Tag: Philadelphia dementia care

Dementia during the Holidays: Diamonds

Brain Change Model

This is the continuation of our series about connecting with a loved one, living with dementia, during the holiday season.

In the previous article about Sapphires, we discussed someone exhibiting signs of dementia, but not actually suffering from the disease. Depression, as well as other possible culprits, are mostly curable. Dementia is different.

What is Dementia?

In this article, we will discuss the first stage of dementia: Diamond.

If you are looking for a three-minute explanation of dementia, here is a great video.

Here are a few important statements to keep in mind:

  1. Dementia is progressive, without a known cure, and leads to death. However, medications and engagement can slow the progression of the disease.
  2. There are over 80 known types of dementia, and sometimes some can exhibit multiple types. The most common type of dementia is Alzheimer’s disease.
  3. Many people are only officially diagnosed further in the disease progression, if at all. (There are many Diamonds that do not know they have the disease, nor do their family members.)
  4. A person living with dementia will loose various skills and abilities as the disease progresses, not just their cognitive capacity.

Diamond

The first stage of dementia is a Diamond because this gem is “clear and sharp”. Diagnosis is tricky because sometimes picking up on changes requires a long visit.

Diamonds can be successful at established habits and routines. They can engage in small talk and appear pleasant. This is because the first skill to be compromised, in Alzheimer’s type dementia, is short-term memory. In other types of dementia, such as frontotemporal, the person loses the ability to control their impulses.

Established habits and social mannerisms continue, because they were usually adopted at a younger age. These memories and skills are preserved are stored differently in the brain.

Interactions become more difficult as they become more substantive. During conversation difficulties can arise if you reference recently learned information. The person living with dementia becomes less flexible at changing habits and behaviors in response to new information. In conversation, the person will begin to appear overly rigid and are prone to snap if they cannot follow the conversation.

Recommendations for engaging with Diamonds

For those living with dementia and are operating as a Diamond, here are some recommendations:

  • Throw out the phrase “Do you remember?” and anything similar. They do not remember and you quizzing them will leave no one feeling better. Instead, try to focus on what they remember, resorting to more distant memories.
  • Involve them in the process as much as possible. They will feel frustrated by being unable to accomplish certain tasks, but your job is to find out the ones they still can do with you or on their own. If they can participate, they will feel competent and valued. Best activities will vary depending on physical abilities and past hobbies, but here are some ideas:
    • Ask them to help you sort or organize, preferably a task that you are not highly prioritizing, but would be nice if complete.
    • Have them paint or color certain objects.
    • Request they tell you a favorite childhood story.
    • Enlist their help watching a pet dog or cat.
    • Try a simpler version of a task they used to enjoy. For example, if they used to complete 1,000-piece puzzles, try a 100-piece puzzle.
  • Do not rationalize or try to occupy the moral high ground. Meet them where they are in their moment. If you seek to stop or prevent a certain activity, offer them an alternative. Substitute, then subtract.

GEM levels can fluctuate based on the person’s energy level, stress, and nutrition. For example, a fatigued or sick Diamond, can operate more like an Emerald for periods of time, before the Emerald stage become their modus operandi. Learn when and how your loved one operates best and use these moments to maximize a connection. Remember, always connect before providing care.

Build your team

It is important to build your care team at this stage before you reach a state of desperation. As the disease progresses, the person will become increasingly dependent on the people who are currently fulfilling the role as caregiver. If this person is you, it will be more difficult to introduce outside help effectively. Your loved one living with dementia may develop abnormal sleep patterns and become less considerate of your needs until theirs are met.

Providing hands on care is more effective after a connection is established. It is recommended that you introduce care early, on a regular weekly schedule, to get the person comfortable with the idea of help before someone needs to actively assist with hygiene and other more private care needs. In this way, you can gradually build your team and establish coverage with a reputable care provider.

Let’s talk

NursePartners is happy to complete a wellness assessment, at no cost, if referencing this article. All assessments are completed by a registered nurse and certified dementia practitioner. Your call is answered by a member of the admin team, at any time around the clock: 610-323-9800.

How to know when its time for home care

Give your thanks by showing them you care

 

This day each year, we gather to give thanks for another year. We are seeing some relatives for the first time in a while. At these reunions we usually put our best face forward. This is no exception for older adults.

 

The Positive Approach to CareTM classifies dementia by six gemstones (click here to learn more). The first two are sapphire and diamond. The sapphire symbolizes normal aging and forgetfulness, which is not dementia. The diamond, however, is the first stage of dementia.

