Current Employee Test #6: Dementia

Dementia is an umbrella term for several symptoms related to a decline in thought process. Common symptoms include a gradual loss of memory, lack of reasoning or judgment, disorientation to surroundings, difficulty in learning, loss of language skills and decline in ability to perform ADL’s (activities of daily living). Dementia can cause agitation, anxiety, delusions (believing something that is not real) and hallucinations (seeing things that are not real). Many forms of dementia are reversible.

Alzheimer ’s disease is the most common form of dementia. It is characterized by progressive impairment in memory, ability to understand, ability to communicate needs, loss of judgment and ability to perform ADL’s. Eventually the client is no longer able to perform ADL’s effectively and becomes dependent on a caregiver to perform these duties. The duration of Alzheimer’s is 3 -20 years. The disease first affects memory but as the disease progresses brain cells die in other areas of the brain until the client needs complete care for all ADL’s. Even in an otherwise healthy person, the loss of brain cells will eventually cause death.

WARNING SIGNS OF ALZHEIMER’S
1. Memory loss. – One of the early signs of dementia is forgetting recently learned information and not remembering the information later.
2. Difficulty in performing familiar tasks- People with dementia can not remember how to do regular daily tasks such as brushing their teeth, making coffee, using a can opener, taking out the trash, checking the mail, etc. etc.
3. Problems with language- A person with Alzheimer’s may not be able to choose the right words to make his or her needs known. They may substitute words making their speech difficult to understand.
4. Disorientation to time and place- It is normal to forget the time or day of the week but and Alzheimer’s patient may get lost on his own street or not know the year or season.
5. Poor or decreased judgment- Alzhiemer’s patients may dress for summer in the winter. Or overdress in the summer with many layers of clothing. They may spend money on things they do not need and send large amounts to telemarketer’s. They can be taken advantage of by home repair scams etc.
6. Problems with abstract thinking- An Alzhiemer’s patient may not be able to add and subtract and take care of their finances.
7. Change in mood or personality- Alzheimer’s patients can have rapid mood swings from calm to anger for NO REASON. They may become unreasonably angry with a caregiver and tell them to leave them alone.
8. Misplacing things- A person with Alzhiemer’s may put things in unusual
places such as keys in the freezer, a wrist watch in the sugar bowl etc
9. Changes in personality- Alzhiemer’s patients can become suddenly suspicious,
fearful of or completely dependent on a family member or caregiver.
10. Loss of initiative- Alzhiemer’s patients may become very passive, sitting in front
of the TV or sleeping most of the time. They may not want to participate in usual activities such as church, social events and shopping for food.

INTERVENTIONS FOR CARE GIVERS
Simplify the environment, decrease noise levels and situations that overwhelm the client. If you go on outings pick less crowded times to visit shopping centers, parks etc.
1. Maintain a routine that is familiar to the client. Eat meals at the same times, shower the same time of the day. Do tasks in the same order. If there will be a replacement caregiver leave a note with instructions on the client’s usual routine and likes and dislikes.
2. Provide frequent rest periods.
3. Post a large calendar. Frequently orient the client to time and date, season, place etc.
4. Remind the client of daily activities and to use the bathroom.
5. Be consistent and introduce new people slowly.
6. Encourage the family to visit and keep traditions with the client without overwhelming the client.
7. Remove unneeded furniture etc. from the rooms.
8. Provide adequate lighting and night lights
9. Avoid restraints but provide adequate supervision.
10. Have the family get a Medic Alert or similar bracelet to identify the client if they wander away.
11. Have handrails and safety devices such as shower chairs installed.
12. Encourage physical activity as tolerated. Go walking at the mall or a park, attend church and social activities. Investigate programs at the senior center..
13. Encourage participation on home care activities. Let the client vacuum, assist with cooking, remember you can not expect the client to complete the task or do it perfectly just let them participate if is safe to do so.
14. Store away potentially dangerous items such as lighters, matches, tools, knives etc., have the family lower the temperature of the hot water heater, remove knobs from the stove if the client wanders around the house and is very confused.
15. Provide exercise as tolerated. Activities need to require little thought such as dancing, painting, folding laundry
16. Avoid stimulants such as caffeine.
17. support normal sleep habits and bedtime ritual—maintain a regular bedtime, change into pajama’s, allow a regular bedtime activity such as prayer, a warm non- caffeinated beverage, a snack, listening to music or reading to the client etc.

CAREGIVING TIPS FROM A PERSON WITH DEMENTIA
1. Give us time and space and keep us doing as much as we can, do not take
over! Let us make mistakes help us not to give up
2. Maybe get us a diary and help us parcel our activities for the day. Keep
Reminding us of the day’s events to get a sense of Tuesdayness or Julyness and to register what we did yesterday or last week.
3. Think up some sort of brain gym- reading children’s books or magazines.
watch quiz shows with us, play board games.
4. Make sure we do not feel overwhelmed. Watch carefully for signs we are
blanking out or going back into our shell.
5. Is there any way we can help around the house? Don’t do it all for us, surely there is something useful we can still do.
6. Make our spaces uncluttered especially the kitchen and bathroom. We have difficulty in vision and coordination which means we knock things over and feel clumsy. Using plastic containers will help.
7. Then when we stare blankly at the mess we have made, please help us clean up, we can not think through the steps needed and get flustered and confused.
8. Avoid background noise if you can when talking to us. If the TV is on mute it first.
9. If children are underfoot, remember we tire easily and find it hard to concentrate. Please limit background noise when there are children around.
10. Maybe think about ear plugs when we are out in public at noisy places
11. Give us time to speak, wait for us to search around that untidy heap on the floor of our brain for the word we want to use. Try not to finish our sentences, just listen and do not let us feel embarrassed if we lose the thread of what we say.
12. Don’t rush into things because we can’t think or speak fast enough to let you know if we agree. Give us time to respond- to let you know if we really want to do it.
13. If we see or smell things that aren’t there, don’t try and persuade us they aren’t. For us they are real. Comfort us and let us know you understand, and that although you can’t se or smell it, you know we do.
14. When you talk to us, think of someway of doing this without questions, which can alarm us or make us feel uncomfortable. If we have forgotten something special that has happened recently, don’t assume it was not special for us too, just give us a gentle prompt – we may be momentarily blank
15. Don’t try to hard to though to help us remember something that just happened. If it never registered we are never going to be able to recall it.
16. If you can avoid saying “ That always happens to me” or “You look so well”
17. Don’t call us “ DEMENTING”. We are still people separate from our disease, we just have a disease of the brain. Saying we are people with a dementing illness has negative connotations.
18. Provide support and material for the sufferers – we need all the support we can get after having what I think is one of the worst diagnoses anyone can get