counseling the alzheimer’s caregiver:

Impact on Self-Efficacy of the Impact on Self-Efficacy of the Caregiver and Disease RecipientCaregiver and Disease Recipient

Aging in America ConferenceAging in America ConferenceSan Francisco, April 28, 2011 San Francisco, April 28, 2011

Counseling the Alzheimer’s Counseling the Alzheimer’s Caregiver:Caregiver:

Presented by Sylvia Brunisholz, Nick Zullo and Sonnie Yudell, Presented by Sylvia Brunisholz, Nick Zullo and Sonnie Yudell, Alzheimer’s Disease Supportive Services Program of Utah Alzheimer’s Disease Supportive Services Program of Utah

1. Do ederly people prefer watching TV or browsing Internet?

Utah Chapter

Solutions-Focused Solutions-Focused CounselingCounseling

Caregiver Impacts and Caregiver Impacts and DilemmasDilemmas

A Plan for Life and CareA Plan for Life and Care

Individualized Cognasium Individualized Cognasium PlanPlan

Neuropsychiatric Inventory Neuropsychiatric Inventory QuestionnaireQuestionnaire

Self-Efficacy of the Client Self-Efficacy of the Client DyadDyad

We will talk We will talk about…about…


Utah Chapter

Looks at the Looks at the positive side of positive side of problems and problems and what works.what works.

Useful with both Useful with both senior spousal and senior spousal and adult offspring adult offspring caregivers caregivers

Solutions-Solutions-Focused Focused CounselingCounseling


R. K. & Gilliland, B. E. (2003). Theories and strategies in counseling and R. K. & Gilliland, B. E. (2003). Theories and strategies in counseling and psychotherapy, 5psychotherapy, 5thth ed. Boston, MA: Allyn & Bacon. ed. Boston, MA: Allyn & Bacon.

Places emphasis on Places emphasis on the future rather the future rather than the present than the present or past.or past.

Client’s are their Client’s are their own experts who own experts who can know what is can know what is best for them best for them



Therapy is Therapy is collaborative collaborative

Uses the resources Uses the resources available to the available to the clientclient

Problems are Problems are reframed in a reframed in a more positive way more positive way



Concerns about Concerns about behavioral and behavioral and Neuropsychiatric Neuropsychiatric Symptoms of the Symptoms of the diseasedisease

Their negative effects Their negative effects for both caregiver for both caregiver and disease recipient and disease recipient

What problems do Alzheimer’s What problems do Alzheimer’s caregivers present with in caregivers present with in counseling?counseling?


Aalten et al. (2005). The course of neuropsychiatric symptoms in dementia. International Journal of Geriatric Psychiatry, 20, 523-530.

Reduced quality of life Reduced quality of life for both caregiver and for both caregiver and disease recipientdisease recipient

More rapid decline More rapid decline trajectorytrajectory

Earlier Earlier institutionalization institutionalization

What are the effects of these What are the effects of these problems?problems?


Burgener, S.C. & Twigg, P. (2002). Interventions for persons with irreversible dementia. Annual Review of Nursing Research, 20, 89-124.

Apathy and depressionApathy and depression

Other cognitive deficits Other cognitive deficits and functional and functional impairment followimpairment follow

(Higher level of CG (Higher level of CG burden and utilization burden and utilization of resources) of resources)

What are common causes of What are common causes of behaviors in early stage (and behaviors in early stage (and resulting CG strain)?resulting CG strain)?


Starkstein et al. (2009). Neuroimaging correlates of apathy and depression in Alzheimer’s disease. Journal of Neuripsyciatric Clinical Neuroscience, 21(3): 259-265.

Studies indicate that Studies indicate that pharmacological pharmacological treatment did treatment did notnot influence the course of influence the course of the neuropsychiatric the neuropsychiatric symptoms in dementia symptoms in dementia

(leaves few options for (leaves few options for CG) CG)

Can these causes be treated (and Can these causes be treated (and thus reduce CG strain)?thus reduce CG strain)?


Aalten et al. (2005). The course of neuropsychiatric symptoms in dementia. International Journal of Geriatric Psychiatry, 20, 523-530.

