Dementia Video 1

 Different types of problems

 Cognitive – memory disorders
 Speech and language,
 Behavioural – agitation, aggression, depression, hallucinations
o Behavioural and psychological symptoms of dementia
 Not everybody gets it – depends on type, stage or how person is affected
 Alzheimer’s – memory problems, difficulty remembering words, behaviour is good (early) ,
not usually aggression, hallucinations, agitation
o Disease progresses – gets these things
 Lewy body disease – hallucinations – see things or hear things that other people don’t see or
hear (aren’t real), early manifestation
Dementia Video 2

good afternoon I'm dr. Anthony Levinson from McMaster University this is my colleague dr. Richard
Strom Co geriatrician and we are here today at our third live event for the I GRE care CA initiative

today's live event is covering off responsive behaviors understanding and managing challenging
behaviors in people with dementia

so welcome dr. Stromm co and i were really pleased with the response so far to our live events and
to the I Jerry care CA website we've had over 22,000 people come and make use of our online
lessons and many many viewers participating in the live events or watching the archives

just a reminder you can watch the participate in this video you already know if you're watching it live
through IG recarey a slash events or through our Facebook page and if you can continue to post
questions either through the IG record CA events chat box or by sending in your comments and
questions through Facebook

so without further adieu let's cover a little bit of background and of course like many things in
medicine we make up lots of different words and expressions just to confuse people

Richard tell us a little bit about the different terms that people may have heard with respect to
challenging behaviors in dementia

sure I think the most common one that we've heard for about the last you know 10 years or so has
been BPSD or behavioral and psychological symptoms of dementia now it's a very broad term and so
I think you know what was originally intended was to say hey there are the problems with dementia
where people have difficulties with their memory and thinking and visual spatial function and all of
those things which are cognitive problems associated with dimension and there's this other category
which is a whole bunch of things and so the behavioral and psychological symptoms of dementia can
include things that we've discussed already so apathy anxiety depression and then things that are
different than that hallucinations delusions and then we get to this other kind of classification of
behaviors where people may be agitated or aggressive they may have hyper sexual behaviors they
may have very repetitive behaviors and so we'll call those responsive behaviors and the reason that
this term is important and probably a little bit more useful for both clinicians and caregivers and the
patients are that the behaviors can happen in response to something so instead of just being
something random oftentimes there are things that take place in the person with dementia
environment that cause them to act that way so for example you know they may get agitated and
aggressive but they're really experiencing pain in their knee or pain from a medical illness or perhaps
they had some sort of infection or something and that has triggered them off you know so I think
that's a much more helpful term because it specifies not only what's happening with the behavior
but what's causing the behavior and if you understand what's causing the behavior then you can
perhaps modify the routine that that person goes through or modify their environment so that
they're less likely to experience that behavior so I think you know we're definitely seeing a trend
over the last few years that more and more people prefer the term responsive behaviors sometimes
people talk about that being more person centric that you yeah trying to understand why might the
person be responding in this way is their behavior related to something in the environment or a
person or a trigger that they might be responding to but some of the other terms that are maybe
more medical or clinical that you may hear our behavioral or psychological in terms of dementia the
other one that sometimes people use is neuro psychiatric symptoms neuro being brain and
psychiatric mind symptoms
so you'vementioned a few of the response of behaviors what are some of the more challenging
behaviors that fall in that category that caregivers you know talk to you about

sure a big one is agitation or emotional lability and so all of us experience that day-to-day you know
you may be exposed to something that causes you get angry or a little bit frustrated now when
somebody has a dementia they may lose the braking mechanism in their brain to kind of keep those
emotions under control and they might become more emotionally responsive with a really small
stimulus so you might have been mildly aggravated before you had dementia but after you have
dementia you might actually get quite upset and start yelling over something that's simple

