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Tips for Seniors (and their Families) on Downsizing Their Home

Sometimes seniors leave a big house to move to a senior community or assisted living. This new home may be more secure, healthier, and happier, but it’s also likely to be smaller.During this process, a family has two main tasks to focus on: helping their senior loved ones settle comfortably with valued possessions and preparing a house for sale. Downsizing with respect and practicality is important to both goals. Here are some transition to assisted living tips that you may find helpful during the process:

Downsizing Made Easy

Downsizing Made Easy

Cherished Possessions

It can be hard to separate possessions that truly matter from things that need to be let go. Be patient with anyone who lived in the house and feels attached to it, and expect difficult feelings as natural to the process. Just don’t let objects take priority over anyone’s well-being: the bottom line is that not everything can stay. If there’s not enough time to sort through everything with sensitivity, temporary storage may be the answer. Families can rent a unit or offer some home storage space so that no one feels stressed by any rush.

If there is time to sort through belongings, have seniors choose what goes to the new residence, what they would like distributed to family or friends, and what can be donated to charity. If children or grandchildren are just starting out in a new home themselves, seniors may be glad to contribute necessities they no longer need. Donations can also be satisfying when an item will help a stranger in need. Some charities will pick up goods and furniture by appointment.

It’s true that homes sometimes collect material things over decades, if homeowners don’t purge periodically. No family member should face exhaustion, or neglect their own family or livelihood, over each and every thing in a crowded house. Make sure the downsizing plan is appropriate for everyone. If the house is going on the market, sellers must declutter it of most contents and deep-clean. It must be staged to attract buyers. Seniors and their families need to commit to being understanding with each other, and also to getting the house sold efficiently.

There are tools that use local sales data to help you find the best time to sell in Atlanta. Statistics for 2014-2016 show that June and July are the best months for closing if you want the highest price possible on the home sale. Thus, listing in April or May, and having the house ready to show then, reaps sales about 7% over the yearly average. If your priority is to sell your house quickly, the data says you should aim for the same two months, since homes closing in June or July spend 1-2 weeks less on the market than those closing in other months of the year.
If you’re debating when to sell your house, find and ask an experienced local agent about the current state of the market and how you can maximize your home sale.

Written by Lin Nulman.

The Need for Dementia Sensitive Primary Care

What was the Inspiration behind this post?

Last week I had a doctor’s appointment with my primary care doctor. It was a 3 pm appointment.  Here it was almost 4 pm and I was just getting called. When my doctor saw me, she immediately apologized and told me the reason for the delay. She said that today many of her patients had dementia, and those appointments take longer than the other appointments, yet they are scheduled for the same amount of time. My doctor knows I work in senior living, so she felt comfortable telling me her feedback of her experience with dementia patients.  My Doctor told me that she spends a large part of the appointment counseling her dementia patients and their families. She also told me, the most frustrating part of her appointments with those with dementia, is explaining to them, that there is little she can do medically to alleviate the symptoms caused by dementia. She said many family members for instance notice their loved one with dementia has suddenly lost weight, and they want a prescription to combat that. She then has to give them the disappointing news that weight loss caused by dementia is a comprehensive symptom and can’t be fixed over night with a prescription. Needless to say, she was very excited to hear about Orchard’s Brand New 4 Tier Nutrition Therapy Program coming in 2018. For more information about Nutrition Therapy for Dementia please visit: http://stage-osl.daveminotti.com/final-stages-of-nutrition-therapy-development-for-dementia-residents/, as well as http://stage-osl.daveminotti.com/nutrition-therapy-at-each-level-of-dementia-care/

What Does Dementia Sensitive Primary Care Mean?

Dementia Sensitive Primary Care, are primary care services that are provided solely to individuals living with dementia. These services are provided by professionals that specialize in dementia, and in many cases only treat those with dementia. This type of care can be provided in a clinic or by a mobile service, by a medical professional ranging from a Nurse Practitioner to a Doctor. This clinic and or professional is designed to replace a person’s primary care provider that they had prior to the dementia.

