Fundamentals of

Dementia Care for Health

Facility Personnel
 Funded by:
Indiana State Department of Health
Co-sponsored by:
IAHSA
IHCA
HOPE
 Module 1:
Understanding Memory Loss
In this section, we will cover:
 Definition of dementia and Alzheimer’s
disease
 Stages of the disease and the
expectations
 Current medications and treatments
 What is Dementia?
 Dementia is a disease process
– Progressive decline in cognitive function
– Memory loss
 Over 170 irreversible dementias
– HIV, Vascular, Lewy Body, Parkinson’s,
Alzheimer’s
 Some forms are reversible (treatable)
– Thyroid disorders, drug interactions,
dehydration
 Delirium, Depression, and Dementia
 Delirium
– Acute onset, can be treated
– Altered state of consciousness
 Depression
– Gradual onset, can be treated
– Look for signs, such as low self-esteem
 Dementia
– Gradual onset, might be treated
– Memory loss and decline in cognitive function
 Alzheimer’s Disease
 Most common form of irreversible
dementia
– Nearly 70% of all dementias are Alzheimer’s
– Over 4.5 million Americans have Alzheimer’s
– It is estimated that 60% of all nursing home
residents have Alzheimer’s disease
 Alzheimer’s is not normal aging
– Learning new information make take longer
– May be difficult to filter out noise
Brain Scan
 The Diagnostic Process
 Multidisciplinary approach that is 80-
90% accurate
– Brain scan, blood and urine tests,
hearing/visual exams
– Neuropsychological testing and interview with
caregivers
 The only way to confirm diagnosis is
with an autopsy
 Stages
Early Middle Late
 Needs  May need  Severe
reminders hands on confusion
care
 Daily  Needs hand
routines  May get lost on care for
difficult easily most
 Changes in personal
 Concentrati
personality care
on-ion is
difficult  May not
recognize
self or
family
 Areas of the Brain Affected
Cognition Behavior Emotion
 Memory  Communi-  Disregulated
cation
 Learning  Disorganized
 Language
 Safety  Apathy (loss
 Praxic
 Personal of energy,
Function care willingness)
deteriorates  Lability
 Abstract  Lapses in (moods
thinking
clarity change)
 Psycho-
motor speed
 Hallucina-
tions
 Delusions
 Medications
 Cholinesterase  Glutamate Receptors
Inhibitors – Namenda
– Cognex
– Aricept
– Exelon
– Reminyl
 Module 2:
Person Centered Care
In this section, we will cover
 Understanding person centered care
and its characteristics
 Identifying strategies for implementing
person centered care
 Find ways to take care of the
professional caregiver
 Person Centered Care
 Person centered care is truly putting the
PERSON first
 Characteristics
– Behaviors are a desire to communicate
– We must maintain and uphold the value of the
person
– Promote positive health
– All action is meaningful
 Person Centered Care, Cont.
 Core psychological needs must be met
to provide quality care
– Love
– Inclusion
– Attachment
– Identity
– Occupation
– Comfort
 Implementing
Person Centered Care
Recognition Negotiation Collaboration/
Facilitation

Play Timalation Celebration

Relaxation Validation Holding

 Stress!
 Stress can lead to poor quality care,
quality of life, and abuse and neglect
 Signs of stress
– Too little or too much sleep, nightmares
– Fatigue
– Headaches, backaches, joint pain
– Diarrhea/constipation
– Frequent accidents
 Module 3:
Communication
In this section, we will cover:
 The impact of verbal and non-verbal
communication
 Examine and demonstrate techniques
for promoting meaningful
communication
 Understand the correct use of validation
and reality orientation
 Verbal and Non-verbal
Communication
 Each person is unique
 Behaviors are a form of communication
 Communication is only 10% verbal
 People with Alzheimer’s maintain the ability to
understand non-verbal long after verbal is forgotten

