9/27/2016 1 Non‐pharmacologic Strategies for Addressing Behaviors and Psychological Symptoms of Dementia AIDA WEN, MD ASSOCIATE PROFESSOR UH DEPARTMENT OF GERIATRIC MEDICINE 9/25/16 2 This presentation was supported in part by the Geriatrics Workforce Enhancement Program (GWEP) DHS, DHHS, Bureau of Health Professions awarded to the Pacific Islands GEC, and by cooperative agreement No. 90AL0011-01-00 from the Administration on Aging (AoA), Administration for Community Living (ACL), U.S. Department of Health and Human Services (DHHS) awarded to the University of Hawaii Center on Aging. Grantees carrying out projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official AoA, ACL, or DHHS policy. University of Hawaii Center on Aging Mr. Sato You are seeing Mr. Sato and his family. He is 85 years old. You have known him for at least 10 years. He is a retired professor. He is relatively healthy with PMH of HTN, BPH and macular degeneration. He was diagnosed with early dementia 5 years ago and has been on Aricept since then. He moved in with his daughter’s family 2 years ago as he needed help with his IADLs. He often refuses help, especially with bathing, and brushing teeth. It is Monday morning and his daughter is exasperated. He had a fall… She tells you that he had an unwitnessed fall Friday night in the bathroom as he was showering, and bruised his left hip. He says abruptly, “I’m fine!” She says he has been more irritable than usual this weekend, yelling and screaming about everything, and telling her to leave him alone. He leans forward and says to you Everyone is spying on me! I’m FINE! “He is driving me crazy!” The daughter appears tired and exasperated. She tells you that when he first moved into her house, things worked out “fine”, but right now… Let’s step back and assess the situation…
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9/27/2016
1
Non‐pharmacologic Strategies for Addressing Behaviors and Psychological Symptoms of Dementia
AIDA WEN, MDASSOCIATE PROFESSOR UH DEPARTMENT OF GERIATRIC MEDICINE9/25/16
2
This presentation was supported in part by the Geriatrics Workforce Enhancement Program (GWEP) DHS, DHHS, Bureau of Health Professions awarded to the Pacific Islands GEC, and by cooperative agreement No. 90AL0011-01-00 from the Administration on Aging (AoA), Administration for Community Living (ACL), U.S. Department of Health and Human Services (DHHS) awarded to the University of Hawaii Center on Aging. Grantees carrying out projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official AoA, ACL, or DHHS policy.
University of Hawaii Center on Aging
Mr. SatoYou are seeing Mr. Sato and his family. He is 85 years old. You have known him for at least 10 years. He is a retired professor. He is relatively healthy with PMH of HTN, BPH and macular degeneration. He was diagnosed with early dementia 5 years ago and has been on Aricept since then.
He moved in with his daughter’s family 2 years ago as he needed help with his IADLs. He often refuses help, especially with bathing, and brushing teeth.
It is Monday morning and his daughter is exasperated.
He had a fall…
She tells you that he had an unwitnessed fall Friday night in the bathroom as he was showering, and bruised his left hip. He says abruptly, “I’m fine!”
She says he has been more irritable than usual this weekend, yelling and screaming about everything, and telling her to leave him alone.
He leans forward and says to you Everyone is
spying on me!
I’m
FINE!
“He is driving me crazy!”
The daughter appears tired and exasperated. She tells you that when he first moved into her house, things worked out “fine”, but right now…
Let’s step back and assess the situation…
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Ask about the home situation
Daughter is working from home.
After the kids go to school, she gets dad up.
She tries to leave dad alone most of the morning to read the paper or watch TV, but he is often disruptive.
Has lunch with dad
She get kids home from school at 2:30
Household becomes busy and noisy
Evenings are the worst‐ full of confrontations.
…Weekends are just unpredictable!
RummagingHoarding
Interrupting
Pushing, Hitting
Screaming
Rule out Delirium
Evaluate for Delirium!◦ Acute onset
◦ Inattention
◦ Disorganized thinking
◦ Altered consciousness
He may have a Medical illness that should be treated!
◦VALIDATES FEELINGS◦REASSURE◦LISTEN◦SHOW AFFECTION◦ASKS FOR PERMISSION◦ENCOURAGE ◦GIVE COMPLIMENTS◦ARE EQUALS- HELP EACH OTHER “SAVE FACE”
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◦KNOW EACH OTHER- REMINISCE◦DO FUN THINGS TOGETHER◦ENJOY SIMPLE THINGS TOGETHER◦CELEBRATE SPECIAL OCCASIONS TOGETHER◦TELL FUNNY STORIES OFTEN◦LAUGH TOGETHER
Try Becoming “Best Friends”
Staff Training
Pet Therapy1:1 Interaction
Try your Non‐pharmacologic “Bag of Tricks”
What worksMEANINGFUL ACTIVITIES
MUSIC THERAPY
SENSORY STIMULATION
From a systematic review of the evidence:VA Health Services Research & Development Service,, March 2011Livingston, et al. Health Technol Assessment 2014; 18 (39)
Meaningful Activities & Continuous Programming
Valued by adults◦Work activities (Productive, helping others, being appreciated)
She tries to leave dad alone most of the morning to read the paper or watch TV, but he is often disruptive.
Has lunch with dad
She get kids home from school at 2:30
Household becomes busy and noisy
Evenings are the worst‐ full of confrontations.
…Weekends are just unpredictable!
RummagingHoarding
Interrupting
Pushing, Hitting
Screaming, Cursing
Developing a Plan….
MONDAY, WEDNESDAY & FRIDAY
Adult Day Care “Club” 9am‐4pm
SUNDAYS
Son flies in from Maui to spend the day with dad two Sundays per month‐ they work in the garden together, go out for lunch then come back and play cards.
Daughter in Mililani spends the day with dad two Sundays per month Brings her Scrapbook for reminiscence activities, and grand‐daughter joins if she is in town from college.
Goes out to lunch
TUESDAY, THURSDAY, SATURDAY
Daughter plans activities to keep him busy:
Gardening‐ He used to enjoy gardening at his old house, so she set up a small garden of vegetables in the backyard.
Walking neighbor’s dog with 14 year old grandchild at 4pm.
Developing a Plan….
BATHING BRUSHING
Slow down the process and allow him to do more
Break down brushing instructions into small steps
Bathing once a week on Sundays before their lunch date,
Get his help‐ to check water temperature, choose towels, choose clothes