What is an Example of Dementia Sensitive Primary Care Center?

The Integrated Memory Care Clinic, located in Atlanta, is a nationally-recognized patient-centered clinic that provides primary care for someone living with dementia. The clinic provides a variety of services to meet the challenging needs of those living with dementia. Whether the patient living with dementia has a cold, needs a vaccine, or has a change in behavior, the clinic can help. Dementia and other chronic conditions are managed exclusively by nurse practitioners who collaborate with geriatricians and neurologists on the team. The nurse practitioners have advanced training and specializations in dementia, geriatrics, and palliative care. A clinical social worker is also a vital member of the team. I personally know people that are patients at The Integrated Memory Care Clinic, and I know some of the professionals that manage it. I can say this clinic does an absolutely amazing job, and I would recommend it to anyone who is looking for Dementia Sensitive Primary Care.

Can Dementia Sensitive Primary Care be done outside of a clinic?

The answer is yes. I personally work with several medical groups that provide concierge dementia sensitive care in a person’s home. They can go to someone’s home or to their community. The group I work with closest has a team of professionals that provide the care. Their team is made up of a Geriatric Psychiatrist, a Nurse Practitioner and a Doctor trained in dementia care, as well as an Occupational and Speech Therapist. These professionals work as a team to define the patient’s cognitive, functional and behavioral profile, and create a care plan to manage their care. The extent to which each specific professional sees the patient depends on the patient’s needs and their profile. These services are offered in a person’s home, and at the Orchard, or another community.

Why do we need Dementia Sensitive Primary Care for those with Dementia?

Currently, 50-90% of all dementia gets misdiagnosed or gets missed all together until a crisis happens.  Even if Primary Care Professionals start to more accurately recognize dementia, the quality of management of the disease after the diagnosis is usually sub optimal. Even if a PCP can diagnose dementia, in many cases they do not have a plan for follow up management. After dementia is diagnosed, there needs to be a plan of care set up to address potentially starting dementia-specific drug treatment to slow the decline, assessment and management of Behavioral and Psychological Symptoms of Dementia (BPSD), safety issues in and out of the home, side effects of psychotropic drugs, as well as the stress of family care givers. Most Primary Care Professionals today are not equipped to provide follow up dementia care. These PCPs are missing the coordination of primary healthcare partners,7730d221ef4d4b91dffa4c2100dde11e--flowers-wallpaper-hd-wallpaper as well as the implementation of support for both people with dementia and their caregivers. Hopefully in the next few years, more Integrated Memory Care Clinics will spring up, and more people with dementia will receive the Dementia Sensitive Primary Care they need.

 

Dementia, I Will Give You My Memory, If You Leave Me My Personality

What Does Dementia Mean to the Average Person?

Dementia is a general decline in cognitive ability severe enough to interfere with daily life. Memory loss is one example. Dementia is not a specific disease. Dementia is a term that describes a wide range of symptoms associated with a decline in memory and other thinking skills severe enough to reduce a person’s ability to perform everyday activities. People with dementia often have problems with short-term memory recall, keeping track of a wallet or other possessions, paying bills, planning and preparing meals, remembering appointments or traveling out of the neighborhood. Dementia is progressive, as symptoms start out slowly and gradually get worse. As Dementia progresses, individuals notice increased memory loss, mental decline, confusion especially in the evening hours, disorientation, inability to speak or understand language, making things up, mental confusion, or inability to recognize common things.

What Does Dementia Mean to Those of Us Who See it Every Day?5724-asorc-microsite-tile

Although the above examples of dementia symptoms are true, and do indeed interfere with a person’s everyday life, they are not a full picture of dementia symptoms. When dementia steals memory, language, thinking and reasoning, these new deficits are referred to as “cognitive deficits” of the disease. The term “behavioral and psychiatric symptoms” describes a large group of additional, and in my opinion most devastating, symptoms that occur to at least some degree in many individuals with dementia. In early stages of dementia, many experience personality changes such as irritability, apathy, anxiety or depression. In later stages, many experience sleep disturbances, mixing up their days and nights, agitation such as physical or verbal outbursts, combativeness, combativeness while getting care, refusal to get care, general emotional distress, restlessness, continuous pacing, shredding paper or tissues, yelling for no apparent reasons, delusions, paranoia, misperceptions, or hallucinations.

