Category: Progression of Dementia

Gantenerumab Clinical Study for those living with Alzheimer’s disease or a Mild Cognitive Impairment

NursePartners is excited to partake in the Graduate I study run by the Clinical Trial Study Group LLC in Jenkintown (www.theclinicaltrialcenter.com.) 

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The Clinical Trial Study Group LLC is looking for adults 50 to 90 years old to participate in this study.  Participants need to be diagnosed as living with an early stage of Alzheimer’s disease or demonstrate mild cognitive impairments which are indicators for the later development of dementia.  The third requirement is that the participant have a “study partner”.  This study partner has at least 10 hours per week of contact with the participant, enabling the study partner to provide accurate information about the participant’s cognitive and functional abilities.

What are the early warning signs of Alzheimer’s disease and other dementias?  See this article.

Participants will either receive an injection of gantenerumab or a placebo, beginning every four weeks and then occurring every two weeks.

What is gantenerumab?

“Gantenerumab is a fully human monoclonal antibody designed to achieve specific and highly sensitive recognition of the assembly structure of major
components in Aβ plaques. This hypothesis has been supported by the results of preclinical studies.”

What is a placebo?

A placebo is a “dummy” drug with no active ingredients.  It is given in order to mitigate against the psychological bias that result in some participants feeling better or worse just for have been given an injection (versus not receiving one).

Want more information about this study?  Call 215-884-1700 or visit the Clinical Trial Center via their website, www.theclinicaltrialcenter.com.

NursePartners, Inc. clinicians are participating in the administration of gantenerumab and the placebo.  However, this is a clinical study whose results are uncertain.  We encourage those interested to ask more questions and to consider all options.

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Carepartners work through role play scenarios with dementia coaches and practitioners

NursePartners practices the Positive Physical Approach to CareTM as developed by Teepa Snow and her team.  Each client living with dementia is classified by a GEM stone.  The characteristics of these GEM stones, along with the client’s personality and unique life experiences, dictate our approach.

All carepartners are trained to connect before providing care.  Simply put, we find this the most effective method.  Too often, carepartners push forth their agenda without enough emphasis on how it is affecting the client.  The mentality is to complete the “to do” list as soon as possible.

Unfortunately, older adults are not always moving at our speed.  If they are living with Alzheimer’s disease or another form of dementia, the situation becomes even more complicated.  The older adult may not realize what we are trying to do, even though these actions are intended to assist them.  When we rush to complete tasks, this can lead to unfavorable outcomes.  If we provide care before connecting, this can increase anxiety, depression, or lead to aggression.

All carepartners are trained in the Positive Physical Approach to CareTM methodology.  During orientation, carepartners work with dementia coaches and practitioners as they role play challenging scenarios.  We want carepartners to be prepared for all types of situations.

Carepartners are trained to put their agenda away and go with the flow.  They focus on connecting before rushing to provide care.  This simple investment of time pays dividends in the long run as a meaningful relationship is developed between the carepartner and the client.  The result is that the client becomes more receptive to receiving care.

In this video, Denise encounters a client actor (dementia coach) who is non-verbal and fixated on a task.  Instead of demanding that the client focus on her, she engages him in his task first.  She continues to have a conversation, even though he does not respond to her.

When it is time to perform the caregiving task, Denise is patient as the client stands up.  She respects his independence and does not rush to do everything for him.  Denise helps explain how to get up and helps stabilize his gait during the process.

As he stands, she lightens the mood with movement and rhythm.  Music and rhythm are deeply engrained in our brains and is one of the best ways to connect with someone living with dementia.  Carepartners that employ this preserved skill are more likely to succeed than those who do not.

Would you like to learn more about GEM care services or want to join our team?  Call us today at 610-323-9800.

Click to the link to see the full video:

Denise demonstrates the Positive Physical Approach to Care

 

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Denise uses the Positive Physical Approach to Care to guide non-verbal client

The GEMS™ brain change model

NursePartners embraces the GEMS™ brain change model developed by Teepa Snow.  Unlike other scales, such as the Global Deterioration Scale or the Dementia Severity Rating Scale, the GEMS focuses on creating constructive opportunities to engage with the person living with dementia.  Clients are still seen as people, rather than former individuals lost to the disease.

The GEMS allows us to adapt our care approaches to connect with the person in their moment.  We acknowledge what is lost, but use other senses to build meaningful relationships with our clients.

Services begin with a comprehensive assessment that goes beyond the clinical needs.  We want to know as much as possible about our clients’ preferences and personal histories.  This will allow us to connect from day one, building a durable and trusting relationship.   NursePartners changes the plans of care as we learn new information about each client.

