Approach and Communication

Approach and Communication

 

            As Alzheimer’s disease progresses it can impact the way a person may communicate.  Communication is vital in the care giving process.  It is the way we express our ideas, feelings, and wants.  In order to maintain a quality life, this basic need must be met.   

 

            An individual with Alzheimer’s may have trouble finding the right words, may misunderstand statements that are made, may repeat the same words or statements, or may revert to speaking a native tongue.  As the disease progress, caregivers may also see the person relying more on gestures than words.  For example, it may be easier to point to an object such as a cup of water, than to ask for a drink.  She may pat the sides of her waist to indicate she needs to go to the bathroom.  Some people may have trouble speaking in coherent statements where the phrases sound more like “word salad.”  Word salad is an incomprehensible mixture of incoherent words or phrases.    Caregivers must rely on gestures and other forms of nonverbal communication in order to understand what the person is trying to communicate.

 

            Despite the fact that communication may become more challenging as Alzheimer’s disease progresses, sensitive ongoing communication is important.  Although the person with Alzheimer’s may not respond to each statement, she still benefits from continued communication.

 

Tips to enhance communication:

 

·         Identify yourself by name and what you are going to do for/with the person. Even if you have known the person for years, it is still important to identify yourself and the task.

·         Call the person by his/her familiar name.

·         Use short, simple, one step instructions

·         Give the person plenty of time to respond to questions and statements

·         Limit available choices to two (2) for the person to decide from ( i.e. the blue dress or the red dress, a brownie or ice cream)

·         Don’t ask questions that rely on memory (remember when you ate eggs for breakfast last week?).

·         Speak in a strong clear voice; don’t yell unless the person has a hearing impairment.

·         Don’t talk down or childlike.

·         Turn negatives into positives. Say “Let’s go here” instead of “Don’t go in there.”

·         Turn questions into statement.  Say “Let’s go eat” instead of “Are you ready for lunch?”

·         Be aware of your tone of voice.  Convey an easy going attitude.

·         Approach from the front and never from behind.

·         Use positive, friendly facial expressions.

·         Be aware of your stance – avoid standing with hands on the hip or crossed arms.

·         Focus on feelings not on facts.

·         Validate feelings and help put those feelings into words.

·         Be patient, flexible and understanding.

 

 

            Good communication will bolster self worth, validate feelings, stimulate memories, and calm and reassure.

Brain Protein Could Halt Alzheimer’s

I read this interesting article in McKnight’s Long Term Care and Assisted Living Newsletter yesterday.  It will be interesting to see how this research continues to develop.

 

Brain Protein Could Halt Alzheimer’s

The key to slowing, or even stopping, the progression of Alzheimer’s disease may lie in a naturally occurring protein produced by the brain, according to recent research.

Brain-derived neurotrophic factor (BDNF) is produced by the brain’s entorhinal cortex, which helps support memory. In patients with Alzheimer’s disease, researchers found that production of BDNF is significantly decreased. By injecting the protein into aged animals and animals bred to exhibit Alzheimer’s-like symptoms, scientists at the University of California, San Diego, were able to stimulate the brain’s memory circuits and prevent cell death caused by disease or brain damage.

The effects of the protein were “potent,” researchers said. The animals that received the treatment soon began producing more BDNF on their own, and researchers noted improved memory function and other long-term benefits. The treatment was deemed safe and effective in animal models, leading researchers to believe the treatment work similarly in humans. Their research was published in the Feb 8 issue of the journal Nature Medicine.

Good People Taking Care of Good People

Good People Taking Care of Good People Means Good Business

 

“I’m only 42.  She’s only 67.  I thought Alzheimer’s was an old person’s disease.  My mother is driving me crazy…and I don’t want to say that out loud.  It’s not her fault.  For so many years, she’s been my rock, my role model, my confidant.  But not anymore.  I’m her rock, and my father’s, and my sister’s, and my brother’s, too.  And my kids are so busy in high school.  My husband, God bless him, tries so hard to keep us sane.  Some weeks it’s a zoo around here.  I really don’t know how we’re maintaining.  We just keep plugging away, but can anyone really survive doing this for very long? …”

 

This was the first few minutes of a very long phone call I received at 9 pm the other night. She needed to vent and I needed to provide some “just right” answers.

 

This is the quality of life experienced by many of the so-called “sandwiched” generation, raising their own families and simultaneously caring for aging parents.  They are trying to be SuperMoms and SuperDaughters; SuperDads and SuperSons.  Working all day, taking care of their own children (and maybe even grandchildren), and then coming home at night to start their second job taking care of their parents.  They do so gladly and respectfully, yet with great burden.

