Thursday, November 23, 2017

Ten Real-Life Strategies for Dementia Caregiving

As caregivers, we often use intuition to to help us decide what to do. No one ever gave us lessons on how to relate to someone with memory loss. Unfortunately, dealing with Alzheimer’s disease and other dementias is counterintuitive; i.e., often the right thing to do is exactly opposite that which seems like the right thing to do. Here is some practical advice:
  • Being Reasonable, Rational, and Logical Will Just Get You into Trouble. Straightforward, simple sentences about what is going to happen are usually the best.
  • People with Dementia Do Not Need to Be Grounded in Reality.  When someone has memory loss, he often forgets important things, e.g., that his mother is deceased.  Redirecting and asking someone to tell you about the person he has asked about or about his home is a better way to calm a person with dementia.
  • Therapeutic Lying Reduces Stress.  Is it okay to tell your loved one that the two of you are going out to lunch and then “coincidentally” stop by the doctor’s office on the way home to pick something up as a way to get her to the doctor?
  • Making Agreements Doesn’t Work.  If you ask your loved one to not do something ever again, or to remember to do something, it will soon be forgotten. Taking action, rearranging the environment, rather than talking and discussing, is usually a more successful approach. For example, getting a tea kettle with an automatic “off” switch is better than warning someone of the dangers of leaving the stove on. 
  • Doctors Often Need to Be Educated By You.   Telling the doctor what you see at home is important. The doctor can’t tell during an examination that your loved one has been up all night pacing. Sometimes doctors, too, need to deal with therapeutic lying; e.g., telling the patient that an antidepressant is for memory rather than depression.
  • You Cannot Be a Perfect Caregiver.    Learning to forgive your loved one as well as yourself is essential in the caregiving journey.

Promoting independence for those living with dementia

  Regardless the task, there are ways to support independence with a person’s participation in their own daily life. By encouraging independence, the person's ability to function will increase, as well as their confidence. Strategies that can support or maintain independence in people with dementia can also lower the level of stress experienced by the caregiver.

  • Encouraging physical activity and maintaining flexibility and strength helps  individuals to continue their daily tasks longer. Encourage some form of physical activity on a daily basis, such as going for a walk around the neighborhood or doing some simple stretches.
  • Identify the daily life skills that the person can still do on their own, even if it takes a little longer For example: If they are able to put on their shoes but cannot tie the laces, consider changing to slip-on shoes or ones with Velcro.
  • Mealtime always presents opportunities to ask the person to help with a part of the task, such as washing vegetables or setting the table. Remember that some days are better than others. If the person has difficultly completing a particular task, perhaps they can try again on another day.
  • Recognize and celebrate the things that can still do!!

Meeting the Psychosocial Needs of People Living with Memory Loss Through Therapeutic Recreation and the Expressive Arts

What is Recreation Therapy?

   Recreational therapy, also known as therapeutic recreation, is a systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illnesses and/or disabling conditions, as a means to psychological and physical health, recovery and well-being. These services are provided by a nationally Certified Therapeutic Recreation Specialist.

Why Expressive Arts?

   For some people living with dementia, verbal communication and expression can become challenging,  Expressive therapies aren’t arts and crafts classes, but a processes for helping clients reach specific goals for self-expression,  experience joy, and their improve their over-all mood.

What outcomes can be expected?

   Outcomes of expressive therapies for individuals with memory loss, dementia, or Alzheimer’s are to maximize their remaining abilities.  We use music, movement, visual arts, storytelling, facilitated poetry and creative writing, improvisation drama groups, cooking, gardening, and Health Rhythms Drumming to encourage self-expression. This is especially useful for those who are unable to express themselves verbally. All interventions are focused on creating a safe and joyful experience, reduce  anxiety, depression, and enhance the quality of one’s life.

Thursday, November 16, 2017

Safety Tips for a Dementia Friendly Home

Most accidents in the home occur during daily activities such as eating, bathing and using the restroom.
Taking measures to improve safety can prevent injuries and help a person with dementia feel more relaxed, less
overwhelmed and maintain his or her independence longer.

  • Avoid serving food and beverages that are too hot. The person with dementia may not remember to check the temperature. 
  • Install walk-in showers.
  • Add grab bars to the shower or tub and at the edge of the vanity to allow for independent and safe movement. 
  • Add textured stickers to slippery surfaces.
  • Apply adhesives to keep throw rugs and carpeting in place, or remove rugs completely. 
  • Monitor the hot water temperature in the shower or bath. Consider installing an automatic thermometer.
  • Pay special attention to garages, work rooms, basements and outside areas where there are more likely to be tools, chemicals, cleaning supplies and other items that may require supervision.

Living with Dual Sensory Loss

Living with Dual Sensory Loss (DSL) is frustrating for both the individual and for those that provide care to the person.  DSL can be very isolating and if not addressed may lead to other health issues such as depression, cognitive decline and decline in her overall health.  Establishing a communication system (behaviors always communicate an unmet need) is the first step, and this is done with a thorough assessment to determine her true functional ability, (is she using avoidance behaviors), explore any preferred interests in her past (knitting, crochet, canning, gardening), and identify  her grieving process stage for this significant loss and other losses she has such as leaving her home, decline in her independence.... Once this is determine, strategies can be developed. 

