricept ® (donepezil)§ Exelon ® (rivastigmine)§Razadyne ® (galantamine)

NMDA antagonist§Namenda ® (memantine)

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Acetylcholinesterase inhibitors

How they work: § They block the enzyme (AChE)

responsible for the breakdown of acetylcholine §Decreased breakdown of

acetylcholine, leads to increased levels in the synapses between neurons

Higher levels of acetylcholine may lead to improved communication

Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015


Acetylcholinesterase inhibitors Aricept® (donepezil)

Starting dose: 5 mg daily

Usual dose: 10 mg daily

Max dose: 23 mg daily

Increase dose every 2-4 weeks to 10 mg daily.

May consider 23 mg daily if patient stable on 10 mg (generally after 3-6 months)

Exelon® (rivastigmine)

Starting dose: 1.5 mg daily (oral)

Usual dose: 6 mg daily (oral)

Max dose: 12 mg daily (oral)

Increase dose every 2 weeks

Exelon® (rivastigmine)

Starting dose: 4.6mg/24hr (patch)

Usual dose: 9.5mg/24hr (patch)

Max dose: 13.3mg/24hr (patch)

Increase dose every 4 weeks

May consider increasing to 13.3mg/24hr patch after 6 months

Aricept Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.Exelon Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.

Razyadyne Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015

.

Acetylcholinesterase inhibitors Razadyne® (galantamine)

Starting dose: 4 mg twice daily

Usual dose: 8-12 mg twice daily

Max dose: 12 mg twice daily

Increase dose after 4 weeks at current dose

Razadyne ER® (galantamine)


Usual dose: 8-24 mg daily


Increase dose after 4 weeks at current dose



.

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Acetylcholinesterase inhibitors Possible side effects:

§ Nausea, vomiting

§ Diarrhea

§Muscle cramps

§ Urinary incontinence

§ Syncope

§ Fatigue

§ Anorexia

§ Behavioral changes

Discontinue use if:

§ Bradycardia (slow heart rate)

§ Gastrointestinal ulcer

Reduce dose or discontinue if:

§ Intolerable side effects occur (nausea, vomiting, diarrhea, muscle cramps, insomnia, fatigue, dizziness)



.

Acetylcholinesterase inhibitors § Initiate therapy for patients with mild to severe Alzheimer’s Disease when clinically indicated§ Benefits may include:§ Cognition§ Activities of daily living § Severity of dementia§ Behaviors§ Nursing home placement

§ Not all patients will respond§ Duration of benefit will vary based on the patient

California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.


§ Choose product based on:§Cost§ Patient specific characteristics §Adverse side effects§Concurrent medications

§ Discontinuing product is controversial and patient specific

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Important considerations:

§ Starting doses of galantamine and rivastigmine are not therapeutic

§ Donepezil and galantamine undergo hepatic metabolism

§ All three may interact with other anticholinergic agents

§ Should be discontinued prior to surgery, unless otherwise stated by surgeon

§ Be mindful of food recommendations


NMDA Receptor AntagonistHow Namenda® (memantine)

Blocks the excessive stimulation of the neuron by glutamate

Excessive stimulation by glutamine may result in neuronal injury or death

https://www.google.com/search?q=memantine+moa&safe=off&biw=1361&bih=921&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjyuIWR_IfQAhWm6oMKHUQ4CA4Q_AUIBygC#imgrc=s6Aq26NYsT6KHM%3A


NMDA Receptor AntagonistNamenda® (memantine)


Usual dose: 10 mg twice daily

Max dose: 10 mg twice daily

Increase by 5 mg twice daily after 1 week, then increase by 5 mg every 1 week until max dose of 10 mg twice daily is achieved

Namenda XR® (memantine)


Usual dose: 28 mg daily


Increase by 7 mg twice daily each week until target dose of 28 mg daily is achieved

Bishara D, Sauer J, Tyalor D. The pharmacological management of Alzheimer’s Disease. Prog in Neuro and Psych. July/August 2015California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.

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NMDA Receptor Antagonist

Possible side effects:

§ Dizziness

§ Balance disorders

§ Hypertension

§ Constipation

§ Headache

Reduce dose or discontinue if:

§ Intolerable side effects occur

§ Severe confusion/altered mental status

Namenda. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015

NMDA Receptor Antagonist

§May be initiated upon diagnosis or later in disease course

§May be used as monotherapy or combined with acetylcholinesterase inhibitors

§Benefits may include:§Cognition §Activates of daily living§Behaviors

§Discontinuing product is controversial and patient specific

Behavioral and Psychological Symptoms of Dementia (BPSD)

“The Scream” –Edvard Munch

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BPSD BasicsBPSD effects 35-85% of all patient living with dementia

Symptoms may cause distress to the patient and care partners

Treatments include both non-pharmacological and pharmacological approaches

BPSD Symptoms

§Agitation

§Anxiety

§Irritability

§Depression

§Delusions

§Hallucinations

Cer ejeira J, LagartoL, Mukaetova-Ladinska E.B. Behavioral and Psychological Symptoms of Dementia. Front in Neuro. 2012. 3(73). 1-21.