Although behavioral Although behavioral disturbances may be disturbances may be mild, people in early mild, people in early stage are less aware stage are less aware of their cognitive and of their cognitive and behavioral deficitsbehavioral deficits

(Varies from (Varies from caregiver’s view) caregiver’s view)

What are the perceptual impacts What are the perceptual impacts of these causes (particularly on of these causes (particularly on CG role)?CG role)?


Onor, et al. (2006). Different perception of cognitive impairment, behavioral disturbances and functional disabilities. American Journal of Alzheimer’s Disease, 21, 333-338.

This perception This perception discrepancy may discrepancy may disrupt the disrupt the relationship between relationship between the caregiver and the the caregiver and the person with dementiaperson with dementia

(This disruption (This disruption contributes to earlier contributes to earlier institutionalization) institutionalization)

What is the relational impact of What is the relational impact of the causes (and CG reaction to the causes (and CG reaction to them)?them)?


Address behavioral Address behavioral symptoms symptoms in early in early stagestage

Do so through Do so through health health promotion activitiespromotion activities; ; early stage persons early stage persons are more willing to are more willing to participate in a well participate in a well organized programorganized program

What is the role of solution-What is the role of solution-focused counseling to treat these focused counseling to treat these causes?causes?


Fitzsimmons, S. & Buetter, L.L. (2003). Health promotion for the mind, Fitzsimmons, S. & Buetter, L.L. (2003). Health promotion for the mind, body, and spirit for older adults with dementia. American Journal of body, and spirit for older adults with dementia. American Journal of Alzheimer’s Disease, 18, 282-290.Alzheimer’s Disease, 18, 282-290.

Promotes and maintains Promotes and maintains optimal health for optimal health for bothboth early stage person and early stage person and caregivercaregiver

Quality of life for bothQuality of life for both

What are the results of solution-What are the results of solution-focused counseling coupled with focused counseling coupled with dementia activity programs?dementia activity programs?


Gymnasium for the BrainGymnasium for the Brain

From a clinical perspectiveFrom a clinical perspective: : Studies indicate that Studies indicate that despite the progressive despite the progressive nature of dementia, nature of dementia, individuals with individuals with Alzheimer’s disease can Alzheimer’s disease can still learn and maintain still learn and maintain their cognitive capacity their cognitive capacity through cognitive trainingthrough cognitive training

The Cognasium Approach: The Cognasium Approach: Improving Dementia Care Improving Dementia Care by Facilitating aby Facilitating aPartnership of Disease Partnership of Disease Recipient, Caregiver and Recipient, Caregiver and Physician Physician

CognasiumCognasium


Sitzer et al (2006). Cognitive Training in Alzheimer’s Disease: A Meta-Sitzer et al (2006). Cognitive Training in Alzheimer’s Disease: A Meta-analysis of the Literature. Acta Psychiatrica Scandinavica, 114, 75-90analysis of the Literature. Acta Psychiatrica Scandinavica, 114, 75-90

From a research From a research perspectiveperspective: Research : Research indicates the human brain indicates the human brain can reorganize after can reorganize after damage and experience damage and experience functional improvements, functional improvements, even in neurodegenerative even in neurodegenerative diseases such as diseases such as Alzheimer’s diseaseAlzheimer’s disease

Cognitive training can be Cognitive training can be effective for managing effective for managing symptoms in individuals symptoms in individuals with early stage with early stage Alzheimer’s disease and Alzheimer’s disease and related dementiasrelated dementias

The Cognasium Approach: The Cognasium Approach: Improving Dementia Care Improving Dementia Care by Facilitating aby Facilitating aPartnership of Disease Partnership of Disease Recipient, Caregiver and Recipient, Caregiver and Physician Physician

CognasiumCognasium


Yu et al (2009) Cognitive Training for Early-Stage Alzheimer’s Disdease and Yu et al (2009) Cognitive Training for Early-Stage Alzheimer’s Disdease and Related Dementia. Related Dementia. Journal of Gerontological Nursing, 35(3), 23-29 Journal of Gerontological Nursing, 35(3), 23-29

