3 Tips for Dementia Management

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Every building in which I've had the pleasure - and challenge - to work has provided a blank canvas from which to jump start my

"therapeutic art." I sum up the personalities, diagnoses, and behavior problems from the start.

 

I've learned that the majority of behavior problems in long term care (and at home) are caused by folks with cognitive decline. Because the diagnosis of "dementia" in patient charts is rarely defined to the actual diagnosis, I decided several years ago to research dementia management in order to provide better care to my patients with cognitive decline. Since then, I have learned a lot!

Here, my friends, are three great tips for managing someone with dementia:

Three Tips for Managing Someone with Dementia:

• Identify the type of dementia
• Learn about the individual
• Modify former leisure interests/avocations to help the individual engage in functional activities with less acting out!

 Identify the Type of Dementia:
When I was a student years ago, I had no idea how many forms of dementia there were. Take a look! I've added links to all the reference sources I used, yet there are many more resources on the internet....the main thing to remember is that each disease has slightly different symptoms, so if you have a family member or patient who is demonstrating behaviors, check out this graph for quick reference:

Types of Dementia:

Broad Category	Type of Dementia	Average Age of Onset	Symptoms
Degenerative Neurological Diseases	Alzheimer's 50-80% of all dementia Check out ALZ.ORG	Early Onset 40’s-50’s Majority: 65 or older	10 Warning Signs
	Lewy Body Dementia	50-83, average survival 7 years	Same underlying changes in brain as Parkinson’s LBDA brochure
	Parkinson’s Disease	Average onset: 60-62 years old at diagnosis	10 Early Warning Signs
	Huntington’s Disease	40 years	Stages
	Fronto-Temporo Lobe Dementia (aka Pick’s Disease)	Between 40-65	Check out symptoms here
Vascular Disorders	Multi-infarct dementia	65	Symptoms
Infections in the Nervous System	HIV dementia	Varies	Symptoms
	Creutzfeldt-Jakob disease	50	Symptoms
Pseudo-dementias	Cognitive Decline caused by: ·         Malnutrition ·         Dehydration ·         Medication-Related ·         Substance Abuse ·         Depression

What to do next?

Learn about the person:



• Interview the person. If they are able to converse, you may have an interesting conversation that sheds a bit of light! If they are unable to have an intelligible conversation,  don't stop...

• Call their contact on the face sheet, usually the DPOA. It's usually a spouse or family member. Tell them you are seeking info about "who this person was" earlier in life so you can create some meaningful activities for them! Usually, if it is a spouse or child of the person, they will share willingly and lovingly about who this person was. I've learned so much through these conversations!!

• If they have done public work, google them! I've learned much about my patients through the internet, usually really good stuff!

Next, modify the activity:


You've learned about the person through conversation. You had an idea of what they loved to do when they were younger and cognitively intact. Now it's time to provide this person with the familiar activity modified for the current cognitive level.

Some examples:

I worked with a man who hadn't said more than a few words for a year. After talking to his daughter, I found out that he and his wife had taken 4-5 trips a year to Las Vegas from the midwest to visit the casinos. He loved to gamble!! I sat down with him and simply handed him a deck of cards. I wanted to see what he would do.

He picked up the cards, rubbed his fingers over the edges, began to turn them over one by one.

"There are 52 cards in a deck...four suits...    diamonds...spades...hearts...clubs..."

I was shocked! Wow. He went on to turn over every card and named the number and suit of each one. He may not have been able to play poker, but he could certainly enjoy his cards.

It's about finding what they love!!

Another lady sundowned every day about 4, just before dinner. Sundowner's syndrome is when someone demonstrates increased confusion, agitation, anxiety or behaviors around sundown. It's a fact of life on a dementia unit.

I interviewed her daughter, and I found out she had enjoyed quilting all her adult life. I knew she couldn't quilt, but how could I modify that task so that she could enjoy it?

I went to the fabric store and bought a bunch of remnants in beautiful colors. I had another patient with whom I was working help me neasure and cut out the fabric into 4" squares. We put them in her "activity box" (more on activity boxes at another post.) 

The next afternoon shortly before dinner, she was teary eyed, running her feet along the floor, leaning foward in her wheelchair and pulling herself along the handrails in the hall.

"Bette, come with me! I have something special for you," I told her.

She rolled up to the table. I took out the fabric and started to lay down one piece at a time, as if I was piecing a quilt. She reached for the fabric and that was it.  She was engaged. Her anxiety and tears melted away as her concentration and focus moved straight into "piecing her quilt."

There was no need to sew or quilt. It was enough to present something familiar that she loved. The staff was then trained to present the fabric squares to her prior to dinner so that she could "work on her quilt." This diminished her sundowning behavior dramatically.

This is not rocket science. It is best done thinking outside the box. You will run into dead ends. Don't give up! Keep looking for the connection. Find the connection with that individual.

What can you do

for your loved ones

or patients with cognitive decline?

Think outside the box!

 Photo credits:

http://www.wpclipart.com/recreation/games/card_deck/cards_symbols/playing_card_symbols.png.html

http://www.janesquiltingscrapbook.com/scrap_quilts.htm