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Lisa Skinner: Hello to all of you who have tuned in to listen
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to this episode of the truth lies and Alzheimer's show. I am
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Lisa Skinner, your host, and I'd like to shout out a very warm
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welcome to all of you who have joined us today. Thank you so
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much for being here. There are so many aspects of living with
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dementia that are unexpected and can surface out of nowhere at
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any time. These are what I call the hidden or secret faces of
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Alzheimer's disease, and as many of you know, they show up
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unannounced are completely unpredictable, and that is the
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reason why it's so important to be prepared for anything that
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emerges on this journey. And to be honest with you, I don't
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think there's much doubt that what makes our relationships and
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caring for those who live with Alzheimer's and related dementia
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so challenging is the disconnect that occurs in our ability to
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communicate effectively with one Another as the progression of
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disease worsens over time, it clearly becomes more and more
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difficult to know what your loved one is trying to tell you
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when they are no longer to able to articulate their wants and
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needs to you. This is the very reason why I cannot stress the
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importance of arming yourself with an arsenal of tools and
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strategies so you can be as prepared as possible when these
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situations arise. And just like we can count on the sun rising
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each morning, you better be sure we can count on these situations
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arising unexpectedly every day, and I want to remind you,
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because I've said this before, not every strategy works for
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each situation every time. So the more tools you have
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collected in your toolbox, the more options you will have to
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use to try to diffuse a situation from escalating into a
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catastrophic reaction where it can just really get out of
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control. So what I'm going to share with you today are some
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triggers and responses to some of the behaviors that occur as a
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result of this disconnect and communication, they typically
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manifest as behaviors, and this is really the way that the
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person you're caring for or your loved one is trying to tell you
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that there is something genuinely wrong. They are not
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trying to be difficult. They are not trying to make your life
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hard. They are not trying to be spiteful. They honestly can no
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longer tell you what is bothering them so they will
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behave in a way to get your attention, trying to relay a
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message to you. And these are the things that you must learn
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to recognize. That is their way of communicating with you. You
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learn to recognize the behaviors, and then you're going
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to have to learn how to identify what the trigger was for that
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particular behavior. So the tips and the tools that I share with
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you, you want to just kind of file them away or collect them
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in your toolbox, as I said. And if one thing doesn't work, you
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can try another, and the more tools you have to pull out and
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try, the better equipped you're going to be for any circumstance
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that will arise. So environmental issues can create
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behavioral problems in people with dementia. Examples of
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environmental related issues are sensory overload. So in other
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words, too much going on around them, being around unfamiliar
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people, noise, lighting, something that startles them,
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agitating behaviors of others in the environment. People with
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dementia pick up other people's moods and emotions, and they can
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mimic those emotions, and that's. Other thing I wanted to
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mention, because people lose so much of their cognitive skills,
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what it really comes down to, at the end of the day, is
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everything that they are reacting to is basically comes
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down to raw emotion, because they no longer have the ability
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to reason things out or to think things through. So these
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behaviors are raw emotion, trying to tell you that they
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need or want something. Tasks presented to a resident with or
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a person with dementia can create these behavioral
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problems. Here are some of the task related issues and
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solutions. So in terms of issues, if a task is
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overwhelming to a person, that can be a trigger, if they feel
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rushed, if it causes them to become overstimulated if a task
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is too complicated, if they are not able to focus on a given
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task, and if they have a poor attention span. So here are some
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of the solutions to those issues. Keep things simple, slow
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it down, stay calm and be gentle. Take one step at a time,
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always make eye contact and repeat instructions as needed.
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Communication can also contribute to a person's
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behavioral challenges. Without effective communication, the
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psychosocial quality of life of the resident quickly
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deteriorates. Now communication can be verbal, nonverbal, or
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both. Now verbal communication is the words we use. Nonverbal
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communication are your actions, your body language and your
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facial expressions, your tone of voice, expression of emotion and
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your inflections are also considered part of nonverbal
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communication. Effective communication is the key to
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working with people with dementia. So when communicating
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with people who have dementia, it helps to face them directly,
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speak slowly, use their name
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and then wait for a response from them. Don't rush. Repeat it
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if necessary. Use cueing or modeling behaviors. Smile at
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them at all times, then they will not absorb feeling a
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sternness coming from you or that you're mad or upset with
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them, and then praise them always and reassure them that
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everything is fine and they're doing great now, according to
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the Alzheimer's Association, there are three basic steps to
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assist in identifying common behaviors and causes. Step one,
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identify and examine the behavior. You should ask
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yourself the following questions, what was the
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behavior? Was it harmful to the individual or to others? What
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happened just before the behavior occurred? Did something
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or someone trigger that behavior? Other questions you
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may consider in order to examine the behavior include what
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happened immediately after the behavior occurred. How did you
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react? The Alzheimer's Association suggests that you
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should consult your loved one's physician to identify any causes
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related to medications or an illness that may be developing.