From a counseling From a counseling perspectiveperspective: : It is a solution-orientedIt is a solution-oriented

It is a type of redirection It is a type of redirection for and by the caregiverfor and by the caregiver

It is focused on the future It is focused on the future and is activity-basedand is activity-based

It de-pathologizes dementia It de-pathologizes dementia and emphasizes remaining and emphasizes remaining capacitiescapacities

The Cognasium Approach: The Cognasium Approach: Improving Dementia Care by Improving Dementia Care by Facilitating aFacilitating aPartnership of Disease Recipient, Partnership of Disease Recipient, Caregiver and Physician Caregiver and Physician

CognasiumCognasium

Encourages better health Encourages better health practices in the caregiverpractices in the caregiver

Nutrition, exercise, cognition Nutrition, exercise, cognition and socialization may impact and socialization may impact Alzheimer’s risk Alzheimer’s risk

Outreach is accomplished Outreach is accomplished through Brain Fitness through Brain Fitness Workshops Workshops

Popular with pre-clinical Popular with pre-clinical senior adults for whom senior adults for whom Alzheimer’s is greatest Alzheimer’s is greatest health worryhealth worry

The Cognasium Approach: The Cognasium Approach: Improving Dementia Care by Improving Dementia Care by Facilitating aFacilitating aPartnership of Disease Partnership of Disease Recipient, Caregiver and Recipient, Caregiver and Physician Physician

Pre-Clinical Pre-Clinical Cognasium Cognasium


Applicable to Early Stage Applicable to Early Stage Alzheimer’s PatientsAlzheimer’s Patients

Including persons with MCIIncluding persons with MCI

Dyadic approach with Dyadic approach with caregiver and disease caregiver and disease recipient; supports recipient; supports caregiver self-efficacycaregiver self-efficacy

Based on an individualized Based on an individualized Cognasium Plan (ICP) Cognasium Plan (ICP)

Post-Diagnosis Post-Diagnosis Cognasium Cognasium


Psychologist Albert Psychologist Albert Bandura has defined self-Bandura has defined self-efficacy as our belief in our efficacy as our belief in our ability to succeed in ability to succeed in specific situations. specific situations.

Caregivers believe they can Caregivers believe they can perform well and view their perform well and view their difficult tasks as difficult tasks as doabledoable if if not something they can not something they can master master

How does How does Cognasium address Cognasium address caregiver self-caregiver self-efficacy? efficacy?


People with dementia People with dementia describe it as isolating and describe it as isolating and life-changinglife-changing

They lose jobs, volunteer They lose jobs, volunteer opportunities, ability to opportunities, ability to drive, connections to family drive, connections to family and friendsand friends

Support groups for Support groups for caregivers; what about the caregivers; what about the ES person? ES person?

How does How does Cognasium address Cognasium address self-efficacy of the self-efficacy of the early stage person? early stage person?


An Individualized An Individualized Cognasium Plan (ICP) for Cognasium Plan (ICP) for the ES person is a direct the ES person is a direct intervention and supportintervention and support

It empowers them to It empowers them to provide input to family and provide input to family and counselorcounselor

Opportunity to make Opportunity to make friends with others in the friends with others in the program – staying program – staying connected and feeling connected and feeling supported supported

How does How does Cognasium address Cognasium address self-efficacy of the self-efficacy of the early stage person? early stage person?


Cognasium defeats nihilismCognasium defeats nihilism

The ICP is for both the The ICP is for both the caregiver and the ES personcaregiver and the ES person

The caregiver/disease The caregiver/disease recipient dyad enters recipient dyad enters counseling in disarray – counseling in disarray – through counseling, roles through counseling, roles are redefinedare redefined

Counseling is offered Counseling is offered individually and as an individually and as an empowered dyad empowered dyad

Cognasium Cognasium


Scene from “Diminished Capacity”

Provides a personhood- Provides a personhood- affirming approach to the affirming approach to the disease recipient without disease recipient without seeming toseeming to

De-emphasizes stress-De-emphasizes stress-burden for CG and burden for CG and addresses their needs too - addresses their needs too - provides respite without provides respite without seeming toseeming to