it's like the problem with the filter

exactly yeah and often times we'll find that happening when let's say a caregiver is suggesting that
the patient is having a problem or the person with dementia rather is having a problem with their
day-to-day activities our pointing out that they might not be as sharp as they used to in certain areas
the person with dementia might get very defensive and agitated and upset surrounding that and two
of the other types of symptoms that I often get called upon to see are hallucinations and delusions
maybe say a little bit about what kinds of things people might notice with respect to hallucinations
or delusions sure and I you know I'm not sure I would qualify these per se as the responsive
behaviors because they're the hallucinations and delusions aren't generally a result of what's
happening in the environment they're more a result of the damage that is happening in the brain so
hallucinations are perceptual abnormalities so people can see something that's not there that other
people do not see or hear things occasionally they can feel things or smell things but most
commonly what we will see in people that have dementia are visual hallucinations and let's slightly
less commonly would be the the auditory hallucinations or things which people hear people can see
animals or insects they may see people occasionally they'll describe children and those would be
more common in advanced stages of most dementia so Alzheimer's disease you usually would not
get that earlier but people that have dementia with Lewy bodies can get that early in the course of
their dementia so very distressing to see for some people and so some people will see them and not
be distressed about these mm-hmm these things that they're seeing so I'd say the most common
hallucinations that people get her visual in nature there are less well-formed hallucinations the
people experience as well so people that have Parkinson's disease with an Associated dementia
might just see shadows passing through the periphery of their vision which would be something
that's more common so they can take on a bunch of different we would call that like a an illusion
where yeah there's something in the environment maybe somebody sees a broom in the corner and
misinterprets it as a as a person and you know again there may be a behavior that arises because of
a hallucination or an illusion so somebody may get frightened thinking there are snakes on the
ground or animals and they may you know walk away from a situation so so as you say the
hallucination or the delusion may not be the behavior but there may be a behavior because of it so
with delusions some of the more common delusions so a delusion is really a a fixed false belief so
somebody thinks that the mafia is out to get them or you know and that's why I say it's often what
we call paranoid delusion where somebody feels like they're being a targeted the really a safety
concern they may be convinced that people are stealing from them or hiding things they may be a
memory problem they've forgotten it and they just assume that it's been stolen so sometimes I think
delusions may be likely to lead to some type of responsive behavior where the person is you know
worried or concerned for their safety and may lash out so yeah I think the most common ones that
we see it in clinics are those of harm so exactly as you're saying someone's trying to hurt you or
harm you potentially infidelity where they're really worried are concerned that their partner might
be unfaithful to them and then theft so being concerned that somebody's trying to steal something
from them and it can happen that hallucinations and delusions overlap and so people will see
something and be they make up a story that exactly it's the yeah so they're seeing somebody in the
room and that person is out to get them or that person is trying to steal something from them so
there can be overlap between the two I guess one of the one of the important things that we also
emphasize if if somebody develops hallucinations very quickly like within a day or two it could be an
important sign of delirium or confusion caused by a medical illness and we do see that quite quickly
so again you know if it comes on slowly and is more typical and it's not the first time then it may be
part and parcel of the dementia but if it's very uncharacteristic and somebody is reporting a new
onset of hallucinations it could be the marker of a medical illness like a urinary tract infection or a
pneumonia I think that's a great point any time in dementia things start moving fast you have to be
really concerned and always consider as as dr. Levinson is saying some sort of medical illness or
something that's not a slow neurodegenerative process