§Disinhibition

§elation

§Repetitive behavior

§Sleep changes

§Appetite changes

§Others

BPSD BasicsChanges in mood and behaviors are generally not sudden (acute)

Any sudden (acute) changes may indicate another medical problem

Non-pharmacological interventions are considered ideal, and should be used first if possible

If non-pharmacological treatments fail, then pharmacological intervention may be necessary

Medication classes used for BPSD include:

§Antidepressants

§Antipsychotics

§Anticonvulsants

§Benzodiazepines

Califor nia Department of Health. Guideline For Alzheimer's Disease Management- Final Report. Apr il 2008.

Antipsychotics Some documentation supports antipsychotic effectiveness in the treatment of BPSD

Targeted symptoms:§Aggression

§Psychosis

§Hallucination

§Delusions

§Extreme agitation

Two main classes of antipsychotics:§Typical antipsychotics

§Atypical antipsychotics


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Antipsychotics

Antipsychotics with the most evidence for BPSD

Risperdal® (risperidone) “atypical”

Zyprexa® (olanzapine) “atypical”

Haldol® (haloperidol) “typical”

Other antipsychotics used for BPSD

Seroquel® (quetiapine) “atypical”

Abilify ® (aripiprazole) “atypical”

Clozaril ® (clozapine) “atypical”

Geodon® (ziprasidone) “atypical”

AntipsychoticsInitiate therapy after other interventions have failed, or when safety may be compromised

Dosing should be patient specific. Consider type of behavior, frequency, onset and predicating factors

Start low and go slow!

“At Eternity's Gate”-Vincent van Gough

Antipsychotics Black Box Warning

There is a documented increased risk of death in older adults taking these drugs for mental problems caused by dementia

Possible side effects:

§Sedation

§Falls

§Anticholinergic effects

§Glucose intolerance

§Elevated cholesterol

§Extrapyramidal symptoms

§Gait disturbances

§Tardive dyskinesia

§Increased mortality

§Neuroleptic malignant syndrome

§Seizures

§Weight gain

§QT prolongation

§Elevated liver enzymes

§Others

California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.Cerejeri J, Lagarto L, Mukaetova-Ladinska E.B. Beavhioral and psychological symptoms of dementia. Front In Neuro. Vol 3. May 2012. 1-21

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AntipsychoticsSummary:

Antipsychotics may be beneficial for some BPSD symptoms

Antipsychotics should be used as a last line option

Start at the lowest possible dose and treat for the shortest amount of time possible

Monitor for side effects and discontinue use if risks > benefits

AntidepressantsSome documentation supports antidepressants effectiveness in the treatment of BPSD

Targeted symptoms:

§ Depressions

§ Agitation

§ Psychosis

§ Disinhibition

§ Irritability

Main classes antidepressants used for BPSD

§ Tricyclic antidepressants

§ Selective serotonergic reuptake inhibitors

§ Serotonin/norepinephrine reuptake inhibitors

California Workgroup. Guideline for Alzheimer’s Disease Management Final Report 2008. California 2008.Cerejeri J, Lagarto L, Mukaetova-Ladinska E.B. Beavhioral and psychological symptoms of dementia. Front In Neuro. Vol 3. May 2012. 1-21

AntidepressantsTricyclic antidepressants

Norpramin® (desipramine)Sinequan® (doxepin)Aventyl® (nortriptyline)

Selective serotonergic reuptake inhibitors

Celexa® (citalopram)Lexparo® (escitalopram)Prozac® (fluoxetine)Luvox® (fluvoxamine)Paxil® (paroxetine)Zoloft® (sertraline)

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Antidepressants

Serotonin/norepinephrine reuptake inhibitors

Cymbalta® (duloxetine)

Effexor® (venlafaxine)

Miscellaneous

Wellbutrin® (buproprion)

Lithium

Remeron® (mirtazapine)

Nefazodone

Desyrel® (trazodone)

AntidepressantsPotential side effects:

§Dizziness

§Blood pressure changes

§Gastrointestinal upset

§Sexual disturbances

§Nervousness

§Changes in sleep

§Sedation

§Dry mouth

§Changes in heart rhythm

§Fatigue

§Weight loss

§Weight gain

Benzodiazepine Comparison Chart. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.Lorazepam Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.c

