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Orchard at Tucker Unveils 4 Tier Nutrition Therapy Program!

We Have Unveiled Orchard’s 4 Tier Nutrition Therapy Program

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

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?

  • Shortness of breath or knot in the throat
  • Stomach cramps or chest pains
  • Headache which could be severe
  • Compulsive eating or excessive alcohol consumption
  • Increased smoking or drug use
  • 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 timeskydd 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
  • lecture series followed by discussion
  • support groups
  • skill-building groups, case studies
  • individual counseling and training
  • family counseling
  • 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 dementiaARP-Caregiving-Summit_80327224-750x485 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.

The Biggest Misconception about the Dementia Brain in Dementia Care

Why is our brain so important?

The brain is the most important organ in the human body. It controls and coordinates actions and reactions, allows us to think and feel, and enables us to have memories and feelings.  Furthermore the brain runs everything. It is the guiding, maintenance, and managing system for hundreds of a human beings needed abilities.

When does dementia occur? The quick answer…

Dementia occurs when the brain is damaged by disease. Sometimes it is one part of the brain, sometimes it is multiple parts.

To understand dementia, we must first understand the brain…

The brain can be divided into different parts: the brain stem and cerebellum, the limbic system, and the cerebral hemispheres.  Each part has different functions.

Brain stem and cerebellum…

The brain stem is at the base of the brain. It controls basic bodily functions such as heartbeat and breathing. The cerebellum
controls balance and posture. Breathing and staying upright are things that we normally do automatically.

The limbic system…

The limbic system is deep inside the brain. It links the brain stem and the cerebral hemispheres. The limbic system includes structures with key roles in memory (the hippocampus) and emotions (the amygdala). The limbic system is the first part of the brain to develop and is sometim6bb16d242f0a68490dfe0106d79a5168es referred to as our “primal brain” and manages many of our survival reflexes. It includes the amygdala which is in charge of the “flight, fright, fight response.

Cerebral hemispheres

The tissue that makes up three-quarters of the brain is called the cerebrum. It is responsible for consciousness, memory, reasoning, language and social skills. A deep groove that runs from the front to the back of the cerebrum divides it into left and right halves: the two cerebral hemispheres.
The left and right cerebral hemispheres have different functions. For example, language is usually dealt wit
h mainly by the left hemisphere. In contrast, awareness of where things are around us is usually dealt with mainly by the right hemisphere.

The lobes….

The four lobes are: occipital, temporal, parietal and frontal lobes. Each lobe does different things, though they also work closely together.The lobes are responsible for our senses. There are 5 ways human beings take in information (data) about the world through their nervous system.. WhatPrint you see, hear, touch/feel, smell, and taste.

The lobes are some of the first areas effected by Dementia..

Dementia diseases often impact abilities in the occipital lobe of the brain which affect a person’s visual field.  Dementia commonly affect the temporal lobes asymmetrically; typically attacking left temporal lobes before the right. This means more loss in language stored on the left, and more preserved skills for much longer. In dementia, different forms of damage to the lobes in the brain can cause someone to become either over-emotional or lacking in feelings. This is one of the reasons that a person with dementia exhibits changes in behavior along with memory loss. Sometimes the changes in behavior may be more pronounced than the memory loss. In these cases, many times dementia gets misdiagnosed since common thinking is, that dementia causes just memory loss.

What is the biggest misconception about the dementia brain  and those with dementia?

Emotional memory is stored in the hippocampal area and is commonly a  preserved skill.  Persons living with dementia may not remember the details of what happened, but will almost always remember how an experience made them feel. Traditional thinking is if someone does not remember what they did specifically shortly after they did it, their day has less relevance, their life should be less purposeful. This is the biggest misconception in traditional dementia care. Those with dementia may get to a point that they don’t remember going to a great concert the next day, or helping to bake and delivering cookies to a police department, but they remember till almost the very end how much they enjoyed the concert, and how good they felt delivering those cookies over to those officers.

The Take Away…..