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So step two is explore potential solutions. The Alzheimer's
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Association also recommends identifying the needs of the
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person with dementia and evaluate if these needs are
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being met. So some of the questions you may consider in
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your exploration is, Can adapting the surroundings
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comfort the person? How can you change your reaction or your
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approach to the behavior? Are you responding in. Calm and
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supportive way. It is very important to keep in mind that
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the person with dementia may be using these behaviors to
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communicate his or her needs in the only way he or she knows
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how. This is why you as a care provider or a family member,
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need to be cautious of your response. It can make all the
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difference in the world. Step three, try different responses.
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Again, once you attempt new responses, you should evaluate,
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did your new response help in this situation, the Alzheimer's
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Association asks, Do you need to explore other potential causes
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and solutions? If so, what can you do differently? There are
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many, many resources you can use to discover positive solutions
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to challenging behaviors. And I want to also remind you again
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that if your response works at that time for that given
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situation, and then the same thing happens again and you try
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that same response, it may not work this next time. So the more
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responses you have to pull out of your toolbox, the more
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chances you will have of diffusing the situation. So
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below, I mean, what I'm going to share with you now is a list of
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what we call 13 R's, what is called a solution focused model.
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And the solution focused model focuses on what you can do right
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now to change the person's behavior, rather than focusing
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on the problem that made the person display a difficult
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behavior. Now this approach does not focus on the past, but
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instead focuses on the present and the future. The 13 R's are
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number one, remain calm your voice and your body language.
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Number two, remove the trigger. You want to eliminate the source
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of agitation, but you have to figure out what that source of
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agitation is. First, not an easy task. Number three, redirect the
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person, so guide them to another task. Number four, reassure them
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by making positive statements. Number five, Repeat if
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necessary. Number six, revise present, one step at a time.
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Number seven, respond, which is listening and paraphrasing their
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words. Number eight, reference, validate their point of view.
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Number nine, remind, always encourage reminiscing and
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praising past accomplishments number 10 reflection, which is
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physically acknowledging communication. In other words,
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one example would be by nodding your head to them. Number 11 is
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reinforced. You can do this by praising positive behaviors
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number 12 reporting incidents, and what they mean by that is,
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write down, keep a journal of things that trigger behaviors so
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you will have a reference to look for in the future, and then
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13 reevaluate, establish the root cause and assess it for
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controlling the situation. So next, I'm going to share with
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you some very specific behavioral responses that you
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may see in people with dementia, each type of behavior you may
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observe, followed by some suggestions that you can do to
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help minimize the undesired behavior when a loved one
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displays anger or agitation. Here's some tips, do not express
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impatience. Maintain calmness, smile and reassure. Speak slowly
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and offer comfort. Redirect. Attached to a quiet area, engage
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with them in a favorite past time, offer a favorite food or
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beverage and whisper. When the person becomes aggressive, it
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can help to again remain calm while you approach them, get
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help, if necessary, use what's called change of faith
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technique, and what that means is you get a different person to
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come in and see if that will make a difference, to diffuse
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the behavior, again, called change of face. Attempt to
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redirect the person, and when you do, redirect them to a safe
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area, for example, their room or a quiet area. Provide a
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distraction. You can use a known interest to distract them when a
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person with dementia is anxious. It also helps to identify the
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trigger and time of the occurrence. It's helpful to keep
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a journal of these things and reinforce positive behaviors,
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help the resident, help the person with dementia, reduce
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anxiety, encourage viewing family photos for discussion,
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that's a great distraction, Keep them busy and use relaxation
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methods. One of the really effective ones is give them a
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hand massage. They love that, and it's very calming. Now, here
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are some things you can do when the person has increased
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behaviors in the late afternoon and evening, often referred to
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as sundowning. Prepare for raised anxiety, turn lights on
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ahead of time. Minimize their distractions, remove any
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clutter, provide a safe place for them to rummage. Offer
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favorite items of interest. Offer snacks and drinks and play
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soft music in the background. That is very effective.
