Category: Progression of Dementia

What is Alzheimer’s disease?

Posted on January 24, 2017 by Jessica Snyder

The basics about Alzheimer’s disease

What is Alzheimer’s disease?

Alzheimer’s disease is a progressive, degenerative disorder that attacks the brain’s nerve cells (neurons) resulting in loss of memory, thinking and language skills, and behavioral changes.

Alzheimer’s is the most common form of dementia.

Dementia is a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases.

Alzheimer’s is not a normal part of aging.

Although it is true that increasing age is associated with increased rates of the disease development, Alzheimer’s is not just a disease of old age. Individuals in their 40s and 50s can also develop dementia.

Alzheimer’s worsens over time.

Alzheimer’s is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer’s is the sixth leading cause of death in the United States. Alzheimer’s disease kills more than breast and prostate cancer combined. At the time of death, one of three seniors dies with Alzheimer’s or another form of dementia. Those with Alzheimer’s live an average of eight years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions.

There is no cure for Alzheimer’s disease.

Since there is no known cure or treatment for this disease, it is important to use the right approach to care. The right approach can slow the worsening of symptoms and improve the quality of life of those living with dementia.

Alzheimer’s disease and the Ability to Walk

Posted on November 21, 2016 by Peter R. Abraldes

Dementia inhibits the ability to walk

Dementia can affect areas of the brain that are responsible for movement and balance. Many individuals affected by Alzheimer’s and other types of dementia gradually lose the ability to walk and perform everyday tasks. Knowing what to expect can make an easier transition for you and your loved one in the late stages of dementia.

Understanding balance and gait

One of the first signs of loss of mobility, is walking unsteadily and shuffling. Your loved one may seem slow or clumsy, causing more accidents and bumping into things. This “slowing” is typically associated with a syndrome called “parkinsonism.” Other signs of Parkinsonism include the shortening of steps, “stooped” posture, and the narrowing of the space between feet. Turning can become more difficult, because the person no longer pivots on their heels, but instead turn in a series of short steps. During the turns, their balance can become unstable, increasing the changes that they fall backward.

Apraxia is another condition associated with dementia and the ability to walk. An ataxic gait is characterized by imbalance, and abnormal, uncoordinated movements. Typically the individual can stand, but is very unsteady, taking small irregular steps. Very early in the course of apraxic walking in dementia, a cane or a walker can help. It is not uncommon to see a person go from a slow, cautious gait, to a normal walking pattern simply by taking up a cane.

How you can help

It is important to note that people with dementia can have problems with walking that are not associated with dementia. Exhaustion and pain can limit how far a person can walk. Sometimes that pain can reflect an unattended problem in foot care or muscle fatigue.
The person you care for may also require a mobility aid, such as a walking cane or a wheelchair in order to feel secure. Sometimes just being physically present can provide your loved one with the confidence and security to walk.
Consider a physiotherapist: They can help with anything from exercises to strengthen muscles to walking aids.

It is not easy to care for someone with mobility constraints! Unfortunately, this issue is usually compounded with others, including constipation, blood clots, and pressure sores.

It takes a team

We can be your team. Falls can happen at any time, leading to permanent deteriorations in health, and it only takes a moment. Let us be there when you cannot. Call us today to learn how we help: 610-323-9800.

Sources:

Understanding Dementia: Balance and Gait Examination – DementiaGuide.com. DementiaGuide, 2001. Web. 23 June 2016.

Understanding Alzheimer’s and other dementias: Hand Under Hand™ Approach

Posted on October 17, 2016 by Peter R. Abraldes

As dementia progresses, it is vital to appreciate the changes in a person’s ability to be able to connect. One critical element that is often missed when trying to share information is the value of changing our delivery process. Dementia care pioneer Teepa Snow developed the hand-under-hand technique, as a guiding and assisting technique that provides family members and caregivers with an amazing connection. It promotes a physical touch connection that is friendly, comforting, and successful, without being intrusive or overbearing.

The hand-under-hand technique also provides a system of feedback and communication between the a loved one living with dementia, and a caregiver. It uses the much practiced and automatic connection between the eye and hand to form a closed circuit between the person who is struggling to understand words and tasks and the care partner. It provides a comforting and calming human connection using a familiar grasp and proprioceptive (deep pressure) in the palm at the base of the thumb.

This eye-hand connection is one of the very first sensory-motor loops established in infants is used endlessly throughout our lives. By using the palmer surface of the hand, and taking the person through the desire motion or movement, we are communicating with touch and movement, without the need for words.

It’s also important and helpful to position yourself below the eye level of the person with dementia. By lowering yourself to their eye level and by using hand-under-hand, you will be able to accomplish your caregiving goals and form a meaningful connection in the process.

Remember: the purpose is to control the situation, not the person. Dementia care partners are in the process together: always do whatever you can to respect the independence, rights, and dignity of the person with dementia.