Real Life Example of a Behavioral Change.

Linda is 87 in the moderate stage of dementia. She retired as a Vice President of a company. Her family told me that she was known for her business acumen and immaculate appearance. Her outfits were always perfectly put together, her makeup and hair flawless. Today, due to the dementia, it is a struggle to get Linda to take a shower, comb her hair, or get any grooming what so ever. She refuses to wear makeup and will very rarely agree to get her hair done. She refuses manicures and pedicures that she used to get weekly for over 40 years.  It is extremely painful for her family to watch Linda, who was always so well put together, now refuse to get her hair done, and be combative when any grooming is attempted.  Unfortunately, this type of a personality change is common to those with dementia.  Dementia has stripped Linda of her desire to look nice and be well groomed. In a year’s time, dementia has changed grooming habits Linda had for over 40 years.

Real Life Example #2

Lynn is 84 in the moderate stage of dementia. She worked as party planner before she retired. She was always very social and the life of the party. Lynn remained social into the mild stages of dementia. During the tail end of the mild stage, Lynn was still social, however when she would be around others they would ask her questions about her family and herself that she had trouble answering due to her dementia. Each time Lynn was not able to answer a question, she would leave the social or the event immediately. Shortly after, Lynn refused to participate in any of the hobbies and socials she enjoyed her whole life. This is another common example of dementia changing a person’s personality, and converting a social butterfly into a reclusive butterfly.

Silver Lining of Example #2.F778569F-5132-4C60-B010-4667A225A893

Lynn was reclusive and isolated for several months. Finally, her family decided to move her to the Orchard at Tucker, a community that specializes in cognitive care and engagement for those with cognitive deficits. Lynn’s family provided the Orchard with a detailed profile as well as her history and the Orchard engagement team came up with a detailed plan to combat Lynn’s new reclusive personality. The engagement team took all the information they were given, and they were able to create an Enabling Environment for Lynn. To learn more about enabling an environment see http://stage-osl.daveminotti.com/creating-an-enabling-environment-is-key-to-providing-dementia-care/)

With the creation of a new enabling environment, Lynn slowly started to participate in some activities. Although the Orchard engagement team did several things to modify her environment, one such modification was surrounding Lynn with other residents that were on her cognitive level. They also made sure that all team members were aware of Lynn’s history and her strong desire to mask her dementia.  When everyone was aware of Lynn’s dementia, and the other resident around her also had dementia, no one asked Lynn any difficult questions, and her dementia never stood out to others. This one environmental change alone led to Lynn participating in activities daily, although never to the extent she used to participate prior to the dementia. Environmental modifications are very helpful, but they can never make up for all the damage caused by dementia. In Lynn’s case, her personality change could have been minimized if an enabling environment was created sooner. I believe Lynn’s personality change was so significant, so quickly, at least in part due to Lynn losing her self-esteem by not being able to answer the questions asked, and her struggle to hide her dementia from those that were noticing. This is a prime example of a personality change that dementia caused, that could have been lessened by an earlier intervention.

The Take Away..

