Tag: Philadelphia home care

Make mealtimes easier

The following excerpt is from the Alzheimer’s Association’s article about Food & Eating.  The complete article and webpage can be found here.

During the middle and late stages of Alzheimer’s, distractions, too many choices, and changes in perception, taste and smell can make eating more difficult. The following tips can help:

  • Limit distractions. Serve meals in quiet surroundings, away from the television and other distractions.

  • Keep the table setting simple. Avoid placing items on the table — such as table arrangements or plastic fruit — that might distract or confuse the person. Use only the utensils needed for the meal.

  • Distinguish food from the plate. Changes in visual and spatial abilities may make it tough for someone with dementia to distinguish food from the plate or the plate from the table. It can help to use white plates or bowls with a contrasting color place mat. Avoid patterned dishes, tablecloths and place mats.

  • Check the food temperature. A person with dementia might not be able to tell if something is too hot to eat or drink. Always test the temperature of foods and beverages before serving.

  • Serve only one or two foods at a time. Too many foods at once may be overwhelming. Simplify by serving one dish at a time. For example, mashed potatoes followed by meat.

  • Be flexible to food preferences. Keep long-standing personal preferences in mind when preparing food, and be aware that a person with dementia may suddenly develop new food preferences or reject foods that were liked in the past.

  • Give the person plenty of time to eat. Remind him or her to chew and swallow carefully. Keep in mind that it may take an hour or longer to finish eating.

  • Eat together. Make meals an enjoyable social event so everyone looks forward to the experience. Research suggests that people eat better when they are in the company of others.

  • Keep in mind the person may not remember when or if he or she ate. If the person continues to ask about eating breakfast, consider serving several breakfasts — juice, followed by toast, followed by cereal.

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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The GEMS™ brain change model

NursePartners embraces the GEMS™ brain change model developed by Teepa Snow.  Unlike other scales, such as the Global Deterioration Scale or the Dementia Severity Rating Scale, the GEMS focuses on creating constructive opportunities to engage with the person living with dementia.  Clients are still seen as people, rather than former individuals lost to the disease.

The GEMS allows us to adapt our care approaches to connect with the person in their moment.  We acknowledge what is lost, but use other senses to build meaningful relationships with our clients.

Services begin with a comprehensive assessment that goes beyond the clinical needs.  We want to know as much as possible about our clients’ preferences and personal histories.  This will allow us to connect from day one, building a durable and trusting relationship.   NursePartners changes the plans of care as we learn new information about each client.

All carepartners attend an initial orientation where they actively participate in a dementia workshop.  Carepartners learn the positive physical approach to care and contribute to a dialogue about the disease.  Dementia coaches then stimulate real life scenarios, filming each carepartner as they approach the hypothetical client.  Carepartners watch themselves as they approach clients, recognizing their strengths and acknowledge an area for improvement.  Scenarios are repeated until carepartners feel confident in the learned approaches.

Carepartners then complete a proprietary training module and final assessment, ensuring that they have understood the training.  At this point, they are ready to be assigned to a client living with dementia.  NursePartners admin will then assess if a client and carepartner would be a good match based on their personalities, interests, and general disposition.

All families are given a description of the GEMS model.  We want them to also connect with their loved one, continuing their relationships.  We help families understand that care techniques must adapt as a person progresses through the disease.  Here is a good summary of the six GEM levels.

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Want to learn more about how we can help your loved one living with a diagnosis of Alzheimer’s disease or another form of dementia?  Call us today at 610-323-9800.

 

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.

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If you want to learn more about reducing challenging behaviors, check out this article from Pines Education.
 

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.

 

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.

 

 

 

 

 

The 10 Warning Signs of Alzheimer’s Disease

The Alzheimer’s Association presents the following as warnings signs of Alzheimer’s disease:

  1. Memory loss that disrupts daily life
  2. Challenges in planning or solving problems
  3. Difficulty completing familiar tasks at home, work, or leisure
  4. Confusion with time or place
  5. Trouble understanding visual images and spatial relationships
  6. New problems with words in speaking or writing
  7. Misplacing things and losing the ability to retrace steps
  8. Decreased or poor judgment
  9. Withdrawal from work or social activities
  10. Changes in mood and personality

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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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.

 

 

 

 

Understanding Behaviors and Adapting Approaches in Dementia Care

Your role as caregiver, family member, or friend evolves with the progression of dementia.  Even faced with challenging behaviors, you can still connect with your loved one and fill their day with meaningful activities.  NursePartners is here to support you while your relationship evolves with the person living with dementia.

 

What is their behavior telling you?

We are constantly learning more about the brain’s ability to comprehend messages.  This includes messages that are delivered through speech versus writing, in a crowded space versus a one-on-one situation, or even a familiar voice versus one of a stranger.

Alzheimer’s disease and other dementias can cause people to act in unpredictable ways. Some individuals become anxious or aggressive while others repeat certain questions or gestures. Messages can be misinterpreted, surprising both the care recipient and caregiver. These types of reactions lead to misunderstanding, frustration, and tension.

It’s important to understand your loved one is not trying to be difficult and that these behaviors are also forms of communication.

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Tips for managing behavioral changes

As carepartners, we need to adapt our delivery process throughout the progression of the disease. When we carry on a traditional conversation, we usually engage in a back and forth volley of information. When a person is diagnosed with dementia, it is important to realize that the three essential language skills for processing and sharing verbal messages need to be supported in different ways. These core linguistic skills are:

  • Vocabulary (the words – the meaning of the content)
  • Comprehension (receptive language – the ability to process the message)
  • Speech production (expressive language – the ability to deliver the message)

Certain retained skills will assist you in conveying a message:

  • Social chit-chat (the back and forth that can mask loss of comprehension, but covers in short simple conversations)
  • Rhythm of speech (this includes awareness of the rhythm of a question that is seeking an answer, as well as ability to sustain rhythm or hear a rhythm that sounds familiar).  Additionally it can and does signal changes in emotion – changes in frequency, intensity, or volume can indicate shifts in emotional state or discomfort.
  • Rhythmic speech as is present in music, poetry, prayer, counting and even spelling.

What you can do:

There are important supportive phrases that can help when they are used in combination with pauses, inflections, visual cues, props, and partial reflective statement to confirm what was said or south:

  1. Seek more information by being nonspecific, try phrases such as  “Tell me more about it.”
  2. Seek demonstration or visual representation with phrases such as  “Could you show me how you would use it?” or“Show me how you’d do it.”
  3. Offer simplified options, by using two options at a time, or encouraging yes/no responses.  Employ the use of object pronouns.

What can help:

Awareness, knowledge, skill and support for both parties.

Mary Stehle, licensed social worker and Senior Care Advisor says, “A person with Alzheimer’s who has lost the ability to understand and communicate through language is always looking for cues from us as to how to interpret the world. They are constantly reading our tone of voice, facial expressions, and body language. When we are tired, stressed, and resentful, they pick up on this and it often impacts them negatively.” It’s important to remember that asking for help is not an act of selfishness, it’s providing better care for both you and your loved one.

We can be by their side when you can’t be. If your loved one need home care assistance or relief – Contact us today.

NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners work with each family to enable safety, comfort and happiness through home-care services.