Category: Progression of Dementia

Understanding Extreme Symptoms of Lewy Body Dementia

Posted on September 30, 2024 by Peter R. Abraldes

Introduction

Lewy Body Dementia (LBD) is a progressive neurological disorder caused by the buildup of abnormal protein deposits (Lewy bodies) in the brain. This results in both cognitive and motor impairments, which worsen over time. Here, we’ll explore some of the extreme symptoms that can emerge as the disease progresses.

1. Severe Hallucinations and Delusions

A hallmark of LBD is vivid visual hallucinations, often involving people, animals, or objects. Over time, these hallucinations become more frequent and intense. Patients may also experience delusions, like Capgras syndrome, where they believe their loved ones are impostors. These false beliefs can cause paranoia, fear, and mistrust, making caregiving especially difficult.

2. Cognitive Fluctuations

Cognitive function in LBD patients can fluctuate dramatically, even within a single day. Patients may switch between near-normal cognition and extreme confusion. During severe episodes, individuals may not recognize familiar people or become completely unresponsive, leading to significant distress for both the patient and their caregivers.

3. Severe Parkinsonism and Mobility Issues

LBD often causes Parkinson’s-like motor symptoms, including tremors, stiffness, and slowness of movement. In advanced stages, these symptoms worsen, leading to severe mobility impairment. Many patients eventually become bedridden, needing full assistance with daily tasks. The risk of falls also increases, making mobility challenges even more dangerous.

4. Sleep Disorders and REM Sleep Behavior Disorder

Patients with LBD frequently suffer from severe sleep disturbances. The most extreme form is REM Sleep Behavior Disorder (RBD), where individuals physically act out their dreams, sometimes violently. This poses a risk of injury to both the patient and their bed partner. Insomnia and excessive daytime sleepiness are also common, worsening cognitive and emotional symptoms.

5. Autonomic Nervous System Dysfunction

LBD often disrupts the autonomic nervous system, leading to extreme symptoms like:

Blood pressure fluctuations: Frequent dizziness and fainting due to orthostatic hypotension.
Bladder and bowel dysfunction: Incontinence or severe constipation.
Body temperature regulation issues: Difficulty feeling comfortable, leading to extremes of feeling too hot or cold.

These complications can worsen overall health, leading to additional challenges like dehydration and infections.

6. Medication Sensitivity

LBD patients are highly sensitive to certain medications, especially antipsychotics. These drugs can exacerbate symptoms, causing severe side effects like worsened motor control and even life-threatening conditions. Non-drug approaches are often preferred, though options for managing psychiatric symptoms are limited.

Conclusion

Lewy Body Dementia is a complex and severe condition marked by extreme symptoms such as hallucinations, cognitive fluctuations, motor impairments, and sleep disturbances. These symptoms make caregiving challenging and require comprehensive, specialized care. Awareness of the extreme nature of LBD’s symptoms can help families and caregivers better understand and manage this debilitating disorder.

NursePartners has helped thousands of families in the Philadelphia region, caring for loved ones living with Alzheimer’s disease, Lewy Body disease, and other forms of dementia. Call us to learn more about how we can best support you, 610-323-9800.

Signs of Dementia in Older Adults with Low Brain Engagement

Posted on September 30, 2024 by Peter R. Abraldes

Dementia, a decline in cognitive function beyond normal aging, can be worsened by a lack of mental stimulation. Older adults who stop engaging their brains through activities such as socializing, problem-solving, or learning may experience a more rapid onset of dementia. Here are the key signs to watch for, especially in those who are running more on habit than on social and intellectual curiosity:

1. Memory Loss

Difficulty remembering recent events, names, or tasks is often one of the earliest signs. Repeatedly asking the same questions or forgetting appointments is common in dementia.

2. Confusion and Disorientation

People may lose track of time, forget where they are, or become confused in familiar settings. This is especially prevalent in individuals who aren’t actively engaging in cognitive activities.

3. Difficulty with Daily Tasks

Familiar tasks such as cooking, managing finances, or following directions become challenging. This may happen more quickly in adults who don’t challenge their brains regularly.

