- 45* peripheral (This is the normal range of vision for an older adult 75 years young.)
- Tunnel vision (The width is about a yard in diameter. Loss of sight occurs in all directions: left, right, up, and down.)
- Binocular vision (Cup your hands around your eyes or use a pair of binoculars to experience this for yourself.)
- Restricted binocular (Cup your hands tighter around each eye, until they are just loose enough to fit a pencil through each opening.)
- 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.)
Category: Progression of Dementia
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.
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:
- Memory loss that disrupts daily life
- Challenges in planning or solving problems
- Difficulty completing familiar tasks at home, work, or leisure
- Confusion with time or place
- Trouble understanding visual images and spatial relationships
- New problems with words in speaking or writing
- Misplacing things and losing the ability to retrace steps
- Decreased or poor judgment
- Withdrawal from work or social activities
- Changes in mood and personality
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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.
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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.
Effective Communication Strategies
Tomorrow Angela Geiger will present on behalf of the Alzheimer’s Association. Angela is a certified dementia practitioner, registered nurse, and founder of NursePartners, Inc. We have been servicing older adults living with a diagnosis of dementia since 2002.
Effective communication is crucial for establishing a good relationship between the carepartner and the care recipient. You will learn new ways to “say hello” and connect as the disease progresses. Angela will show us how to incorporate the Positive Physical ApproachTM into daily interactions to make them more meaningful and successful.
She will also explain how we can connect through each of the senses. As the disease progresses, some senses are heightened. We will also learn how to use visual cuing over verbal cuing. Often those living with dementia invent words to communicate. We should anticipate these changes and react accordingly. By knowing the care recipient’s history, we will increase the odds of our success.
It is also important to ensure that the care recipient still feel competent and involved in their own care. We can make this possible by simplifying the decision process. This is done by minimizing distractions and communicating directly with the care recipient.
We look forward to seeing you tomorrow at the Delaware Valley Veteran Home at 2pm.
The address is 2701 Southampton Road, Philadelphia, PA 19154.
Connecting through meaningful activities
One of the common mistakes we make as caregivers is to eliminate the very activities that give older adults a sense of purpose. Our first inclination is to “entertain” instead of giving older adults a “job-related” activity. However, older adults also need to feel needed and seen by others as productive members of society. For many of us, productivity equates to the feeling of importance.
Assigning tasks requires creativity. It is most successful upon taking the time to understand an individual’s unique history and personality. For someone living with dementia, traveling back in time is common. We can anticipate some of possible job-related activities by knowing what our clients did for work 20,30, or 60 years ago. We piece this puzzle together through a thorough initial assessment and continued conversations with family and friends.
Sometimes job-related tasks can be accomplished by involving the client with their own care. Depending on their GEMTM level and living arrangements, clients may even want to take part in activities for other residents. In the Diamond and Emerald stages, we need to take care to control for external stimuli that might distract from the schedule or make unnecessary changes. For later GEM stages, we will then have to adapt tasks to ensure that the client continues to successfully complete them.
We welcome the opportunity to tell you more about our dementia care services.
Why Choose Us?
- We focus on what our clients can do, not what they cannot.
- There is a no cost, collaborative health and wellness assessment.
- 24/7 availability, including holidays and weekends.
- We are staffed with Certified Nursing Assistances (“CNA”s), not Home Health Aides. All of our CNAs have years of geriatric experience and exhibit a passion for caring for those with progressive diseases.
- Regular visits by licensed clinicians to ensure customer satisfaction.
- Carepartners are employees of NursePartners, not subcontractors.
- We seek to engage our clients in meaningful activities; we seek to exceed your expectations.
- Our standards are higher than those set by the healthcare industry.
Study to evaluate the impact of a cancer fighting drug on slowing neurodegenerative disease progression
This NPR article discusses how Nilotinib seems to work by eliminating toxic proteins that build up in the brains of people with Parkinson’s and Alzheimer’s. The drug seems to activate a mechanism in brain cells that acts like a sort of garbage disposal. Read the entire article on NRP.
Currently Georgetown University is looking for participants for a randomized, double blind, placebo-controlled study to evaluate the impact of low doses of a cancer fighting drug on slowing the progression of neurodegenerative diseases. Learn more about the study.
NursePartners does not advocate for any specific type of medication. Our holistic approach seeks to connect before providing care. For clients with advanced forms of dementia, we explore different ways to say hello and communicate.
Our carepartners follow the Teepa Snow’s positive physical approach to dementia care. Through extensive training, carepartners learn how to deescalate situations and build meaningful relationships with our clients. We do not promote a purely medicated method for working with clients living with dementia.