Non-pharmacological interventions are always best, but if she/he does have depression, memory loss, or anxiety this would need to be addressed medically.  When someone begins to isolate due to DSL or other reasons, validating their fears of avoidance behaviors such as fear of leaving their room (falling, bathroom concerns, being abandoned...) and building trust is crucial. Supporting those who are lonely, bored, or believe there is no longer a purpose in their life is what we do best. November and December is the perfect time to offer and share opportunities for to smell, touch, and reminisce about memories of family holidays. Note: holidays can also be very difficult for anyone because of losses, so make sure you acknowledge all emotions.  

If the person is reluctant to leave her room, you may check in and see if she there is friend you could invite to her room (serve herbal tea and cookie) then use the old "Columbo approach (a last minute thought as you are leaving the room) and ask for their help to assemble candy bags for a children's party, pull and dry rose petals for making potpourri  bags, sort nuts, or familiar tasks such as breaking beans, cutting up vegetables, stirring cookie dough...  If she is not open to a visitor, then you can set up the task and begin doing it with her. Once she becomes engaged you can exit ("I have to check on something") and this will encourage some self-directed interests. You can also provide her with a lighted high vision magnifying glass that can be attached to a table, and use a microphone with amplification (I have used a karaoke machine). Once she begins to trust that her needs will be met, then she may begin to take some risks and even try recording her legacy.

Friday, July 31, 2015

A lesson from my childhood

Yesterday I was shopping in
an enormous home supply
store ready to navigate the
overwhelming vastness of
inventory, I experienced one
thing that saddened me and
one that gave me hope. It wasn't the frustration of walking 
the half mile through the aisles to find two items,or the wasted 
time spent in seeking help, but my experiencing fond emotions from
my childhood. 

As I strolled down the plumbing department, I remembered going to
the hardware or auto parts stores with my father. I was a daddy's girl and
any opportunity to run errands with my father was seldom missed. To me, he was
the smartest man I knew. I can remember to this day the excitement I had and 
still have when I walk into a store with so much "stuff". I have always been 
curious and was reminded of how attentive and patient my father was to teach 
me what the "stuff" was for. Dad was a jack of all trades and could fix about anything. 
For example, I distinctly remembered the day we needed a "thingamajig" for our 
toilet so it would again flush on command. So my dad and I headed out to the 
neighborhood hardware store with the old broken part in hand. We were on a 
mission. We walked straight to the plumbing department (I told you my dad was smart)
and we meticulously examined all the possible replaceable parts. Finding what we
needed, my dad then showed me how the float and flush valve worked. He took my little
hand and ran it over the refill tube and explained that even though it lived in a toilet,
the water in the tank was clean and I need not to be afraid of getting my hands wet.
I learned how the flapper functioned and that the chain can be adjusted. I soaked it
all in (yes that pun was intended. Looking back, I guess I was being "toilet trained" for a second time.

The need to find my items and continue with my errands for the day created a sense
of urgency and it brought me back to the present. I continued on and was noticing the
fathers and occasional mothers strolling through the aisles with their children, and came
upon a man, and perhaps his young son, shopping in the"magical parts" department for
that "thingamajig" that made things disappear; a part for that all mighty commode.
It was then that I became sad. The little boy was curious and began touching values,
flush levers, and wax seals and asking little kid questions. The dad quickly responded
by directing the boy to "not touch" and handed him his cell phone commanding that the
child play a game so he could "think". The child quickly obeyed without protest. Maybe
the man was in a hurry or was having a stressful day but the missed opportunity to
teach his son a lifeskill that would perhaps serve him well in his future, was gone.
As much as I wanted to tell that dad to "teach his son how to fish and feed him for a
lifetime", I took a deep breath and relished in the memory of the lesson I learned from
my own father. I finally found the two items on my list and headed to check-out. As I
turned the corner at the lumber aisle I overheard a father telling his daughter how a
miter box worked. As I walked passed I could see the little girl holding a coping saw
in her hand. Once again, I relished in the memory of the same lesson from my own
dad, and it was then I was given hope. Some parents still take the time to "connect"
with their child and share valuable knowledge.

When I learned how important those little parts of the commode were, I not only learned
a skill that would help mold me into a self-reliant and independent adult, I felt the
connection and love from my father. So whether you are a parent or a professional that
influences children's lives, please don't miss out on a " teachable moment." These
moments don't just teach skills, but gives you opportunities to connect with the child.
That day I was truly connected to my father, who is still the smartest man I have ever
known. And by the way, I had to replace my  "thingamajig" earlier this year.

Wednesday, July 15, 2015

Elderhood and drumming

As a HealthRhythm Drumming Facilitator, some of my most enjoyable music making experiences have been with senior adults. Some sessions were community based, but many were in senior communities with adults living with loneliness, memory loss, depression, or feelings of helplessness. When adults with memory challenges, or those adults just unmotivated to engage, therapeutic drumming can be a non-threatening intervention that spark's moments of joy in their day.

When we pass through childhood, adulthood and finally reach edlerhood, our needs and efforts to continue to learn, engage with others, try new activities, and remain both cognitively and physically active do not change. If anything, because many elders are retired and living with years of free time, engagement and connecting with others is even more important. 

Rhythm is a powerful tool to globally stimulate the brain. For example, vision and speech are in two different areas of the brain, but music uses the whole brain, reaching different pathways. Music can ignite past memories and for some, those that may feel are unreachable, will begin to connect with a simple pat of a foot.

Drumming can give a sense of personal power. The drum places an individual in the present, and can be very grounding. For individuals who have difficulty expressing feelings verbally, drumming encourages opportunities to release emotions and experience a means of self-expression.  The benefits of music making with drums may just be the key for communicating with those who no longer feel they have a voice.