I have spoken with so many loved ones of those with dementia, and they have all agreed, that the behavioral changes caused by Dementia that are hardest on their loved one, as well as the entire family. Losing your memory is nothing compared to becoming a different person.  Also, it is the behavioral changes caused by dementia that impact one’s life, much more negatively than memory loss. It is much easier to compensate for a person’s memory loss than to compensate for extreme anxiety, paranoia, combativeness, or refusal to get care. These behavior symptoms are rarely talked about. When you ask the average person what dementia means, they will say dementia causes memory loss. Most people do not realize how many other terribly negative symptoms are caused by dementia. They don’t realize that if dementia just caused memory loss, most people with dementia would have a much better quality of life. Most people don’t understand the devastation dementia causes. Dementia causes comprehensive memory loss, not just memory loss of what happened yesterday, or what time it is, but in many cases the loss of one’s personality. Very rarely are the personality changes positive. Almost always these behavioral personality changes negatively impact a person’s quality of life.  These changes often create a completely different person, often unrecognizable to friends and family. As dementia progresses, these changes happen quickly and become more and more noticeable.  It is important to understand that they are still the same person inside. They have not changed on the inside, the way they now communicate with the outside world has changed. Dementia causes a person to have a battle, both internal and external, a battle for who they were, and how they were ones perceived.

Creating an Enabling Environment is Key to Providing Dementia Care

How does Dementia effect a person’s ability to enjoy their hobbies and participate in activities?

Dementia gets worse over time. Although symptoms vary, the first problem many people notice is forgetfulness severe enough to affect their ability to function on a daily basis and to enjoy hobbies. One example is playing cards. A person with dementia will likely begin to forget the rules of a card game they have played their whole life. They may mess up during the game, which will usually cause them to avoid a card game they have played their whole lives all together. Aside from general forgetfulness, people with dementia often find that they lack the motivation to do anything. This loss of motivation can be attributed to general apathy or that certain activities have no value if they cannot be carried out as before.  Repeated difficulty doing hobbies that used to be easy is also a painful reminder of the progression of the disease. Lastly but in my opinion most importantly, there is the issue of personal pride which causes masking, which is not wanting to show others that one cannot do something well or is forgetful. Even those who carry on with their usual activities sometimes lack the motivation or the incentive to get started due to the brain changes that come along with dementia. Family members often find it difficult to deal with apathy, particularly if the person with dementia has always been a fairly active person. In order to understand how Dementia and apathy are related, please visit my previous blog post http://stage-osl.daveminotti.com/apathy-is-a-main-the-road-block-of-dementia-care-at-home/
What does creating an enabling environment for a person with Dementia mean?
The first step is to know what type of activities or hobbies a person enjoyed prior to the dementia.  Activities that are related to or connected with past hobbies are often easily accomplished as they bring a sense of familiarity. The second step is to align the type of activity to the stage of dementia. Over simplifying activities for someone with more capabilities is just as detrimental as not simplifying them at all.
Real Life Example: Lets take a puzzle activity. You are working with Jane who has mild dementia, who loves puzzles, and has done them all of her life. You present Jane with a 25 piece puzzle. She finishes it quickly and wonders why you brought her such a “child like” puzzle. This further effects Jane’s self esteem and reminds her that the world notices her cognitive deficits and has started treating her as a child. On the other hand you are working with John, who has moderate dementia, who also loved puzzles. You bring John a 200 piece puzzle. He struggles and struggles with it and after 10 minutes give up in frustration. The solution would have been to give the Jane the 200 piece puzzle and to give John the 25 piece.
What if you are working with a new person and are not sure of their current abilities?
Lets take the above example of Jane and John and puzzles. If you are not sure of their abilities you bring several puzzles to both. In Jane’s case, if you see her quickly putting it together, you tell her that she is doing a great job, and that you knew that puzzle was too easy, and that you brought another one and put the 200 piece in front of her. In John’s case, as soon as you notice that he is struggling you tell him that it appears that there are pieces missing from that puzzle, and you have one for him that has all the pieces, at which point you take out the 25 piece puzzle. It is very important to say that there is something wrong with the puzzle so that John does not feel that you changed puzzles because he could not do the first one.
What is another example of creating an enabling environment?
Choosing a simplified version of an activity, or an easier game or version are also ways of creating an enabling environment. Simplifying an activity or a game by removing some of the steps.
Real life example: Jenn used to be a chef and has cooked her whole life. She has given up cooking on her own but loves to participate in cooking activities. Jenn is in the moderate state of dementia.  You have a cookie recipe that makes cookies from scratch by first making dough and then baking the dough. In order to enable the environment for Jane, you take that same recipe but you remove the more difficult steps such as those steps where the dough is made and you start with the dough being in front of Jenn.  You have now created a simplified version of a hobby that Jenn can do and she will get the same final cookie as she would have if the cookie was made from scratch.
Many do not realize that time awareness is part of an enabling environment but it is..
Many people with dementia loose track of time in general. They also have trouble remembering appointments as well as at what time activities take place. Because they start forgetting and missing activities and appointments, many times they stop attempting to go to any of these appointments or activities. To create an enabling environment, you must take the remembering out of their minds. Instead of telling them in advance, scheduling future events or appointments, you tell them in the moment right before the appointment or activity. You also reassure them, that you will get them for the each activity, not because they will forget, but because you want to. This will take the stress of remembering out of the equation and help foster more participation in hobbies and activities.
1503696303319The Take Away…
Creating an enabling environment takes on many forms. Some of these forms are tangible activities and some are communication styles. It is important to know that creating an enabling environment is not a skill that most people naturally have. It is not a skill that you make up as you go. It is imperative to surround a person with dementia with those who understand dementia, and have received specialized training and have experience with things such as creating an enabling environment and communicating with a person with dementia. Continuing dementia education is a great way to learn the skills to engage a person with dementia. Join us at the Orchard at Tucker, 2060 Idlewood Rd, Tucker GA 30084 on Thursday, January 4th at 6:00 pm for our monthly Live & Learn Dementia Education Forum. For more information call 404-775-0488 or download http://stage-osl.daveminotti.com/wp-content/uploads/2017/12/Live-Learn-Dementia-Educational-Forum.pdf

