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Balancing maximum independence and home safety for individuals
- 1. Jay White, MS Gerontologist Virginia Commonwealth University BALANCING MAXIMUM INDEPENDENCE AND HOME SAFETY FOR INDIVIDUALS WITH DEMENTIA
- 2. An increased understanding of Home Safety specifically pertaining to adults with a DRD Increased awareness of the spectrum of Dementia Related Disorders (DRD) A greater understanding of the current impact of Dementia in the United States Basic Introduction to Person-Centered Care and Aging in Place LEARNING OBJECTIVES
- 3. Person-Centered Care is an approach to care that respects and values the uniqueness of the individual, and seeks to maintain, even restore, the personhood of individuals. We do this by creating an environment that promotes: WHY PERSON-CENTERED CARE? Personal Worth & Uniqueness Social Confidence Respect Truthfulness Independence Engagement Hope
- 4. WHAT IS PERSON-CENTERED CARE? Person- Centered Care Fosters optimal aging for the individual Empowers Care is driven --as much as possible-- by the individual and supported by the caregiver Core Values of •Choice •Dignity •Respect •Self-Determination •Purposeful Living
- 5. ADDING A DIAGNOSIS OF DEMENTIA
- 6. DEMENTIA: IT’S NOT JUST ALZHEIMER’S Dementia affects 5% of people 65+ 5% and about 40% of adults over the age of 85 40% This accounts for over 5,000,000 adults in the United States Between 2000 and 2010 diagnoses of a Dementia Related Disorder has increased 68%
- 7. GENERAL WARNING SIGNS Memory loss that disrupts daily life Challenges in planning or solving problems Difficulty completing familiar or routine tasks Confusion with time or place Trouble processing visual images or spatial relationships New problems with words in speaking or writing Misplacing things and problems with retracing your steps Decreased or poor judgment Withdrawal from work or social activities Changes in mood or personality
- 8. Do you work with adults with a Dementia Related Disorder: Yes No SURVEY
- 9. Dementia is a group of illnesses DEMENTIA: A BRIEF OVERVIEW Late-onset (age 65+) is most common, slowest-progressing Average course of Dementia of Alzheimer’s Type (DAT): 6-20 years 40% Alzheimer’s Disease is the most common form of dementia
- 10. ALZHEIMER’S DISEASE IS ONE OF OVER TWO DOZEN TYPES OF DEMENTIA
- 11. PROMINENT DEMENTIA SYNDROMES Alzheimer’s Frontotemporal dementia Lewy Body dementia Vascular dementia Huntington’s disease Parkinson’s dementia
- 12. WHY SUPPORT AGING IN PLACE FOR ADULTS WITH A DRD?
- 13. HOW CAN WE SUPPORT AGING IN PLACE? SUPPORT AGING IN PLACE HOLISTICALLY = Person- Centered Biologically Psychologically Sociologically Spiritually Entering into a reciprocal relationship as a Care Partner
- 14. What do you consider the largest barrier to success for adults with a DRD aging at home? 1. Wandering 2. Nutrition 3. Agitation 4. Isolation 5. Care Partner Availability 6. Others? BARRIERS TO SUCCESS
- 15. CHALLENGES FOR AGING IN PLACE 9 out of 10 older adults prefer to live at home (AARP, 2006). This will not change with a diagnosis of Dementia. Homes that are isolated from services Living in homes that are too large or unfamiliar Homes that are not functional for the aging Homes that are rural
- 16. HOME SAFETY CHECKLIST: STAIRS, HALLS Falls can be prevented! Can you clearly see all steps in your home as you go up and down? Free of clutter? Handrails on interior and exterior stairways? Are all loose carpets and runners fastened to the floor or removed? Are there night lights in the hallways?
