Reaching Beyond the Shadows…An Overview of Dementia

Macomb County Department Senior Citizen Services

Presented by

Karen D. Bisdorf Kathryn Ann W. Kozlinski

10th Annual Michigan Traffic Safety Summit

Aging In America

• 1 in 10 Americans have a family member with a cognitive impairment

• 1 in 3 knows someone with dementia

• 2002 - 4.5 million 2010 - 5.1 million

• Census now 65/85 85/105 105/115• 2030 the baby boomers will have turned 65

• 7.7 million persons will present with a dementia-related illness in the US

What is Dementia?

• Dementia is an umbrella term • The loss of mental function

two or more areas of the brain Language, memory, judgement, personality, or visual–spatial comprehension.Severe enough to interfere with daily life.

• Damage causes the death/malfunction of brain cells.

Dementia Related Illnesses

• Alzheimer’s Disease

• Lewy body dementia

• Vascular dementia

• Stroke - CVA

• Multi-infarct dementia

• Medication imbalance

• Alcohol/drugs

• Korsakoff’s Syndrome

• Parkinson’s Disease

• Tumors

• Head injury

• Nutritional

• Environmental

• If it affects the heartIt may affect the brain

Prevalence of Dementia• Ages

– 10 percent

• Over 65 years– 45 per cent

• Over 85 years– 60 percent

• 90 years and over

• Phases– Beginning

• 3-5 years

– Middle

• 8-13 years– Late

• 1-3 years

No cure – insidious - progressive disease2-21 years diagnosis to death8-12 years hands on caregiving needed

Warning Signs

Profound memory loss

Misplacing things

Abstract thinking

Difficulty with routine tasks

Change in mood & behavior

Language skills

Loss of initiative

Disorientation time/ place

Poor or weak judgement

Personality changes

Circumstances in Which You May Encounter a Person With Dementia

• Driving– Appearance of DUI– Traffic Violations– Traffic Accidents– Erratic Driving

• Wandering 60 – 20%– Lost and Confused– Walking & Driving

• Endangered Adult– Critical Incidence

• False Reports– Home Invasion– Theft– Misplaced items– Shoplifting

• Victimization– Scams, Schemes,

Swindles– Abuse & Neglect

• Sexual Misconduct– Indecent Exposure

Macomb CountySenior Assessment Request

• Endangered adults

• False reports

• Victimization

• Abuse or neglect

• Unsupervised activities

• Community service referrals

Communication Guidelines

• Approach from the front when possible

• Approach with respect – maintain their dignity

• Introduce yourself– call them by name if possible

• Maintain eye contact– establish some type of rapport

• Speak in slow distinct tones

Encounter Tools

• Look for physical and medical needs first

• Look for a medical alert or ID bracelet

• Pay close attention to mood & emotion

• Easily redirected if not agitated

• Allow as much space as possible

• Avoid backing them into a corner

• Environmental noise & bright light areconfusing

Communication Tools

• Be clear about your expectations– Project the feeling that you assume they can and will do

what you ask of them

• Request their assistance– Don’t order or demand

• Don’t push or pull – Walk beside– Direct with gestures – Instructions one at a time

Communication Tools

• This is a disease of emotions– Control the emotional environment– Maintain control-they will mimic you– Don’t argue– There is no logic- they can’t follow your reasoning

• Don’t try reorientation to time & place– Find out where they are in time – Work at that level– Do not lie

– Ask them non-threatening questions

Signs of Unsafe Driving

• Forgetting how to locate familiar places

• Failure to observe traffic signals

• Slow or poor decisions in driving

• Driving at inappropriate speeds

• Becoming angry or confused while driving

• Night blindness

• Being uncomfortable on the road

Restricting a Driver

• Family doctor may write a “do not drive” prescription• Family maintain control access to the car keys• Disable the car - remove the distributor cap or battery• Park the car on another block or in a neighbor’s

driveway• Discuss unsafe driving practices with insurance agent• Encourage family members to keep a record of their

observations to share with person, other family members and health care professionals

Why Do People Wander

• Restless - Bored

• Confused about time and place

• Change in physical environment

• Over stimulated environment “getting away”

• Argument with caregiver

• Fear caused by delusions or hallucinations

• Medication side effects

• Sundowning a biological clock

Endangered Person

• These persons are not “missing”

• They are “endangered”

• Time is of the essence

• Do they have an ID bracelet?