All carepartners attend an initial orientation where they actively participate in a dementia workshop.  Carepartners learn the positive physical approach to care and contribute to a dialogue about the disease.  Dementia coaches then stimulate real life scenarios, filming each carepartner as they approach the hypothetical client.  Carepartners watch themselves as they approach clients, recognizing their strengths and acknowledge an area for improvement.  Scenarios are repeated until carepartners feel confident in the learned approaches.

Carepartners then complete a proprietary training module and final assessment, ensuring that they have understood the training.  At this point, they are ready to be assigned to a client living with dementia.  NursePartners admin will then assess if a client and carepartner would be a good match based on their personalities, interests, and general disposition.

All families are given a description of the GEMS model.  We want them to also connect with their loved one, continuing their relationships.  We help families understand that care techniques must adapt as a person progresses through the disease.  Here is a good summary of the six GEM levels.

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Want to learn more about how we can help your loved one living with a diagnosis of Alzheimer’s disease or another form of dementia?  Call us today at 610-323-9800.

 

Vision Changes for those Living with Alzheimer’s disease or another form of dementia

Our field of vision changes as we age, but the changes are drastic for a person living with dementia.  Eventually the field of vision becomes so restricted that sight becomes a main obstacle in carepartners connecting before providing care.  The results could worsen anxiety, hallucinations, mood swings, aggression, and other behavioral issues. 
Visual deterioration progresses in the following order:
  1. 45* peripheral (This is the normal range of vision for an older adult 75 years young.)
  2. Tunnel vision (The width is about a yard in diameter.  Loss of sight occurs in all directions: left, right, up, and down.)
  3. Binocular vision (Cup your hands around your eyes or use a pair of binoculars to experience this for yourself.)
  4. Restricted binocular (Cup your hands tighter around each eye, until they are just loose enough to fit a pencil through each opening.)
  5. Monocular (The brain shuts off vision to one eye.  This is because the brain is prioritizing other bodily functions such as digestion, respiration, and blood circulation.)
NursePartners practices the positive physical approach to care.  We emphasize the importance of recognizing these changes in order to build meaningful and successful relationships.  Admin includes dementia practitioners and coaches that train our carepartners in dementia care before placing them to work with our clients.  
Want to learn more about our dementia training?  Think these approaches can enhance the quality of life for your loved one? 

Call us to learn more about how we can help: 610-323-9800.

Philadelphia demenia care, Philadelphia home care, Philadelphia Alzheimer's disease“Ambers”, or clients living in a middle stage of dementia, experience the world with binocular vision.
If you want to learn more about reducing challenging behaviors, check out this article from Pines Education.
 

Vascular Dementia: causes, progression, and support

This video from the UK Alzheimer’s Society explains vascular dementia.

As described by the video, our neurons require a healthy blood supply.  Our blood brings oxygen and nutrients to each of these cells.

Vascular dementias typically develop in one of two ways.  A major stroke can seriously damage the brain by cutting off the blood supply for a period of time.  Symptoms of dementia would be observable afterwards.  In contrast, a multi-infarct dementia can develop through a series of smaller strokes or by a narrowing of the blood vessels.  In both cases the blood supply is inhibited, either for lesser time for a series of smaller strokes, or gradually by limiting the amount of blood that reaches each neuron.

Certain cardiovascular diseases put individuals at higher risk for developing a vascular dementia.  These include high blood pressure, high cholesterol, and heart disease.

Symptoms include problems planning, organizing, and concentrating.  We should strive to break down complex tasks into basic steps and to simplify the environment.

Unlike other steps of dementia, vascular dementias tend to progress in a step-wise manner.  Although no treatments exist to reverse the associated effects of previous damage, a person living with the vascular dementia may stabilize at a new baseline if the blood supply remains constant.  However, if the blood supply continues to change, deterioration may happen at a quicker pace than for other types of dementia (Brain Test).

It is important for older adults living with vascular dementia to have the support they need to live their lives.  By focusing on what they can still do, we support clients living with this diagnosis.  NursePartners pairs dementia trained certificated nursing assistants with clients living at home or a facility.  Contact us today to learn more about our GEM care services for clients living with dementia.  610-323-9800

 

 

Hallucinations in Lewy Bodies and other types of dementia

Below is a video clip from Teepa Snow, explaining how the type of hallucination dictates our response.  This video clip is the basis of this article.

Hallucinations: Visual, Verbal, Tactile

Hallucinations are common for older adults living with dementia, especially Lewy Bodies.  As carepartners, it is our responsibility to address the vision and make the care recipient more comfortable.  In order to do this, we need to understand how the person feels about their hallucination.