Cognasium is action-Cognasium is action-oriented; a natural oriented; a natural response to needsresponse to needs

Cognasium Cognasium


Cognasium Approach: Organic, family- oriented, connective, reinforcing, transforming

Cognasium is possible only after addressing the caregiver’s Cognasium is possible only after addressing the caregiver’s

needs needs Caregiver Support and Caregiver Support and CounselingCounseling

Advance Stages

Pre- and post-testing shows

● Reduced depression

● Enhanced social support

● Capacity to manage symptoms

Diagnosis

Cognasium

Cognasium is possible only after addressing the caregiver’s Cognasium is possible only after addressing the caregiver’s

needs needs Caregiver ImpactsCaregiver Impacts Some caregivers have littleSome caregivers have little emotional difficultyemotional difficulty

More than 40% More than 40% have high have high emotional stress emotional stress

About 1/3 have About 1/3 have symptoms of symptoms of depressiondepression

Caregiver stress is related to nursing home Caregiver stress is related to nursing home placement, but caregiver stress is often just placement, but caregiver stress is often just as high after nursing home placementas high after nursing home placement

Cognasium Objective: Caregiver Intervention

What aboutWhat about

Alzheimer’s Caregiver Alzheimer’s Caregiver Impacts?Impacts?

Compared with other unpaid Compared with other unpaid caregivers of people with caregivers of people with Alzheimer’s and other Alzheimer’s and other dementiasdementias

● Are more likely to report fair Are more likely to report fair or poor healthor poor health

● Are more likely to say that Are more likely to say that caregiving made their health caregiving made their health worseworse

There areThere are

Factors that Worsen Factors that Worsen the Impact of Alzheimer’s the Impact of Alzheimer’s

CaregivingCaregiving

Behavioral symptoms of the care recipientBehavioral symptoms of the care recipient

Co-existing medical conditions of the care recipientCo-existing medical conditions of the care recipient

Lack of perceived help from other family members and Lack of perceived help from other family members and friendsfriends

Belief that one has no choice about caregivingBelief that one has no choice about caregiving

Many personality characteristics of the caregiver and Many personality characteristics of the caregiver and the care recipient and their prior relationshipthe care recipient and their prior relationship

The reality of The reality of

Alzheimer’s Caregiver Alzheimer’s Caregiver ImpactsImpacts

Many Alzheimer’s/dementia advocates say that 40%, Many Alzheimer’s/dementia advocates say that 40%, 50%, 60% of caregivers dies before their care 50%, 60% of caregivers dies before their care recipientrecipient

There is no data to support that statementThere is no data to support that statement

One study of caregivers One study of caregivers in generalin general found that found that caregivers who were experiencing strain were 63% caregivers who were experiencing strain were 63% more likely to die than non-caregivers; over 4 years, more likely to die than non-caregivers; over 4 years, about 17% of the caregivers died compared with about 17% of the caregivers died compared with almost 11% of the non-caregiversalmost 11% of the non-caregivers

In our own state: In our own state:

Alzheimer’s Realities in Alzheimer’s Realities in UtahUtah

In 2010, there were 32,000 persons with Alzheimer’s In 2010, there were 32,000 persons with Alzheimer’s disease in Utah (70% of all dementias)disease in Utah (70% of all dementias)

Utah will experience a 127% growth in Alzheimer’s Utah will experience a 127% growth in Alzheimer’s prevalence from 2000 to 2025, highest in the nationprevalence from 2000 to 2025, highest in the nation

There are 101,000 Utah dementia caregiversThere are 101,000 Utah dementia caregivers

They provided 115 million hours of unpaid careThey provided 115 million hours of unpaid care

This care was valued at $1.3 billionThis care was valued at $1.3 billion

According to 2010 Facts and Figures Report, reported to Congress in May, 2010

What caregivers tell us: What caregivers tell us:

Top 10 Caregiver Top 10 Caregiver DilemmasDilemmas

Why do Alzheimer’s Caregivers reach out for help? Why do Alzheimer’s Caregivers reach out for help? A recent survey of Helpline calls, revealed the Top 10 A recent survey of Helpline calls, revealed the Top 10 Caregiver dilemmas Caregiver dilemmas (regarding the Alzheimer’s loved one)(regarding the Alzheimer’s loved one)

● 30% wanted to know, “Is it Alzheimer’s30% wanted to know, “Is it Alzheimer’s?” ?” (What are (What are the signs and symptoms?)the signs and symptoms?)