Verbal Non-verbal
 Tone  Gestures
 Pitch  Facial expressions
 Rate  Posture
 Pause
 Non-verbal Strategies
 Your mood will be mirrored
 Approach from the front
 Establish eye contact
 Speak at eye level
 Use gentle touch
 Point or demonstrate
 Verbal Strategies
 Use calm, gentle voice
 Call person by name
 Identify yourself
 Use short, simple sentences
 Speak slowly and respectfully
 Eliminate distracting noises
 Use familiar words
 Give simple choices
 Give one instruction at a time
 Allow time for the person to respond
 Validation vs. Reality
Validation Reality
 Become part of the  Early stages, only if not
person’s reality upsetting
 Acceptance  Short explanations
 Feelings into words  New information can be
frustrating
 Acknowledgement
 Reality becomes based on
the past
 Therapeutic Fibbing
 The use of telling fibs or lies in an effort
to calm
 We are never sure how much
information a person may be able to
process or remember
 Should only be used when absolutely
necessary, look for other ways to calm
and support, such as redirection
 Module 4:
Understanding Behaviors
In this section, we will cover:
 Understanding of how and why
behaviors become challenging
 Ways to prevent behaviors
 Techniques for responding to
challenging behaviors
 Emotions a person with dementia is
likely to experience
 Human Emotions
Joy Anger
Pleasure, love, Rage, hate, displeasure
happiness, sexuality

Fear Sadness
Guilt, shame, anxiety Misery, grief
 Respond to Feelings
 Enter the person’s reality
 Look for feelings behind the words
 Empathize
 Be non-judgmental
 Respect their needs
 Your emotions will be mirrored
 Communicate comfort, warmth, and praise
 Smile!
 Put the person’s feelings into words
 Allow for negative feelings
 Problem Solving Behaviors
 Task
– Too complicated, too many steps, not modified,
unfamiliar
 Environment
– Too large, too much clutter, excessive stimulation, no
clues, poor sensory, unstructured, unfamiliar
 Physical health
– Medications, impaired vision/hearing, acute illness,
chronic illness, dehydration, constipation, depression,
fatigue, physical discomfort
 Miscommunication
 The 11 W’s
 Who has the behavior?
 What is the specific behavior?
 Why does it need to be addressed?
 What happened just before?
 Where does it occur?
 What does the behavior mean?
 When does the behavior occur?
 What is the time, frequency?
 Who is around?
 What is the outcome?
 What is the DESIRED change?
 Preventing Behaviors
Diversion or distraction Removal

Redirection Task breakdown

Stimulus Control Environmental

manipulation
Reassurance Setting limits
 Responding to Behaviors
 Anxiety/agitation
– Response to misinterpretation of environment
or people
 Aggressive reactions
– Usually directed at caregiver or another person
 Rummaging
– Looking for something meaningful
 Repetitive crying out
– Unresolved pain or discomfort
 Module 5:
Activities of Daily Living
In this section, we will cover:
 Causes for resistance to ADL’s
 Strategies that promote participation
 Possible techniques for managing
ADL’s
 Identifying signs of abuse and neglect
 Causes for Resistance
 Memory loss
 Decreased attention span
 Impaired judgment
 Loss of ability to communicate
 Difficulty with motor skills
 Strategies for Participation
 Anticipate problems or events
 Provide a routine
 Establish rapport
 Talk with a calm voice
 Do not attempt to use reason or logic
 Do not rush
 Avoid arguing
 Focus on abilities
 Strategies for Participation, Cont
 Approach—knock, announce, privacy
 Encourage the person to do as much as
they can
 Praise for small successes
 Provide for privacy
 Do not keep person waiting
 Demonstrate what you want done
 Stop when frustration occurs
 ADL Tips
 Dressing
– Layout clothes, limit choices, item to stroke
 Bathing
– Keep routine consistent, privacy, adequate lighting
 Toileting
– Evaluate!
 Eating and swallowing
– Ensure adequate intake, pleasurable experience,
independence
 Sleeping
– Reassure, speak softly, adequate lighting
 Module 6:
Families
In this section, we will cover:
 Empathizing with feelings that a person with
Alzheimer’s and their families may experience
 Identifying and informing families of resources
 Identifying strategies for building a positive
relationship with families
 Understanding the unique opportunity for a
long term relationship
 Family Feelings
 Denial
 Frustration
 Isolation
 Guilt
 Anger
 Loss/grief
 Letting go
 Conflict Resolution
 Denial can be healthy
 Educate in small doses
 Do not push to hard
 Encourage support groups
 Acknowledge
 Listen
 Feedback
 Privacy
 Internal Resources
 Staff members
 Library
 Administrator
 Family counsels
 Care plan meetings
 Alzheimer’s Association
 Helpline
 Family Education
 Support Groups
 Care Consultation
 Safe Return
 Strategies for Positive Relationships
 Show support
– Family tours, communication processes
– Validate emotions, develop realistic
expectations, compliment, report good news
 Promote successful visits
– Offer suggestions and support
– Bring in family videos, pictures
– Activities