  • Does the person living with dementia think they are in their childhood home with their favorite dog?
  • Does the person living with dementia believe other residents are hiding in their bathroom?
  • Is someone stealing something from the client’s room?
  • Is a traumatic childhood experience resurfacing?

Our first task is to answer the following question: Does the hallucination scare our client?

If the hallucination is not scary, ask the person how they feel about the image.  Go over to the area with the older adult and look where they gaze.  Ask questions.  Listen to their responses and formulate new questions based on those answers.  Your goal is to get as many details as possible about the hallucination.

As you delve deeper, the original hallucination will disappear.  Eventually their brain will not be able to match their own verbal responses to the image “seen” by their visual sensory organs.

This is your opportunity to switch the topic.  Engage them in a new activity and move out of the original environment.  Do not mention anything that allows them to circuit back to the hallucination.

 

In order to help, we first must understand how the hallucination makes the older adult feel.  

If the client is visibly scared by the hallucination, our approach needs to be different.

We should not ask them for more information about the image!  Instead, we need to offer them more immediate sensory input.

Those living with dementia have a heightened sensation in the palm of their hands.  They also loose the “skill” capacity in some fingers as all fingers become used for “strength”.  By using the hand-under-hand technique, you protect the care recipient and yourself, while providing reassurance.  You are able to guide their next action by retaining a grasp.

When faced with scary hallucinations, you can apply immediate and repeated pressure to their palms by pumping your palm against theirs.  This sensation feels good and will help to redirect their attention.

You will want to be on the person’s preferred side.  This is also known as their dominant side or the side in which they prefer to write.  This is important because it allows you to draw their view more easily.  The client also pays more attention to data and sound on their dominant side.

Simultaneously, you should show that you are worried!  Ensure your face and words match.  Tell and show them how worried you are about the hallucination.

Follow up with an action plan.  Now that you understand, how will you help?  What will you do to get the object to go away?  Where will the client go to be safe?  Describe your next few action steps to the care recipient.  Continue to use the hand-under-hand approach, pump their palm, and continue to look and sound concerned.

Hallucinations are not preventable for those living with Lewy Bodies dementia.  However, we can work to minimize their occurrences in other forms of dementia.  The typical triggers for hallucinations are an emotional experience from that day or week that causes the client to time travel, emotional distress, infection, and dehydration.  A hallucination may be a sign that something else is wrong physiologically with the client.

 

 

 

 

 

Overview of the GEM levels

NursePartners practices the GEMTM level approach to connect with our clients living with dementia.  One of the first things we teach carepartners is to find new ways to say hello.  Depending on a client’s GEMTM stage, we need to communicate through engaging other senses.

Each of our clients receives an activity basket and customized plan of care.  Carepartners help engage older adults in meaningful projects and activities of daily living.  A nurse visits clients biweekly to ensure the success of our approaches and address signs of progression.

NursePartners admin have all completed the GEMTM training and include dementia coaches and practitioners.  We are committed to honoring our clients and assisting their families.

 

The 10 Warning Signs of Alzheimer’s Disease

The Alzheimer’s Association presents the following as warnings signs of Alzheimer’s disease:

  1. Memory loss that disrupts daily life
  2. Challenges in planning or solving problems
  3. Difficulty completing familiar tasks at home, work, or leisure
  4. Confusion with time or place
  5. Trouble understanding visual images and spatial relationships
  6. New problems with words in speaking or writing
  7. Misplacing things and losing the ability to retrace steps
  8. Decreased or poor judgment
  9. Withdrawal from work or social activities
  10. Changes in mood and personality

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As we age, our organs do not perform as before.  The brain is no exception.  Some natural cognitive decline is natural.  When presenting the early warning signs, it is important that we put each warning sign in its proper context.

It is also important to remember that each person has their own baseline.  We do not all have the same skills or personalities.  Life experiences and family relationships also impact how we develop as individuals.  In order to receive a proper diagnosis, a physician must take the time to fully understand the personality and life experiences.  Other factors such as  stress, depression, and vitamin deficiencies might be to blame.

