Week 6 - Late Stage Dementia Flashcards
How is late stage dementia manifested?
- Changes in physical abilities - eat, swallow, walk
- Increased difficulty to sleep
- Personality changes
- Hallucinations
- Difficulty responding to own environment
- Difficulty socialising & communicating
- Increased vulnerability to infections (e.g. pneumonia)
What are the stages of advancing dementia?
Difficulties with ADLs, incontinence, deterioration in speech & language, deterioration in motor function
What are the behavioural and psychological symptoms of dementia (BPSD)?
- Agitation
- Aggression
- Depression
- Hallucinations
- Sleeplessness
- Wandering
What are the areas assessed in the Functional Assessment Screening Tool for Dementia (FAST)?
Level 1 - no difficulty either subjectively or objectively
Level 2: complains of forgetting location of objects, subjective word finding difficulties
Level 3: difficulty in job performance objectively, difficulty in travelling to new locations
Level 4: decreased ability to perform complex tasks (IADL)
Level 5: requires assistance to choose proper clothes to wear (settings season, occasion)
Level 6a-e: ADL related (dressing, toileting, showering)
Level 7a-f: communication, mobility and expression related (sitting up, walking, speaking, facial expression)
How does the sensory system change as one ages?
- Vision: decreases visual acuity & perception; visual impairment
- Auditory: age-related hearing loss
- Gustatory: diminished ability to differentiate scents
- Tactile: difficulty detecting, localising & diminishing input; hypersensitive
- Proprioceptive: decreased mobility, muscle atrophy from being bed / chair bound
- Vestibular: interconnected with auditory, visual & proprioceptive systems; dizziness & vertigo, reduced balance due to hearing loss
- Interception: internal self-awareness; diminished awareness to pain, bladder / bowel control, hunger
What is the Model of Imbalance in Sensoristasis?
- Behavioural challenges displayed by dementia patients is caused by sensoristasis imbalance (high or low-stimulus imbalance)
- High-stimulus imbalance exceeds stress threshold; low-stimulus imbalance leads to sensory deprivation
- Both leads to intrapsychic discomfort which leads to agitation / episodic or premature decline or both in instrumental and social function
What are some antecedents that leads to high-stimulus imbalance?
Human intervention, environmental factors
What are some antecedents that leads to low-stimulus imbalance?
Circadian rhythm disturbances, neurophysiological decline
What assessment tool can be used to intervene low-stimulus imbalance?
Poor Activity Level (PAL)
- Checklist that establishes patients activity profile -> individual activity plan
What are some assessment tools that can be used to measure SYMPTOMS of late dementia clients?
- Pain Assessment in Advanced Dementia Scale (PAIN AD): 5-item scale (breathing, negative vocalisation, facial expression, body language, consolability)
- Cohen-Mansfield Agitation Inventory: 29-item questionnaire to measure types & frequency of agitated behaviours
What are some assessment tools that can be used to measure QOL of late dementia clients?
- Quality of Life in Late Stage Dementia (QUALID)
- QUALIDEM: QOL in all stages of dementia
- Brandford Wellbeing Profile
What are the Four Activity Levels to plan interventions for dementia patients?
- Planned Activity Level
- Able to carry out activity, might not be able to solve problems, require guidance / prompts to complete task - Exploratory Activity Level
- Able to carry out familiar tasks in familiar surrounding, activity needs to be broken down - Sensory Activity Level
- Concerned with sensation, activities needs to be kept simple, requires demonstration of action - Reflex Activity Level
- May not be aware of the environment, any movement is a reflex response to the stimulus, single sensation at a time