Nutrition Therapy at Each Level of Dementia Care

mousse-desserts-square.dlWhat is a common challenge for those with Dementia?

Challenges at mealtime are extremely common for those with dementia. These mealtime challenges will change as dementia progresses. There are distinct and separate challenges that are associated with early, middle and late stage dementia.

What are the common mealtime challenges for those in the Early Stage of Dementia?

  • Forgetfulness
  • Loss of concentration
  • Changes in food preferences
  • Reporting that foods taste bland (foods previously enjoyed)
  • No longer enjoying favorite restaurants
  • Unable to hold attention through a meal
  • Distracted by the environment at mealtime

What are the common mealtime challenges for those in the Moderate Stage of Dementia?

  • Confusion and unawareness of surroundings, place and time
  • Appetite increase and weight gain
  • Decreased appetite and weight loss
  • Failure to understand proper use of utensils
  • Refusal to sit during meal times- pacing, wandering
  • Increased difficulty with word finding and decision making
  • Unable to recognize food temperatures
  • Unable to see food as food (may think food is poisoned)
  • Unable to recognize food items once liked
  • Hiding of food

What are the common mealtime challenges for those in the Severe Stage of Dementia?

  • Preference for liquids over solids, due to appetite change or lack of swallowing ability
  • Aggressive or combative behaviors during a mealSmoothies
  • Clenches jaw, or closed fist when attempting to feed or be fed
  • Refusal to eat due to unknown reasons (variety reasons could be at play)
  • Inability to self feed, not being used to being fed
  • Swallowing impairments ranging from mild to severe
  • Weight loss despite regular caloric intake (can also be due to increase activity due to increased anxiety)

What are some important tips for a creating a dining environment for those with Dementia?

  • Tableware contrast ( avoid white plates on white linens)
  • Too many utensils
  • Avoid high gloss floors
  • Natural light is best
  • Avoid a distracting dining environment with too many items on the table
  • Make sure the table and chair is sturdy, and of the right height
  • Simplified dining room is best
  • All food served at once is usually best (although there are some exceptions)
  • Offer finger foods (avoid finger food that are too intricate or rare)

What if the above tips do not work?

If the above tips do not help with the challenges presented at mealtime, your team needs to take further steps to make sure that nutritional needs are met and your resident with Dementia is getting adequate caloric intake and the necessary nutrition.