 

And it’s not just the “busy-ness” of caregiving that is burdensome.  Caregivers of persons with Alzheimer’s disease and other dementias shoulder a particularly heavy burden of care.   The real burden is the mental stress and the anguish of watching a parent slowly lose his or her mind.  While only one person is diagnosed with the disease, dementia impacts each and every family member for a very long time.

 

These same sons and daughters are the ones calling in late to work because there’s a crisis at home, leaving at lunch time to make sure their parent and the house is safe, and occasionally leaving work early to take Mom to the doctor or to run errands.  Nearly one-fifth of all workers are caregivers.  67% of working caregivers report that they miss work because of their caregiving responsibilities.  In fact, 27% of all unscheduled absences are due to family issues.  Twenty seven percent.

 

Multiply that 27% by the number of Baby Boomers hitting the prime ages of either caring for an aging parent with dementia, or being diagnosed with dementia themselves.  The Baby Boomers were born between 1946 and 1964, making them 62 to 44 years of age.  At 62, 10% will be diagnosed with dementia. 

 

Our workforces and their families are burdened and in need of relief.  The primary caregiver for a person with dementia is generally (but not always) a daughter, 45 to 55 years of age, whose siblings live seven hours apart.  One in four of you reading this has already been impacted by dementia in your families and close associations, yet our companies may offer little beyond a referral source. 

 

How can you and your business or business organization be a catalyst for relief?

 

 

It starts by identifying your colleagues, employees, friends, relatives, and neighbors who are fading under the heavy burden of caring for an aging parent with dementia.  Often, they won’t complain, but you can see it in their eyes and hear it in their voices when you simply ask, “How’s your family?”

 

Offer flexibility in work hours and workplaces to employees who demonstrate responsibility in accessing that option.

 

Implement a decision support service, run by a professional provider network, which tailors “just in time” solutions for individual employees and their families, including

• Individualized relief plans for the employee, his/her family, and aging relative based upon a thorough assessment
• Training for caregivers and supervisors
• Consultation on stress relief and healthy stress management practices
• Training and consultation in managing the crises and complexities of the disease issues
• Organization of community-wide partners for relief
• Education of those partners about the struggles of families facing Alzheimer’s and related dementias

 

Activate the responsible network 24 hours a day, 7 days a week.  Family crises do not usually happen at 2 pm on a Tuesday; they happen at 9 pm on Thursdays and 3 am on Saturdays and 11 pm on Sundays.  The network is of no service if it is unavailable when needed. 

 

And here’s the really important step – the culture of the workplace must support the services, benefits, and policies that are in place in order to be fully accessible to those in need.

 

Anyway you look at it, good people taking care of good people is good business.

Written by Ellen Dunnigan

CEO Alzheimer’s Care Group/Sollievo

www.alzcaregroup.com        www.mysollievo.com

 

Satellite Radio

Satellite Radio

 

            Music is a wonderful therapeutic tool.  Many of our memories are tied to music that we heard while growing up or during a specific event.  Imagine Christmas without the carols, road trips in the car without sing alongs, or prom without those sappy love songs!

            Satellite radio offers a wide range of options for people living in a nursing home.  Activity programs can be designed and complimented with the many different types of music programs played throughout the day.  Options on satellite radio range from Baroque Period Classical, Rock-n-Roll, Gospel and Latin Funk to Country Gold. 

            For example jazz or upbeat 50’s music could be played in the morning during an exercise group.  A sensory group that needs soft music could be paired with the opera station or nature sounds.  I once came across a polka channel and used it during a German Fest.  Caregivers were able to help many residents do the polka.  Some of the people said they hadn’t had that much fun in years!

            Many activity programs use music from the 1920-40’s.  It is always important to remember that residents who are in the mid-stage of Alzheimer’s believe that they are 40 years younger than they actually are.  Today, when preparing music that would be familiar, program directors should consider music from 1968.  That year in music there were many popular hits which are now considered classics.  For example:

 

Louis Armstrong:  What a Wonderful World

Otis Redding:  Sitting on the Dock of the Bay

Johnny Cash:  Folsom Prison Blues

Simon and Garfunkel:  Mrs. Robinson

The Beatles: Hey, Jude

The Who:  The Magic Bus

 

            People with dementia will light up when they hear a favorite song.  It is a great way to start reminiscing about school, young love, work, or vacations.  Don’t be afraid to use the music that was popular 40 years ago.  Chances are good that this music will be associated with many of their memories.