so let's just talk in broad terms very simply about some of the non medication or non drug strategies
that people use but I think it would be good for us to go to questions relatively soon and Isuspect
some of these will come up and and medication or drug strategies and and no non drug strategies
will probably come out through some of the questions but maybe just a few key points about some
non medicine strategies that might be useful yeah I think the the first thing that we always say is
look around and see what's taking place before the behavior happens so if the person let's say is
getting a bath and they're being exposed completely and that's when they're getting agitated then
you have to think well what's happening throughout the bath period and you and I wouldn't want to
be exposed in that experience so it's not going to change just because you have a dimension so let's
say an appropriate intervention is just bathing them using a sponge bath and only exposing the parts
of the body that need to be washed they've actually done randomized control trials in that and you
know shocking people that get a selective disrobing technique have less of a behavior so just being
specific understanding what's happening before the behavior arises and what's happening in the
environment as well as any of the health care providers or caregiver activities when the behaviors
are happening sometimes sometimes people like caregivers it can be helpful to keep a bit of a diary
mm-hmm and you you may not be you know sometimes it can be obvious what a trigger is oh every
time you know that my loved one has a bath but it's not always easy to tell so sometimes keeping a
diary of when some of the behaviors occur can help you to spot patterns and as I think as you said
paying attention to the person their needs the environment and trying to figure out what might be
the trigger mm-hmm sometimes people will become upset if they're having a difficult time
processing a lot of information at the same time it can become really agitated when they're out in
public if they're all of a sudden put in a situation where they have to talk to a lot of people and so
that might be a situation where you'd want to minimize exposure to that setting which makes them
upset so avoiding triggers in that sense is very important kind of anticipating situations yeah might
make things worse not overloading people with your expectations of them and then to your point
about keeping a diary of when things are happening you know oftentimes these behaviors are
common to occur you know between four o'clock and six o'clock in the evening and people will tell
us and and that's common it's called sundowning we can talk a little bit more about that later but if
you take a diary in or very diligent about understanding when those things are taking place then
you'll see these patterns emerge and understand that they're actually quite common I think to trying
to avoid triggers it's it's hard being a caregiver so monitoring your tone in your response to the
behaviors can avoid escalation so if there's an abrupt emotional response on the part of the person
that has dementia if you can monitor and regulate your tone and keep a neutral body language so
you're not getting upset and aggressive then that can prevent things from escalating further so much
easier said
yeah but you're absolutely right there's and I guess there's a whole teaching approach called the
gentle persuasive approaches and it's you know in part can ya ain't an you're cool can you not get as
frustrated as you might be and it's you know keep calm and carry on so to speak absolutely and I
think the indirect to your point part of this is instead of becoming angry or frustrated at theperson
and their behaviors thinking of something that might distract them from what's upsetting them at
the time so listening to some music or getting them a warm cup of tea you know can I make you a
cup of tea would you like a warm glass of milk can I get you some cookies you know oh what's on
television at this time and if you know something personal about them their personal history maybe
something they'd be interested in so if they were a keen historian oh you know what are your
thoughts on the Spitfire airplane or something like that and I think that gets into knowing and
understanding the person before they had dementia

getting back to your point about a person-centered approach the more you understand about their
personal narrative and what they've been through all of that stuff doesn't go away it becomes less
apparent at the further the illness goes on but there's still a lot of those memories and almost
reflexive behaviors so I think that's also helpful way to engage them absolutely yeah

yeah all right well let's let's go to some questions now and we'll take the first question now Mike my
dad is in a home on a dementia unit so I guess you know in a long-term care type of situation or
nursing home what can we do when he refuses to let the AIDS give him a shower mm-hmm you kind
of talked a little bit about some of the challenges that can occur with bathing and so any any sort of
strategies that sometimes work

in this case I think sometimes there are and sometimes there is not so sometimes you have to
provide that person with space and it's less than ideal especially when it comes to bathing but how I
would say you know how well can your dad express his feelings or concerns at this point can he
describe any specific reasons why he doesn't want to have a shower so trying to understand if there
are yeah is it that the temperature of the room is too cold is it that there's not enough lighting
occasionally could you change the the you know between a male or a female yeah there's the
personal support worker or the aide I think sometimes to theirs their people may have their favorite
personal support workers or aides that they connect with and so they may have a better relationship
and a better chance and then I think what you suggested before if if the person is able to
communicate the things that are troubling them great if not maybe try something like minimizing
the exposure starting with a sponge bath and you know maybe there's good days and bad days and
you can pick a good day with a person they like and try a sponge bath and see see if that method
works but there is not always yeah an easy answer no that's and instead of being rigid on
expectation so you know they have to have a bath four times a week it might be taking your time or
taking the time to really give them space to go through a routine slightly slower and maybe it only
happens twice a week you know it's more of a harm reduction approach in that sense and there was
a there's sort of a fallback or a comeback too to that but it sounds like one of the things that's in
inhibitor is that the the person is worried about soiling themselves I think yes the showering and
incontinence can be upsetting and embarrassing so probably trying to do toileting before the shower
the bathing might be one of approach there but again you know it may be there's me maybe not an
easy answer but that would be one approach then that might work and I think the personal support
workers that are on the ward or the nursing staff that are on the ward if you come up with some of
these ideas they may be response responsive to the need back that yougive them and they they
themselves might not be trained in managing responsive behaviors and I think that's important to
note - there's not one curriculum that the personal support worker receive they're not all educated
in exactly the same way so the more that you're able to learn about these behaviors and instruct
them the higher the likelihood of success I think and I think that's generally been considered to be a
real challenge in terms of the education of medical students residents physicians we don't have
necessarily a lot of training in geriatrics and dementia and I think the same goes for many of the
people working in in long-term care or nursing homes they may not have a lot of training there's
often a lot of staff turnover that so again itis one of our rationales for I Jiri care is to help the
caregivers to learn some of these key messages and back to your point about let's say the gentle
persuasive approach is that's an online learning system for formal caregivers nurses doctors and
personal support workers to learn so if you feel there's a lack of understanding on the part of the
formal caregivers then you could point the institution that you're dealing with towards that resource
to try and help educate them