The first thing your team needs to do is to do a full assessment of each person’s unique situation and determine the specific deficiencies caused by the mealtime challenges.  During the assessment your team must set goals and prioritize the deficiencies, identify resources needed based on the severity of a person’s challenges. Your team needs to also identify possible behavioral and nutrition interventions such as a change of dining environment. Finally your team should specify the time and frequency of the intervention.

What’s Next?

Please check back soon for Part II of this article

 

Elevated Emotions Even Without Memory while Living with Dementia

Which last longer for those with Dementia or Alzheimer’s Disease? Memories or Emotion?

Have you seen long lasting emotions in a loved one with Dementia or Alzheimer’s after the memory causing the feelings have faded? I have on many occasions. Although I have seen it live on so many occasions, there is now science behind it. It’s no surprise that people with Alzheimer’00000s have trouble recalling memories. It is, after all, the hallmark symptom of the disease. However, a new study has found that events can have a longer term and profound effect on how they feel even if they do not remember the particular event.

The Study..

A new University of Iowa study further supports an inescapable message: caregivers have a profound influence—good or bad—on the emotional state of individuals with Alzheimer’s disease. They may not remember a recent visit by a loved one or having been neglected by a loved one, but those actions can have a lasting impact on how they feel. University of Iowa researchers also showed individuals with Alzheimer’s disease clips of sad and happy movies. The patients experienced sustained states of sadness and happiness despite not being able to remember the movies.

The Emotional Life of those with Dementia and Alzheimer’s Disease….

These studies confirm that the emotional life of those with dementia and Alzheimer’s disease last far beyond the tangible memory of an event, regardless if the event was good or bad. “This confirms that the emotional life of an Alzheimer’s patient is alive and well,” says lead author Edmarie Guzmán-Vélez, a doctoral student in clinical psychology, a Dean’s Graduate Research Fellow, and a National Science Foundation Graduate Research Fellow.

The Take Away…

Despite the considerable amount of research aimed at finding new treatments for Alzheimer’s, no drug has succeeded at either preventing or substantially influencing the disease’s progression. Against this foreboding backdrop, the results of this study highlight the need to implement new care giving techniques and care models aimed at improving the well-being and minimizing the suffering for the millions of individuals afflicted with Alzheimer’s. These studies prove that traditional thinking about the emotional life of someone with Dementia and Alzheimer’s Disease is lacking immensely. Traditional thinking still tries to convince people that if they don’t remember it does not matter. At the Orchard at Tucker, we feel it Not Only Matters, but it Matters More. Although these studies are wonderful, we see the importance of emotion based care each and everyday by watching our residents.

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Preference Centered Therapeutic Diets in Dementia & Alzheimer’s Care

puree5What is a Therapeutic Diet?

A therapeutic diet is a diet that controls the intake of certain foods, liquids or nutrients. It is part of the treatment of a medical condition and are usually prescribed by a physician and planned by a dietician or a nutrition specialist. A therapeutic diet is usually a modification of a regular diet with items added or subtracted from a diet. Therapeutic Diet is modified or tailored to fit the nutrition needs of a particular person.
Types of Therapeutic Diets? There are many more than listed below..
  • Nutrient Modification Diets such as renal diet, low salt diet, diabetic diet
  • Texture Modification Diets such as puree diet, mechanical soft diet, liquid diet
  • Food Allergy or Food Avoidance Diet such as gluten free or lactose free diet
  • Supplemental Diet where additional supplements or fortification is added

What is a Preference Centered Therapeutic Diet?

A diet that takes into account the resident’s clinical condition or limitations, in conjunction with personal  preferences, when there is a nutritional indication. It is designed based upon resident’s preferences and desires for their quality of life. Residents goals are also at the center of a preference centered diet. Residents must be provided with all of their nutritional options, detailed description of the need for therapeutic diets, and the consequences and risks associated with not following the recommended diet. A resident needs to be provided with every alternative available, as well as the recommended time frame for the diet.

