dementia care specialist level 1 training · 2019-05-24 · seeing gems sapphires –true blue...

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Welcome“It’s all about You”

Provincial Long Term & Continuing Care Conference

May 14, 2019

Charleen Phelps, R.N. Teepa Snow, Positive

Approach, LLC

Gems®

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Seeing more than loss

The Living Gems®

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..

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What is

Dementia?

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The person’s brain is dying

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Four Truths About Dementia

1. At least 2 parts of the brain are dying

2. It is chronic and can’t be fixed3. It is progressive and will get worse4. It is terminal

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only with permission

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Tab 1

Page 6

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How we Take in Information

1. What you see

2. What you hear

3. What you feel/ touch

4. What you smell

5. What you taste

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How We Give Information

Visual – How we look

Verbal – What we say

Touch - What we do

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Visual Cue Options:

Signs

Pictures

Props or Objects

Gestures

Facial Expressions

Demonstrations

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Normal Brain Brain with Alzheimers

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Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains

G. Small, UCLA School of Medicine.

Primitive

Brain

Primitive

Brain

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Primitive Brain is in Charge of:•Survival:

•Autonomic protective – fright, flight, fight + hide or seek•Pleasure seeking – meeting survival needs and finding joy

•Thriving – Running the Engine:•Maintain vital systems: BP, BS, O2sat, Temp, pain•Breathe, suck, swallow, digest, void, defecate•Circadian rhythm• Infection control

•Learning New and Remembering:• Information •Places: spatial orientation•Passage of Time: Time awareness

Tab 1

Page 10

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HippocampusBIG CHANGE

Learning & Memory Center• Way finding• Learning &

Memory• Time Awarness

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Amygdalae:

Dangerous Need

Risky Want

Dislike Alert/Aware Like

Tab 1

Page 10

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• Impulse Control• Be Logical• Make Choices• Start-Sequence-

Complete-Move On

• Self Awareness• See Others’

Point of View

LeftRight

LeftRight

Executive

Control

Center

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Vision Center – BIG CHANGES

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1. Less Peripheral Awareness

2. Tunnel Vision

3. Binocular Vision

4. Object to Use Confusion

5. Monocular Vision

6. Limited Visual Regard

Changes in Visual RegardWith each new level of vision change, there is a

decrease in safety awareness.

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Understanding Language – BIG CHANGE

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Hearing Sound – Not Changed

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Sensory StripMotor Strip

White Matter Connections

BIG CHANGES

Formal Speech & Language

CenterHUGE CHANGES

Automatic Speech

Rhythm – Music

Expletives

PRESERVED

LeftRight

LeftRight

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Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains

G. Small, UCLA School of Medicine.

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Progression of Dementia

Alzheimer scale: Early - Middle - Late

Global Deterioration Scale 1 - 7

Allen Cognitive Levels 0 - 6

The Gems®

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Seeing more than loss

The Living Gems®

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A Positive Framework…seeing GEMS

Sapphires – True Blue – Slower BUT Fine

Diamonds – Repeats & Routines, Cutting

Emeralds – Going – Time Travel – Where?

Ambers – In the moment - Sensations

Rubies – Stop & Go – No Fine Control

Pearls – Hidden in a Shell - Immobile

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Dynamic Assessment

Visual regard

Ability to speak and understand

Skill in movement

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•True Blue

•Optimal Cognition,

•Healthy Brain

Sapphires

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Sapphire

True Blue

•Optimal Cognition Aging normally

•Slowing down: needs more time to process

•True to self: likes/dislikes are same

•Able to learn: takes practice

•Stress, fatigue or pain can induce Diamond moments

•Time to recharge or heal can restore to Sapphire

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Clear and Sharp

Routines and Rituals Rule

Diamonds

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Diamond

Clear and Sharp

•Routines and Rituals Rule: likes familiar•May resist change or won’t let things go•Rigid under pressure: limited perspective•Becoming protective: may be territorial•Repeats self: hard to integrate new information•Can cover mistakes in social interaction•Symptoms may or may not be dementia related

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Emeralds

Green and

On the Go with a Purpose

Naturally Flawed

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Emerald

•Green and On the Go with a Purpose

•Naturally Flawed

•Desires independence: noticeable ability change

•Vocabulary and comprehension diminishing

•Communication becoming vague

•May neglect personal care routines

•On the go: needs guidance and structure

•Difficulty finding way to and from places

•May be lost in time

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Ambers

•Caught in a Moment of Time

•Caution Required

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Amber

Caught in a Moment of Time

•Caution Required

•Focused on sensation

•Will react to how things: look, sound, feel, smell or taste

•Lives in the moment: not socially aware

•No safety awareness: typically very busy

•Difficulty understanding and expressing needs

•No ability to delay needs or wants

•Needs help with tasks: may resist

•Hard to connect with: may exhaust care partners

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Rubies

Deep and Strong

Others Stop Seeing What

Is Possible

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Rubies •Deep and Strong

•Others stop seeing what is Possible

•Retains rhythm: can sing, hum, pray, sway and dance

•Understands expressions and tone of voice

•Losing ability to understand language

•Limited skill in mouth, eyes, fingers, and feet

•Can mimic big movements: gross motor abilities

•Loss of depth perception; monocular vision

•Falls prevalent: can only move forward

•Care Partners will have to anticipate unmet needs

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Pearls

•Hidden Within a Shell

•Beautiful Moments to Behold

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Pearls

Hidden Within a Shell

•Person is still there

•Moments of connection take time and will be short

•Knows familiar: unmet needs may cause distress

•Unable to move by themselves: fetal position, still and quiet

•Primitive reflexes have taken over: difficulty swallowing

•Brain failure shuts down body: diminishes need too eat or drink

•Care Partners need to give permission to let go

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What to Do!?

Go with the flow

Use Supportive Communication techniques

Avoid reality orientation

Use objects and the environment as cues

Apologize

Use gestures and pointing

Acknowledge and accept their emotions

Use empathy and validation

Use familiar phrases or known interests

Respect values and beliefs

Be where they are in the moment

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The LIVING GEMS®

Progression of the Condition

To the tune of This Old Man

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SAPPHIRE true, you and me

The choice is ours, and we are free

To change our habits, to read, and think and do

We’re flexible, we think it through!

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DIAMOND bright, share with me

Right before, where I can be

I need routine and different things to do

Don’t forget, I get to choose!

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EMERALD – go, I like to do

I make mistakes, but I am through!

Show me only one step at a time

Break it down and I’ll be fine!

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AMBER – HEY!, I touch and feel

I work my fingers - rarely still

I can do things, if I copy you

What I need is what I do!

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RUBY – skill – it just won’t go

Changing something must go slow

Use your body to show me what you need

Guide, don’t force me. Don’t use speed!

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Now a PEARL, I’m near the end

But I still feel things through my skin

Keep your handling always firm and slow

Use your voice to calm my soul.

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“It’s the set of the sail and not the gale that determines our

direction!”

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THANK YOU!

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