caring for those with dementia
DESCRIPTION
Caring for those with Dementia. Sheryl Bagshaw , MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist. Dementia questions most often asked:. How do I deal with his/her behavior? How do I get through to him/her? What is the trick to understanding dementia?. - PowerPoint PPT PresentationTRANSCRIPT
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Caring for those with Dementia
Sheryl Bagshaw, MBA, SSW, CVWCertified Dementia Practitioner
Cognitive Interventionist
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How do I deal with his/her behavior? How do I get through to him/her? What is the trick to understanding dementia?
Dementia questions most often asked:
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How do I communicate with someone with dementia?
How do I deal with behaviors?
In other words:
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Let’s start by talking about
BEHAVIORS
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Managing negative behavior using a learning behavior model that includes triggers, behaviors, and consequences (reinforcement or punishment)
Relies on manipulating triggers, setting boundaries, and providing reinforcements
May affect identity and self-esteem Assumes specific cognitive abilities such as
awareness, judgment and reasoning
Behavior Management and why it does NOT work:
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Is the demented person aware of his/her behaviors?
Can the person with dementia manipulate his/her own behaviors?
How disruptive is the behavior? Is it ok to allow the individual to be
demented? And, most importantly…
Questions to ask ourselves:
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Whose Behavior Needs to be Managed?
OURS!!!
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Not listening Impatience – the more you hurry, the more
time it’s going to take Arguing – Join their journey Not explaining Expecting them to act/behave a certain way
(Allow them to be demented) (They are not in our world – we are in THEIRS)
Trying to get them to do something that is not their idea
Primary External Cause of Agitation: Caregiver Approach
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So what approaches to behaviors DO work?
Need-Driven Behavior ApproachAnd Validation
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Normal needs + abnormal conditions = disruptive behavior
Uses the environment and individual strengths/preferences to meet and prevent unmet needs
Assumes that behaviors are not abnormal, deliberate, or good/bad
Behaviors do not need to be resolved, needs do and then behaviors will cease
BASICALLY…
Need-Driven Behavior Approach
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ALL Behavior = Communication
NEEDS!
Look for the NEED and you will know how to respond to the behavior!
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Maslow’s Hierarchy of Needs: A
ct.
Esteem
Love/Belonging
Safety/Security
Physical
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Medical Needs:
Physical
Care Needs:• PAIN• Constipation• Infection• Oxygen• Blood Sugars• Sleep Disturbances• Med Interactions
• Hot/Cold• Hungry/ Thirsty• Continence• Tired• Over/Under- Stimulation • Movement
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Safety/Security Needs:
Safety/Security
• Looking for a family member• Thinking they are being poisoned• Thinking people are stealing• Want to go home • Hiding things• Feeling unsafe/paranoid• Unsure of others• Locking/barring doors• Elopement risk
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Love/Belonging Needs:
Love/Belonging
• Space invaders• Use a lot of physical touch• Sexually inappropriate• In the middle of everything
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Esteem
Esteem Needs:• Looking for something to do• Ask if they can help• Pick up familiar items• In the middle of everything• Negative self-statements
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Self Actualization Needs:Act.
• Looking for something to do• Ask if they can help• Pick up familiar items• In the middle of everything• Negative self-statements
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Bridging the Behavior/Communication Gap:
ValidationEmpathy
Reminiscence
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Validation:- Is a method for communicating with those with dementia- Uses listening skills, empathy, reminiscing- Helps individuals with dementia to feel heard and validated- Gives demented individuals a sense of esteem/worth- Shows that another’s feelings/ communications are acknowledged and respected- Sees behavior as a form of communication
of needs
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Validation Method:- Ask questions – who, what, when, where (stay away from why)- Reflective listening – repeat back what they say in the form of a statement or a question- Ask the extremes – “what’s the worst thing about ______”- Ask the opposite – “what if (the opposite) were true”- Use ambiguity – s/he, they, it- Empathize – “that must be _____” (name that emotion)- Reminisce – “has there ever been a time when ____”- Match/mirror emotions/actions (non-verbal)- Use eye contact/touch
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The best way to explain VALIDATION is by using examples of some of our communication failures with demented individuals and showing how we can use validation to improve them.
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1. Arguing with them
Example: Day of the week
Validation: Don’t Argue!“WE are in THEIR world” – it only frustrates them when we try to bring them back to ours. Method: Ask questions
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2. We approach them wrong and/or don’t communicate
Example: Moving a resident
Validation: Approach is everything.“Be on their level.” Method: Eye contact, Empathy
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3. Reassure them/don’t let them express emotions (sympathy vs. empathy)Example: Patient wanting to leave (blocking the entryway)
Validation: Allow them to safely express emotions. “The cat ignored becomes the tiger.” Method: Empathy, Need
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4. We assume we know the problem and how to fix it
Example: Resident angry about his money.
Validation: Look deeper“Look for the need.” Method: Reflective listening, Ask the extremes
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5. We fail to see the world from their view.
Example: Patient who needs a brief change.
Validation: Perception is reality.“It has to be his/her idea.” Method: Look for the need
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6. We lie to them
Example: “Where is my husband?”
Validation: Therapeutic Lies are harmful“Demented individuals have it within themselves to solve their own issues.” Method: Ask ?’s, Reminisce
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7. We bombard them with information
Example: Doctor’s appointment
Validation: Keep it simple, overstimulation is not good“Overstimulation, like boredom, causes anxiety.”
Method: Matching, ambiguity
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8. We expect them to remember things
Example: “You remember…”
Validation: Keep self-esteem intact.“Has there ever been a time when...” Method: Reminisce
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9. We don’t stimulate them
Example: Henry
Validation: All individuals have worth and deserve our attention.“Music is to the soul what words are to the mind.” Method: Reminisce, music
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Henry
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10. We don’t listen to the non-verbalExample: Gladys
Validation: Communication is 70% non-verbal.“Please hear what I’m not saying.” Method: empathy, music, touch, eye contact
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Gladys
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Communicating with someone with dementia is about:1. Accepting their realities2. Listening3. Validating their experiences4. Sharing their emotions5. Simplifying your communications6. Looking for the need7. Asking for their input8. Providing appropriate stimulation9. Reminiscing10. Being honest/truthful with them
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If you want to learn more about communication, Validation, and other dementia issues, you can access my website:
www.dementiaassist.com
(You can also find dementia assist on Facebook)