Dementia

Caring for the Caregivers

Carrie L. Kreps, PharmD, FASCP, BCGP

Objectives

• Distinguish neurodegenerative cognitive impairments (Alzheimer’s Disease and dementia) from age-related cognitive changes

• Identify common behavioral and psychological symptoms of dementia

• Describe care needs for persons with Alzheimer’s Disease and dementia

• Distinguish between palliative care, assisted living, home care and skilled nursing facilities

Objectives

• Identify the challenges faced by individuals diagnosed with Alzheimer’s Disease or dementia

• Describe strategies for wellness and supporting individuals with Alzheimer’s Disease or dementia

• List strategies to assist with common dementia related behaviors

• Explain therapies that help minimize Alzheimer’s Disease and dementia related behaviors

• Recognize how the diagnosis impacts a person’s well being and engagement in the community.

Dementia

• A general term for loss of memory and other mental abilities severe enough to interfere with daily life

• Caused by physical changes in the brain

• Classified in stages: mild, moderate or severe

Types of Dementia

• Alzheimer’s Dementia

• Vascular Dementia

• Dementia with Lewy bodies

• Frontotemporal Dementia (Pick’s)

• Alcohol-induced dementia (ARBD)

• Mixed Dementia

Alzheimer’s Disease

• Over 5 million people are living with Alzheimer’s Disease (AD) in the US

• 6th leading cause of death

– 1 in 3 seniors dies from Alzheimer’s disease or other dementia

• $259 billion in cost (2017)

• 15.5 million unpaid caregivers

Prevalence

• 1 in 10 (10%) people over age 65 has Alzheimer’s

• African-Americans are almost twice as likely to have AD or other dementias as whites

– Hispanics about 1.5 times as likely

AD Patho

• Irreversible, progressive brain disorder

• Involves proteins (plaques) extracellularly and intracellular fiber tangles building up in the brain, leading to blocking nerve signals and destroying nerve cells

10 Early Signs and Symptoms of Alzheimer’s

1. Memory loss that disrupts daily life

2. Challenges in planning or solving problems

3. Difficulty completing familiar tasks at home, at work or at leisure

4. Confusion with time or place

5. Trouble understanding visual images and spatial relationships

10 Early Signs and Symptoms of Alzheimer’s

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

Environmental Modifications

• Optimal temperature and lighting

– Proper lighting especially around stairs

• Appropriate space and noise (minimize distractions)

• Slippery floors

• Throw rugs

• Cords or clutter

Environmental Factors

• Physical restraints, including bedrails

• Inadequate lighting

• Lack of handrails on stairs

• Unfamiliar environments

• Polished floors

• Improper height of beds, chairs, or toilets

Environmental Factors

• Falls

• Bathroom

• Rugs

• Stairs

• Burns

• Space heaters

• Water temperature

Understanding

• Address physical needs first

– Hunger

– Thirst

– Social Interaction

• Emotional needs

– Focus of the person feelings not necessarily the facts

– Redirect energy into soothing activities

Reduce Frustrations

• Schedule wisely

– Establishing a routine makes the day less agitating or confusing

• Take your time

• Involve the person

• Provide choices

• Provide simple instructions

• Reduce distractions

Communication

• Choose simple words and short sentences

• Use a soft and calm tone of voice

– Avoid talking to the person as if they are a child

– Avoid talking like the person is not there

• Minimize distractions such as radio and TV

Communication

• Call person by name and make sure you have their attention

• Allow time for a response

– Be careful to not interrupt

• Try to frame questions and instructions in a positive manner

Incontinence

• Bathroom routine/schedule. Don’t always wait for them to ask.

• Watch for signs of the person needing to go to the restroom. Ex. restlessness or pulling at clothes

Wandering

• Insure the person carries identification and/or medical bracelet at all times

• Consider signing up for for Alzheimer’s Association Safe Return

Nutrition

• Inadequate nutrition is common in patients with Alzheimer disease

• Micronutrients and fats important for the brain and nervous system

• Under-nutrition can lead to frailty, reduced mobility, decreased skin integrity, and increased risk of falls and fractures.

Nutrition

• Possible causes of a poor appetite

– Not recognizing food

– Poor fitting dentures

– Medications

– Not enough exercise

– Decreased sense of smell and taste

• Weight loss is associated with increased morbidity and mortality

Mealtime

• Limit distractions

• Keep the table setting simple

• Check temperature of the food

• Be flexible on food preferences

• Provide person plenty of time to eat

• Eat together

Non-pharmacological Interventions

• Music/dance therapy

• Massage therapy

• Aromatherapy

• Exercise therapy

• Animal assisted therapy

• Memory training

• Support Groups

Music Therapy

• Memory recall

• Positive changes in moods and emotional states

• Sense of control over life

• Non-pharmacological mangement of pain and discomfort

• Opportunities to interact socially with others

Musical Therapy

• Think ahead: Make playlist of different songs for different moods

– Upbeat/animated songs in the morning to get the day started

– Soothing songs during bathing

– Soft music to create a calm enviroment

Aromatherapy

• Essential oils have been used to ease symptoms of anxiety, depression and insomnia

• Certain essential oils can be used for controlling different symptoms

Essential Oils

1. Lavender - Calming/balance emotions. Depression, anger and irritability

2. Peppermint- Stimulate mind and calm nerves

3. Rosemary – Uplifting oil used to stimulate the mind and body. Can increase appetite

Massage Therapy

• Improved circulation

• Positive outcomes on agitation and anxiety

Exercise Therapy

• Exercise can help with cognitive impairment

• Improve musculoskeletal strength –decreased falls, fractures and deaths

• Reduces agitated behavior

• Improves mood and fitness level

Exercise Therapy

• Goal: At least 30 minutes a day 3x per week

• Strength Training

• Aerobic Exercise

– Walking/Jogging

– Dancing

– Swimming/Water aerobics

– Aerobic exercise class

Animal Assisted Therapy

• Gaining popularity in facilities

• Pet interaction associated with relaxation and bonding

• Dogs may be able to reduce aggression and agitation

• Small study showed aquariums in the dining rooms of facilities stimulate more eating and weight gain

Caregivers

• In 2016, 15.9 million family and friends provided 18.2 billion hours of care to those with dementia

• Approximately ¼ of dementia caregivers are “sandwich generation” caregivers – caring for parents and children

Here to Help

• In-Home Care

• Adult Day Care Programs

• Continuing Care Retirement Communities

• Adult Family Homes

• Nursing Home Facilities

• Memory Care Units

In-Home Care

• Daily visits to help with personal care and other tasks

• Can be covered by Medicaid, many Veterans have access to this type of assistance

Adult Day Care

• Provide care for those individuals who are unable to stay at home by themselves

• Able to interact with other adults

• Often covered by Medicaid

Assisted Living

• Opportunity to live independently within a structured community

• Bridges gap between living independently and nursing homes

• Typically not covered by Medicaid,

– Used to secure place for high level care

• Spouse of dementia patient can live with them

Nursing Home

• Also known as a skilled nursing facility, long-term care facility and custodial care

• Usually for patients who can no longer live on their own and need consistent medical care

• Covered by Medicaid

Memory Care Unit

• Often found within assisted living facilities and/or nursing homes

• Specialized unit with additional services

• Secured with alarms – prevent eloping

Questions???