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Creating an Enabling Environment is Key to Providing Dementia Care

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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

Final Stages of Nutrition Therapy Development for Dementia Residents

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What is Nutrition Therapy and who can benefit from it?

Eating and enjoying a meal is part of our everyday life and important to everybody, not least to people living with dementia. A healthy diet and nutrition is fundamental to well being at any stage of life and to helping to combat other life-threatening diseases. We believe it plays as important a role in relation to dementia progression, and a resident’s quality of life. Under-nutrition is common among older people generally, particularly common among people with dementia. Under nutrition tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace as the disease progresses. The mechanisms underlying weight loss and under nutrition in dementia are complex, multi factorial, and unique to each person. Common reasons include reduced appetite, increased activity, the need for a modified diet and, decreased nutrient absorption. For some forms of dementia, it may be that central regulation of appetite and metabolism is disturbed as an inherent feature of the disease. Although we can’t avoid these symptoms which lead to malnutrition and under nutrition, we can manage them with a variety of Nutrition Therapy Options. Orchard at Tucker’s Nutrition Therapy Program is designed to help combat under nutrition and bring back the joy of eating to those who have lost it.

We are in the Final Testing Stages..

After many months of work with our team and partnering dieticians, Orchard Senior Living is in the Final Testing Stage of our 4 Part Nutrition Therapy Program.  Today’s enriched smoothies were a huge hit. These enriched smoothies are designed to help those in the moderate to severe stage of dementia, who have lost significant weight in the last 6 months, and for whom all other care and environmental modifications have failed.  Each 4 oz pretty glass delivered 240 calories, 9 grams of Organic Protein, and so much more. Most importantly each glass looked and tasted amazing!picc (2)

Orchard at Tucker’s Nutrition Therapy Program Coming in nt22018..

Nutrition Therapy at Each Level of Dementia Care

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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

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

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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

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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.