4. Decline in Communication Skills

A person might struggle to find the right words or follow conversations. Social withdrawal often accompanies this, particularly when the individual is no longer mentally or socially active.

5. Mood and Personality Changes

Depression, irritability, or apathy can occur, especially in those who are less engaged in stimulating activities. These mood shifts often signal cognitive decline.

Cognitive Inactivity and Dementia

Lack of mental stimulation can accelerate cognitive decline in older adults. Regular brain engagement—through reading, puzzles, or social interaction—helps build neural connections. Without these activities, the brain’s cognitive reserve diminishes, increasing the risk of dementia.

Preventive Measures

While there’s no cure for dementia, engaging the brain can help delay its onset. Simple steps like doing puzzles, learning new skills, staying socially active, and maintaining a healthy lifestyle can slow cognitive decline and promote better mental health.

In summary, older adults who stop challenging their brains are at higher risk of developing dementia, or having their dementia progress quicker. Recognizing early signs and promoting brain-engaging activities are key to maintaining cognitive function as we age. NursePartners has a team of dementia certified carepartners who seek to build engaging and durable relationships with your loved one. Want to learn more? Call us today at 610-323-9800!

seniors by the beach Signs of Dementia in Older Adults with Low Brain Engagement

Most Effective Phrases for those living with Dementia

Posted on August 10, 2023 by Peter R. Abraldes

As we know, often it is not what we say, but how we say it, that impacts our probability of success. It is no different than with caregiving.

Someone living with dementia is grappling with a loss of control. They are older adults who have lived their entire lives, led successful careers, raised families, and are used to being in control. It is not easy to accept the fact that they need help from others to carry on with basic tasks.

Therefore, consider the following phrases and how we might change them:

I want you to … –> May I help with that?
You need to … –> Can I do that with you?
That’s not what I told you … –> Would it be alright if?
No, not like that… –> How about we try it this way?
You can’t… –> How do you feel about this?
Let me do that for you… –> How about we do this together?
Why don’t you… –> Do you prefer this or that?
Don’t you remember? –> This is your (house/sister/son,etc.).
Please do this… –> Would you like to do that now or in a few minutes?

In addition to changing our phrases, we can also use new ones when we encounter difficult situations. If your loved one in angered or frustrated, acknowledge how they feel and explicitly express empathy. They do not like their situation any more than you. This will help them feel understood.

walk outside Most Effective Phrases for those living with Dementia

Some of these ideas came from the Mayo Clinic’s magazine “Living with Dementia”, specifically Chapter 3, p. 42.

What is a carepartner?

Posted on July 14, 2023 by Peter R. Abraldes

NursePartners adopts the terminology “carepartner” to describe a “caregiver” who is a partner in a client’s care. The key word is partner, since the certified nursing assistant involves the client in their own care. This helps preserve the client’s sense of dignity and responsibility for their own well-being.

In particular, carepartners connect with clients before providing care. This requires getting to know more than that client’s clinical care needs and digging deeper into the client’s interests and life history.

It also involves using the hand-under-hand technique to guide and support the client to partake in their own care. Sometimes this can be used to help transfer a client, help bring a spoon to the mouth, or hold a sponge while bathing. For some tasks, the carepartner can help trigger muscle memory which allows the client to continue the action independently.

The Mayo Clinic also differentiates the term caregiver from carepartner.

“Learning to approach support and caring as a partnership means seeing the person living with dementia as a while person, and not making assumptions based on a diagnosis or label. It means including the person with dementia in decision-making. A care partnering approach is one of doing ‘with‘ rather than always doing ‘“‘for'” (Chp. 2, p. 18).

actively cooking with Nana What is a carepartner?

The advice from this article comes from NursePartners Positive Approach to Care training as defined by Teepa Snow. We have also incorporated information from the Mayo Clinic’s magazine, Living with Dementia: A Guide to Caregiving and Support. Specifically it came from Chapter 2, “Your role as a caregiver”. The original content was published by Meredith Operations Corporation in 2023.

Diagnosed with dementia?