Examples of a Preference Centered Therapeutic Diet?

Example 1.

Dan has been exhibiting chocking during his meals following his stoke. He has undergone a full evaluation by his doctor and speech therapist who both deemed Dan has dysphagia. Following this diagnosis Dan was prescribed a puree diet. His care partners then started turning his usual meals into puree form. Dan was presented with pureed steak, carrots, pork, and other foods he used to enjoy before the diet restriction. Dan has not enjoyed those pureed meals and has lost 20 pounds in one month. One of the care partners noticed that Dan will eat puree items that naturally come in puree form such as mashed potatoes, smoothies, yogurts and puddings. After these observations, a nutrition specialist created a menu for Dan that includes only puree items in their natural form. Additional flavors of mashed potatoes and yogurt along with other naturally puree foods were ordered in order to fill up Dan’s week with a healthy diet with a variety of choices.

Example 2.

Angie has heart disease. After an examination, Angie’s doctor placed her on a salt restricted diet. Following these orders, Angie has refused to eat most foods and lost 15 pounds. She complained that her food tasted bland and she did not want it. Angie’s care partners contacted her doctor and explained the dilemma and requested that the doctor look into liberalizing Angie’s diet. Angie was also explained in detail the risks and consequences of putting salt back into her diet with her current heart disease. Knowing all the risks, Angie deemed that at 90 years old her Goal was not prolonging longevity, but having the best quality of life. It was her preference to add salt back to her diet, understanding the risks. Her doctor felt that Angie and her family understood the risks and liberalized her salt intake. Angie gained 10 pounds the following month. She was able to enjoy her food again.

The Take Away..

Although therapeutic diets are sometimes necessary and beneficial to a resident’s health, a preference centered therapeutic diet just enhances the benefits buy focusing on the residents’ goals, desires, preferences, along with their nutritional needs and doctor’s orders. All five components work together to create a therapeutic diet that is beneficial to residents’ health yet minimally negatively impacts their desires and quality of life.

The Subtle Signs of Swallowing Problems for Those with Dementia and Other Diseases

How does swallowing actually occur?

The oral phase of swallowing requires a complex interplay of chewing, food bolus formation, and push of the bolus to the back of the throat for the process of swallowing and movement to the esophagus and stomach. Multiple facial and oral muscles, such as the tongue, are responsible for this phase. Once the food bolus is to the back of the throat a series of muscular contractions occur to move the bolus into the esophagus and away from the airway. The airway is temporarily closed as the food bolus is pushed past the tracheal opening and into the esophagus. The food bolus then makes its way to the stomach through another series of coordinated muscular contractions within the esophagus.

Sounds Complicated Right? It is and lots can go wrong..

Due to the complexity of the swallow mechanism, a multitude of problems that can arise. The most common cause of oral dysphagia (swallowing trouble) is stroke, with up to 45 percent of stroke patients develop swallowing problems following the stroke. Other neurological diseases such as Parkinson’s disease, Multiple Sclerosis, Dementia, and Alzheimer’s disease are known to cause swallowing difficulties. Lesions, re flux conditions, and cancer have also caused swallowing troubles but to a lesser extent.

There are obvious and less obvious signs of swallowing difficulties…

Everyone knows that if a person coughs up food or gags while eating, they likely have swallowing troubles. However there are other more subtle signs that can go easily unnoticed such as long breaks between bites, being horse, drooling, frequent heartburn,  and acid re-flux.

What can happen if these subtle signs are ignored?

If subtle signs are ignored they can result in choking, where food partially or fully obstructs a person’s airway, aspiration or inhalation of food or liquids, oral secretions or gastric secretions into the airway and lungs. Also gastric secretions may be inhaled without bacteria causing aspiration pneumonia. A person may aspirate not only food or fluids that are introduced into the mouth but also their own saliva or any gastric secretions, which may be re-fluxed into the airway.

What can be done?

