changing the culture of dementia care one mind at a time ......4 © teepa snow, positive approach,...

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Changing the Culture of

Dementia Care

One Mind at a Time

www.teepasnow.com


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copyrighted materials or DVD content from Positive

Approach, LLC (Teepa Snow) may be used for personal

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Copyright 2017, All Rights Reserved

Teepa Snow and Positive Approach® to Care

Any redistribution or duplication, in whole or in part, is

strictly prohibited, without the expressed written consent of

Teepa Snow and

Positive Approach, LLC


The ABC’s of Dementia

and Caregiving:

Essentials for Good Care

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PET Scan of 20-Year-Old

BrainPET Scan of 80-Year-Old

Brain

PET and Aging:

ADEAR, 2003


As we age, our processing

speed slows, but

we do not lose function in

our brains, unless…

Something Goes Wrong

With Our Brains


Ten Early Warning Signs for Alzheimers

and Some Other Dementias:-Memory loss for recent or

new information, repeats self

frequently

-Difficulty doing familiar but

difficult tasks: managing

money, medications, driving

-Problems with word finding,

mis-naming, or mis-

understanding

-Getting confused about time

or place, getting lost while

driving, missing several

appointments

-Worsening judgment: not

thinking thing through like

before

-Difficulty problem-solving

or reasoning

-Misplacing things, putting

them in odd places

-Changes in mood or

behavior

-Changes in typical

personality

-Loss of initiation,

withdraws from normal

patterns of activities and

interests

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Normal vs. Not Normal

Aging:

Normal Aging:

-Slower to think

-Slower to do

-Hesitates more

-More likely to ‘look

before leaping’

-Know the person but

not the name

-Pause to find words

-Reminded of the past

-Harder

Not Normal Aging:

-Can’t think the same

-Can’t do like before

-Can’t get started

-Can’t seem to move on

-Doesn’t think it out at all

-Can’t place the person

-Words won’t come – even

later

-Confused about past

versus now

-Very different!


So… What is Dementia?

- It changes everything over time

- It is not something the person can control

- It is not always the same for every person

- It is not a mental illness

- It is real

- It is hard at times


What is Dementia?

It is both

a chemical change in the brain

and

a structural change in the brain

So…

Sometimes they can and sometimes they can’t

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Four Truths About Dementia:

- At least 2 parts of the brain are dying

-One related to memory and the one other

- It is chronic – can’t be fixed

- It is progressive – it gets worse

- It is terminal – it will kill, eventually


The person’s brain is dying


Dementia

does not equal

Alzheimers

does not equal

Memory problems

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Alzheimers

Disease

•Young Onset

•Late Life Onset

Lewy Body

Dementia

DEMENTIA

Other Dementias•Genetic syndromes•Metabolic issues•Alcohol related•Drug exposure•White matter diseases•Mass effects•Depression/psych conditions•Infections: BBB cross

Fronto-Temporal

Lobe Dementias

VascularDementia


Alzheimers Disease:• New details lost first

• Recent memory worse

• Changes noticed over time

• Some language problems, mis-speaks

• More impulsive or indecisive

• Gets lost in time or place

• Several forms or patterns

• Young onset can vary from late-life onset

• Downs is high risk

• Related to beta-amyloid plaques and tau pathologies


Lewy Body Dementia:• Movement problems, falls

• Visual disturbances

• Delusional thinking

• Fine motor problems: hands and swallowing

• Episodes of rigidity and syncope

• Insomnia and sleep disturbances

• Nightmares that seem real

• Fluctuations in abilities

• Drug responses can be extreme and strange

• Related to synuclein protein malformations

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Vascular Dementia:• Sudden changes in ability, can be some

recovery

• Picture varies by person

• Can have bounce-back and bad days

• Judgment and behavior ‘not the same’

• Spotty losses

• Emotional and energy shifts

• Least predictable

• Caused by problems with blood flow, oxygen, nourishment of brain cells


Frontal-Temporal Dementia:• Many types

• Related to tau pathologies

• Temporal: language change

• Difficulty with speaking: missing or changing words

• Rhythm OK, content missing

• Not getting messages

• Frontal: impulse and behavior control changes

• Says unexpected, rude, mean, odd things

• Apathy: not caring

• Problems with initiation or sequencing

• Disinhibited: sex, food, drink, emotions, actions


Normal Brain Alzheimers BrainUsed with permission from Alzheimers:The Broken Brain,

1999 University of Alabama

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Learning & Memory Center

HippocampusBIG CHANGE

Learning and

Memory

Center

Hippocampus:

Big Change


Understanding Language – Big Change


Hearing Sound – Not Changed

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Sensory Strip

Motor Strip

White Matter

Connections:

Big Changes

Formal Speech

and Language

Center:

Huge Changes

Automatic Speech

Rhythm – Music

Expletives:

Preserved


Executive

Control

Center:

Emotions

Behavior

Judgment

Reasoning


Vision Center – Big Changes

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Dementia cannot be cured,

but it can be treated:

- With knowledge

- With skill building

- With commitment

- With flexibility

- With practice

- With support

- With compassion


How Can We Help…Better?

