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Friday, July 3, 2015

My Past Is Now My Future

For those of y'all who are looking for resources on Dementia, I found the perfect book entitled, "My Past Is Now My Future." It is written by Lanny Butler (OTR) and Kari Brizendine (PT) and it is a great resource for everyone, including families of those with dementia. It's a very easy to read, short book with descriptions of the 7 stages of dementia and what to expect in each stage. They also do a great job describing the difference between dementia and natural aging. The back of the book also contains a "My Way" questionnaire that is great to use to gain more knowledge regarding one's daily routine . Lanny also teaches Dementia continuing ed courses which I would HIGHLY recommend, especially for those of you who work with Dementia on a regular basis. I went to one entitled "Therapeutic Approaches to Dementia" and thought it was a great continuing ed! I actually purchased this book when I attended the class.  Below, I have compiled some information from the book regarding the various stages of Dementia and certain things to look for in each stage. I have only included a brief synopsis of each stage, so I would highly suggest the book as the book goes into more detail with specific examples.

Stage 1: Normally, during the first stage of the Global deterioration scale (would recommend using this as an assessment for those with dementia dx), you will see no symptoms other than stress related memory problems.

Stage 2: Short term memory loss occurs more frequently in this stage. Usually, in this stage, no one knows that the individual is experiencing memory problems because the individual has become so good at using compensatory strategies to mask their short term memory loss.

Stage 3: In this stage, people continue with their daily routine, however, compensatory strategies are no longer working.  People are also starting to notice that these strategies are unsuccessful.

Stage 4: The individual recognizes that compensatory strategies are not working for them and start to fear what will happen if they can no longer remember and live safely in their home environment. Family members are starting to notice that the individual can no longer function safely in the home environment and start to fear the individual may wander away from home and get lost. The individual will start asking the same questions throughout the day and urinary incontinence may also be noted. Usually, the individual will become upset with family members when they try to take them away from their home environment in this stage. In the book, a checklist is provided to assess safety of the individuals home environment. Also, they provide some tips on finding the right placement for the individual if care is needed outside of the home.

Stage 5: By this stage, the individual no longer realizes memory loss is occurring. The individual will still dress appropriately and appear normal, however, damage to the brain has progressed by this stage. If you work in a long term facility , you might notice that in this stage  the patient states "I'm just visiting here, I don't live here." They will want to participate in activities in the facility and try to engage others as well. People in this stage should be independent with self care activities (may need signs to locate items, however, still mostly able to perform self care independently). If you do place signs around, make sure signs are labeled with what is familiar to the resident. For example, they may refer to the word "brief" as "underwear" and so on.  In this stage, escape behavior will occur frequently because the individual will state to people 'they are just visiting.' Posture and gait will appear normal in this stage and the individual will still make eye contact when conversing. The book also suggests that family members provide the individual with an audio message just incase the individual gets upset and tries to elope; this audio message can be played to help calm the patient. In this section of the book, it also goes on to explain the importance of validation therapy and entering the world of the individual with dementia.

Stage 6: At this stage, you may notice the individuals appearance is a little off. They might walk around with one shoe, take off their glasses, etc. If the individual does not feel comfortable, the clothing item is usually removed in this stage. Vision changes also occur and peripheral vision becomes limited or non-existent. Depth perception is also limited. Falls increase due to decreased depth perception and shorter stride length (and they begin to shuffle their feet). LEATHER soled shoes should be a recommendation.  Eye gaze slowly progresses downward and at the end of this stage, it is about 1-2 feet in front of them. Signage should be placed 20-30 inches from the floor at this stage due to decreased ability to visual track upward. In this stage, most will stop feeding themselves. Caregiver education is important to make sure the resident eats and stays hydrated (also see if verbal, tactile cueing will help initiate the feeding process). The book also goes into detail regarding coming up with creative interventions surrounding the individuals residual memories (relating to what is important to the patient such as past hobbies, career, etc.). It's important to remember that in this stage,  new learning does not occur even with constant repetition. The book states people with dementia often retain their ability to read well into the late stages.

Stage 7: This is the last stage of the Global Deterioration Scale, and in this stage, most of those with dementia will stop speaking during this period. This stage appears to be a time where senses dominate everything (if anything tastes, smells or feels good, the individual will go for it). A key thing to know in this stage is that most people in end stage dementia will die of aspiration pneumonia (this is where you will collaborate with other disciplines to enable the individual with a better chance for safely swallowing food items). Research has shown that the last taste receptors we have are sweet and bitter. It's better to provide food in separate bowls with sugar or splenda all over the food. The authors talk about how they provided a lady in this stage of dementia with a yellow feather duster (yellow is the color we see most clearly as we age) and how she rubbed her hand against the feather duster and marched down the hallway. This was done because this was something the patient use to perform (In residual memory).

Obviously, this is just a brief overview of each stage. P.S.The information I have stated above has come directly from the book. 

Does anyone have any specific recommendations of successful creative interventions for the various stages? Would love to hear :)

link to book here

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