 

A diamond is highly functioning and may not be aware of its own cognitive decline. It can cover up forgetfulness and other warning signs for periods of time, such as during your reunion.

 

We should spend extended periods of time with our loved ones to truly understand their needs. Although casual conversation throughout the reunion will not paint a perfect picture, it can help us understand if we should investigate further.

 

As you talk, test their short-term memory. Alzheimer’s disease inhibits our ability to form new memories first. Discuss something new and bring up the same topic a few hours later. See if they remember having this discussion.

 

During conversion, do they appear frustrated or fixated in a train of thought? Are they unable to “shift gears”?

 

Even if your loved one is not experiencing a cognitive decline, they are still a sapphire. How is their mobility, hygiene, and nutritional intake? Would they be happier or healthier if these basic needs are met? How about socialization? Have they been getting out of the house and trying new things?

 

GEM care for dementia or traditional home care can help your loved one operate at their best. Old age or a progressive disease does not need to prevent them from enjoying their time with us. Have questions about how GEM care or traditional home care can best support your loved one?

 

Call us to learn more or to schedule a complementary wellness assessment by a

Registered Nurse and Certified Dementia Practitioner: 610-323-9800.

 

NursePartners is open 24 hours a day, 365 days a week: 610-323-9800

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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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.) 

dementia study, Alzheimer's disease study

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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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.
 

NursePartners looks for carepartners at local career fair

NursePartners was proud to participate in the career fair hosted by the Philadelphia Regional Library system.  Our two delegates were Lakeya Dula, Senior Recruiter and Dementia Coach, and Nafeesah Mays, Certified Nursing Assistant (“CarePartner”).  Philladelphia dementia care, Philadelphia best home care, Philadelphia dementia careNursePartners is looking for CNAs, LPNs, and RNs who specialize in geriatric care.  We are always growing our team and want dependable CarePartners to work in consistent care teams.  We offer assignments (not “shifts”) in three company divisions: traditional home care, GEM (dementia care), and staffing at our partner facilities.  Carepartners receive the detailed plan of care and report before arriving for a first assignment with a new client.

If you are interested in joining our team, please complete an application online for the desired position: https://www.nursepartners.org/about/employment/

Lakeya Dula executes the entire hiring process, beginning with a screen, personality assessment, interview at the Philadelphia Office, executive huddle, background and drug screen tests, orientation, dementia workshop, and additional dementia training.  She seeks personable and dependable CNAs for all three company divisions.  NursePartners is looking for carepartners that want to make a difference in the lives of older adults.  As an executive team, we proceed with each hire only after asking ourselves: “Would we want this CarePartner to care for an older adult in our family”?  If so, we are confident to place them in the homes of our clients. 

Nafeesah Mays has made an exceptional impression on seven of our clients.  As a CarePartner with more than 16 years of working experience in home care and long-term care and assisted living communities, we are happy to have her as part of the team.   As part of the orientation process, Nafeesah participated in an orientation that included a dementia workshop.  During the workshop, dementia coaches role play difficult scenarios with carepartners to see how they might respond with our clients.  Role plays are filmed and played back to the CarePartner so that they can see themselves from the eyes of the client.  Nafeesah is in the process of completing additional dementia training.

The role of depression and diabetes in the development of dementias in older adults

What are the symptoms of depression for older adults?  Does depression increase the risk of developing a dementia?  What is the impact of other chronic conditions such as diabetes?

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We mitigate the risk and continuation of depression. It is important to engage older adults in meaningful activities, not only to fight  depression, but also the development of other more serious conditions.

It is important for us to recognize these signs of depression in our older relatives and friends (“Depression in Older Adults”).   

  • Loose of interest socializing or in hobbies
  • Worries about being a burden, feelings of worthlessness
  • Slowed movement or speech
  • Neglect of personal care such as skipping meals, forgetting meds, neglecting hygiene
  • Lack of motivation and energy
  • Weight loss or general loss of appetite
  • Sadness or feelings of despair
  • Sleep disturbances, issues falling asleep, staying asleep, or beginning to sleep at different times

It is important to incorporate meaningful activities and interactions into the lives of older adults.  NursePartners has two company divisions dedicated to offering individualized companion and care services to older adults living in Philadelphia, Montgomery, Chester, and Delaware counties.  By involving your loved ones in meaningful activities early, you may stave off a development of a dementia, especially if the older adults are already dealing with chronic conditions such as diabetes.

In a population-based study of 2.4 million adults in Denmark, depression and diabetes were independently associated with greater dementia risk.  The combined association of the two disorders had a higher association with the risk of developing a dementia than the aggregate effects of the two dependent variables individually.