AntidepressantsSummary:

May be a good alternative to antipsychotic use

Depression is main use, however, may show benefit to other BPSD symptoms

Choose product based on patient characteristics and intended use

Requires 4-8 weeks at current dose to see full results

Do not abruptly discontinue (taper dose over several weeks)

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BenzodiazepinesSome documentation supports benzodiazepine effectiveness in the treatment of BPSD

Targeted symptoms:

§Anxiety

§Agitation

§Insomnia

§Restlessness

Cerejeira J, Lagarto L, Mukaetova-Ladinska E.B. Behavioral and Psychological Symptoms of Dementia. Front in Neuro. 2012. 3(73). 1-21.Benzodiazepine Comparison Chart. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.

Lorazepam Oral. Facts and Comparisons 4.0 online [Internet Database]. Wolters Kluwer. Available at: http://online.factsandcomparisons.com. Accessed October 12, 2015.cCalifornia Department of Health. Guideline For Alzheimer's Disease Management- Final Report. April 2008.

http://www.naturalstressreliefguide.com/image-files/anxiety_stress.jpg

BenzodiazepinesMay be used to manage acute or chronic agitation, anxiety or restlessness

Consider shorter acting benzodiazepines

Available benzodiazepines:

§Xanax® (alprazolam)

§Klonopin® (clonazepam)

§Valium® (diazepam)

§Ativan® (lorazepam)

§Serax® (oxazepam)

§Restoril® (temazepam)

§Halcion® (tiazolam)


BenzodiazepinesPotential side effects:

§Changes in behavior

§Balances changes

§Confusion

§Dizziness

§Disinhibition

§Sedation

§Hallucination

§Lethargy

§Abnormal dreams

§Seizures

§Sexual changes

§Anorexia

§Changes in liver enzymes

§Blurred vision

§Gastrointestinal distress

§Drowsiness


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Benzodiazepines

Summary

Often used to control acute or intermittent anxiety, agitation or restlessness

Recommend use at the lowest possible dose, for shortest time possible

Often using 30 to 50% of adult dose is sufficient

Monitor for changes in dizziness, vision and mental status

Monitor for increased risk of falls

On The Horizono Currently there are five FDA-approved Alzheimer’s drugs

o The function of the currently approved drugs are to help alleviate symptomso The target of drugs under current investigation will be to modify the disease

o Beta-amyloid

o Tau Proteino Inflammation

o Insulin resistanceo New imaging and diagnosing techniques are currently under investigation

o Many clinical trials available

Alzheimer’s Association. Treatment Horizon. Available at :http://www.alz.org/research/science/alzheimers_treatment_horizon.asp. Accessed October 14, 2015.

Tablet Engaged Active Minds Empowering Your Care Team

alzheimer’s association | Greater PA Chapter 2016 York County Education & Resource Conference Nov. 30, 2016 @ Wyndham Garden York

PRESENTED BY GENERATION CONNECT WEAREGENERATIONCONNECT.COM

What is your definition of “team”?

What is the common goal of your care team?

How do you empower members of your care team?

Keys to teamwork?

TEAMS

YOUR CARE TEAM

DEBBY’S CARE TEAM

STORIES

How does your care team use photographs, stories and reminiscing?

How can technology help?

APPS FOR STORIES

Camera

Adobe Spark Video

Swaha

RELAXATION

How does your care team use relaxation techniques?


APPS FOR RELAXATION

Virtual Active

Relax HD

MUSIC

How does your care team use music and singing?


APPS FOR MUSIC

YouTube iTunes

Spotify SingFit

GAMES

How does your care team use games?


APPS FOR GAMES

Traditional Games

Tangram Colorfy

DIGITAL MEMORY BOX

What is a digital memory box?

How can I create one?

QUESTIONS & CONTACT

WeAreGenerationConnect.com

Michael:

[email protected]

Debby:

[email protected]

Stations #1 - Stories

Station #2 - SingFit

Station #3 - Virtual Active

Station #4 - Tangram

STATIONS

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Hope with PURPOSE Presented by:

Good News Consulting, Inc

140 Roosevelt Ave. Suite 210 York, PA 17403

(717)843-1504

www.goodnewsconsulting.com

Like us on FACEBOOK!

Objectives

• Take Care of You

• Taking Care of THEM

•Have PURPOSE

DO the BEST you can until you know better.

Then, when you know BETTER, DO better!

Maya Angelou

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Who are Caregivers?