Posted on July 14, 2023 by Peter R. Abraldes

A diagnosis of dementia affects everyone differently. According to the Mayo Clinic’s magazine, Living with Dementia: A Guide to Caregiving and Support, these reactions can summarized as follows:

Embarassment
Sadness
Fear
Disbelief
Anger
Shock
Loss
Numbness
Relief

angie and nana heads outside Diagnosed with dementia?

Before the diagnosis, individuals and their families may have been frustrated by their inability to explain changes in mood, behavior, and memory. This is why sometimes a diagnosis can provide understanding into the true root cause and help individuals and their families adapt to the new reality.

The diagnosis empowers us to proactively support ourselves or our loved ones to find new ways to support the person living with dementia. The Mayo Clinic suggests that a diagnosis can:

Give us the answers to those changes in mood, behavior, and memory that we noticed before. Clarity can allow us to focus on what we can change, and acknowledge what we cannot.
Cognitive changes will be seen for what they are, a part of the disease process, instead of a defect of the individual.
We can support the older adult to leverage their current abilities to still live a life fully of meaning, focusing on what they can do, instead of dwelling on what they cannot.
We can prepare ourselves with information, support, and resources for those living with dementia. We can join support teams and learn from other who have gone through the journey.
Proactively connect and engage with the person living with dementia. Activity and socialization will help slow the disease progression and improve the quality of life.
Permit the person living with dementia to organize their health and financial legal documents and plan ahead for the future.

The advice from this article come from the Mayo Clinic’s magazine, Living with Dementia: A Guide to Caregiving and Support. Specifically it came from Chapter 1, “Adjusting to a diagnosis”. The original content was published by Meredith Operations Corporation in 2023.

Late Stages of Dementia – How to Identify Them and What to Expect

Posted on March 3, 2023 by Abraham Aquino

Late-stage dementia can be a tough and challenging time for caregivers and loved ones. However, understanding what to expect during this stage can help make the experience more manageable. The progression of dementia is marked by changes such as memory loss, language impairment, and carrying out familiar daily tasks. Though it’s difficult to predict the exact course of this progressive disorder, the last stage of dementia has specific identifiable characteristics.

As caregivers, it’s important to understand what happens in your loved one’s brain and how that affects their behavior and capabilities. At NursePartners, our Certified Nursing Assistants (CNAs), also known as CarePartners, support and care for dementia patients whether they are aging at home or in a healthcare facility. We’ll connect with your loved one as they endure the last stage of dementia symptoms, which can be a challenging and emotionally charged experience.

It’s important to understand the final stages of this disease so you can better adjust your care techniques to be more effective. In this post, we’ll let you know what to look out for during the final stages of dementia.

late stage dementia, home care, Alzheimer's disease

What is Late-stage Dementia?

Late-stage dementia is the final stage of progressive brain disorder. This is when symptoms become severe enough to significantly interfere with daily life and everyday activities. The exact symptoms will vary from person to person, but they can be extremely challenging for the individual and their caregivers.

At NursePartners, we are trained in using The GEMS™: Brain Change Model, designed by world-renowned occupational therapist Teepa Snow. We use this approach to connect with and care for patients at every stage of dementia.

Under The GEMS™: Brain Change Model, Dr. Snow categorizes dementia stages as gemstones. It’s an approach that encourages a strong care partnership by seeing your loved one as precious, unique, and capable. Our CarePartners use this model to help them to live fully in their moment. The advanced stages of dementia are classified as follows:

Amber

Ambers prefer to live in the present and are sensation-driven, manipulating, gathering, and touching objects. They emphasize wants and needs and occasionally wander while unaware of risks. Since they have trouble comprehending and expressing needs due to their limited communication ability, choosing familiar and sensory-stimulating activities is best.

Ruby

Rubies start to lose their motor coordination. They also experience difficulty with visual awareness and major sensory changes, causing them to require assistance with everyday activities and actions such as brushing, buttoning, and walking. Hand-under-hand assistance helps rubies feel safe and secure.

Pearl

In the last stage of dementia are our Pearls. They are oblivious to their surroundings like a pearl layered and concealed within a shell. They are also motionless and quiet. Pearls cherish intimate moments by clinging to pleasant noises and recognizable voices.