The use of hand-under-hand is multi-faceted:

It is used when greeting someone to sustain a physical connection, allowing the person to become more comfortable with your presence in their intimate space. It differs from a normal handshake that can be uncomfortable to sustain. By having a hand-under-hand rap, you will be able to tell if the person is enjoying your presence and wants you to allow them more space. If they keep trying to let go you, let go and move back further. They may need a break or may not want you in their intimate space at that moment.
It can be used when helping your loved one move around. It provides greater stability and support as well as a feedback loop.

Since the arm is the rudder that guides the ship, by rotating the foreman outward or inward you can direct the walking path.
By tipping the forearm down you can indicate physically the cue to sit down in a seat or on the bed.
By tipping the forearm upward you can help the person stand upright.

When used in combination with a gesture or point, it can help provide directions and reassurance when moving through the environment in the later stages, or when in an unfamiliar setting. Because a family member or caregiver is close to the person, the awareness of balance, coordination, fear, or distress is telegraphed can be responded to in a timely manner.

Hand-under-hand is essential during the Amber, Ruby, and Pearl gem stages. It allows you to use their dexterity to operate the tool or utensil while your loved one is still actively participating and moving their body parts toward their body (hand to mouth, hand to chest) as they have done for their entire lives. This automatic loop allows people living with dementia a sense of both control and involvement.

Finally, it provides the care partner or family member a way to get feedback on preferences, understanding, readiness, and willingness to participate. It provides a way to do with, not to do or do for.

NursePartners can alleviate the need for informal caregiving services

Posted on June 29, 2016 by Peter R. Abraldes

Caring for an aging relative on your own is no easy task. Eventually you will need a team of individuals for guidance and support.

NursePartners provides care for those who can no longer care for themselves. We relieve families from the chore of providing informal caregiving services. Our approaches to care allow family members to maintain enjoyable relationships with their loved ones.

Our early intervention prevents you from “learning on the job” as you try to anticipate the next development in dementia. The techniques that worked well last week will probably not work well this week. Unfortunately, informal caregivers lack the resources they need to provide adequate care to the loved ones. In consequence, the informal caregiver becomes frustrated and feels unfulfilled.

We prefer that you maximize on the enjoyable moments with your loved one, and let us handle the rest. The longer you spend as informal caregiver, the less time you have to advance your career and build your own retirement security.
Here is some data from AARP and MetLife that show you some the consequences of the decision to become the informal caregiver for an aging relative:

AARO Duration of Care - 2 MetLife Impact of Parental Caregiving on Lost Wages

Why reinvent the wheel? Normally care begins by doing the laundry, preparing meals, and assisting with hygiene. However, the progressive nature of the disease will soon demand that you become the first caregiver. By the end, you will find yourself surrounded by a team of 5 to 10 other caregivers.

Providing care independently is a massive undertaking. The first step should be to establish a living estate or business. You will also be responsible for hiring, firing, and managing staff daily operations. Remember to also mitigate symptoms of depression, fatigue and deteriorating health, not just for the care recipient, but for other caregivers and yourself!

Don’t forget to seek a Workers’ Compensation policy, establish payroll to properly submit taxes, and keep meticulous bookkeeping. If your loved one has a long-term care policy, you will need to submit flawless reimbursement requests or face rejection. In your free time you will be coordinating all medical appointments, pharmacy prescriptions, and speaking to other vendors.

Our business is built to account for these needs. We provide the expertise and the employees to help you through this difficult period. We want you enjoy the best moments with your loved ones, while we help you through the worst. You and the care recipient are our clients.

Do not underestimate the advantage of introducing us to a care recipient earlier on in the diagnosis. Trust needs to be established and we want to connect before providing care. When our introduction is delayed, so too is our ability to make this meaningful connection.

Building Hands-On Caregiving Skills for Dementia Care

Posted on March 7, 2016 by NursePartners

As dementia progresses, it is vital to appreciate the changes in a person’s ability to be able to connect. One critical element that is often missed when trying to share information is the value of changing our delivery process. Dementia care pioneer Teepa Snow developed the hand-under-hand technique, as a guiding and assisting technique that provides family members and caregivers with an amazing connection. It promotes a physical touch connection that is friendly, comforting and attention-getting without being intrusive or overbearing.

It also provides a system of feedback and communication between the a loved one living with dementia, and a caregiver. Hand-in-hand uses the much practiced and automatic connection between the eye and hand to form a closed circuit between the person who is struggling to understand words and tasks and the care partner. It provides a comforting and calming human connection using a familiar grasp and proprioceptive (deep pressure) in the palm at the base of the thumb.

It’s also important and helpful to position yourself below the eye level of the person with dementia. If you do only these two simple things (get down and use Hand Under Hand), life will be much easier on everyone. Guaranteed.