• Are they registered in theAlzheimer’s associations safe return program?

Endangered Persons

• Won’t knock on doors Won’t flag you down

• They won’t answer if you call their name

• They don’t think they are lost

• They may not stand out in a crowd

• Will be drawn to water, ditches, culverts

• Will walk in the snow shoeless & coatless

• Check the immediate area first

• Then go to old familiar places

• They wander on foot, by car, and by boat

Survival Rates

• 50% chance to find them alive in the first 16 hours

• That percentage drops by 10% each hour they are lost

• 46% of those found deaddied of hypothermia or dehydration

Safe Return Program

• SRP provides identification products – ID bracelets/necklace /key chains

• 24 hour hotline

• Registration in National data base

• Access to law enforcement agencies

• Direct connect to nationwide Alzheimer’s Association offices

Safety and Care Tips

• Impaired person’s can’t be left alone or unattended in waiting rooms, offices or vehicles

• Automatic car windows can be dangerous

• The person should sit next to the driver, not alone in the back seat of cars without protection locks

Rapid Assessment Look, Listen and Test to determine the risk

• Look – Body Language:

• Clenched fist, staring or hyper-vigilance, inappropriate facial expressions, posture, red face

– Psychomotor Activity:• Pacing, wringing hands, rapid breathing, clenched

teeth, ballistic movements

– Physical Appearance• Blank facial expressions, Inappropriate clothing,

disheveled

Rapid Assessment• Listen

– Speech content• What is the person talking about, who is the person

talking to, are they responding to real people and events. Do they have a legitimate gripe.

– Speech organization:

• Is the person fluent, does he/she jump from one topic to another, can he follow a conversation

• Test– Receptivity:

• Can you connect with the person, are they going to cooperate, do they react to their name, will they follow simple directions

Good Judgement

• Rapid assessment is completed in a matter of moments and does not guarantee freedom from risk, or the potential for a catastrophic reaction

• Trust your gut• Get a history when possible

– What medications are being taken– History of child or spouse abuse– History of violence during disputes

Referral Resources

• Michigan Department of State– Request for Driver Evaluation– Form OC88

• Elder Referral-Request for Individual/Family Assessment– Macomb County Senior Citizen Services

• Adult Abuse Hotline– Adult Protective Services (APS)– Request for Investigation – 800.996.6228

Information or Assistance

Macomb Co. Department of Senior Citizen Services586-469-6313

Macomb Co. Adult Day Service Program586-466-6817 or 586-469-5579

Alzheimer's Association -Greater Michigan Chapter800-621-0379

Alzheimer’s Association 24/7 Helpline800-337-3827

Alzheimer’s Safe Return Nationwide Program888-572-8566

Information or Assistance

State of Michigan Insurance Commission

Traffic Associations of Michigan Offer driving assessments and safe driver classes

Duke Family Support Program, Durham, NC 800-672-4213

North Carolina Division of Aging 919-733-0440

Resources

At the Crossroads, A Guide to Alzheimer’s Disease, Dementia and Driving Publication # 105013 The Hartford, Hartford, CT. 06115

We Need to Talk, Family Conversations with Older Drivers Publication # 105924 AARP /The Hartford

Driving for Life, A Guide for Older Drivers and their Families Publication # BBBB 000 Michigan Secretary of Statewww.michigan.gov/sos

Resources

Alzheimer’s AssociationSafe Return Program Law Enforcement Official Training bookPublication # PF 203zSafe Return Video Law Enforcement

Safe Return Program Applications– English Chinese

– Korean Polish– Russian Spanish– Vietnamese

Resources

Michigan Area Agencies on AgingHandout

Michigan Directors of Services to AgingHandout

AARP www.aarp.org

AARP Life Answers www.aarplifeanswers.com

National Institute on AgingP.O. Box 8250 Silver Springs, MD 20907-8250

Comments

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Thank you for the opportunity of speaking with you today