so we have another question this one from Alberta the person saying their mother is on a in the
long-term care or dementia unit she packs and unpacks her belongings sometimes several times a
day and sometimes this includes even moving furniture around and moving furniture out of her
room the person is wondering how how can I get her to understand that she may actually injure
herself and and just to not do these behaviors

mm-hmm I mean that's that's a real challenge and the the downside certainly is any risk of injury so
you'd really want to minimize whatever she's doing to the point of personal risk but in terms of
unpacking that might be something that occupies her mhmmm and if she doesn't feel distressed
while she's doing it it might actually be contributing to making her calm so if it's the furniture side of
things it's really the risk because it's heavier and moving furniture is you know more of a challenge
then perhaps it's a question of trying to anchor the furniture and let her unpack the less heavy items
because that might be providing benefit there are people that we've seen so for instance somebody
that was a secretary or an administrative assistant's coming to assistant coming to the nursing
station all the time and appearing agitated and frustrated but people knew that she was an
administrative assistant so they sat her down at a keyboard and allowed her to tighten and so she
started typing and that took away a lot of her distress or anxiety and this might be a similar situation
if you if you force her to stop doing all of it it might actually have a bit of a negative outcome so and
try and identify yeah if you can identify the the positive things about it maybe she was somebody
who enjoyed traveling and there's packing or maybe it is something that you know is she expressing
some of her frustration with living there and is wanting to leave I think again it's trying to understand
what is the behavior a response to are there particular positives about it because it's a diversion are
there ways that you can either distract when there are maybe things that are potentially more
dangerous like moving furniture or come up with creative workarounds that can you bolt furniture
or remove pieces that could be problematic and I know that's easy for me to say because I'm not the
person that has to clean up everything that she's unpacked but often in these situations we try and
look for any positive outcome associated with it andonly really intervene when there's a large
amount of risk it should be said - that one of the types of behaviors that can occur in dementia is I
think we refer to it in another lesson about perseveration some repetition doing the same things
over again so it's hard to know whether the the packing and unpacking has become a bit of a habet
from that standpoint that roulette relates to a repetitive behavior rather than there being particular
meaning around the packing and right off here's

another question about - you referred earlier to sundowning and that would seem to be a good topic
because I think a lot a lot of people use that term does a person sundown at the same time each day
so maybe say a bit more about what sundowning is and why we think it occurs and whether it
happens like clockwork
absolutely the exact time so it doesn't have to happen at the exact time in terms of 5:30 every day
but between those general hours I'm not sure the physiologic mechanism whether it's related to
fluctuations in the level of cortisol or circadian rhythms we're not exactly sure but people tend to
have worsening cognitive impairment at that time so they may have worsening memory their
attention decreases so their ability to stay in conversations their ability to follow commands may get
worse and then some of the other agitation may take place or pacing so many of the responsive
behaviors we kind of cover in the lessons but repetitive walking around the floor or even the
hallucinations and that the experience might get worse at that time so I wouldn't say it happens at
an exact particular you know an exact time of day but it happens within that window generally and
you know maybe it's 3:30 for some people and maybe it's 7:30 for other people but closer to the end
of the days when people will experience that sundowning effect sometimes some the people's sleep
cycles and yeah day/night cycles may be off in dementia zand if they wake up in the middle of the
night I think it's generally comment that they may be disoriented and may not be aware of where
they are and may have behaviors in response to that they may be frightened about losing track of
where they are and it usually doesn't happen in people that have mild cognitive impairment or a
mild or dementia you'll usually see sundowning much more frequently when people have moderate
or severe dementia