● 16% wanted to know how to get help caring for a 16% wanted to know how to get help caring for a loved one at homeloved one at home

● 11% wanted help due to burnout11% wanted help due to burnout

● 11% needed help finding a diagnosis11% needed help finding a diagnosis

● 9% were seeking help with disturbing behavior9% were seeking help with disturbing behavior

Top 10 Caregiver DilemmasTop 10 Caregiver Dilemmas

Helpline survey continued…Helpline survey continued…

● 8% said they could not handle care at home 8% said they could not handle care at home anymoreanymore

● 5% were seeking help with coping skills5% were seeking help with coping skills

● 5% were in crisis and needed emergency help5% were in crisis and needed emergency help

● 3% had questions about legal and financial issues3% had questions about legal and financial issues

● 2% needed help dealing with family conflict2% needed help dealing with family conflict

The progression of the The progression of the disease is different for disease is different for each – tailor the inter- each – tailor the intervention to retained skillsvention to retained skills

Accurate assessments Accurate assessments are essential are essential

Plans identify coping Plans identify coping strategies for CG and well-strategies for CG and well-being and self-esteem for being and self-esteem for ES personES person


Cognasium Goal: Link diagnostic and medical care with counseling and supportive services

Helpline

Care Consultation

A Plan for Life and Care

Diagnosis

Richards et al (2003). Defining “early dementia” and monitoring intervention. Aging and Mental Health, 7, 7-14

Physicians seek such services for patientsPhysicians seek such services for patients

National Survey of National Survey of PhysiciansPhysicians

Physicians listed these unmet needs in caring for Physicians listed these unmet needs in caring for dementia patients dementia patients (a variety of management needs not available for (a variety of management needs not available for

patients/caregivers through traditional medical practices)patients/caregivers through traditional medical practices)::

● More support of families of patientsMore support of families of patients

● Support groups, case management, financial Support groups, case management, financial management management (we call it “financial emotions”)(we call it “financial emotions”) ● Instrumental support, homecare services Instrumental support, homecare services (transportation and shopping)(transportation and shopping)

● Identifying appropriate living situations Identifying appropriate living situations (assisted (assisted living, long term care setting and treatment)living, long term care setting and treatment)

National Survey of National Survey of Physicians Physicians Continued…Continued…

Physician listed these unmet needs in caring for Physician listed these unmet needs in caring for dementia patients dementia patients (specific needs regarding patient safety were (specific needs regarding patient safety were

mentioned)mentioned)::

● Safety Safety (of living situation), home assessments, (of living situation), home assessments, respite or backup care, dispensing of medications, respite or backup care, dispensing of medications, unsafe drivingunsafe driving

● Help with patient wandering and dementia abuseHelp with patient wandering and dementia abuse

● Psychiatric help available as rapidly as neededPsychiatric help available as rapidly as needed

● Concern about helpfulness of Adult Protective Concern about helpfulness of Adult Protective ServicesServices

Before Cognasium…Before Cognasium…One physician stated, “We have not referred any patients; it's usually family members who find these resources. We do not know of much.”

Another physician stated, “I think what they do is give families some information and resources for daycare and nursing homes that have Alzheimer's settings. I don't know if there is an actual office to go in and get help.”

Physicians in the survey estimated that about Physicians in the survey estimated that about 40% of their patients were above age 65 and 40% of their patients were above age 65 and about 10% of their patients had cognitive about 10% of their patients had cognitive impairment, Alzheimer’s disease, or another impairment, Alzheimer’s disease, or another form of dementiaform of dementia

After Cognasium…After Cognasium…One physician stated, “We would evaluate the patient, then neurology, and then the Alzheimer's Association can provide us with the kind of help that they can provide. So if we can have the physician, the Alzheimer's Association, and the family sitting together in one room it makes things better.”