It all starts with your

approach!


Five Skill Areas:

•Getting Connected

•Hand-under-Hand® Assistance

•Ways of Cueing and Helping

•Time-Out Signal

•GEMS® Levels

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Positive Physical Approach™:

- Pause at edge of public space (6 feet)

-Approach within visual range

-Approach slowly

-Offer your hand and make eye contact, smile

-Call the person by name

-Stand to the side to communicate

-Respect personal space

-Wait for a response


A Positive Approach(To the Tune of Amazing Grace)

Come from the front

Go slow

Get to the side,

Get low

Offer your hand

Call out the name then wait…

If you will try, then you will see

How different life can be.

For those you’re caring for!


Hand-under-Hand®

Assistance:

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Hand-under-Hand®

Assistance:

1.Start in a regular handshake position

2.Next, while keeping the bases of your

thumbs connected, shift your fingers

to wrap around the back of their hand

3.Then, rotate so that your hand is on

the bottom of theirs, supporting them



Ways of Cueing and Helping:

- Sight or Visual cues

- Verbal or Auditory cues

- Touch or Tactile cues

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Visual Cues:

•Signs

•Pictures

•Props/objects

•Gestures

•Facial expressions

•Demonstrations


Verbal Cues:

• Keep it simple and short

• Directed

• Matched to visual cues


Touch Cues:

• Touching a body part

• Handing the person an item

• Using Hand-under-Hand® assistance

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Time-Out Signal:


As part of the disease people

with dementia tend to develop

typical patterns of speech,

behavior, and routines.

These people will also have

skills and abilities that are lost

while others are retained or

preserved.


Progression of Dementia:

The GEMS®

Sapphires

Diamonds

Emeralds

Ambers

Rubies

Pearls

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Sapphires:• Us on a good day

• Clear and true to ourselves

• May feel ‘blue’ over changes

• Some are ‘stars’ and some are not

• Can typically choose our behavior

• May have other health issues that affect behaviors

• Recognize life experiences, achievements and values

• Can follow written info and hold onto it


Diamonds:• Sharp, hard, rigid, inflexible, can cut

• Many facets, still often clear, can really shine

• Are usually either Joiners or Loners

• Can complete personal care in familiar place

• Usually can follow simple prompted schedules

• Misplaces things and can’t find them

• Resents takeover or bossiness

• Notices other people’s misbehavior and mistakes

• Vary in lack of self-awareness

• Use old routines and habits

• Control important roles and territories, use refusals


Emeralds:

• Changing color

• Not as clear or sharp, more vague

• On the go, need to ‘do’

• Flaws may be hidden

• Time traveling is common

• Are usually Doers or Supervisors

• Do what is seen, but miss what is not seen

• Must be in control, but not able to do it correctly

• Do tasks over and over, or not at all

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Ambers:• Amber Alert- Caution!

• Caught in a moment

• All about sensation and sensory tolerance,

easily over or under stimulated

• May be private and quiet or public and noisy

• No safety awareness

• Ego-centric

• Lots of touching, handling, tasting, mouthing,

manipulating

• Explorers, get into things, invade space of

others

• Do what they like and avoid what they do not

like


Rubies:

• Hidden depths

• Major loss of fine motor finger and mouth skills,

but can do gross motor skills like walking,

rolling, rocking

• Comprehension and speech halted

• Wake-sleep patterns very disturbed

• Balance, coordination, and movement losses

• Eating and drinking patterns may change

• Tends toward movement unless asleep

• Follows gross demonstration and big gestures

for actions

• Limited visual awareness

• Major sensory changes


Pearls:• Hidden in a shell: still, quiet, easily lost

• Beautiful and layered

• Spends much time asleep or unaware

• Unable to move, bed or chair bound, frequently fall

forward or to side

• May cry out or mumble often, increases vocalizations

with distress

• Can be difficult to calm, hard to connect

• Knows familiar from unfamiliar

• Primitive reflexes

• The end of the journey is near, multiple systems are

failing

• Connections between the physical and sensory world

are less strong but we are often the bridge

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you wish to apply concepts or ideas contained from this presentation you are taking full

responsibility for your actions. Neither the creators, nor the copyright holder shall in any event

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provided as is, and without warranties.

Any links are for information purposes only and are not warranted for content, accuracy or any

other implied or explicit purpose.

This presentation is copyrighted by Positive Approach to Care and is protected under the US

Copyright Act of 1976 and all other applicable international, federal, state and local laws, with

ALL rights reserved. No part of this may be copied, or changed in any format, sold, or used in

any way other than what is outlined within this under any circumstances without express

permission from Positive Approach to Care.

Copyright 2017, All Rights Reserved

Teepa Snow and Positive Approach to Care


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