What are the Symptoms of Dementia Towards the End of Life?

The symptoms of late-stage dementia can vary depending on the underlying cause. Still, people in the last stage of dementia are more likely to experience a decline in physical and cognitive function.

The last stage of dementia symptoms include:

Difficulty remembering names and faces
Struggling to speak coherently
Having a limited understanding of what is being said to them
Inability to walk
Difficulty swallowing and feeding themselves
Inability to use the toilet independently.

They may also suffer from weight loss, incontinence, and sleep problems. In addition, people with late-stage dementia are at an increased risk for falls and other accidents. As the condition progresses, they typically become bedridden and require around-the-clock care.

Further changes are common as a patient’s condition deteriorates within a few days or hours of dying. The person may:

worsen more quickly than before
lose consciousness
be unable to swallow
become agitated or restless
develop an irregular breathing pattern
have a chesty or rattly sound to their breathing
have cold hands and feet.

How Long Does the Late-stage of Dementia Usually Last?

On average, the final stage of dementia last one to two years. Ultimately, the length of time a person spends in the last stage of dementia will depend on many factors, including the underlying cause of the disease and the individual’s overall health.

How to Support Someone During the Last Stage of Dementia?

Knowing that your family member or friend is near the end of life can be devastating, but making some plans may make things easier. When someone reaches the final stages of life, one of the main concerns is ensuring they are comfortable and as pain-free as possible.

There are a few things that you can do to manage difficult behaviors associated with late-stage dementia:

Create a calm and safe environment: Make sure the space around them is uncluttered and free from potential hazards. Consider using soft lighting and calming music to create a soothing atmosphere.
Encourage communication: Try engaging them in conversation and activities they enjoy. This can help them feel more connected and less frustrated.
Provide support: It is important to provide physical and emotional support to the person with dementia and other caregivers. This can help reduce stress levels and prevent burnout.

Professional Help for Late-Stage Dementia Available in Philadelphia, Montgomery, Chester, and Delaware Counties

For 20 years, NursePartners has supported families by providing compassionate and experienced nurse care to their loved ones living with dementia. We will work with you to devise a comprehensive care plan for your relative.

All Home Care Clients are Entitled to a Bill of Rights

Posted on June 23, 2022 by Peter R. Abraldes

Our traditional home care clients are entitled to a basic list of rights, which we call the “Bill of Rights”. We keep these in mind throughout the entire process, from meeting the client, forming the care team, and through supporting them throughout the length of service.

Know his/her rights.
Choose the home car agency that will provider their care.
Receive competent care without regard to race, creed, color, age, gender, sexual orientation, or national origin.
A personal and written care plan and participation in decisions affecting their care.
Receive services with reasonable accommodations of individual needs and preferences.
Be treated with respect, consideration, and kindness.
Be served by dependable and responsible caregivers.
Enjoy confidentiality regarding all medical, financial, and personal information.
Be free of physical, verbal, emotional, and sexual abuse from anyone, including caregivers.
Request caregiver replacements when necessary.
Contact the agency twenty-four hours a day, seven days per week.
Receive services as contracted and given an explanation of all changes.
Voice complaints, have them reviewed, and resolved without an interruption in service.
Receive referrals to other health care providers if the service is denied based upon the ability to pay.
Refuse any treatment or service.
Entitled to privacy, modesty, and security.
Have their property respected.

If the client is living with dementia, they are entitled to the rights above, in additional to a few more which are worth enumerating.

To be informed of their diagnosis.
To have appropriate, ongoing medical care.
To be productive in work and play.
To have expressed feelings taken seriously.
To be free from psychotropic medications if at all possible.
To live in a safe, structured, and predictable environment.
To enjoy meaningful activities to fill each day.
To be out-of-doors on a regular basis.
To have physical contact including hugging, caressing, and handholding.
To be with persons who know one’s life story, including cultural and religious traditions.
To be cared for by individuals well-trained in dementia care

How Do Caregivers Deal with a Patient Who Refuses to Bathe?

