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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.
The 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
What 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 meal
- 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
Comprehensive Dementia Care Includes Educating Family Caregivers
What is Dementia?
Dementia is the loss of many or all cognitive abilities, such as thinking, remembering, and reasoning, as well as behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.
What happens to many caregivers of loved one’s with Dementia?
Caring for a loved one with dementia can be challenging and, at times, overwhelming. Frustration is a normal and valid emotional response to many of the difficulties of being a caregiver. While some irritation may be part of everyday life as a caregiver, many caregivers feel feelings of extreme frustration. Frustration and stress negatively impact their physical health and may cause a caregiver to be physically or verbally aggressive towards their loved one.
What are the Warning Signs of caregiver frustration?
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Shortness of breath or knot in the throat
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Stomach cramps or chest pains
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Headache which could be severe
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Compulsive eating or excessive alcohol consumption
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Increased smoking or drug use
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Lack of patience or the desire to strike out
- Sleepless Nights
Why is dementia education important for families caring for loved ones with dementia?
Dementia is called a family disease, because the chronic stress of watching a loved one slowly decline affects everyone. Education helps caregivers understand their loved one’s challenging behaviors and how to respond to them correctly. Often starting out caregivers use intuition to help decide how to respond to a challenging behavior. Unfortunately, dealing with Dementia is counter intuitive, and often the right thing to do is exactly opposite of what seems like the right thing to do. Caregiver education also helps families understand the progression of their loved ones disease. They will learn what to expect and therefore have an opportunity to prepare for these changes. Changes in their loved one’s cognitive abilities wont be a shock every time
they happen, because a caregiver will be prepared for them to happen. Caregivers will also learn which skills are typically retained the longest and can tailor their interactions with their loved ones’ based on these abilities.
How can communities help educate dementia care givers?
There are a wide variety of ways to educate and support family caregivers. Some of these ways are:
- community workshops and educational forums
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lecture series followed by discussion
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support groups
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skill-building groups, case studies
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individual counseling and training
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family counseling
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technology-based training that can be done at home
The Takeaway…
At Orchard Senior Living, we find all of the above methods useful. Each of these methods should be utilized by a community whose priorities are to provide comprehensive dementia care to their residents and their family caregivers. Currently we offer our 3 Step Navigating the Transition Program to individual and families. We also offer our monthly 2 hour Live and Learn Series which combines skill building, lecture, discussion, as well as an educational forum. Both of these programs are presented by a dementia specialist, specializing in family counseling and dementia
training. We also offer a support group facilitated by a Clinical Social Worker. We are currently in the final stages of bringing a web based training program to our residents’ family members to help them on a daily basis. We believe comprehensive dementia care is more than the traditional model of a secure memory care, care partners helping with ADLs, and an Activity Calendar. Comprehensive Dementia Care is taking care of a resident and their families from the time prior to a move in, as well as throughout their entire journey. To find out about the Comprehensive Care Programming at the Orchard call us at 404-775-0488 for a private counseling appointment to determine how we can help. If we can’t help you in your unique situation, will will provide you with the information for those who can.
Delicious Puree Recipes for Assisted Living & Memory Care
One of my favorite puree recipes are Mango Moose Cups. They are easy to make, and most importantly very delicious.
Ingredients you will need
- 1 tsp gelatin powder
- 2 tbsp water
- 5 oz mango puree
- 2 tbsp granulated white sugar (or more to taste)
- 5 oz heavy whipping cream
Dissolve gelatin into 1 tbsp of water. Heat remaining 1 tbsp water until it is hot/almost boiling and add to gelatin, stirring until gelatin is fully dissolved. Add gelatin and puree into blender and mix on high speed until fully blended. In a stand mixer, add 2 tbsp sugar and heavy cream and whip on high speed until stiff peaks form. Slowly add puree into the whipped cream, folding it into the cream until completely mixed and uniform in color. Pour into individual portion cups and refrigerate to set.
It is very important to use pretty glassware that is the right size for the right person. One person may require a 4 oz glass and one a 12 oz glass. It is important to note that personal preferences are very important in all food preparation. Here is an example of a pretty glass.
If we follow this wonderful, easy to make recipes you will get:
Mango Mouse Cups
(please note that the garnishment on top of the mouse is for decoration designed to make the cup look appetizing. Decoration should be removed prior to consumption for those that are on a pure diet)