Another physician described the ideal Alzheimer’s Association partnership: “a multidisciplinary network that you can call on to go to the patient's house, make an assessment, give us some feedback, and maybe provide a therapist to help the family adjust and help with medications. [The goal would be] to have a team that we can rely on and still be able to be in charge of the medical issues.”

Physicians like the case management of practice Physicians like the case management of practice patients provided by the Alzheimer’s Associationpatients provided by the Alzheimer’s Association

Cognasium AddressesCognasium AddressesNeeds of People in Early-Needs of People in Early-

StageStage

Early diagnosis of ADRD is necessary to establish a baseline and track changes, target interventions to maintain functioning, make plans, and ensure adequate medication prescription and use

People with ADRD maintain awareness more than is realized. It is important to acknowledge this by including them in care planning and allowing them to be part of decision making

The ADRD person’s perception of abilities may not be updated to self-ensure safety. Caregiver must be vigilant to maintain safety

Cognasium Cognasium is a type ofis a type ofCognitive Training Cognitive Training

(non-pharmacological intervention to improve (non-pharmacological intervention to improve cognition)cognition)

The human brain can reorganize after damage and experience functional improvements, even in neurodegenerative diseases such as Alzheimer’s disease

Cognitive training can be effective for managing symptoms in individuals with early stage AD and dementia

Evidence is emerging regarding the effectiveness of cognitive enhancement interventions such as memory aids, neuropsychological rehabilitation and reality orientation for managing symptoms

Neuropsychiatric Inventory Neuropsychiatric Inventory Questionnaire Questionnaire

Assesses domains of dementia behavior including their frequency and severity. Twelve domains include agitation, depression, anxiety, apathy, etc. Assesses behavioral changes based on standardized caregiver interview

Assessment of caregiver distress based on integrated scale to evaluate distress associated with behavioral changes in the person with dementia

Supports teaching and communication with caregivers based on changes in the symptom ratings and supports counseling intervention

Neuropsychiatric Inventory Neuropsychiatric Inventory Questionnaire Questionnaire

Hallucinations Delusions Agitation/aggression Dysphoria/depression Anxiety Irritability

Dr. Jeffrey Cummings, http://npitest.net/about-npi.html

DisinhibitionEuphoriaApathyAberrant motor behaviorSleep & night-time changeAppetite and eating change

Neuropsychiatric Inventory Neuropsychiatric Inventory Questionnaire – KQuestionnaire – Key CG ey CG

indicators indicators

Agitation/aggression

Anxiety

Apathy

Sleep & night-time change

Appetite and eating

_______________

_______________

_______________

_______________

_______________

Distress33% reduced

16% increased

45% reduced

12% reduced

16% reduced- Eighteen Cognasium Dyads, - Eighteen Cognasium Dyads, eight- months post-test, eight- months post-test, April, 2011April, 2011

Safe environment for Safe environment for anger, shock and tears; anger, shock and tears; hope and support is hope and support is providedprovided

“There is life after “There is life after diagnosis” through diagnosis” through socialization, exercise, socialization, exercise, nutrition and cognitive nutrition and cognitive stimulationstimulation

We are “Making Sense of We are “Making Sense of Alzheimer’s” (branded Alzheimer’s” (branded Utah Symphony Utah Symphony collaboration)collaboration)““Making Sense of Alzheimer’s” is a branded collaboration with the Utah Making Sense of Alzheimer’s” is a branded collaboration with the Utah

Symphony that garnered national attention in 2010Symphony that garnered national attention in 2010


Activity-Based Dementia Care Activity-Based Dementia Care

Why Cognasium WorksWhy Cognasium Works

It is a form of the “chronic It is a form of the “chronic care model” Patients (and care model” Patients (and their families) become their families) become more informed and more informed and activatedactivated

Interventionists are more Interventionists are more proactive, which should proactive, which should result in improved clinical result in improved clinical and functional outcomesand functional outcomes