Covariates included martial status and its possible effect on depression and general health.

According to the study, “during the first year after depression, the associated hazard of all-cause dementia was elevated by nearly seven-fold”.  Additional periods of depression decreased the risk of developing a dementia in comparison to the first year but left the overall hazard ratio dementia risk rate about twice as high as those without depression (See Figure 1).  

This is a link to the full study, “Impact of Depression and Diabetes on Risk of Dementia In a National Population-Based Cohort”.

Other studies have focused on the singular impact of depression on dementia.  To learn more, consult the authors’ reference list in the study cited above.

 

Early Alzheimer’s disease diagnosis: Building Your Care Team

An early diagnosis of Alzheimer’s disease or another dementia can lead to a range of extreme emotions such as anxiety, depression, anger, or relief.  Although there is no cure for this progressive disease, with enough time the person living with dementia can prepare for the future.  The diagnosed person can establish the details of their own care before they are determined by others.

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        Effective caregiving requires a team and a plan.

If you are a family caregiver, you must also prepare yourself for the future instead of reacting to changes as they occur.  It is not possible for one person to attend to all the emotional and physiological needs of another adult in the face of a progressive and terminal disease.  Often intergenerational lines are blurred, and the caregiver assumes multiple roles.

The person living with dementia will increasingly depend on their caregivers.  If you are the only one, they will depend exclusively on you to make sense of the world as they experience changes to their vision, sight, coordination, and speech.  Their memory will be impaired as tangles and plaques increase, neurological connectivity is disrupted, and brain tissue atrophies and is removed from the body.

Often, we make the comparison between raising a child and caring for an older adult.  However, unlike a child, older adults have collected a lifetime of experiences, even if they are no longer able to communicate them.  These experiences give older adults a sense of pride and expectations for how they are to be treated.  Even if they are unable to articulate their wants, they have established a sense of pride.  Eventually they will depend exclusively on their caregivers for assistance.  This means if you are the only caregiver, they will depend on you for 100% of their needs.  When building a relationship, it is important to incorporate the client into their own plan of care.  This is done easiest earlier in the disease progression.  If you wait too long to incorporate other caregivers into your team, the care recipient may be unwilling to accept care from anyone but you.

Even if the caregiver thinks they are physically able to provide care on their own, this care is ineffective.  Extreme stress inhibits our ability to perform our best.  Family caregivers often suppress their own needs and wants to attend to those of the person living with dementia.  Family caregivers find that they are completing the tasks, but without connecting to the care recipient and making mistakes that often lead to confrontation with the care recipient.

If you find yourself frustrated when providing care, consider evaluating yourself for signs of stress.  Click here to complete the assessment.

Qualified professionals are available to help you with the stresses associated with caregiving.  The Lutheran Settlement House offers a free Caregivers Reducing Stress program that creates an individualized program for you in the comfort of your own home.  This program is available for those living within Philadelphia County.  If interested, please visit their website here.

Have you built an effective care team?  Even if your stress levels are tolerable now, you will eventually need help.  Acting now prevents inadequate care and stress in the future.  It allows us to learn the stories of your loved one in time, so we can incorporate them to effectively connect while providing care.

Let us form part of your care team, call 610-323-9800 or complete this form.

 

NursePartners’ coordinates grocery services for our clients

Grocery shopping is not just a chore, it’s essential.  Older adults are especially susceptible to malnutrition (World Health Organization).  It is important that they receive enough nutrition for their bodies to operate well.  Although they may need less calories than younger people, older adults still need to consume the same nutrients.

This population is at increased risk for malnutrition if they have a few of the following risk factors, as identified by Frank W. Jackson, M.D.,

  • in general poor health
  • poor eating habits
  • sudden and unexpected weight changes
  • taking multiple medications
  • poor dental health, especially dental deterioration
  • economic difficulties, causing the older adult to not spend money for their own nourishment
  • loneliness and lack of social contacts; eating is a social activity
  • cognitive impairments that no longer allow the older adult to care for themselves

Remember that the senses are also changing for older adults.  If a food no longer tastes good, it becomes less desirable.  Try using new seasonings and pepper to revive old favorite foods (Elder One Stop).

It is important not only to buy and consume the groceries, but to discard those that have already expired.  Eating an expired food item puts you at risk for food poisoning.  Common symptoms include diarrhea, vomiting, fever, nausea, and dizziness, among others (Health: One How To).