Orchard Senior Living is determined to bring a new type of dementia care to those inflicted with dementia. It is an engagement focused cognitive care model, where we focus on activities that will be stored in our residents’ emotional memories which they will have with them till they take their last breath.

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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.

Nutrition Assessment is a Part of Dementia & Alzheimer’s Care

Determining if your loved one needs additional nutrition care or nutrition therapy starts with a nutrition assessment.

What is Nutrition Assessment?

Nutrition assessment is a process that nutritionist or dietitian uses to evaluate your nutrition level and determining your current nutrition needs. Your nutrition level ranges from great to extremely deficient. The first step is to determine your individual nutrition needs for optimal health. This step includes knowing a thorough history of your diet, lifestyle, medical, chronic conditions.  The second step is the evaluation of your nutrition status, calorie, protein and nutrient needs, adequacy of your diet, possible deficiencies or food intolerance(s), need for further testing, recommendations for diet and lifestyle changes and supplements.

Your Nutrition Assessment looks at all these areas:

  • Diet history
  • History of Weight Loss
  • Recent illnesses or Diagnosisexps21585_THCA153054D10_15_4b
  • Lifestyle history
  • Medical history (such as Dementia or Alzheimer’s)
  • Evaluation of blood and diagnostic tests
  • Recommendations for testing (testing for allergies, for vitamin deficiencies)
  • Evaluation of nutrition status (how serious is the deficiency)
  • Calorie needs (based on height, weight, activity level, sex)
  • Protein needs
  • Nutrient needs
  • Adequacy of your diet
  • Possible diet deficiencies
  • Food intolerance

The Takeaway…

Identifying malnutrition is an important first step in identifying a problem. 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. 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. 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 2018 Nutrition Therapy Program is designed to help combat under nutrition and bring back the joy of eating to those who have lost it. However it all starts with an nutrition assessment.

 

 

Proper Hydration Care is Essential in Dementia Care

Why is Proper Hydration Important?

Drinking fluids is crucial to staying healthy and maintaining the function of every system in your body, including your heart, brain, and muscles. Water and fluids carry nutrients to your cells, flush bacteria from your bladder, and prevent constipation. Dehydration is the most common fluid and electrolyte problem and one that can have devastating long-term effects.

Who is most at risk of getting dehydrated?

Seniors often don’t get enough fluids and risk becoming dehydrated, especially during summer when it’s hotter and people perspire more. Older people don’t sense thirst as much as they did when they were younger. And that could be a problem if they’re on a medication that may cause fluid loss, such as a diuretic.

What are the Symptoms of Dehydration..

 

  • Increased thirst
  • Dry mouth
  • Tired or sleepy
  • Decreased urine output
  • Urine is low volume and more yellowish than normal
  • Headache
  • Shriveled Skin
  • Dizziness and Vomiting
  • Muscle Weakness/Muscle Cramps
  • Increased Pulse Rate

Why is Dehydration so detrimental to Proper Dementia Care?

Dehydration increasesdehydration-lead confusion, causes muscle weakness and extreme fatigue. Increasing confusion in a person with dementia may lead to a dangerous and a negative event such as falling and breaking a hip b405bf69ae40082ad930857892a8991a. Increased muscle weakness in a person who already has dementia makes them many times more likely to have a fall and end up in the hospital or rehab.

How to Defeat Dehydration?

In a Community caring for residents with Dementia or Alzheimer’s, who are normally confused or forgetful, extra diligence in providing proper hydration as well as monitoring for dehydration is essential. Those who have dementia, need to be reminded to drink fluids throughout the day. Fluids should also be brought directly to the person with dementia and they should be encouraged to drink. Flavored waters in pretty containers are helpful and yield a more positive outcome. A group hydration station is a fun activity that could be done daily. A variety of colors and flavors should be offered each week, to keep hydration fun. You should also remind those with dementia and their family members that fluids will decrease pain, keep them more alert, reduce constipation, and keep them out of the hospital. Dementia or not, no one wants to go to the hospital.