Remember: the purpose is to control the situation, not the person. Dementia care partners are in the process together: always do whatever you can to respect the independence, rights and dignity of the person with dementia.

The use of hand-under-hand is multi-faceted:

It is used when greeting someone to sustain a physical connection, allowing the person to become more comfortable with your presence in their intimate space. It differs from a normal handshake that can be uncomfortable to sustain. By having a hand-under-hand rap, you will be able to tell if the person is enjoying your presence and wants you to allow them more space. If they keep trying to let go you, let go and move back further. They may need a break or may not you in their intimate space (within arms reach) at that moment.
It can be used when helping your loved one move around. It provides greater stability and support as well as a feedback loop.

Since the arm is the rudder that guides the ship, by rotating the foreman outward or inward you can direct the walking path.
By tipping the forearm down you can indicate physically the cue to sit down in a seat or on the bed.
By tipping the forearm upward you can help the person stand upright.

Hand-under-hand is essential during the Amber, Ruby, and Pearl gem stages. It allows you to use their dexterity to operate the tool or utensil while your loved one is still actively participating and moving their body parts toward their body (hand to mouth, hand to chest) as they have done for their entire lives. This automatic loop allows people living with dementia a sense of both control and involvement.

Finally, it provides the caregiver or family member a way to get feedback on preferences, understanding, readiness and willingness to participate. It provides a way to do with, not to do or do for.

In the video below, Snow demonstrates how to use Hand Under Hand™ as part of the process of helping someone to bathe. But Hand Under Hand™ can be used in multiple ways: to help someone to eat, to walk, or even to calm down in a crisis.

NursePartners is committed to providing uncompromised care to those living with a diagnosis of Dementia. Our CarePartners are trained in the GEM Level Approach, and work with each family to enable safety, comfortability 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.

Finding The Right Care: The GEMS™

Posted on February 17, 2016 by NursePartners

The decision to trust your loved one in the care of another is a difficult one. If you have a parent or loved one who suffers from Dementia, it can feel very stressful and scary. Many times you find yourself losing the parent you once knew and loved, as their disease progresses. As dementia progresses, in-home care may become an important consideration for your parent.

NursePartners caregivers understand your challenges. Our approach to Dementia Care is based on the GEMs™, techniques, strategies, and approaches to care which was created by Teepa Snow, Positive Approach LLC. The GEMs™ approach to Dementia Care is a classification system using GEMs™ to compare the different stages of Dementia. The GEMs™ are used as a metaphor to define normal aging and the skill sets and needs of those living with the effects of Dementia or other brain changes. Just as GEMstones need different settings and care to show their best characteristics, so do people. Rather than focusing on a person’s loss when there is brain change, seeing individuals as precious, unique, and capable encourages a care partnership that is the core of this model. The goal is to provide better support and care when someone is living with this ever-changing condition, and to help them live fully in their moment. By appreciating what is changing and what is still possible, we can have interactions that are more positive, communication that is more productive, and care that is more effective and less challenging for all concerned.

As described above, this classification system, categorizes stages of Dementia within 6 different GEMstones.

The GEMs™

Sapphire: A sapphire is a “true blue.” Sapphires may feel “blue” due to changes with the aging process, although there are no significant changes in cognition, and no signs of dementia. They are committed to lifelong patterns, and enjoy the things the way they’ve always been.
Diamond: The first stage of actual dementia, or the diamond stage, occurs with the first signs of change or signals of a stressed brain. Diamonds are “clear and sharp,” successful with established habits and routines. Diamonds like to feel competent and valued, and it is important for them to feel comfortable and in control. A diamond can still do things as they always have, but they become more territorial and less aware of boundaries.
Emerald: Emeralds are green and “on the go.” Vague, and flawed internally, they may get lost in their past life, places and roles. They may have problems with communication and comprehension asking who, what, where, and when often. Emeralds are most comfortable when doing familiar tasks. They like to engage, help others, and want to feel like they have a purpose.
Amber: Ambers like to live in moments of time, and are focused on sensation – manipulating, gathering and touching things. 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.
Ruby: Rubies experience late-stage changes as fine motor skills are very limited. Loses 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.
Pearl: Layered and hidden in a shell, pearls are still and quiet, unable to actively move or respond, with limited awareness of the world. Pearls enjoy pleasant sounds and familiar voices, and grasp onto moments of connection.

Understanding each stage of the GEM process allow us to adjust hands-on care. We work closely with our caregivers to provide rigorous training, focused on the needs of each individual and their unique situation.

Recommended: Teepa Snow’s Dementia Caregiver Guide is a great resource for Positive Approach techniques for caregiving, Alzheimer’s and other forms of dementia.

Simplify your journey: Call 610.323.9800 or send a request by e-mail to learn more.

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