- 17. Are your stove controls easy to see and use? Are flammable objects (towels or loose fitting clothing) kept away from your stove? Can you reach items you regularly use without climbing on a chair or stool? Or if you do have a stool, is it sturdy? Again, if you have mats or rugs, are they secured to the floor? KITCHEN SAFETY CHECKLIST
- 18. LOW TEMPERATURE SAFETY BURNERS Electric Safety Burners • 1/3 to 1/2 as hot as regular burners, but hot enough to boil water & cook a meal • Food, oil, & most household products will not catch fire • Attaches over existing burners • Assess person's cooking skills for safe usage KITCHEN: QUICK TIPS
- 19. • Cluttered tabletops • Excessive pattern • Hard-to-use dinnerware • Hard-to-eat food items (e.g., large sandwiches) • Uncomfortable furnishings KITCHEN/DINING ROOM: QUICK TIPS
- 20. DINING: QUICK TIPS Speak slowly •it takes the person more time to understand and respond. Encourage •Use encouraging words - Instead of "Don't", or "Sit down, you must eat!“, try to use "Look at this delicious food I made especially for you!” Describe •Always tell the person what you’re serving. Orient •Use pointing, light touch, or an occasional tap on the table to orient the person. Simple and specific •Use simple but specific verbal commands as in "Lift your spoon!" or "Scoop the apple sauce!" •Avoid saying something like "Finish eating, Mom!" Move slowly and calmly •Rushing a person can trigger agitation. Smile a lot •It can help reduce the person's stress (and yours) and make for a more relaxing mealtime. •Ever heard of laughter yoga?
- 21. BATHROOM: QUICK TIPS Do the tub and/or shower have a non-skid surface? Do you have a grab bar installed in your tub or shower? Or what about a bath seat? Watch those mats and rugs! Are you able to get on and off the toilet easily? Consider purchasing a raised toilet seat or consider having a grad bar installed. Does your bathroom have a nightlight? Is your hot water heater set too high (keep under 120 degrees)
- 22. Solution: Anti-Scald Valves installed on faucets, shower heads or tub spouts SCALD RISKS: QUICK TIPS Lower water heater temperatures can increase bacterial growth. For example, 120°F has been the standard recommended water heater temperature for reducing hot water scalding risk. This lower temperature, however, can increase health risks, as bacteria can thrive at temperatures below 140º F, especially in electric heaters. Older adults with weakened immune systems are at increased risk for Legionella bacteria (which causes pneumonia) when water heater temperatures are reduced. Most homes and apartments have water heaters set at 140°F or above. A severe burn can occur in 5 seconds at 140º F or in 1 second at 150º F.
- 23. BATHROOMS: QUICK TIPS Bathing Chairs Showering a person who is sitting is easier and safer than lowering a person into and lifting them out of a tub. The right bath chair or transfer bench can increase the comfort, safety, and hygiene of the person you care for and - as a bonus – is back-friendly for you. We've sorted through a lot of information to give you a condensed "things you need to know" list. Not all bath chairs are equal. For example, some features are safer or more comfortable than others and some chairs are too large to fit into every tub. TIP A colorful towel on the seat that contrasts with the tub floor can help reduce fear of falling for those who have dementia-related problems with depth perception or for those with low vision.
- 24. DEMENTIA-FRIENDLY ACTIVITIES • Increase positive feelings • Bring out hidden memories • Reduce challenging behaviors LIVING ROOM: QUICK TIPS Suggestions: Listening to or signing favorite songs, watching short, soothing videos, looking at magazine or photo albums, aromatherapy hand massage, pet therapy
- 25. LIVING ROOM NEEDS • Good lighting • Comfortable seating • Quiet - reduce distracting sounds • Places to store items (table, armoire, etc.) LIVING ROOM: QUICK TIPS
- 26. MEDICATIONS: QUICK TIPS •Coordinate with all care providers to ensure each knows what the other has prescribed (including OTC, PRN and Herbals)COORDINATION •Ask/Look for possible drug-drug interactions or drug-food interactionsDRUG INTERACTIONS •If swallowing becomes a problem, see if the medication is available in another format (compounding pharmacies may be an option)INGESTING •Keep a journal!JOURNAL •Invest in a pill box organizerORGANIZATION •Develop a routine or invest in alarm remindersROUTINE AND REMINDERS •Use simple language with clear instructions when administeringSIMPLE AND CONCISE •Keep even PRN’s, OTC’s, Herbals and Vitamins in a locked drawerLOCK •Make sure emergency numbers are easily accessibleEMERGENCIES •Review protocol on a regular basis with the progression of the DRDREVIEW
- 27. http://www.alzpossible.org/wordpress-3.1.4/wordpress/webinars- 2/medication-related-issues/ BIOLOGICAL WELLNESS: ISSUES OF POLYPHARMACY AND AGING IN PLACE
- 28. The plagues of loneliness, helplessness and boredom account for the bulk of suffering among our older adults. --“The Eden Alternative”. www.edenalt.org SOCIALIZATION INSIDE AND OUTSIDE OF THE HOME
- 29. Choose the Best Time and Place Plan Ahead Know How to Interact Make sure that whoever is interacting with your loved one knows how he or she can best communicate with the person with dementia. Remind them that they are not only important to you for their presence and support, but that they are still important and vital people in the life of your loved one. SOCIALIZATION: QUICK TIPS
- 30. FOR THE CARE PARTNER Full time Long hours No vacation Applicants are chosen at random without consent! Recharge your batteries Treading Water
