Transcript File - Chaplain Miller Ministries

Understanding &
Ministering to
Family Members with
Dementia &
Alzheimer’s Disease
Presented by Frank Miller, Chaplain
Education Consultant with
Heritage & ARC Home Health &
Hospice Care
The Basics
Dementia
vs
Alzheimer’s Disease
Dementia

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Refers to symptoms that include
changes in memory, personality, and
behavior
Does not mean “crazy”
Changes in brain function are
significant enough to interfere with
daily functioning in a person who is
awake & alert
Dementia


Alzheimer’s Disease is most common
cause of dementia (50-60% of all
cases)
Other diseases causing dementia are
stroke; depression; problems with
thyroid, liver, kidney, and vitamin
deficiencies; brain tumors, brain
injury, some infections, etc…..
Dementia is NOT…


Occasional forgetting of names,
location of objects, finding the “right”
word, what you were going to do
when you entered a room, etc.
“10 Warning Signs of Alzheimer’s”
www.alz.org/AboutAD/Warning.asp
Alzheimer’s Disease

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
First described by a German physician,
Alois Alzheimer in 1907
Dr. Alzheimer did an autopsy of a
woman in her 50’s and found brain
had beta-amyloid plaque &
neurofibrillary tangles
Progressive & ultimately fatal disease
Brain Fact:
Some causes of dementia
are potentially reversible
but
Alzheimer’s Disease is not
reversible.
Normal brain
Alzheimer’s brain
Stages of Alzheimer’s


Alzheimer’s Association: 7 stages from
“no impairment” to “very severe
decline”
Simpler classification
– Mild
– Moderate
– Severe
Mild or early stage

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Forgetfulness
Inability to learn new things
Difficulty managing finances, planning
meals, taking medications on schedule
Able to do most activities including
driving
Gets lost going to familiar places
May be depressed
Moderate stage



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Forgetfulness extends to “old facts” (moving
backwards in time)
Repeats stories and makes up stories to fill
in gaps
Difficulty performing tasks
Behavior problems
–
–
–
–
Agitation
Restlessness
Wandering
Paranoia, delusions, hallucinations
Moderate stage (cont)

Problems with intellect and reasoning
– Poor judgment
– Forgets manners

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Appearance & hygiene deteriorate
Sleep disturbances
Severe (late) stage

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May groan, scream, mumble, or speak
gibberish
Refuses to eat
Fails to recognize family or faces
Difficulty with all essential activities of
daily living
Requires considerable care & may
need to be institutionalized
Alzheimer’s
disease
affects
every
individual
differently
Care of Dementia Patient


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Diagnosis as soon as possible
Use of available medications
Identify other health problems that
might be contributing to dementia
– Other diseases, medications, depression,
nutrition deficiencies, pain, etc.

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Good nutrition & hydration
Willing & capable caregiver
FDA approved medications
for Alzheimer’s Disease

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Aricept (Donepezil): approved for all stages
Exelon (Rivastigmine): mild to moderate
stages
Razadyne (Galantamine): mild to moderate
stages; used to be called Reminyl
Namenda (Memantine): moderate to severe
stages
Note on medications:
Approved drugs offer a
modest, temporary delay in
worsening of the disease.
But…it can buy time to
make decisions & save
money for additional help.
A staggering fact…
Approximately 5 million
Americans care for a
loved one with
Alzheimer’s disease at
home
Fatigue
Caregivers & Families

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Alzheimer’s affects entire families,
particularly as disease progresses
Caregivers often experience
depression, anxiety, stress, &
helplessness
Caregivers need respite time to
maintain their own health
Caregivers & families need education
Great resources

The 36-Hour Day by Mace & Rabins
Creating Moments of Joy by Jolene Brackey
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Alzheimer’s Organization website

www.alz.org
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Alzheimer’s Association
North Central Texas Chapter
101 Summit Ave #300
Fort Worth, TX
817-336-4949
Long-term planning
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Know end-of-life wishes of patient
Implement Durable Power of Attorney
& Living Will
Investigate assisted living facilities &
nursing homes (Memory Care facilities
are best equipped for Alzheimer’s
patients)
Long-term planning (cont)

Respite for caregiver
– Other family members
– Friends
– Paid caregivers (agency, privately hired, respite
through Alzheimer’s Association)

Home Health Care (skilled)
– Medicare pays 100% for patients who qualify
– May also be covered by some insurance
On the surface, there’s not
much JOY in Alzheimer’s
The Facts
Disease of losses—short-term
memory at first and then longterm memory later
 No cure!
 Progressive!
 We aren’t sure what causes it!
 It is a disease of grief after grief
after grief!