© 2008 Alzheimer’s Care Group

www.alzcaregroup.com

 

Activities for Alzheimer’s

Here’s a quick and easy way to make a resident have a personally meaningful day.

Goal of the Laundry Day Kit 

 

The goal of this kit is to provide sensory stimulation through touch, smell, and sight on a variety of levels.  It should also stimulate memories of working around the home, mom, and children.

Start with a clothes basket.  It should be large enough so that all of the items fit into it easily.

 

Fill your basket with:

• Clothing items:  small children’s clothing, t-shirts, socks, ect.
• Linens: table clothes, wash clothes, blankets, pillow cases, ect.
• Clothes pins
• Linen scents
• Clothes line
• Spray bottle with water

 

 

 

Activity Ideas and Suggestions

 High functioning uses:

1.      Designate a place to hang a clothesline. `

2.      Residents can hang clothing on a clothes line with the clothes pins, and then can take them down later.  Staff should slightly dampen clothing with water in spray bottle.  Fresh linen scent can be added with fabric softener (or other linen scents) in the water bottles.

3.      Random folding can occur any time a resident is not involved in a task but would like to have something to do.

4.      Clothing can be removed from basket and placed on a table for residents to walk up to and fold or for staff to ask residents to help with folding.

5.      Socks can be sorted by pairs and then colors.

 

 Lower functioning uses:

 

            The same uses can be used with the lower functioning as with the higher functioning.  However, residents will need more cueing and 1:1 assistance.  The lower functioning resident may not be able to complete the task as quickly or even at all, but he/she may be able to participate in modified level.  For example, the resident might not be able to roll a matching pair of socks, but could fold the appropriate pair.  Resident might not be able to match up a pair, but will fold two socks together.  Staff should offer positive praise and cueing to enhance the activity task to bolster self confidence.  

 

Resident to Resident Altercations

Resident to Resident Altercations

            Resident to resident altercations can be a serious and difficult issue to face as a caregiver in a nursing home.  Aggressive behaviors can be verbal (yelling, cursing, name calling) or physical (hitting, pushing).  These events can occur without any provocation or because of a misinterpretation of facts or situations.  Caregivers must be able to respond appropriately when one resident begins arguing or fighting with another resident.

              No group of people living together will get along all of the time.   Even the closest families will argue or become annoyed with one another.  Residents living on an Alzheimer’s Care Center are confused due to the cognition loss that they are experiencing from the disease process.  A roommate for example is a stranger, in most cases, that she has never met before.  She is now sharing this space with someone who she is expected to trust automatically.  If she is already experiencing paranoia then becoming accustomed to sharing her space may even be more of a challenge.  When this is tied together with the fact that all of the residents are living with the same cognition loss and confusion about living in an unfamiliar place, the situation may be fertile for aggression.

            Caregivers must approach the situation in a calm manor.  Typically residents with dementia suffer from lability.  They will mirror the emotions of those around them.  If caregivers rush into a situation yelling, pushing, or threatening, the resident will become even more aggressive.  Caregivers must try to identify the immediate cause of the agitation.  What happened right before the incident occurred?  What is occurring in the environment?  Is it too loud?  Caregivers should focus on feelings and not facts.  Validate what the person is feeling and help put those feelings into words.  “I understand you do not want Sally in your room.  Tell me about this photo of your mother.  Did you help her with the garden she is standing next to in this photo?”  Once a caregiver has been able to put those feelings into words, then use redirection to help refocus the energy onto a new task. 

            The best way to eliminate resident to resident altercations is prevent them before they occur.  Programming is the key to success with this goal.  Caregivers should integrate as much of a resident’s past interests into her current daily schedule.  This will not only help the resident to feel as though she has a purpose, it will also prevent boredom.  The need for a purpose does not diminish as a person’s dementia progresses.  In fact, staying focused with purpose is as important in the late stages of the disease process as in the early stage.

            Caregivers need to remember the following important tips in dealing with resident to resident altercations:

·        Never raise your voice to the residents fighting

·        Focus on the feelings not on the facts

·        Limit distractions during the incident

·        Validate feelings and help put those feelings into words

·        Shift focus onto another activity

Prevent behaviors by developing a person centered daily purpose programming calendar.

Keeping the mind exercised

If you turn on the news, you will probably hear something about “brain games.” What exactly are brain games anyway? They are games that stimulate the brain, and give your brain a work-out. Many games we are used to playing do not require much thought. I remember when I was younger my brother and I would have SORRY tournaments. SORRY, even though I still love the game, is not a brain game.