- 31. www.thiscaringhome.org www.alz.org www.dementiacarecentral.com www.liftcaregiving.com My91yearoldmom.com www.dcrinc.org Your Area Agency on Agency Communities of Faith RESOURCES
Notes de l'éditeur
- Why are we leading with a definition of Person-Centered Care? We must know the individual before we can adequately and accurately understand symptoms of dementia. Too often, individuals and families look at symptoms they perceive as dementia and fear the worst. It is important to realize from the beginning of this training that there are over TWO DOZEN recognized types of dementia and that is without even looking at depression, delirium and other types of “pseudo-dementia.”Person-centered care is an evolved method of caregiving that transforms the way in which staff work with those they are caring for and with one another.Person-centered care is best achieved when residences move from centralized management with standardized procedures to a team environment with individualized responses at the resident level.We know the person’s needs by knowing the person.The team’s ability to respond individually to those for whom they are caring means the resident is able to live in an environment which supports the “normalcy of his or her life.”Consider showing the video: http://nursing.flinders.edu.au/comeintomyworld/media/video.php?video=8
- Here is more information and terminology associated with PCC.What would you define as “purposeful living”?
- Don’t go from baseline to a diagnosis of Alzheimer’s Disease immediately. Consider alternatives. Consult a specialist.
- Speaker notes: Consider directly addressing the fallacy that “Alzheimer’s” and “Dementia” are entirely separate. Emphasize that Alzheimer’s is one form of dementia, and that there are several others. (e.g., “His doctor says he either has dementia or Alzheimer’s” is a common example of this misconception)Dementia is a term for a group of diseases that affect cognition and memory. Alzheimer’s Disease is the most common form of dementia and is typically associated with the gradual loss of memory, reasoning, orientation and judgment along with the progression of a number of behavioral disorders including confusion, depression and aggression.
- Note that 43% of DRD (Dementia Related Disorders) are diagnosed as Alzheimer’s diseases in adults over the age of 65.Alzheimer disease: This is the most common cause of dementia, accounting for about half of all cases. Alzheimer disease is at least partly hereditary in that it tends to run in families. (Just because a relative has Alzheimer disease, however, does not mean that another family member will have the disease.) In this disease, abnormal protein deposits in the brain destroy cells in the areas of the brain that control memory and mental functions. People with Alzheimer disease also have lower-than-normal levels of brain chemicals called neurotransmitters that control important brain functions. Alzheimer disease is not reversible, and no known cure exists. However, certain medications can slow its progress.Vascular dementia: This is the second most common cause of dementia, accounting for as many as 40% of cases. This dementia is caused by atherosclerosis, or "hardening of the arteries," in the brain. Deposits of fats, dead cells, and other debris form on the inside of arteries, partially (or completely) blocking blood flow. These blockages cause multiple strokes, or interruptions of blood flow, to the brain. Because this interruption of blood flow is also called "infarction," this type of dementia is sometimes called multi-infarct dementia. One subtype whose origin is not well understood is Binswanger disease. Vascular dementia is related to high blood pressure, high cholesterol, heart disease, diabetes, and related conditions. Treating those conditions can slow the progress of vascular dementia, but functions do not come back once they are lost. Parkinson disease: People with this disease typically have limb stiffness (which causes them to shuffle when they walk), speech problems, and tremor (shaking at rest). Dementia may develop late in the disease, but not everyone with Parkinson disease has dementia. Reasoning, memory, speech, and judgment are most likely to be affected. Lewy body dementia: This is caused by abnormal microscopic deposits of protein, called Lewy bodies, which destroy nerve cells. These deposits can cause symptoms typical of Parkinson disease, such as tremor and muscle rigidity, as well as dementia similar to that of Alzheimer disease. Lewy body dementia affects thinking, attention, and concentration more than memory and language. Like Alzheimer disease, Lewy body dementia is not reversible and has no known cure. The drugs used to treat Alzheimer disease also benefit some people with Lewy body disease. Huntington disease: This inherited disease causes wasting of certain types of brain cells that control movement as well as thinking. Dementia is common and occurs in the late stages of the disease. Personality changes are typical. Reasoning, memory, speech, and judgment may also be affected. Creutzfeldt-Jakob disease: This rare disease occurs most often in young and middle-aged adults. Infectious agents called prions invade and kill brain cells, leading to behavior changes and memory loss. The disease progresses rapidly and is fatal. Pick disease (frontotemporal dementia): This is another rare disorder that damages cells in the front part of the brain. Behavior and personality changes usually precede memory loss and language problems. Parkinson disease and Huntington disease begin in subcortical areas. They cause the subcortical type of dementia.