Posted on June 3, 2022 by Abraham Aquino

How Do Caregivers Deal with a Patient Who Refuses to Bathe?

Being a family caregiver for an older adult is a selfless act of kindness, love and loyalty. Such a noble role, however, can prove challenging, especially for those who were not trained as professional caregivers. We are reminded of this on difficult days, such as when our elderly relative refuses help with bathing.

Many seniors refuse to bathe due to the onset of dementia, concerns about safety in the tub, a lack of interest, arthritis, or other issues. Bathing is an important part of personal hygiene, and we must make sure this need is met, even if that requires us to change our approach. Private nurses and professional caregivers are trained to do just that.. Here are some of their tactics:

Home Care Services for Your Loved One - Nurse Partners

Use Negotiation Skills

Even though the older adult requires care, we must be careful to respect their dignity. They have lived long and fulfilling lives and do not appreciate taking instructions as if they were children again. In brief, this means that they do not like being told what to do. Private nurses and professional caregivers take the time to connect before providing care. This might mean preparing a favorite meal or taking them to see a friend after bath time.

Speak Favorably About Bath Time

Trained and experienced carepartners understand your loved one’s mindset and frame bath time as a positive experience rather than a chore. For instance, they may use the words, “pampering” or “relaxing” in reference to bathing. They may even use nicely scented soaps to encourage your relative to relax while taking care to warm a towel for use before getting out.

In addition, private nurses are more compassionate and sensitive to patients who may be embarrassed by body odors and soiled clothing. This in turn helps the elderly patient to feel at ease.

Professionals rely heavily on positive reinforcement in their work. Elders, just like everybody else, love compliments. A private nurse will be quick to point out how good a senior smells after taking a bath, compliment them on their choice of clean clothes, and so on.

Make it a Gradual Process

Sprinkler faucet A full shower or bath may be intimidating for some elders. Maybe your loved one falls into this category. A private nurse could break down the task into stages to make it easier. They may begin with simply asking to wipe off your loved one’s face. If they are receptive then the private nurse will gradually move to gently clean their underarms and other parts of the body, all while engaging them in conversation.

The private nurse will stop once your loved one becomes resistant. They know that your relative may eventually warm up to the idea of a full bath or shower.

Having the Know-How

Some seniors may not like the idea of getting a bath from a stranger. This is why it is important to build your care team early. Trust takes time to develop. After establishing a routine, older adults become comfortable with assistance, even when it requires help bathing.

Nurse Care in Philadelphia, Delaware, and Montgomery Counties

Getting your aging loved ones to take a bath can sometimes feel like an uphill battle. Fortunately, you have access to professional help. At NursePartners our private nurses are experienced in helping your loved ones to maintain proper personal hygiene while helping them to keep their dignity intact. They are also trained to assist your loved ones with their medical needs.

Establish a Daily Routine for those living with Alzheimer’s disease or another dementia

Posted on October 2, 2020 by Peter R. Abraldes

Daily Routine

For most of us, routines are a key part of our day-to-day lives. Routines are powerful tools that keep us energized, productive, and most importantly – grounded during a stressful time.

Overall, routines are a key component of staying healthy. For people with dementia who have trouble receiving and storing new sensory information, routine and repetition are critical to function.

A model routine includes set times for waking up and going to sleep, regular hygiene practices, consistent eating patterns and other key activities. The effect the coronavirus pandemic has had on daily life has unfortunately disrupted much of our normal routine living. Disrupting the routines of those with dementia creates a lot of stress for someone who cannot track information. The pandemic is already stressful enough to most of us, yet for those suffering with dementia this abundance of stress can lead to an increase in confusion and memory issues. The good news is that this is most often temporary and can stabilize once people get back to a routine.

Ways to help

Here are some recommendations for the best ways to help a loved one with dementia during this time:

Stick to a routine as much as possible.

In all the chaos and confusion of the pandemic, creating structure and routine in your loved one’s life can create an environment that is comforting with clear expectations. One way to implement a clear routine is to have a white board, or a calendar on the wall that includes a plan for the day. You can alter these to reflect new activities to be done throughout the day and week.
Connect Online.