You may wonder why I would blog about these type of games on an Alzheimer’s blog. Back in 2006 the Alzheimer’s Association and USA Today reported that the use of these games could improve speech and brain dysfunction.  The use of these games could also improve memory and problem solving skills and reduce the Alzheimer’s disease process.  Keeping the mind exercised has always been an important part in the treatment for Alzheimer’s.

So, how can you start exercising the brain? Glad you asked. Here are a few suggestions on keeping your brain and your loved one’s brain healthy and active:
-Any Soduko games-you can find these games at any major retail store such as Target, Walmart, Meijer etc…
-Nintendo Wii- These are also used in nursing homes and assisted living homes across the country right now. You can play golf, tennis and even bowling.
-Try new technology!  This is a great way of keeping the brain active as well.  Just by getting on the computer and learning how to e-mail will keep the brain exercised.
-Scrabble- this game has been a long for years, and if you don’t cheat by using the dictionary, it is a great way to exercise that brain of yours!  And for all those tech-geeks out there, you can now even play this game online!

Living at home longer

My grandmother is taking care of my grandfather who has Alzheimer’s.  Did you know that if she continues to seek guidance on how to take care of my grandfather, and is knowledgable about what he needs, that he will be able to stay at home a year and a half longer? It is true; studies are showing that if the caregiver is knowledgable about the disease and how to help someone with the disease, the patient will be able to stay at home longer.

Look at it this way, an edcuated caregiver will allow the family to stay at home a year and a half longer. If you had your family member at a nursing home, and you were paying privately; you would be spending close to $90,000!  If the caregiver is educated on how to take care of their loved one who has this awful disease, they can keep them home and save themselves money!

But caregivers need education, and they need support!  If you are a caregiver, and you do have questions there are places that can help you. Reach out, and get help! Remember, if you are educated, you can keep your family member home a lot longer!

Visits Bring “Just What the Doctor Ordered” to Alzheimer’s Patients

Many times families stop visiting their loved one who is in a nursing home because the visits are awkward. While avoiding the nursing home may be easier on family members, for the person with Alzheimer’s, not receiving that special attention could have a negative impact on the progression of the disease.

 Although people with Alzheimer’s have difficulty remembering recent events, visits with family and friends can help boost the patient’s spirits, which can have a positive effect on overall health. Families who stop visiting because they don’t know what to do or what to say are not alone. The following is a list of activities that families can do during their visits:

·         Create a family photo album together, labeling photos with the date, place and names of those pictured

·         Watch old movies

·         Watch home movies of family events

·         Plant flowers in the center’s courtyard garden

·         Create simple arts and crafts

·         Write letters or holiday greeting cards

·         Listen to old music

·         Bring a calm pet to visit (if the nursing home or Alzheimer’s Care Center allows)  

Tips on Celebrating The Holidays With a Person With Alzheimer’s Disease

With the holiday season approaching, there is certain to be some element of apprehension and uneasiness among families of people with Alzheimer’s disease.  Here are a few tips to make the season a bit merrier and the New Year happier.

Bear in mind that Alzheimer’s disease usually first affects the frontal lobe of the brain, where information about “places” is stored.  So, to the person with Alzheimer’s disease, going to another home, even if it has been visited often in the past, may seem to them a strange and unfamiliar place.   Because of this confusion, the person with Alzheimer’s disease may get irritable and upset with everyone, and the probable cause is the seeming unfamiliarity of that place.

That is not to say that a person with Alzheimer’s disease must stay in the dedicated Alzheimer’s care center for the holidays.  Every person with Alzheimer’s disease has some strengths, as well as limitations.  Determine what these are, and work around the limitations.  It’s probably true that a small, quiet gathering will be more easily handled that a large, noisy one.

Another possibility related to this season’s celebrations and family gatherings is that some members of the family may not be aware the person has Alzheimer’s disease.  Others may be doubtful, even though they have been informed.  Still others may simply not understand.

Why not use the sometimes-traditional holiday letter to share this news in a helpful and non-inflammatory way?  It’s best if relatives and members of the family are kept informed.  As an example, a family might write – “George was diagnosed with Alzheimer’s this summer.  He is currently living in the Alzheimer’s Care Center at Bear Creek Nursing and Rehab.  We keep trying to focus on the positive aspects and on George’s strengths.  We are planning a small gathering with George over the holidays and would like for you to attend.”

Above all, if you are a family member, you are doubly positioned.  Position one is to give your loved one with Alzheimer’s disease the best care possible.  Position two is that you must take care of yourself.

A good gift for an Alzheimer’s patient is more hugs, and continuing love, along with regular short visits.