- What we are doing is creating a more diverse menu of living options for older adults. We know that nine in ten older adults want to age in place (AARP, 2000). Here are options in addition to creating a more person centered approach among institutional models. And let me be clear that these are not solutions; just more options. It really is all about the person-environment fit.
- To reduce both the risk of Legionnaire's disease and scalds, many experts recommend keeping the hot water heater set at higher temperatures (140°F+) and delivering safer, temperate water (110° – 120°) at the tap through the use of anti-scald valves. A severe burn can still occur at 120°F, but it takes 5 minutes, allowing the person and caregiver more time to react.These DIY anti-scald products are available as either separate valves that you screw onto existing faucets and showerheads or as replacement fixtures (tub spouts, showerheads, or hand held shower heads) with integral anti-scald valves.Special Note: Because persons with dementia may be unable to operate the faucet with the anti-scald valve installed, it may be best used with a live-in caregiver, given that the hot and cold water must be properly mixed or the water will not flow. Devices should be checked often to make sure they're working properly.
- Always be person-centered in your approach. What did your loved one like in the past? What yields positive results now?
- Remembering which meds to take, the right dosage, and at what times of the day can be difficult for anyone - and a daunting or impossible task for a person with dementia. Without a medication system in place, things can go desperately wrong for a person with declining memory and organizations skills. For example, he or she may take a medication, and then not know whether they've actually taken it. Pill bottle tops, difficult to remove, may be simply left off, allowing the bottles to spill. A person may sometimes take a medicine relying solely on the pill's color, leading to confusion with similar pills. And they may forget - is it one or two of the pink or blue pills? In addition, pills may be hidden under clutter.We all know how a person's health can suffer if they forget a medication, take the wrong one, or take too many. That's why it's essential that the person you care for gets assistance in managing their meds.The type of assistance needed depends on his/her stage of the disease, the complexity of their medication regimen, and whether or not they live alone. For example, in the early stages, he or she may be able to take medications independently, if you sort and organize their pills in a 7-day pillbox. But in the late stages, you'll need to administer all medications and keep them in a safe place to reduce the risk of an overdose.
- It is important to review the many possible side effects of drugs. Many prescriptions for DRD’s can have GI side effects, which may lead to malnutrition or dehydration, that may quicken the disease progression.
- Throughout our lives, we interact with friends, family, and strangers on a daily basis. It is important that persons with dementia continue to have these sort of meaningful encounters, even as their disease progresses. While it is true that your loved one may have trouble retaining memories or remembering his or her own loved ones, he or she can still recognize the attention, feelings, and moods of others.
- Choose the Best Time and PlaceSocial visits should be planned for the times when your loved one is feeling their best. Visits should occur in environments that are not too crowded or busy.Plan AheadMake sure that friend and familiy have appropriate expectations by explaining the nature of the disease and what to expect as it progresses. Prepare visitors by informing them of how the mind and behavior of your loved one has changed. Prepare some sort of activity that can be shared during a visit, such as singing a song, looking through old photo albums, or taking a walk, as this can give your loved one something to focus upon. If there are pictures of the person(s), offer them to your loved one as a visual reminder to who is coming to visit.Know How to InteractMake sure that whoever is interacting with your loved one knows how he or she can best communicate with the person with dementia. Let visitors know that they should go with the flow and try to follow these guidelines:Avoid talking in loud voicesTalk slowly and avoid quick phrases.Be prepared for emotional outbursts and if there are some, speak calmlyKeep eye contactIdentify the person with dementia by name, so that he or she knows when someone addresses him or herBe prepared to repeat themselvesUse commonly used words or phrasesUse props and objects if neededBe prepared for the person with dementia to forget what he or she just said or get confused easilyLook interestedRemind them that they are not only important to you for their presence and support, but that they are still important and vital people in the life of your loved one.
- Delight in the “small stuff”Accept help from “the village”. Family, friends, faith communities, in home care, adult day, long term careTreading Water…it will be increasingly difficult to tread water for two people. Know your limitations and reach out for support.The more you support your loved one’s ability to tread water, the easier it is for you.