  1. Memory loss that disrupts daily life
    • Forgetting the names of new classroom of students is normal.  This is different from being unable to remember the name of your spouse or children (if you have a few!).  Typically we forget names, but are able to remember them on our own later.
  2. Challenges in planning or solving problems
    • This is relative to your problem solving skills when you were younger.  If these skills were never strong, they will also be weak as an older adult.
  3. Difficulty completing familiar tasks at home, work, or leisure.
    • The key word is “familiar”.  If you have never been good at folding clothes, this is not a familiar task, and therefore there is no cause for concern that you still cannot do it well.
  4. Confusion with time or place
    • It is normal to write the year wrong in January or to think it is Tuesday when it is in fact Wednesday.  Life stresses causing us to loose track of the passage of small periods of time.  However, it is not normal to perceive yourself as being in the opposite season or many years in the past.
  5. Trouble understanding visual images and spatial relationships
    • Vision generally worsens as we age.  Older adults aged 75+ typically have peripheral vision of about 45 degrees in each direction.  Older adults living with dementia will develop tunnel vision.  Eventually this vision becomes binocular and then monocular.  They will also have issues gauging distance while driving or recognizing the depth perception of items in a room.
  6. New problems with words in speaking or writing
    • Some older adults may have a stutter or become timid in large group settings.  Their energy level or stress can also impact their ability to speak well.  We also all forget the names of items, especially words that we use infrequently.  It is not normal to forget words that are common to our every day life.  If we forget them, we may remember them by mentioning other related words.  If we think of the common word after this activity, this may be a sign of a developing cognitive impairment.
  7. Misplacing things and losing the ability to retrace steps
    • We all loose our keys, unless we are very disciplined!  We may leave them in our pockets, put them on the counter, or periodically forget to even bring them out of the car.  These are all normal acts.  What is abnormal is putting keys in the fruit bowl, refrigerator, or give them to a friendly stranger.
  8. Decreased or poor judgment
    • Related to the above, poor judgment might be falling victim to a sweepstakes scam or donating more than you can afford.  We all have different levels of judgment, but typically this decline is hard to uncover in family and friends.
  9. Withdrawal from work or social activities
    • This is especially relevant for extroverts.  If a person finds themselves suddenly lost in a conversation this could be an issue.  However, we should consider other issues such as depression or exhaustion.  Introverts may avoid social activities, but enjoy gatherings among family and a few friends.  If these behaviors change over the course of months or years, this might be cause for concern.
  10. Changes in mood and personality
    • These are differences that arise over the course of the medium and long term.  Keep in mind that life experiences can also permanently impact one’s personality.  It is important to take the time to understand if traumatic incidents are to blame.

 

 

 

 

Daily Care: Late Stage Alzheimer’s Disease

How can we, family and carepartners, support the people we know living with Alzheimer’s disease or another form of dementia?

Keeping loved ones stimulated and providing ability-based care and support cannot be overstated. At NursePartners, we recognize the GEMS™ model as an effective method for providing a treatment plan for individuals affected by dementia.  Click here for an introductory overview of the classification system describing the stages of the journey.

By appreciating what is changing and what is still possible, we can provide care that is more effective and less challenging.

 

Stage 3 – Severe/Late (lasts about one 1-3 years) – Rubies and Pearls

As dementia moves into the final stage, it can be difficult to know how to meet needs. Many lose their ability to control movement and respond to the environment. As memory and cognitive skills worsen, your loved one may need extensive help with daily activities.

The goal of care at this stage is to focus on preserving dignity and quality of life. Although your loved one may lose the ability talk and express needs, you can still connect with them, enjoying interactions and experiences of their past life.

 

About Rubies and Pearls

Rubies

Rubies experience late stage changes as fine motor skills are very limited. Losses in depth perception, as well as limited visual awareness and major sensory changes result in needed assistance with utensils, brushing, buttoning and moving. Hand-under-hand assistance helps rubies feel safe and secure. Suggested activities together include: reading, playing music, and looking through old photos.

Pearls

Pearls are still and quiet, unable to actively move or respond, with limited awareness of the world. Pearls enjoy pleasant sounds and familiar voices, grasping onto moments of connection.  Whether it’s the smell of their favorite perfume, or a beloved radio program, these small experiences can help capture a moment in time and evoke pleasant memories. Being present, patient, and understanding with your loved one will help them escape feelings of isolation associated with late stage Alzheimer’s.

Planning the Day

  • Tailor the environment with the interests of your loved one. This can allow them to emotionally connect to things they previously enjoyed.
  • Plan the days to have a balance of restful and active periods to help your loved ones transition slowly and gradually from one to the other.
  • Observe the person for signs of stress. Keep lights low and noise to a minimum. Consider visiting in smaller numbers.
  • Use your voice to engage and encourage, talking quietly to tell stories and reminiscing about past events.
  • Discover which eye they use for vision.  Do not obstruct their line of site and get on or below eye level when speaking with them.

