Caring for a person with dementia means we must understand that:

  • The individual does not see the world the same way we do

  • What we see as normal can be very confusing and threatening to the individual

  • We must enter their reality as they cannot conform to ours

  • The individual needs us to be patient, supportive and understanding

  • We have to change our mindset because they cannot


5Domains


Early-Stage Care Management:

EarlyStage

Maintain the essence of each person throughout the disease.

  • Life Story: Gather documentation and information indicating who the person has been throughout their lifespan
  • The Person is NOT the Disease: Do not allow the disease to become the overlying identification of the person.

Health care advocacy is essential

  • Includes: Early screening, detection through differential diagnosis, and interventions to treat other conditions causing decline and behavioral changes

Keep activities to the routine and familiar

  • The goal is to maintain function and involvement in activity, not to increase skills or new learning

Structure the Environment

  • Safety and ease of movement for the caregiver and the individual with Alzheimer’s or related dementia
  • Adapt programs for safety

 Provide Explicit directions, cues and verbal prompts

  • Increase the use of visual cues such as pictures or direct observations

Plan for future stages

  • Starts early and continues through the disease process
  • It is essential to communicate with the entire support team to plan for the entirety of the disease

Possible Early-Stage “Behaviors”

  • Change in preciously observed behaviors
  • Apathy
  • Lack of pleasure
  • Withdrawal from activities previously enjoyed
  • Irritable, easily upset, volatile emotions, suspicious, paranoia
  • Loss of language skills

Mid-Stage Care Management:

Mid-Stage

Increasing need for one-on-one care, especially with Activities of Daily Living (bathing,dressing,grooming, etc)

  • Use guided hand-over hand assistance with ADL’s
  • Look into appropriate adaptive equipment to help with these tasks
  • Provide tactile cues and demonstration of gross motor movements
  • Use bright primary colors to establish contrast and draw the eye

Validate the individual from their perspective of time and space.

  • Forcing an individual with dementia to accept aspects of reality that he or she cannot comprehend is cruel
  • Emotions have more validity then the logic that leads to them
  • Focus on empathy and understanding, all behavior has meaning

Modify the routine and environment when necessary to meet the changing needs

  • Minimize stimulation in the persons environment
  • Adjust lighting to reduce shadows or dark corners which can appear to be holes to an individual with dementia

Assess need for future placement or supports needed to age in place

  • Long Term Care programs
  • Advance Directives
  • Guardianship

Pay attention to caregiver burn out


Possible Mid-Stage “Behaviors”

  • Hoarding

  • Repetition

  • Paranoia/Suspicion

  • Physical/Verbal aggression

  • Wandering/Sundowning

  • Inappropriate sexual behaviors

  • Withdrawn or emotionally removed¬†

Late Stage Care Management:

Severe_Stage

Care priorities need to shift to relief of pain symptoms and emotional stress

  • In spite of the best care, attention and treatment the individual is approaching the end of his or her life
  • Focus should be on comfort and Dignity
  • Routine activities including, bathing, feeding, toileting and dressing may require total support and increased physical strength on the part of the caregiver
  • Focus on controlling infection
  • Support the caregivers dealing with grief and stress

Active treatment and activities:

  • Comfort, joy producing and being in the moment
  • Encourage and support relationships such as family by providing quiet and pleasant visiting areas
    • Enjoying the individuals favorite music together
    • Reminiscence (enjoying memories of the life lived)
    • Providing warm blankets
    • Sitting in the sun (watching birds at the feeder)
    • Providing food and liquids

An individuals sense of taste, touch and smell will still remain

  • Use these remaining senses to communicate with the individual and for sensory information/activities
    • Favorite music, aromatherapy, massage therapy
  • Be ready to assist through prompting movement or to perform the ADL for the individual
  • Assume understanding of your presence and voice even when the adult does not seem to be responding
  • Do not talk about the individual as though he or she is not present
  • Be calm and relaxed in body language and tone of voice.

Possible Late-Stage “Behaviors”

  • Rocking backwards and forwards, repetitive movements or questions

  • Hallucinations, delusions (distorted ideas)

  • Restlessness, pacing, wandering

  • Excessive hand activity (wringing hands, fidgeting, tapping)