yeah so here's another very good question a challenging one what would the psychological
understanding be of why a person with dementia would treat their primary caregiver who's maybe a
kind and caring concerned primary caregiver why would they treat that person potentially very badly
but maybe react well to other loved ones who either rarely visit or aren't involved in their care that
often

so this person saying they've seen that often with parents with dementia and so they're saying it
seems like a bit of a common response that the person with dementia may be more mean to their
sort of main care partner and treat other people you know with more respect I'm not sure all right I
this would only be a guess but usually the things that you experience are just more exaggerated
when you have a dementia so I don't think it's that infrequent for our immediate family to see us at
our worst and potentially we might feel more comfortable showing sides of ourselves that are less
desirable to our immediate family to then to people that know us less well or Cs less frequently and
I'm wondering if if that's just an exaggerated response to the normal I fix you know circumstances
that we we see in people that don't have dementia I'm not sure if you have any I don't think there's
an easy answer to it I would agree with them that it's not necessarily an uncommon phenomenon in
part it's probably because you know the main caregiver is also probably experiencing some good
interactions but they're having that many more interactions and some of them may be more
challenging they're depending on their primary caregiver role and strategies that they're using they
may be one that is safe setting more limits on the person with dementia or often more in
confrontational types of situations I think it does highlight one of the challenges that can occur for
care partners is you know not everybody has necessarily had a really smooth uh relationship with
their parents growing up and you may be in a position as a caregiver of having to care for a parent
with dementia when you you know didn't necessarily have a very loving relation with relationship
with them so that can be a real challenge as a caregiver which is a stressful situation at the best of
times and you may be feeling resentful as a caregiver and it may be doubly the case if you didn't
have a great relationship with that parent growing up I think that those are the hardest sets of
circumstances that I've seen for caregivers because there's no positive reinforcement for some
people while they're caregiving so it's definitely a challenge
so we've got a longer question here my mother's in an assisted living facility usually when I visit she's
in bed resting and mostly uncommunicative she doesn't want me to bring her flowers she feels she
has to take care of them she no longer wants to phone wants us to phone her because the ringing of
the phone makes her anxious and she has no ability now to actually call out is there anything siblings
and I can do to encourage engagement with her surroundings staffs been diligent in trying to get her
involved in activities for the past year and a half but although compliance she usually declines and
wants to return to her room should we be trying to coax her to do more things that she doesn't want
to do

so this is a really good question that ties in with the discussion of apathy I would say yeah what are
your thoughts on this I think so you know the first the first question we always ask when we don't
have all the information is this is this apathy or is this related to depression or anxiety and so those
are the things that the these are the types of situations where I'd want a bit more information first in
saying you know she having more sad thoughts as she feeling down she's lost interest in activities
that bring her pleasure she can't concentrate as much she's feeling excessively guilty or especially
thinking about death more frequently actively expressing thoughts of committing suicide or other
nonspecific symptoms like experiencing pain we talked a lot about these things in our our last yeah
last live event and so if that's not there and there's no medical illness there and the dementia is you
know progressing then we'd say that's that's apathy that's the lack of desire to get up and perform
goal-directed activities so if she's if she's not that distressed by it if the stress is mostly from the
family and the staff and if it is more apathy than depression and anxiety then it's okay not to coax
her I think the idea is if you can engage her in activities that she enjoys great but if she is wanting to
opt out and doesn't appear to be depressed then it's okay to let her not do things you know yeah I
guess there's no one right approach but it isn't necessarily the case if she has this apathy that she's
necessarily sad and absolutely fine just gonna leave her alone

so here's another question that came in can a change in behavior occur without notice like very
suddenly the person is almost like a split personality one minute there one way and all of a sudden
there another

