Week 10 Tute - Dementia Flashcards
Signs of early dementia
- Problems coming up with the right word or name
- Difficulty performing tasks in social or work settings
- Losing valuable objects
- Trouble with planning or organising
Signs of moderate dementia
- Forgetting events or about one’s own personal history
- Confusion about where they are or what day it is
- Help choosing proper clothing for the season or the occasion
- Changes in sleep patterns
- Personality and behavioural changes, including suspiciousness and delusions or repetitive behaviour
Signs of advanced dementia
- Require high levels of assistance with ADLs
- Changes in physical abilities, including the ability to walk, sit and, eventually, swallow
- Difficulty communicating
- Lose awareness of recent experiences as well as of their surroundings
Occupational needs of people with dementia
- Reassurance, security and safety
- Engagement in meaningful activity
- Opportunities for social interaction
- QOL throughout progression of the disease
OT assessment for people with dementia
- Obtain background information
- Assess cognitive and motor capabilities (observation, cognitive tests and assessment of function)
- Environment (assess for safety/amount of stimulation)
- Occupation (identify strengths and current interests)
- Mood and behaviour (carer/family report or observe)
OT assessment for carers
- Establish rapport/obtain background information
- Identify daily routines, interests, typical activities
- Preferences, care giving style
- Capabilities for caregiving
- Validate their caregiving
OT for people living in the community with early to moderate dementia
- Modify environment
- Safety
- Simplify/moderate the amount of stimulation - Adapting/simplifying daily activities
- Basic ADLs
- IADLs
- Community/leisure activities - Help establish routines
- Activity engagement tailored to their capabilities and interests
- Reminiscence
- Gardening
- Cooking
- Music
- Dancing - Simple stress reduction approaches (e.g. music, hand massage)
- Coaching/education of carer
- Education
- Role play
- Demonstration
- Problem solving
What is COPE
- Program designed to support people with dementia living in the community and their carers
- Helps to maintain functional independence and problem solving
What does COPE identify that people with dementia living in the community should be offered?
- Environmental assessment and modification to aid independence
- Prescription of assistive technology
- Tailored intervention to promote independence
- Task simplification and education for carers and family
If someone with dementia exhibits behavioural and psychological changes, what approach
- Consider and address possible causes of the behaviour
>bodily needs: hunger, thirst, pain, toilet
>boredom: wanting to have something to do
>loneliness: wanting to be with someone
>anxiety/stress: about not understanding things etc.
>”wandering”: looking for someone/something - Check stresses in the environment
>minimise noise, clutter, check there have been no changes to room/routine - Understand meaning of the issue and creatively problem solve
- Use simple stress management approaches
- Music therapy
- Reminiscence
- Activity/exercise
3 phases of the Tailored Activity Program (TAP)
Phase 1) Assessment
- Session 1 & 2 (person, carer, environment)
Phase 2) Implementation of TAP
- Sessions 3-6 (up to 3 activity prescriptions, stress reduction techniques, communication strategies, environmental modification)
Phase 3) Generalisation
- Sessions 7-8 (modifying activities for future, caregiver training to adapt environment and activities in accordance with progression of disease
What do you do if someone with dementia is talking and acting as if they are in the past (e.g. wanting to catch a bus to visit their mother)?
- Imagine their reality
- DO NOT correct them
- Reflect feelings (acknowledge feelings behind what is being expressed
Communication principles when communicating with people with dementia
- Calm, reassuring voice
- Speak slowly
- Keep it short
(“It’s lunch time.”
“Let’s go this way.”
“Here are your socks”) - Give simple, positive directions - 1 step at a time (level of simplification depends on person’s cognitive capacity)
- Show person what to do by demonstration
- Use gestures and props to help
- Use principles of validation
- Do not be drawn into argument
- Avoid abstract questions
What does the Dementia Behaviour Management Advisory Service (DBMAS) do?
- Provide appropriate clinical interventions/advice to help family carers and aged care staff of residential aged care facilities managing BPSD
>clinical support, information and advice
>delivery of tailored information and education workshops
>assessment, short-term case management
What do family caregivers need?
- Knowledge of disease process
- Validation as a caregiver
- Understanding the capabilities of the person with dementia
- To develop skills in:
>problem-solving
>communication
>behavioural management
>task and environmental simplification - Ability to take care of self