• Family or friends providing a range of assistance from a few to 40+ hours per week and activities ranging from providing transportation or running errands to direct physical care including feeding, bathing, toileting, dressing, and 24 hour monitoring. -AARP

According to an AARP Study

• 1:4 caregivers report that they are living with the person cared for and most caregivers fulfill multiple roles, they live with a partner, work and manage caregiving responsibilities at the same time and are primarily women.

2016 Alzheimer’s Disease Facts & Figures

• In 2015, 15.9 million family & friends provided 18.1 billion hours of unpaid care to those with Alzheimer’s and other dementias. That care had an estimated economic value of $221.3 billion.

• Approximately 2/3 of caregivers are women. 34% are age 65 or older. 41% of caregivers have a household income of $50,000 or less.

• On average, care contributors lose over $15,000 in annual income as a result of reducing or quitting work to meet the demands of caregiving.

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STRESS-What is it?

• Stress- body’s natural reaction to tension, pressure and change

• It effects us physically and emotionally

• Everybody experiences stress

• Prolonged stress can lead to serious health problems

• Stress means different things to different people.

10 symptoms of Caregiver stress

• Denial

• Anger

• Withdrawal

• Anxiety

• Depression

• Exhaustion

• Sleeplessness

• Irritability

• Lack of Concentration

• Health Problems

Tips to Manage Stress

• Know what resources are available

• Get help

• Use relaxation techniques

• Get moving

• Take time for yourself

• Become an educated caregiver

• Take Care of Yourself

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Why You’re important • You’ll be able to better take care of others.

• You’ll be able to manage daily responsibilities more effectively and efficiently.

• You’ll be happier and healthier.

• Your stamina, insight, and thinking abilities will be better.

• You’ll get along with others more effectively.

• You’ll be better able to think up solutions to your problems.

Caregiver Resources

• Alzheimer’s Association-www.alz.org

• AARP-www.aarp.org

• Adult Day Programs

• In-Home Assistance

• Visiting Nurses

• Meals on Wheels

• Senior Resource Directory

Taking Care of Them

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Positive Approach

1. Approach from the _______________

2. Go_____________________________

3. Move to the ____________________

4. Get ___________________________

5. Offer your______________________

6. Call them by ____________________

Use this EVERTIME!

COMMUNICATION SKILLS

• HOW YOU

SPEAK

• WHAT YOU SAY

• HOW TO

RESPOND

• TONE – Friendly

• PITCH – LOW

• SPEED - SLOW

Have Purpose

• What was their purpose?

• What can this look like today?

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THE CHALLENGE

• People with Dementia lose the ability to plan

• People with Dementia lose the ability to self-initiate

• People with Dementia lose the ability to follow-through with daily routine (comfort zone)

THE SOLUTION

• We help them create a meaningful day through their interaction with us.

• We help them gain a sense of control.

• We help them be successful no matter what their level of ability

***** ENGAGEMENT *****

ENGAGEMENT – what is it? • Interactive 1:1

– Conversing

• Reminiscing

• Discussions

– Giving / Following Directions

– Techniques for helping with life skills

• Therapeutic

– Planned intervention

– Spontaneous intervention

• Areas of Interest – nurturing center; office; kitchen etc.

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ENGAGEMENT – why?

RESEARCH SHOWS:

• Benefit of repetition – practice what is retained (ability left)

• Benefit of exercising the brain regardless of cognitive level

• Minimizing behavior by creating opportunities for success

• Relationships are KEY to all people

• Consistency creates familiarity (comfort zone)

PLAN SUCCESSFUL ENGAGEMENT

• KNOWLEDGE OF THE PERSON

• PLAN TO USE PERSON’S ABILITIES

and MEMORIES

• INDIVIDUALIZED TOOLS TO USE

ENGAGEMENT Intellectual, Spiritual, Social, Physical, & Sensory

RESEARCH SHOWS:

• Consistency creates familiarity – same types daily

• Benefit of exercising the brain regardless of cognitive level with variety of content

• Benefit of repetition – practice what is retained (ability left)

• Minimizing behavior by creating opportunities for success in areas of familiarity

WE DO THESE TO CREATE “NORMALCY”

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You can make a difference!

An old man walked up a shore littered with

thousands of seashells and starfish,

beached and dying after a storm. A

young man was picking them up and

flinging them back into the ocean. “Why

do you bother?” the old man scoffed.

“You’re not saving enough to make a

difference.” The young man picked up

another starfish and sent it spinning back

to the water.

“Made a difference to that one,” he said.

Caregiving Gems - Alzheimer's Association · Diamonds Emeralds Ambers Rubies Pearls. 1/3/2017 7...

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