that's not very common and we talked about if anything changes quickly in a dementia then you
have to go back to the drawing board and consider whether or not this is related to an acute or
short-term confusional event called delirium it can mbe associated with medical problems pain
dehydration constipation urinary retention where the person can't empty their bladder there's a lot
of other causes that we wouldn't get into but certainly in the absence of any kind of obvious trigger
what I change in the in a particular person or it would be much less common it would be less
common and you know if the person isn't that communicative because they've lost some of their
language then you would worry about something like an extreme type of migraine headache or a
headache orsomething like that absolutely

so here's a different comment my loved one seems to be able to turn it on appears more lucid when
they go for a doctor's visit but then is confused after we leave the appointment
and that's I mean that's really interesting because I don't see the people when they go home for
their appointment but I will say that doing some research protocols I actually had the chance to go
back and observe people that have dementia multiple times in the same day and it was interesting
to see the fluctuations in their cognitive abilities within the same day because often we'll only see
them once as a caregiver so cognitive abilities can fluctuate naturally I think that's the the benefit of
standardized tests that really stress the brain so a good one if there's just some mild cognitive
changes is the Montreal cognitive assessment and that's where you can't really hide things or turn it
on the types of questions that are asked or stress your brain enough that if there are problems and
you are having confusion it should be able to show us where you're having problems so one is there
are natural fluctuations in cognition that occur with people that have dementia in particular people
that have dementia with Lewy bodies fluctuate a lot there are normal fluctuations with people that
have dementia but then also we can get around that if you're concerned that they're not presenting
their true cognitive abilities to their doctor by doing these objective cognitive tests I think it's a it's
highlights as well you know mostly when we're in the clinic you know we're seeing just a small
snapshot of somebody and it highlights the incredibly valuable perspective of the caregiver that is
spending the other 23 and a half hours so you know this is it's great if if the loved one is allowing you
to attend the doctor's visits because it would be really important for you to offer your perspective on
some of the day-to-day functional and cognitive challenges so that is why getting all collateral history
from care partners is so important because you only get a little snapshot in the office so and you're
allowed to to discuss those things if you have concerns as well and you know we don't do any
assessments in cognition without asking collateral from the caregivers so it's a very important part
it's kind of neat everything together with the person with dementia is saying what the caregivers are
saying for collateral history and objective cognitive tests to put it all together and figure out what's
taking place I think the other thing is that the context sometimes around a doctor's visit or a specific
activity is familiar to the person so you know unless the doctor is asking other types of questions or
doing more detailed testing people have a kind of a sense of this is what I'm expected to say or do
yes or having a charming personality some people just have charming personalities and those will
outshine any of the collagen cover albums cover up some of the weaknesses exactly

so here's a question my mum does not like suppertime and the person thinks it's associated with
when they have to leave would it be better to not say goodbye and just sneakout so I'm thinking this
is somebody who's loved one who is in long-term care and has like a meal so what would you what
would you suggest there
I think there's no great answer and a lot of the responsive behaviors as well it's great that you've
limited this down to being associated with and you leaving and then it's a question of I think
experimenting and seeing what happened so if they have really bad short-term memory problems
then they might not actually remember the fact that you left in which case if you leave and you avoid
causing them distress or being upset then I think that's completely reasonable and there's no easy
answer for these responsive behaviors or emotional patterns so I would I would try one thing and if
you feel okay with that and it's not causing distress or its minimizing the distress that the person
experiences then it's completely reasonable to to try that and see what happens and then ask the
staff afterwards what happened and then if you do that all the time and it reduces herdistress then I
think it's a completely reasonable course of action I think I think this is a relatively frequent scenario
too and you know I think trying to get to know the routine at thefacility and and figure out the meal
times often what is suggested here is you know don't completely sneak out without saying goodbye
prime the staff that you're going to leave when they sit down for the meal once they're sitting down
and they have sort of the diversion and distraction of the meal then you might even just sort of
whisper in their ear you know I'll see you later something like that so again you sort of you you use
the advantage of there being some distraction and try to minimize it and also highlight that you
know you'll you'll be back again so but yeah and there's no one right right way to do it

