Care for elderly persons with physical, cognitive ...newagecare.net/wp-content/uploads/2019/12/Care-for-elderly-person… · Problem Solving Steps 5. Treat or eliminate antecedents

Care for elderly persons

with physical, cognitive,

behavioral and social

disabilities

2019 4th Quarter In-Service0.5 hr

Dementia Patients and Caregivers

▶ 5.2 million Americans have AD (Alzheimer's disease.)

▶ 11 percent of people age 65 and older have AD

▶ 15.5 million dementia caregivers

2017 figures

▶ Most home based care and MD/NP visits will be for moderate to severe stage dementia

▶ Goals of care are to maximize physical function while maintaining a safe, supported environment for patient and caregiver

©AAHCM

Assumptions for this talk

Desired Outcomes for Dementia

▶ Attain and maintain highest practicable level of personal functioning

▶ Decrease severity and frequency of neuropsychiatric symptoms

▶ Delay institutionalization of patient, if possible▶ Promote caregiver and patient-centered decision-making▶ Reduce caregiver stress and burden▶ Enhance caregiver involvement and comfort with dementia

care

AMA, Dementia Performance Measurement Set, 2011

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Family Centered Dementia Care Plans

▶ For moderate to severe stage dementia, focus will be on:◦ Presentation of non-specific symptoms

◦ Developing a care plan when discussing diagnosis of “dementia”

◦ Easing guilt and worry and supporting the caregiver

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Conclusions

▶ Home care visits can improve care of dementia patients by allowing provider to see patient environment and interactions

▶ Assessment of patient function and behaviors can allow a tailored, patient specific intervention

▶ Skills training of caregiver improves quality of life for both members of dyad

▶ Promotion of caregiver and patient-centered decision-making enhances success of caregiving

©AAHCM

Caregiver Care Recipient▶ Improve Patient’s life▶ Management of problem

behaviors or concerns▶ Safety

▶ Empower Caregiver▶ Knowledge▶ Problem solving skills▶ Coping skills⚫Communication, stress

management

▶ Improve Caregiver’s▶ Physical well-being▶ Emotional well-being▶ Health and self-care▶ Social support

Caregiver Intervention Goals

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Problem Solving Steps1. Determine problem

o Patient behavior

o Caregiver reaction or concern

2. Define/operationalize o Frequency

o Duration

o Intensity

o Characteristics

o Antecedents and consequences of behavior (ABC Process)

3. Assess previous attempts to address4. Set goals and realistic outcome

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Problem Solving Steps5. Treat or eliminate antecedents and triggers

o Unmet physical needs (e.g., pain)

o Unmet psychological needs (e.g., loneliness)

o Environmental causes (e.g., stimulation, noise)

o Psychiatric causes (e.g., depression)

6. Develop plano Brainstorm best practice and evidence guidelines strategies

o Help caregiver select strategies based on type of problem and dyad’s needs, abilities, and resources

o Write strategies down

o Teach caregiver to use strategies, practice and role model

7. Review and troubleshoot plan

©AAHCM

Problem Solving – Define Problem▶ Problem: Confusion, agitation, dependence,

◦ When does it happen?

◦ Where does it happen?

◦ How often does it happen?

◦ Is anyone around?◦ Is the patient hurt?

decreased mobility, falls▶ Operationalize:

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Problem Solving – Goals▶ Problem: Wandering▶ What would make it better:◦ Keep from wandering▶ Adapt environment to reduce

exit-seeking◦ Make wandering safe ▶ Identification/GPS▶ Safe wandering paths

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Problem Solving – Possible Solutions

▶ Problems: Increased dependence in dressing, unable to choose appropriate and clean clothing, increased agitation

▶ Possible solutions: ◦ Medication◦ Attendant◦ Lay out clothes◦ Simplify tasks◦ Limit choices◦ Cue, prompt◦ Modify environment

©AAHCM

Cognitive Restructuring▶ Managing the relationship between thoughts and

feelings when problem cannot be changed◦ Identify the situation◦ Identify current thoughts◦ Recognize current emotions/feelings◦ Challenge/replace unhelpful thoughts◦ Match milder feelings to milder thoughts

©AAHCM

Thought RecordIdentify the situation –describe the events that led to your unpleasant feelings

Identify your thoughts

(ought, must, should)

(awful, terrible, horrible evaluation)* Negative thinking

Recognize your feelings and emotions

Challenge and replace or substitute unhelpful or negative thoughts with more helpful or milder thoughts

Match milder emotions to your milder thoughts

Situation Current Thoughts Emotions Substitute Thoughts

Substitute Feelings

What happened? What are you thinking?

What are you feeling?

What is a different way of thinking about the situation?

What are you feeling?

* All or nothing

* Awfulizing

©AAHCM

Trouble with Bathing – What to Do?Problem Solving Approach

▶ Possible solutions: ◦ Simple directions◦ Keep the patient’s routines◦ Make bathroom safe and

inviting◦ Remove frightening things◦ Respect privacy◦ Offer support◦ Praise

▶ Determine what and why:◦ Depression◦ Decreased eyesight/ hearing◦ Fear◦ Physical discomfort◦ Too much going on◦ Physical illness◦ Change in routine◦ Modesty issues◦ Resistant

©AAHCM

Trouble with Bathing – What to Do?

Step 1 Step 2 Step 3 Step 4 Step 5

Situation Current Thoughts

Current Feelings

Challenge & Replace

New Feelings

My mother hates to take a bath.

It’s a struggle every day.

If I was a better caregiver, I could do this.

Frustrated.Weary.Dread.Tired of doing this.

Maybe she doesn’t need a bath every day.

Maybe a sponge bath is ok.

Flexible.

Capable of doing this.

Cognitive Restructuring Approach

©AAHCM

Stress Management

▶ Stress Management/Relaxation Exercises◦ Signal Breath

◦ Music

◦ Stretching

◦ Guided Imagery/Visualization

◦ Pleasant Events

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Conclusions

▶ Assessment of caregiver functioning critical in dementia home careo Caregiver coping and stresso Patient behavior management

▶ Certain topics needed for all dyads

▶ Targeting to needs of dyad critical for success

▶ Skills training should address

o Problem solvingo Cognitive restructuringo Stress management

©AAHCM

Question 1

One of the main outcomes for the

care of dementia patients is to attain

and maintain the highest possible

level of personal functioning

A.True

B.False

Question 2

One method to deal with the

problems associated with the care of

dementia patients is:

A.problem solving approach

B.cognitive information processing

C.long-term care

D.palliative care

Question 3

As a caregiver, one of the methods to

deal with cognitive decline is to use

stress relieving techniques

A.True

B.False

Sources

https://www.unmc.edu/intmed/divisions/...ltc/dealingwithdif

ficultbehaviorsi_.ppt

www.olderpa.org/Resources/.../UnderstandingSeniorBullyi

ng2013%20handout.ppt

www.aahcm.org/resource/resmgr/Annual.../Managing_De

mentia_at_Home_-.ppt