Supplemental Info for Special Care Unit Admissions

ALZHEIMER’S AND DEMENTIA CARE

The Alzheimer’s Special Care Unit was opened August 1998 to meet the special needs of people suffering from Alzheimer’s Disease or related dementias. The SCU is designed to meet the needs of people in the middle stages of dementia (stages 4 & 5). The program’s intent is to maintain the resident’s highest quality of life through recognition of losses but the emphasis is placed on existing abilities. The program provides experiences that create feelings of usefulness, success and pleasure thereby preserving the individual’s dignity and self-esteem. The program recognizes the individual’s reality, validates his/her feelings and utilizes techniques to foster communication which decreases episodes of challenging behavior and increases feelings of security.

The following overview of dementia will hopefully assist family members in understanding and dealing with a loved one who has dementia.

Dementia is a debilitating condition of the brain characterized by loss of memory, function and personality. It is not a disease in itself but a group of symptoms that may accompany certain diseases. True dementia is caused by diseases for which there are currently no cures, and are progressive and irreversible.

Some Diseases Causing True Dementia:

·   Alzheimer’s Disease: the most common cause of dementia

·   Ceutzfeld-Jacob Disease: the human form of Mad Cow Disease

·   Huntington’s  Disease: a dominate gene, hereditary illness

·   Vascular Dementia: strokes are the second leading cause of dementia

·   Multiple Sclerosis: approximately 7% of people suffering from severe MS will develop dementia

·   Normal Pressure Hydrocephalus: backup of cerebrospinal fluid into the brain

·   Parkinson’s Disease: approximately 30% of people with Parkinson’s develop dementia

·   Pick’s Disease: characterized by Pick bodies (composed of abnormal protein) in the brain. Usually occurs around age 55. More common in women. Life expectancy is approximately 10 years after the onset of symptoms. Characterized by personality changes and severe speech problems. Behavior is compulsive. Tend to pace constantly. Have difficulty initiating, sustaining or stopping a behavior.

·   Lewy Body Disease: characterized by Lewy bodies (composed of abnormal protein) in the brain. Tend to have a Parkinsonian gait (stiff) and frequent falls. Visual hallucinations are common. The syndrome is more frequently identified in men than in women over the age of 60.

·   HIV and AIDS

Some Conditions Causing Pseudodementia: (false dementia)

·   Depression

·   Drug reactions

·   Thyroid Disorders  

·   Nutritional Deficiencies

·   Brain Tumors 

·   Alcoholism 

·   Infection 

The goal in pseudodementia is to recognize and treat the condition and the dementing symptoms will disappear. When a person suffers from both a dementing illness and depression, treating the depression usually results in some cognitive improvement.

Most dementing illnesses follow the same path: neurons (nerve cells) are damaged, lose their ability to communicate and die. The brain can’t replace nerve cells, therefore brain function is lost.

Alzheimer’s Disease (AD) is the most common cause of dementia, affecting more than 4 million Americans alone. It affects 10% or more of individuals age 65 and older and 50% of individuals 85 and older. There are 7 stages of AD and as people progress through the various stages their needs change.  AD is distinguished from other dementing diseases by characteristic change in the brain visible only upon autopsy. These are:

·   Plaques: composed of the protein beta amyloid. They occur between the cells and assault the cells from without.

·   Tangles: composed of the protein tau. They occur within the cell and assault the cell from within.

In addition, as with other illnesses causing dementia, the concentration of the neurotransmitter Acetycholine drops. This is the chemical that initiates and conducts impulses between nerve cells. This is why people with dementia have difficulty processing information. In AD Acetycholine drops up to 90%.

Symptoms of AD: (occur very gradually)

·   Forgetfulness and memory loss are the first symptoms noted by friends and family. As the disease progresses their short-term memory is lost because that part of the brain responsible for storing short-term memory (Hippocampus) is destroyed by stage 5. This is why they are so repetitive. Once the Hippocampus is destroyed they no longer remember that they are ill. This is a blessing for them but can be very problematic for the family. People in stage 5 have short-term memory of approximately 5 minutes. They may ask you where their deceased spouse or their “small” children are. Don’t attempt to correct them or try to orient them. This is their reality. If you remind them that their spouse is deceased, it is as if they are hearing it for the first time and they will begin to grieve all over again or they may accuse you of lying. Long-term memory stays somewhat intact well into the disease process.  They are living in the past and you need to step into their reality.