okay we've got one or two other questions this is a person who's a volunteer at a long-term care
facility and and also at a hospital they do a lot of talking with residents who are having difficulty
coping and and have exhibited behaviors the hospital I guess has someform of counseling but not
not the nursing home they're wondering about any recommended readings or resources

any any I can suggest there's a the Alzheimer Society has a guide called shiftingfocus which is a good
recommendation not just for somebody working in long-term care but for for care partners generally
andit actually kind of covers some of the things that we've talked about today we do have our our
lesson 8 refers to the apathy so it would be appropriate for the one person and the resources
associated with that and then lesson 9 is the one where we talk about more the responsive
behaviors and we have a few resources there including the link to the Alzheimer's shiftingfocus any
otherresources or readings that you would recommend I I think you've covered it and I think those
are great resources and then just if you're looking for the care team in facility to be better educated
would be the gentle persuasive approaches as side of things so and actually one other really good
resource that we just came across was out of Mount Sinai in Toronto is an app called dementia
advisor and it has a series of scenarios that give very helpful very real-world realistic scenarios with
some of the same suggestions that we've talked about today things that might be helpful in terms of
those kinds of approaches I think to checking out the Center for aging and brain health innovations
website to see all of the different new technologies that are coming out as well and educational
applications there's a lot of great things that it's been interesting to see the explosion of
interventions for dementia caregivers so there's lots of new technology that's coming out quite
frequently in educational apps and educational platforms so and I guess it's interesting

we're at the 42 minute mark of a 45 minute one and we have not talked about medications right for
responsive behaviors and honestly in part it's because really medications are typically a last resort
but do you want to say in a brief period of time say anything about the role of medicines and sure
you know I think exactly as you're saying it's a last resort but it is commonly required and we don't
usually use them unless the person's at harm to themselves or harmto the people around them or
the degree of distress that the behaviors are causing or unmanageable on the part of the caregiver
and the person with dementia so if you have a complete sleep-wake reversal and nobody in the
house is able to sleep for weeks on end that's not a tenable situation the same thing if people are
striking out and being very aggressive we've gone through all our procedures we understand that
there's no specific antecedent set of factors that are starting it they don't have a medical illness
there's nothing else that we can treat like pain or dehydration so we've gone through ourwhole
process and what we're stuck with is something that's a very severe behavior then we'll intervene
commonly the medications we'd use to intervene are antipsychotics so risperidone Haldol
quetiapine or our common ones we won't go I'm feeling I'm feeling that maybe a future live event
rice is talking about the different totally medicines but I guess one of the bottom lines is really the
scientific evidence the data behind the effectiveness of medicines for the management of agitation
and challenging behaviors in dementia it's there's not great science behind it and there's a side
effect so we I think we would encourage you to go through lesson 9 which does talk about the
different classes of medicines and and then maybe maybe a future live event on the topic I think so
you know one one thing just to mention is that they they do work very well for certain people and
sometimes the science is lacking because of the way we measure right the outcomes and so you
know if we're measure all of the bps D and we don't focus in on specific behaviors with specific
medications we into problems so there are side effects associated with them and adverse events but
for some people they're absolutely necessary and for some households and some caregivers their
life-saving

yep okay so that's all the time we have for today any questions that we didn't get to will try to
answer on our Facebook page really please take a moment to fill out the brief survey it's super short
wafer-thin and we're really looking for more input into other topics for live events and anything else
other suggestions you have to improve the experience a couple reminders our next live event will be
on Wednesday December 12th at 1:00 p.m. Eastern Time in thenext period of time we will put a
copy of this video on the website which you can access at IG recarey CA slash events I would really
encourage you to subscribe to our email newsletter which will also keep you aware of when new live
events are coming but use the survey to tell us what you'd like to hear more of in future live events
at this point I would also like to thank our sponsors fundings provided by the Canadian Centre for
aging and brain health innovation which is powered out of Baycrest the Jerris center here at
Hamilton health sciences McMaster University and the Hamilton health sciences foundation and the
Alzheimer Society of Hamilton Halton I would be remiss if I did not remember to say teamwork
makes the dream work so I want to thank Stephanie Jamie Mike and our whole team at the division
of e-learning innovation for helping put together these live broadcasts and we look forward to
seeing you again December 12th thank you very much Thanks