In a community setting, all care partners must be trained to carefully observe each resident for not blatant signs such as chocking, but for the subtle signs such as drooling, and long pauses and usually get confused for something other than swallowing challenges. When a person lives alone, the signs of swallowing trouble usually go ignored until they end up in the hospital. In many setting, little attention is paid to dining room observation. Orchard at Tucker understands the importance of monitoring these subtle symptoms and finding the problem while it is minor,Nutella-Stuffed-French-Toast-with-Strawberries and before it causes a resident irreversible harm.

Transition Care Giving is Essential in Dementia Care

Transition and change in general is hard on everyone…

Have you ever moved into a new house? Started a new job? If you answered yes than you can recall your first week.  Do you recall how stressed out you were with the change? Change of location, change of routine is hard on everyone, however having Dementia and Alzheimer’s makes change about 10 times harder.

Transitioning While Having Dementia? About as Hard as Sky Diving While Being Afraid of Heights..

Dealing with an aging loved one that has dementia or Alzheimer’s can be very stressful, especially when it is time to move that senior into an Assisted Living or Memory Care Community. Many families see how important a familiar environment is to their loved one. Being in a familiar place with a familiar daily routine is something that many with Dementia come to rely on. Families worry about the stress that can happen with their loved one during the transition. Stress is escalated in seniors whose cognitive capacity is limited by their Dementia or Alzheimer’s disease. This is a very real fear. Depending on the progression of disease, changes can be very upsetting and disruptive to the patient. Seniors suffering with progressive degenerative brain disease cannot frame their fears and anxiety with logic, as the rest of us can.  A change in environment can often cause tremendous stress for the senior.

What is Transitional Care?

A private duty caregiver meets the senior prior to the move into a community and accompanies them to the community. The caregiver than spends between 4-12 hours each day for 3-14 days with the senior. They accompany them to activities and trips. The caregiver helps a senior learn their new environment. The caregiver stays with the resident for the scheduled hours. The caregiver is there at arm’s length if a senior gets anxious, confused, or stressed out. The amount of hours and days of transitional care depends on the seniors’ cognitive level,  as well as their stress and anxiety threshold.

Why is Transitional Care Important?

Many seniors whose cognitive abilities are hampered by Dementia and Alzheimer’s, have heightened levels of anxiety. They also experience higher levels of stress in many situations. They also retain less new information, which makes change this much harder. The transitional care giver is there to help lessen the stress of transition by being there with the senior to guide them one on one. Once the senior is settled in their new home, the caregiver remains a part of their care plan until they have become accustomed to their new surroundings.  A transitional care taker may start out by spending 12 hours with the senior for the first 3 days. After the 3 days, they spend 8 hours for the next 4 days. After the first 7 days, the hours go to 4 hours for the next 3 days. After that the hours go to 4 hours a week. Each senior is different, however it is recommended that transitional care giver hours get cut slowly based on the seniors’ needs. It usually takes about 30 days to get adjusted to a new community and getting a transitional caregiver involved softens that blow.

Do Communities Offer Transitional Care?

Some corporate giants like Brookdale do have their own agencies. Most smaller companies partner with an agency so that transitional care is provided by a caregiver that is not employed by the company. Orchard Senior Living now has a sister company Peach Home Care which provides transitional caregivers and private duty caregivers to residents.

How does Parkinson’s disease progress?

Parkinson’s disease does not affect everyone the same way. Symptoms of the disorder and the rate of progression differ among people with the disease. Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly or that their handwriting is slow and looks cramped or small. This very early period may last a long time before the more classic and obvious symptoms appear.

As the disease progresses, symptoms may begin to interfere with daily activities. The shaking or tremor may make it difficult to hold utensils steady or read a newspaper. Tremor is usually the symptom that causes people to seek medical help.

People with Parkinson’s often develop a so-called parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward (called festination), and reduced swinging of the arms. They also may have trouble initiating or continuing movement, which is known as freezing.

Symptoms often begin on one side of the body, or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms are often less severe on one side than on the other.p progression