 

NursePartners coordinates grocery orders for clients.  We want to ensure that they are eating a well-balanced diet, consuming enough calories, and avoiding expired items.  Carepartners record what the client eats for each meal.  They do a weekly inventory all items in the refrigerator and cabinets and gives a report to our Administrative Assistant, Tarika Kirkley.  Tarika purchases the groceries online and coordinates the delivery.  A carepartner will be present to confirm the items received and place them away.

As you involve us in the process, it frees you time to enjoy the older adults in your life doing other activities.  To learn more about this and other services, call 610-323-9800.

 

ARTZ Philadelphia Opens the Doors to People Living with Dementia

NursePartners seeks out resources for family members of clients living with dementia  We find that children and spouses often find themselves burdened with their new role as caregiver, forgetting how to connect with their loved one on other levels.  Programs such as ARTZ Philadelphia brings the client and their caregiver together to talk about what they learn.  Caregivers are often surprised by how they are able to reconnect with their family members or clients.

 

Philadelphia dementia care, Philadelphia home care

The following answers were provided by Susan Shifrin, Founder and Executive Director of ARTZ Philadelphia.

 

 

How do families participate in your program?

In our museum programs, people with dementia diagnoses and their family members come together to engage in conversations that we facilitate about art.

Carepartners and those they love to participate on an even footing.  What ends up happening is that participants rediscover the joy of conversing with one another about things other than illness.

The carepartners tend to witness their loved ones behaving differently than they might at home.  They see their wit, their humor, their intellectual engagement with the art and with others in the group. This can remind the carepartners of all the attributes they love about the people they are caring for.

 

What is the cost of admission?

Absolutely free.

 

Can I bring my loved one if they are in a wheelchair?

100% yes.  All of our ARTZ @ The Museum sites accommodate individuals in wheelchairs.  When people first register for our programs, we send them an informal survey to assess their particular needs before their first experience with us: do they have low vision, are they hard of hearing in one ear, do they require assistance walking?  When we set up the seating for our programs, people in wheelchairs will be front and center for group conversations.

We do our best in general to ensure that participants are physically positioned to take the most from the program.

 

I am a professional carepartner, not a family member.  Can I still attend?

Absolutely.  We had a wonderful woman named Eve who came to museum programs for three years, hardly missing one.  Eve came with her professional carepartner.

After Eve passed away, the professional carepartner approached ARTZ director about assisting other clients.  Now she accompanies a new client to the program.

The carepartner was almost as beloved as Eve by the original group.

The connection is the same for all attendees.

 

I am not an art history expert, is this the right program for me?

Our programs aren’t about art history or expertise (though both are welcomed if participants bring them).  It is about being in the moment and connecting with other people around a work of art.

80% of participants start by saying they do not know anything about art.  They end up being the liveliest and most opinionated about art, receiving validation by group.

 

What other similar resources are available to me?

ARTZ has one program specifically for carepartners, called Cafes for carepartners.  This is to give carepartners time to do things they believe are fun, engaging, and stimulating with others who know what they are going through.  These cafes are not support groups, though they offer supportive experiences. While care partners sometimes choose to talk about their caregiving experiences with each other, just as often, they don’t. It’s completely up to them to set the agenda.

Cafés for Care Partners also offer opportunities to tour gardens and museums.  When we are about to partner with a new museum or art center, we invite our care partners to vet the new sites before we incorporate them into our programs.

ARTZ is hoping to develop new programs around music.

ARTZ has a partnership with Jefferson that pairs people living with dementia at various stages  and/or care partners (both are called “mentors”) to medical, nursing, pharmacy, and occupational therapy students over a period from six to eight weeks.  The program participants first get to know one another through shared experiences around works of art.  Over time, students get to know those with the diagnosis as people first, through series of one-on-one encounters.  Mentors teach future healthcare providers what it means to live with dementia, from the inside out.

Health professions students tell us that they are reminded why they chose to go into medicine through this program.  They went into medicine to make human connections.

 

If I want to go to your next event, what should I do?

If you have access to the Internet, go to website www.artzphilly.org.  Choose “participate in a program” on the home page.  You will see “ARTZ in the museum”.  Click on this.

The new page will tell you more and what you can expect.  Go to the section “Explore Upcoming Events”.  There is a little button next to the program that says, “Register Now”.

If you do not have access to the web, you can make a phone call to Susan, 610-721-1606 and she will make sure you are listed on the program.

There is a monthly newsletter, you can sign up for it via the website (https://www.artzphilly.org/) of their Facebook page (https://www.facebook.com/ARTZPhiladelphia/).