Online communication is a valuable tool in times when we may not be able to visit our loved ones face-to-face. From Skype, to Facetime, to Facebook Video calls, there is a great deal of technology that can help you keep in touch with your loved one and fight social isolation.
Beware of negative media.

While online communication can be a good and useful tool for connecting, you must also ensure that your loved ones are not being bombarded by fear and hysteria in the free time they spend online. Exposing your loved one with dementia to too much negative information can have serious effects on their emotional state. While they might not remember the details of newscasts, they hold on to the emotional information. As a result, they may feel increased fear, anxiety and stress, but not understand why.
Manage stress

Engage your loved one with activities, hobbies or listening to music.

Focus on the Past

Since taking in new information is difficult, focus on reminiscing – talk about past events, trips, other activities that they have done.

Signs to watch

In times of stress, someone with dementia may experience increased confusion or agitation, or may exhibit behavioral changes and act out of character. This is most often only temporary.

However, if you notice some of the following behaviors developing, you should contact your care provider:

If your loved one is acting out of character or begins putting themself in danger by wandering off or becoming physically aggressive.
If there are new areas of confusion or new types of behaviors that persist over the course of several days.

We understand these are difficult times, and for our loved ones experiencing memory disorders, it can be even more trying. Remember, we are all in this together. .

NursePartners creates permanent care teams to introduce stability and routine into the lives of older adults. All teams are managed by a registered nurse and certified dementia practitioner. Care is provided right at home, or wherever home may be. Want to learn more about how we can help you? Call us, and ask for Angie, Carole, or Jessica:

610-323-9800

Could it be dementia?

Posted on August 26, 2020 by Peter R. Abraldes

Early symptoms of dementia can be subtle and vary between people. While some people pick up on changes in their own thinking or behavior that might be caused by dementia, sometimes these signs are first noticed by those around them.

If you have noticed a change in someone close to you, the steps below can help you assist them in seeking diagnosis and treatment.

Identifying the Early Indicators

Early diagnosis can help people better live with the disease, giving them options to pharmacological and social remedies that have help to slow the progression of dementia. It also allows your loved one to have control in preparing for their future.

Early signs that a person might have dementia can include:

Being vague in daily conversation
Memory loss that affects daily functioning
Loss of enthusiasm or interest in activities that used to be fun
Difficulties in thinking or choosing the right words
Changes in personality
Difficulty following instructions
Difficulty following stories
Emotional instability

If you notice these changes, try to find a time and place to have a conversation with your loved one. See if they notice these changes too.

Seek out a medical professional

Try to set up an appointment with a doctor. Any doctor can diagnose dementia, including a primary doctor.

If they are reluctant to see a doctor to discuss memory concerns, try to pair this appointment with a routine checkup.

Accompany your loved one to the doctor’s office to make the trip easier. Offer to take notes and drive.

Avoid self-diagnosing

Do not self-diagnose. There are other conditions that mimic signs of dementia and delirium, the most common being a urinary tract infection or depression. Others are medicines, stress, nutritional disorders, stroke, alcohol misuse, hormone disorders and brain. It is important to identify the cause, even if not dementia.

To know one person with dementia is to know one person with dementia

As of now, there are over 80 types of dementia, the most common form being Alzheimer’s disease. All people carry unique live experiences and family structures. This includes where we grew up, our occupation, and education. Throughout the progression, including in the beginning, appeal to the likes and interests of the person living with dementia. Simplify tasks if they are stuck.

It will take a team

The needs of someone living with dementia intensify throughout the course of the disease. Eventually all regular bodily system cycles may not correspond with those. Your loved one may want to be up during the night, eat at different intervals, and even wander and forget where they are going. You will be tested 24/7 all days of year, without vacation. Your job becomes thankless and their frustration may be taken out on you.

It is important to build your care team slowly as needs change. Consider at a minimum help every other day. This will be a good start in ensuring that your loved one’s needs are met and that they continue to engage socially with other people.

Let us be part of your care team

We have been caring exclusively for older adults since 2002.

Call us today to learn how NursePartners can help you through this journey: 610-323-9800.