Intervention with caregiver Intervention with caregiver results in improved results in improved neuropsychiatric symptoms neuropsychiatric symptoms




Cognasium is a day retreat Cognasium is a day retreat program for persons with program for persons with Alzheimer’s and other dementiasAlzheimer’s and other dementias

Participants have varying MMSE Participants have varying MMSE scores but socialize and support scores but socialize and support each othereach other

Impacts on home environment – Impacts on home environment – less behaviors, increased caregiver less behaviors, increased caregiver well-being, delayed institutional well-being, delayed institutional placementplacement

LTC placement by plan, not crisisLTC placement by plan, not crisis




Music and dementia care – annual Music and dementia care – annual collaboration with the Utah collaboration with the Utah Symphony and Utah Opera Symphony and Utah Opera

Visual arts in dementia care – Visual arts in dementia care – engenders socialization and gives engenders socialization and gives family members a new family members a new appreciation for the patient’s appreciation for the patient’s value and quality of life needsvalue and quality of life needs

“I Remember Better When I Paint”“I Remember Better When I Paint”

“Meet Me at MoMA coming to Salt “Meet Me at MoMA coming to Salt Lake (Utah Fine Arts Museum and Lake (Utah Fine Arts Museum and CACIR)CACIR)




Movement and dance in dementia Movement and dance in dementia care – Art Access funded by care – Art Access funded by Kennedy Foundation emphasizes Kennedy Foundation emphasizes dance as a means of reminiscence dance as a means of reminiscence therapytherapy

Cognitive stimulation – learning a Cognitive stimulation – learning a foreign languageforeign language

Some dyads are utilizing Mind-Some dyads are utilizing Mind-Body Bridging program as part of Body Bridging program as part of their ICP’stheir ICP’s

This spring, Wheeler Farm This spring, Wheeler Farm excursionsexcursions




Every step we take addresses CAUSE, CARE and CURE of Every step we take addresses CAUSE, CARE and CURE of

Alzheimer’sAlzheimer’s Next Steps in UtahNext Steps in Utah

People + People + ScienceScience

COUNSELING - Integrate COUNSELING - Integrate cognasium into day care for cognasium into day care for early stage, home and early stage, home and community-based care settings, community-based care settings, primary care and programs with primary care and programs with Area Agencies on Aging and Area Agencies on Aging and Veterans AdministrationVeterans Administration

CAREGIVER SUPPORT – Reach, CAREGIVER SUPPORT – Reach, educate and empower caregivers, educate and empower caregivers, provide respite, self care training provide respite, self care training and caregiver conferencesand caregiver conferences

SUSTAINABILITY - implement SUSTAINABILITY - implement evidence-based intervention and evidence-based intervention and incorporate research findings, incorporate research findings, build resources through build resources through community and funding community and funding partnerships, professional partnerships, professional trainingtraining

Utah’s Alzheimer’s Growth Utah’s Alzheimer’s Growth Rate Rate

Source: Alzheimer’s Facts and Figures 2010, presented to Congress in Source: Alzheimer’s Facts and Figures 2010, presented to Congress in March, 2010March, 2010

45% increase

From 2000

To 2010

127% increase

Projected

from 2000

to 2025

Highest of any state

Our challenges motivate us

Cognasium: Cognasium: Counseling Counseling intervention that emphasizes intervention that emphasizes

health promotionhealth promotion

““Honest doc – if I’d Honest doc – if I’d known I was known I was gonna live this gonna live this long, I’d have long, I’d have taken better care taken better care of myself.”of myself.”

Every client, interventionist Every client, interventionist and volunteer will be invited to and volunteer will be invited to develop an Individualized develop an Individualized Cognasium Plan (ICP) for brain Cognasium Plan (ICP) for brain fitnessfitness

The compassion to care, the leadership to conquerThe compassion to care, the leadership to conquer

“When the Lord calls me home,

I will leave with the greatest optimism

for the future” - Ronald Reagan

counseling the alzheimer’s caregiver:

Documents

ederly people

cg strain

disease recipientaging

alzheimers caregivers

cg role

irreversible dementia

caregivers view

early stage