At this point in the disease, the world is primarily experienced through the senses. You can express your caring through touch, sound, sight, taste and smell.

Activities for Rubies and Pearls

  • Playing their favorite music
  • Reminiscing about past events
  • Reading portions of books that have meaning for the person
  • Looking at old photos together
  • Preparing a favorite food
  • Rubbing lotion with a favorite scent into the skin
  • Brushing their hair
  • Sitting outside together on a nice day

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NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families to enable safety, comfort and happiness through home-care services.

If your loved one need home care assistance or relief, our team would love to help.

Contact us today.

 

 

Daily Care: Moderate Stages of Alzheimer’s Disease

We can support the people we know living with dementia by keeping them mentally stimulated and providing ability-based care and support. At NursePartners, we recognize the GEMS™ model as an effective method for providing a plan of care for individuals living with Alzheimer’s disease or another form of dementia.  Click here for an introductory overview of the classification system and to understand the stages of the journey.

By appreciating what is changing and what is still possible, we can provide care that is more effective and less challenging.

 

Stage 2 – Moderate/Middle (lasts 2-10 yrs) – Emeralds and Ambers

At NursePartners, we use the “Emerald” or “Amber” classification for clients with moderately developed dementias.  We prefer this terminology because we know that all clients are operate at their best with the right approach to care.

A client normally persists in the Emerald and Amber stages the longest out of the other GEM levels. During this time, damage to the brain can make it difficult to express thoughts and perform routine tasks. It is important to allow your loved one to be involved in their day-to-day routine. Provide meaning through relevant activities that were part of their past because this will provide them with a sense of self-worth and add to their quality of life.

There will be acute changes to their self-awareness and senses.  We need to be able to distinguish daily changes and overall trends.  By having an established relationship with the client, we are also able to tell the difference between a client’s personality quirks and further developments of the disease.

 

About Emeralds and Ambers

 

Emeralds

Emeralds may get lost in time, thinking that are in another place or assuming a former role. They have problems with communication and comprehension, often asking questions that begin with “who”, “what”, “where”, and “when”.  At this GEM level, clients are making small mistakes with their personal care, but may not recognize it.  Some examples of this might be fastening buttons in the wrong holes, putting shoes on the wrong feet, or not changing clothing or brushing hair before leaving the home.  It is not important that we “correct every mistake”, but make changes subtly by using the right approach.  Sometimes this requires relating to the “mistake”, by discussing how we do this ourselves.  We could also pull out another piece of clothing and convince the client how good they look in that particular piece.

Emeralds are most comfortable when doing familiar tasks. They like to engage and help others, as well as feeling like they have a purpose. At a family functions, engage them by asking to help set the table and then clean it up. Choose favorite activities or hobbies of the past, but do not impose time limits for completing each task

Activities at home

Activities around the house can help Emeralds feel involved and provide a sense of normality. Activities such as setting the table, watering plants, and cooking can reflect past hobbies and interests, and can be a good way of retaining skills. Helping in the kitchen can also bring people together, as many experiences revolve around meals: holidays, birthdays, church potlucks, summer barbecues, weddings. Some activities for Emeralds include:

  • Cooking: salads, ice cream, Jell-O, pudding, no-bake cookies and pies, etc.
  • Copying recipes from magazines onto cards
  • Making a grocery list of items needed for recipes
  • Setting the table: Folding or rolling silverware into napkins

 

Ambers

Ambers like to live in moments of time, and are focused on sensation – manipulating, gathering and touching.  They are focused on wants and needs, and sometimes are exploratory without safety awareness. Their communication is limited with difficulty understanding and expressing needs, so activities selected need be familiar and sensory stimulating. Ambers may enjoy sing-alongs or being in visually stimulating outdoor locations.

Family members find it hard to find new ways “to say hello”.  We need to remember that there are other ways to communicate beyond verbally.  This is the time to start using those our methods.

Some activities for Ambers include:

  • Sorting nails, screws, and other hardware.
  • Organizing nail polish and lipsticks by color and shape.
  • Grouping coins, according to date, value or place of origin.
  • Rearranging the order of the silverware drawer by forks, spoons and knives.
  • Categorizing playing cards into decks or suits that match.

Planning the Day

  • Make a schedule and follow it: be structured but allow flexibility.
  • Offer a variety of activities everyday: leisure, work, rest, and self-care.
  • Create a flow for the day: build up and then slow down.
  • Build a foundation of familiar and favorite activities.

______________________________________________________________________________

NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families to enable safety, comfort, and happiness through home-care services.

If your loved one need home care assistance or relief, our team would love to help.  Contact us today.