Transcript Hospice Care of the Dementia Patient

Alzheimer’s and
Related Disorders
Dr. BC Farnham & Elizabeth Pugh, LBSW, CM
This program is made possible through a collaborative community-education partnership between The Consortium for Advancements
in Health & Human Services, Inc. and Kindred at Home. The primary goal of this effort is to increase public awareness and access to
hospice and home health through the provision of community-based education. Contact Hours are awarded to professionals who
complete this program by The Consortium for Advancements in Health & Human Services, Inc. (www.cahhs-partners.org)
The Consortium for Advancements in Health and Human Services, Inc. © 2014
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This education program for healthcare professionals was developed by The Consortium for Advancements in Health and
Human Services, Inc. (CAHHS) and is facilitated by the presenting agency via a community education partnership agreement.
CAHHS is a private corporation and is solely responsible for the development, implementation and evaluation of its
educational programs. There is no fee associated with receiving contact hours for participating in this program titled,
Alzheimer’s and Related Disorders. However, participants wishing to receive contact hours must offer a signature on the
sign-in sheet, attend the entire program and complete a program evaluation form.
The Consortium for Advancements in Health and Human Services, Inc. is an approved provider of continuing nursing
education by the Alabama State Nurses Association, an accredited approver by the American Nurses Credentialing Center's
Commission on Accreditation.
The Consortium for Advancements in Health & Human Services, Inc., is approved as a provider of c ontinuing education
in Social Work by the Alabama Board of Social Work Examiners, #0356, Expiration Date: 10/31/2016.
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In most states, boards providing oversight for nursing and social work recognize contact hours awarded by organizations
who are approved by another state's board as a provider of continuing education. If you have questions about acceptance
of contact hours awarded by our organization, please contact your specific state board to determine its requirements.
Provider status will be listed on your certificate.
CAHHS does not offer free replacement certificates to participants. In the event that CAHHS elects to provide a replacement
certificate, there will be a $20.00 administrative fee charged to the individual who requests it.
Learning Objective (s):
 Participants completing this educational program
will be able to do the following:
 Understand and recognize the four types of
Alzheimer’s Disease.
 Understand ways to communicate with a patient
with Alzheimer’s Disease.
Dementia vs. Normal Aging
‣ Forgetfulness due to aging or stress is NOT
dementia related.
‣ Dementia is not a disease but a group of
symptoms.
Dementia
 Loss of intellectual functions and memory
sufficient to impair activities of daily living.
Occurs in Domains of…
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Memory
Language
Visuospatial Skills
Complex cognition
Emotion and Personality
4 Major Types
 Dementia: Alzheimer Type
 Vascular Dementia: multi-infarct
 Diffuse Lewy Body Dementia
 Pick’s Disease
Dementia: Alzheimer Type
 50% of all dementias
 Affects 4 million people
 Irreversible
 Neurofiber tangles & senile placques destroy cerebral cortex producing
atrophy
 Average Life expectancy 3 to 10 years
Vascular Dementia
 5 – 10% incidence
 Blockages in small arteries of the brain cause a loss of
circulation beyond the blocked area…lead to brain cell
death
 Causes: High blood pressure or heart disease
 Step–wise progression; periods of stability with sudden
significant declines
Diffuse Lewy Body Dementia
‣ 15% incidence
‣ Caused by protein deposits in the brain
‣ Characterized by hallucinations and difficulty with motor skills
‣ Acute/Rapid onset
‣ Life expectancy similar to Alzheimer’s Dementia
Pick’s Disease
‣ 15% incidence
‣ Affects frontal and temporal lobes of the brain
‣ Causes personality changes, socially inappropriate
behavior, amnesia, speech difficulties
‣ Younger onset, more commonly between age 40
and 60
Prognosis
‣ Permanent Loss of Neurons
‣ Medications, which prevent breakdown of
acetylcholine, may slow progression for a period
of time
Signs and Symptoms
 Memory Loss – short and long term
 Confusion
 Loss of reasoning and intuition
 Inability to learn new things
 Poor judgment
 Loss of ability to use knowledge
 Loss of ability to carry out motor tasks or follow
directions
Signs and Symptoms
 Personality changes
 Frustration, withdrawal, suspiciousness or
restlessness
 Disturbance of sleep cycle
 Inability to perform ADLs
 Inability to recognize friends and family
 Emotional instability
Behavioral Issues
 Anxiety
 Resistiveness to care due to inability to
understand their environment and need for care
Causes of Death
 Infection
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Impaired immune function
Immobility
Incontinence
Skin breakdown
Impaired swallowing
 The patient “fades away”
Communication and
Alzheimer’s Disease
Non-Verbal Communication
‣ Caregivers should learn to read the body language
of people with AD
‣ Use all senses
‣ If patient is unreceptive leave them alone for a few
minutes
‣ Make nonverbal messages match your words
‣ Add positive, pleasant nonverbal behaviors
Verbal Communication &
Language Changes
 People with AD may:
 Not be able to keep up with conversation
 Not understand directions
 Have increased confusion with background noise
Verbal Communication
Tips and Techniques
 Use simple, short sentences
 Say the person’s name
 Establish eye contact
 Speak clearly, calmly and repeat as needed
 Look for cues the person has heard you
 Act out the message
 Address the person by their given name
Early Stages
‣ Discuss important business in the mornings
‣ Focus on one topic at a time
‣ Use specific words, names of people and objects
‣ Do not use pronouns or general language
Middle Stages
‣ Give stimulation that can be sensed emotionally
‣ Give touch in a systematic way
‣ Stimulate smell
‣ Comb their hair
‣ Give favorite foods
‣ If the patient speaks in single words, then you
should speak in single words
Late Stages
 Speak warmly, quietly and with eye contact
 Pat or stroke their hand
 Touch with love
 SMILE
Effective Reaction Skills
 Control your emotions
 Analyze the situation
 Be positive
 Acknowledge the patient’s emotions
Use Communication Cards
 Print a clear message
 Make cards personal
 Read it with the patient
 Plan ahead
References
Special care of nursing home resident’s with alzheimer’s disease or related disorders. (n.d.).
Retrieved August 17, 2010 from Florida Health Care Association website:
http://www.fhca.org/
Stavitsky, K., Brickman, A. M., Scarmeas, N. Torgan, R. L., Tang, M. X., Albert, M., Brandt, J.,
Blacken, D., & Stern, Y. (2006). The progress on cognition, psychiatric symptoms and
functional abilities in dementia with lewy bodies and alzheimer’s disease. Arch Neurol,
63 (10). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17030662.
Zannetti, O., Solerte, S.B., & Cantoni, F. (2009). Life expectancy in alzheimer’s disease. Arch
Gerontol Geriatr, 49. Retrieved from http://www.med.umich.edu/alzheimers/
Alzheimer’s association. (2010). Retrieved from http://www.alz.org/index.asp
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