Jolene Brackey, author of
Creating Moments of Joy says…
“We are not able to create a perfectly
wonderful day with someone who has
dementia, but it is absolutely attainable to
create a perfectly wonderful moment; a
moment that puts a smile on their face, a
twinkle in their eye, or triggers a memory.
Five minutes later, they won’t remember
what you did or said, but the feeling you
left them with will linger.”
How do you create a
moment of joy for
someone with
dementia?
What brings joy to you?
For the person with
Alzheimer’s disease and
short-term memory
loss, life is made of up
of moments.
Remember…
As the disease progresses, the
person with Alzheimer’s disease
becomes younger and younger in
his mind.
 He/she may not recognize family
members because in the age of
his mind, the loved ones were
children.

Live their reality…
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Never force our reality on a person
with dementia.
If your elderly husband insists he is 30
years old, ACCEPT it.
– It is HIS reality.
– His wife was young & wrinkle -free.
– The children were in grade school.
Thou SHALT adjust the truth
(in this situation)…
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You will never be able to reason
with a person with Alzheimer’s
disease.
An 82 year old woman keeps trying
to find her mother. It is cruel to tell
her that her mother died years ago.
Each time she hears this news, she
will grieve her mother’s death.
Example…
George, who mowed a golf course for a
living, gets up early every morning
and insists that he must go to work.
Instead of telling him he is 83 and is
retired, you tell him it has been raining
and his boss called and told him to
take the day off.
Now, he can enjoy his day off instead
of arguing with you about going to
work.
(joy!)
We need to change
because the person with
dementia cannot change.
The only person I can
make change is ME.
Communication
90% of what the Alzheimer’s
patient understands is nonverbal communication
Touch is communication

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Basic need of life
Craved from the first moments of life
Our hands portray what is inside of us
Your mood is their mood.
 If
Momma ain’t happy, ain’t
nobody happy!
 Find
a way to put yourself in a
good mood
 Quiet music has a calming
effect
Communication
Strategies
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Be calm, positive, matter-of-fact
Reduce background noise &
distractions
Talk to person face-to-face, at eye
level
Touching the person may hold
attention
Communication
Strategies (cont)
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Demonstrate task
Praise non-verbally (hugs, smile, pat
on back)
Use short, simple sentences
Keep it positive--try to avoid negative
words such as “no, don’t, can’t”
Communication
Strategies (cont)
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If person is fixated on one subject
such as his old job, communicate
using person’s long-term memory. “I
understand you were a very good
farmer.”

Avoid questions that require shortterm memory
We must
find the
ways to
“tickle”
those longterm
memories
Make a connection…
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Instead of asking, “How are you?”,
compliment them and start a
conversation.
Tap into their greatness…
“I understand that you made the best
chocolate pie in town!”
The answer may be “yes” OR she may
launch into a memory of her chocolate
pies.
(joy!)
Busy hands are happy
hands…
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Create things for the person to do
even if doesn’t need to be done—
sorting laundry, shucking corn, sorting
nuts and bolts, rolling yarn into balls
Have no expectations…allow mistakes
(joy!)
Maintaining the
independence of the
person with Alzheimer’s
disease will make the
caregiver’s life easier and
maintain dignity as well as
stimulate the brain.
Odd behaviors are
common with Alzheimer’s
patients…
wandering, dressing
problems, verbal
outbursts, hiding things,
“borrowing” things that
don’t belong to them, etc.
Choose your battles
What if the person insists on
wearing the same outfit every
day?
Ask yourself:

Does this cause harm to the person?

Does this annoy me? Probably, but

Does this case harm to other people?

No.
who cares.
No.
Do they remember they wore this
yesterday? No.
Patience…
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You’re going to lose it…we all do
When you have been asked the same
question over & over, you WILL be
frustrated!
Take a break…say you have to go to
the bathroom, even if you don’t need
to
Take a walk
Do something for YOU!
YOU…the caregiver
 Need
to take care of
yourself before you can
take care of someone else
 Be involved in your own life
 Spoil yourself as often as
possible
Discover
ways to
decrease
your
stress
Smile
 Lifts
your
spirits
 Relieves
stress
 Maybe you
will get a
smile back
Exercise
Reduces stress
 Increases blood flow to brain
 If person with dementia is also
able to walk, it can relieve stress
for both of you

Each one of us possesses
the power to bring joy
into another person’s
life…
You choose…be a drop of
rain or a ray of sunshine.
-unknown
In turn, you will create joy
for yourself!
Our value lies in what we
are and what we have
been, not in our ability to
recite the recent past.
-Homer, a man with Alzheimer’s
disease