Treating Individuals with Dementia with Respect

1. Treating Individuals with Dementia with Respect Shelia Selznick, OTR, Participant Care Coordinator Bertie Strickler, TRS, Program Director Thursday February 24th, 2011 Circle Center Adult Day Services

2. Understanding Dementia • Two parts of the brain are dying • Chronic – all other health issues have been addressed • Progressive • Terminal • No choice involved- individual is not misbehaving • It’s not the person – It’s the illness

3. It’s the Illness Not the Person

4. We want normal …. We want control Our brains are working, functioning and healthy We like to think we are always right Individual is doing all they can. We need to go with the flow. Individual’s brain is shrinking, not processing well. When an individual fights back, cusses, shows negative behaviors – it’s the disease – we have to develop more effective skills Keeping ourselves in check

5. You have to meet individual where they are • Let Go (Feelings, Relationship) • Develop a new relationship • Accept that it takes more time • Enter their world and accept that they may not be able to enter yours • Try to form new habits • Repetition is essential. It takes 400 times of trying/using a skill for an 85 year old with healthy brain to develop new habit.

6. “You’ve got to greet before your treat!” • Connect – use preferred name to identify individual • Use visual, auditory and physical cues • Using physical cues without visual and auditory creates uh-oh moment. • Goal is to create ah-ha moments of success by using effective skills

7. Effective Communication • Creativity • Sense of Humor • Enter individual’s world • Find Reality- Know about the disease

8. Tips for Talking • Connect to individual – use preferred name • Use same words • Tell their story- have individual fill in the blank (So you lived in ______ where you worked as a ____) • Avoid diarrhea of the mouth • Don’t ask just tell

9. We can all paddle together and go somewhere or …… Have individuals partner up – hold hand out and push- resistance- stop pushing back- it takes two to tangle and two to dance

10. Communication Pitfalls • Trying to hurry up individual • Doing for them • Arguing • Trying to make them make sense of things • Thinking that individual has a choice- if they just tried harder they would remember

11. Communication Pitfalls Con’t • Don’t you remember when ….” • Talking Fast • Overwhelming individual with too much information • Being the boss

12. Not Communicating Makes Me Feel ……

13. Tips for being more effective • Stop resisting. If we resist, make interaction a power struggle we will be faced with increased resistance • Focus on the relationship Not the task • It takes two to tango or two to tangle • Break into small steps guiding individual to what you want them to do • Use what individual has and help them find skills they are missing • Don’t answer questions with an answer – we need new skill • Don’t blame them • Provide choices, help individual feel sense of control

14. Questions/Comments

15. Concurrent Illnesses that Can Lead to Decrease in Cognitive Functioning • UTI • Dehydration • Upper respiratory infection • Constipation • Mini stroke • Change in caregiver • Change in location • Medicine side effect • Death or loss of significant person • Undetected fracture

16. Skills To Develop • Respect intimate space • Use auditory, visual, and physical cues • Hold individuals hands and give them hand pumps. Allow individual to assist with task (feeding, dressing, etc) • Show and tell individual what you want them to do • Respond with new words, new place, new activity • Don’t answer questions with answers- engage in conversation- Find out what individual needs • Provide individual with option (Do you want this or this)

17. Emotional Angry Sad Lonely Scared Bored Physical Hungry/Thirst Tired or too much energy Need output (pee or poop) Too cold or hot In pain Identifying Needs

18. Resources • Teepa Snow, OTR, presented at Lexington Court Rehabilitation and Healthcare Center, Richmond, VA 12/1/10.