Tag: Philadelphia dementia care

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.) 

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The Clinical Trial Study Group LLC is looking for adults 50 to 90 years old to participate in this study.  Participants need to be diagnosed as living with an early stage of Alzheimer’s disease or demonstrate mild cognitive impairments which are indicators for the later development of dementia.  The third requirement is that the participant have a “study partner”.  This study partner has at least 10 hours per week of contact with the participant, enabling the study partner to provide accurate information about the participant’s cognitive and functional abilities.

What are the early warning signs of Alzheimer’s disease and other dementias?  See this article.

Participants will either receive an injection of gantenerumab or a placebo, beginning every four weeks and then occurring every two weeks.

What is gantenerumab?

“Gantenerumab is a fully human monoclonal antibody designed to achieve specific and highly sensitive recognition of the assembly structure of major
components in Aβ plaques. This hypothesis has been supported by the results of preclinical studies.”

What is a placebo?

A placebo is a “dummy” drug with no active ingredients.  It is given in order to mitigate against the psychological bias that result in some participants feeling better or worse just for have been given an injection (versus not receiving one).

Want more information about this study?  Call 215-884-1700 or visit the Clinical Trial Center via their website, www.theclinicaltrialcenter.com.

NursePartners, Inc. clinicians are participating in the administration of gantenerumab and the placebo.  However, this is a clinical study whose results are uncertain.  We encourage those interested to ask more questions and to consider all options.

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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.

 

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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/).

Hallucinations in Lewy Bodies and other types of dementia

Below is a video clip from Teepa Snow, explaining how the type of hallucination dictates our response.  This video clip is the basis of this article.

Hallucinations: Visual, Verbal, Tactile

Hallucinations are common for older adults living with dementia, especially Lewy Bodies.  As carepartners, it is our responsibility to address the vision and make the care recipient more comfortable.  In order to do this, we need to understand how the person feels about their hallucination.

  • Does the person living with dementia think they are in their childhood home with their favorite dog?
  • Does the person living with dementia believe other residents are hiding in their bathroom?
  • Is someone stealing something from the client’s room?
  • Is a traumatic childhood experience resurfacing?

Our first task is to answer the following question: Does the hallucination scare our client?

If the hallucination is not scary, ask the person how they feel about the image.  Go over to the area with the older adult and look where they gaze.  Ask questions.  Listen to their responses and formulate new questions based on those answers.  Your goal is to get as many details as possible about the hallucination.

As you delve deeper, the original hallucination will disappear.  Eventually their brain will not be able to match their own verbal responses to the image “seen” by their visual sensory organs.

This is your opportunity to switch the topic.  Engage them in a new activity and move out of the original environment.  Do not mention anything that allows them to circuit back to the hallucination.

 

In order to help, we first must understand how the hallucination makes the older adult feel.  

If the client is visibly scared by the hallucination, our approach needs to be different.

We should not ask them for more information about the image!  Instead, we need to offer them more immediate sensory input.

Those living with dementia have a heightened sensation in the palm of their hands.  They also loose the “skill” capacity in some fingers as all fingers become used for “strength”.  By using the hand-under-hand technique, you protect the care recipient and yourself, while providing reassurance.  You are able to guide their next action by retaining a grasp.

When faced with scary hallucinations, you can apply immediate and repeated pressure to their palms by pumping your palm against theirs.  This sensation feels good and will help to redirect their attention.

You will want to be on the person’s preferred side.  This is also known as their dominant side or the side in which they prefer to write.  This is important because it allows you to draw their view more easily.  The client also pays more attention to data and sound on their dominant side.

Simultaneously, you should show that you are worried!  Ensure your face and words match.  Tell and show them how worried you are about the hallucination.

Follow up with an action plan.  Now that you understand, how will you help?  What will you do to get the object to go away?  Where will the client go to be safe?  Describe your next few action steps to the care recipient.  Continue to use the hand-under-hand approach, pump their palm, and continue to look and sound concerned.

