Category: Progression of Dementia

Angela scheduled to be keynote speaker for “Remembering Those Who Forget”

We are excited to announce that Angela will serve as the keynote speaker for the Presbyterian Older Adult Ministry (POAM) at the event, “Remembering Those Who Forget”.  Angela will talk about her decades of experience working with those living with dementia.  She will be sure to touch upon practical care approaches that can be implemented immediately, in addition to giving her clinical perspective on the disease.  The event is open to those wanting to learn more about Alzheimer’s disease and other forms of dementia.

We would appreciate registration prior to attending the event.  This event is scheduled for next Thursday, May 2, at 8:30am to 1pm in Plymouth Meeting.  Exact details can be found via this link: https://presbyphl.org/events/presby-older-adult-dementia-workhop/

Early warning signs of Alzheimer’s disease or another form of dementia

NursePartners presents on behalf of the Alzheimer’s Association.  One of the most commonly requested presentations discusses the early warning signs of Alzheimer’s disease or another dementia.  We compare these signs with others that are more typical of age-related changes.

It is very important to remember that each person is unique, with their own baseline. If you are looking to identify a developing form of dementia, consider all factors that make up that individual, including their personality, life experiences, family, and education. Warning signs are problematic when a few more or more exist.  

The signs of normal aging are just examples. These vary depending on each person.  If you have additional questions, you are welcome to call our 24/7 line at 610-323-9800 or the Alzheimer’s Association hotline 1-800-272-3900.

If you would like to see one of our dementia practitioners or coaches speak, join us at an upcoming event or request one by calling 610-323-9800.

 

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How dementia care is different from traditional home care

Why work with a home care company that specializes in dementia care?

Most non-medical home care companies care for those living with dementia, but services are not equal among providers. There are over 80 types of known dementias and each present a unique set of challenges.

In addition, a client’s progression of dementia depends on their background, personality, and support system. No two clients are ever alike.
Even if a company develops a comprehensive plan of care that includes all of these components, they still need to ensure that the direct care team remains informed and is relatively stable. If either falter, so does the quality of care. Carepartners must remain in communication with one of our registered nurses or dementia coaches throughout the process. They communicate with one another through client care record sheets and a journal that symbolizes the development of their relationship with the client.

Carepartners undergo an educational seminar, role playing scenarios, and additional dementia training before ever assuming their first assignment with a client living with dementia. Additional training is provided for more challenging types of dementia.

NursePartners created the GEM division to care for those living with dementia. This is distinct from our traditional home care division. We put together a plan of care based on the client’s type of dementia, specific needs, background, personality, and support system. Each client is associated with a GEM stone, which indicates where they are in the progression of the disease.

At each stage, we alter our approaches for connecting and providing care. Verbal cues become less effective than visual and touch cues as the disease progresses. We also are aware of the client’s visual scope and in which directions it declines.

If you have questions about how your loved one could benefit from GEM care services, we are available 24/7 to take your call: 610-323-9800.

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Carl and Melva painting together on a cold winter day.

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.