·   Loss of ability to learn and retain information: They have difficulty remembering recent conversations and events. Due to the destruction of the Hippocampus they cannot learn new information. They are able to do things that they learned in the past. For example: They retain the ability to read but are unable to process the information. This is called procedural memory.

·   Confusion: At first family members will observe difficulty following a complex train of thought or performing tasks that require many steps (e.g. balancing the checkbook, cooking a meal). 

·   Language problems: They experience trouble  “name finding” in stage 5. Their speech becomes very empty. They don’t tell you the “what” and “where”. Instead of saying, “Put the glass in the sink.” They will say “Put this in that.” By stage 6 they are unable to speak using sentences and by stage 7 they may have a vocabulary of 2 to 3 words or they may make unintelligible sounds or become completely mute.

·   Personality changes: Personality traits usually exacerbate over the course of the disease.

·   Behavior problems: They may become irritable and suspicious because they may misinterpret visual and auditory stimuli.

·   AMNESIA: loss of memory

·   APRAXIA: loss of ability to coordinate learned movements such as using utensils at  meals

·   APHASIA: the inability to speak or understand the spoken word

·   AGNOSIA: the inability to recognize what is seen. Recently a resident had visitors who brought her candy. She went into the kitchen looking for a candy dish. She placed the candy in a coffeepot and served her friends.

Communication with persons suffering with dementia can be challenging. As the disease progresses they have more and more difficulty processing information. Language problems begin in stage 5 and worsen in stages 6 and 7.They may be able to process only part of what is said and eventually become unable to understand the spoken word. Fortunately, only 7% of communication is verbal, 35% is how the words are spoken and 58% is our body language. Eventually it is only through our non-verbal communication, that they can tell whether we are  “friend” or  “foe”.

Tips for Family and Friends to Facilitate Communication with Persons Suffering from Dementia

·   Always approach the person from the front, never from the back or side (peripheral vision is lost during stage 6) to avoid startling them, which could lead to a catastrophic reaction.

·   Make eye contact. Use face-to-face communication, making sure the person can see your facial expressions and body language.

·   Cue them to who you are  (e.g. “ Hi mom, it’s your daughter Sally.” or “ Hi dad, I’ve brought your grandson Billy for a visit.”) As the disease progresses they will know that you are someone special but may have the relationship confused.  They may call you their sister, husband or mother. Don’t correct them because you will only be calling the deficit to their attention.

·   Speak slowly and with a calm voice.

·   Use simple words and sentences.

·   Avoid using abstract words, generalizations and pronouns because they are too complex for the person suffering with dementia to process. (e.g. Do not say “Here it is.” say “Here is your coat.”)

·   Avoid open-ended questions. (Do not ask,  “What would you like to drink?” ask “Would you like a drink of water or orange juice?”) Remember that they have trouble with word finding and if they are unable to retrieve the word they will answer “no” even if they are very thirsty. They try to cover their deficits.

·   Be redundant. Repeat the sentence or question exactly at least once. Remember they have difficulty processing information and they process more slowly than we do.  “Would you like water or juice?” Pause to allow them time to process the information, if no response repeat the question exactly the same way. If again there is no response simplify the question. “Are you thirsty?” This requires only a “yes” or “no” response.

·   Do not ask them challenging questions (e.g. “What’s my name?”) If they are unable to remember, you are calling attention to their deficits. I once overheard an exchange between a resident and her daughter. The daughter kept asking “What’s my name mom?’ The resident replied “If you don’t know, why should I tell you?” She was attempting to mask her deficit.

·   Minimize environmental stimuli. Turn TVs and radios off. Take them to a quiet area. By stage 6, many individuals suffering from dementia view appliances such as eyeglasses, hearing aids and dentures as “entrapments”. They frequently take them off and misplace them. Many families take these items home and bring them back when visiting. Most people with dementia will wear these articles when directly supervised.