Hallucinations are not preventable for those living with Lewy Bodies dementia.  However, we can work to minimize their occurrences in other forms of dementia.  The typical triggers for hallucinations are an emotional experience from that day or week that causes the client to time travel, emotional distress, infection, and dehydration.  A hallucination may be a sign that something else is wrong physiologically with the client.

 

 

 

 

 

Patience when caring for someone living with dementia

Patience is crucial when caring for someone living with dementia.  Often times the burden of care falls uneven on a spouse or a child who lives close to their parents.  It takes us a while, if at all, to realize that it takes more than one person to support another living with dementia.

When an interaction is not going as planned, we suggest the following steps:

 

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1.) Step Back: It is okay to not have an immediate response.  Think before you react and ensure your facial and body language matches your words.  We want to make sure we are engaging visual stimuli before offering a verbal message.  As Teepa Snow suggests, engage the senses by offering cues in the following sequence: visual, verbal, touch.

If the person living with dementia is doing an undesirable activity, consider if the activity is dangerous to them or others.  If it is not, reassess the urgency of change.  Could this be a moment for connection?

 

2.) Respond instead of Reacting: A thorough response requires doing the analysis to see why we seek to change the current behavior.  Are we imposing our logic on their situation?  Could it be that we are not taking the time to enter their reality?  This can be a mentally draining task and is one of the reasons why caregivers become frustrated with the person entrusted in their care.

Sometimes we are not trying to correct a behavior, but rather a narrative.  A person living with dementia might be time traveling or experiencing a hallucination.  Instead of trying to reorient them to reality, take that time to ask them questions about their past or their visions.  Often times we can find our best moments of connection by patiently requesting that they tell us more.

Throughout our response, we want to incorporate the art of substitution before subtraction.  If we want to remove something from their hands, offer them something else to hold first.  If we want to free them from a hallucination, ask more questions.  Often times they will reach a point where their mind no longer can describe the often that does not exist.

 

3.) Make plans, but expect them to change: Put your agenda in your back pocket.  It is often very difficult for non-caregivers to understand why it takes so long to accomplish the activities of daily living.  Why does it take an hour to take a shower?  Why does it take two sittings to finish a meal?

Our approach matters, and unlike caring for a child, an older adult has lived a long life and is used to be being treated with dignity and respect.  Although their memories may have faded, these feelings of pride are deeply engrained.  We need to go with their flow, not the other way around.  We need to take extra measures that may not seem “logical” in order to satisfy their emotional needs.

A classic example of this would be wrapping a towel around the care recipient in the shower.  Although this might make the cleaning process more challenging, it allows the person being showered to feel less exposed to caregiver.

 

4.) Figure out what you can and cannot control:   We need to remember that activities are a means to connect with the person living with dementia.  If we are playing a known game, it is okay to throw out the rules.  For example, instead of playing a card game, why not sort the deck?  As the disease progresses, your loved one might derive more comfort from holding items versus sorting them.  This is okay.  We are learning to adapt to their changing senses and using these to find new ways to say hello.  If you are unfamiliar with GEM levels, learn more here.

Here are some ideas for activities for someone living with dementia.  At NursePartners, we provide activity baskets to our clients living with dementia.  These typically include coloring, puzzles, and cards.  Activities are introduced and rotated out as interests or abilities change.

 

5.) Take care of yourself: We impose our logic on the person living with dementia, but fail to apply it to ourselves.  No matter how much help you have, you also need a break!  Caring for a person living with dementia can be a daunting task.  If you are emotionally drained or physically inept to perform your role, you become less helpful for the person needing your care.  It is not selfish, but rather essential, to take time to enjoy your life and keep yourself healthy.  

Please ask us for more support resources.  NursePartners is a founding member of the National Aging in Place Council of Philadelphia.  We invest our time in this organization in order to comfortably refer you to resources in our community, some of which are free.

 

This article was inspired by Teepa Snow and a post by AgingCare.com.