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When a person is disruptive, you may seek their attention,
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approach them in a friendly manner, redirect them to a
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private area, if possible, inform them of a change in
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routine, encourage an independent activity, involve
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them in any plans, If possible, and help them gain their coping
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skills. Here are some things you can do to help with sleep
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problems. Monitor their sleep patterns, determine cause such
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as hunger or discomfort, provide daily exercise, establish
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routine napping, if necessary, remind them that it's their
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bedtime. Provide security items such as a favorite picture or
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stuffed animal. Create rituals such as hand massages, drink,
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prayer, beds, etc, and wind down activity participation after
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dinner. Unless requiring exercise, it's always best to do
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more stimulating activities earlier in the day and wind down
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as the day progresses, on supply night lights, if they're
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preferred, and reassure them that you will check on them
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throughout the night. Now, tips for handling agitation include
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address any chaos in the environment by reducing noise
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levels and the number of other people, avoid moving household
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objects around whenever possible. Familiar object
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located in the same places provides them with a sense of
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security. Change the immediate environment. When the person
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with dementia becomes agitated again, play soothing music. It's
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magical. It's powerful. Safety proof the environment to allow
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for as much autonomy as possible with the least number of hazards
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handling communication problems include giving reassurance. Is
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trying to use a touch if verbal support isn't working. Again,
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limiting outside distractions. Turn off radios and television.
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Listen for the meaning of the feelings behind their words.
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Speak clearly and loud enough to be heard, and then, of course,
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use nonverbal means of communication, such as body
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language, facial expressions and touch. Many people with dementia
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have ongoing communication problems. This is going to
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include forgetting words using repetitive phrases and other
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things that you will notice now how to handle delusions,
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hallucinations and paranoia, along with Anxiety, delusions,
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hallucinations and paranoia are extremely common behavioral
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issues in people with dementia, and they may occur as a result
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of changes in physical health of the brain. So some tips for
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handling delusions, hallucination and paranoia
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include probably the most important thing is avoid arguing
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or trying to impose a sense of truth or reality into the person
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with dementia. Why it absolutely does not work. Don't feel the
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need to play into the lie. You can be honest while still
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providing dignity and respect, and then reassure that person by
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saying things like, I am so sorry. You are getting upset by
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this. Let me see if I can help and then redirect the person
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with dementia to divert their attention to something more
00:22:01
appropriate tips for handling sleeplessness and sundowning. So
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insomnia and sleeplessness also known as sundowning, are again
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common behaviors in people with dementia. They occur due to a
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combination of factors and can be worsened by exhaust, by being
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exhausted after a day's events. So some tips on handling
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sleeplessness and sundowning include avoid giving your loved
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one alcohol, caffeine or sugar, considering hiring help at night
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so you as a caregiver can get enough sleep without having to
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leave your loved one with dementia unattended. Discourage
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napping during the daytime, talk to a healthcare provider about
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natural sleep induced medication such as melatonin, and turn the
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lights on and close the curtains well before sunset to eliminate
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confusion about the time, particularly in the winter
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months. And then the last tip I have for you today is how to
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handle wandering. It's not always easy to find out why a
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person with dementia is wandering, but caregivers can
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use these insights to help them more effectively deal with that
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problem. You can add child safe plastic covers to doorknobs. You
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can consider having them carry a GPS tracking device, always have
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a current photo on file, just in case the person with dementia
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goes missing, register them with the safe and sound program in
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your local area. Install door alarms and set them to go off if
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the door is opened, and finally, install locks that require a
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key, keeping safety issues in mind for all people in the home.
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So those are hopefully some very helpful and valuable tips for
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you to consider while encountering some of these
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challenging behaviors that will occur. So in my segment, what's
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news, I want to share with you an article that I stumbled upon.
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It was in Fortune, well presented by CVS Health, and the
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title of the article is called cognitive decline after
00:24:45
retirement is a universal trend. Here are four ways to reverse
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it. The article was written by Aaron Prater, and it was
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published on May 19, 2023 so.
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And this is what the article tells us now. It was authored by
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researchers at the University of Cologne in Germany and the
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University of California San Francisco. The researchers
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interviewed nearly 9000 European retirees, ages 50 and older,
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from 17 countries each completed six memory assessments over the
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course of 13 years. Their findings retirement was
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generally associated with a moderate decrease in Word recall
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and memory decline accelerated after retirement. This was true
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in all countries involved, even in those with more generous
00:25:48
welfare systems and higher pension benefits, like Germany,
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Austria, France and Belgium, versus those with low public
00:25:57
pensions, like Portugal, Greece, Israel, Estonia, Poland and
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Slovenia. The study showed that postponing retirement can
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protect against cognitive decline, especially among the
00:26:12
more highly educated. But let's face it, the article says life
00:26:19
is short for those who can and wish to retire on time, here are
00:26:25
four tips for staying mentally sharp during what should be the
00:26:29
most joyous season of your life. So keep or get connected. A
00:26:35
quarter of Americans age 65 and older, are socially isolated.
00:26:41
According to a 2020 report from the National Academies of
00:26:45
Sciences, Engineering and medicine, while loneliness is
00:26:50
miserable, it's also more, it's also more, it poses a health
00:26:58
risk as deadly as smoking a dozen cigarettes a day the US
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Surgeon General, Dr Vivek Murthy recently told attendees of
00:27:09
Fortune's brainstorm health conference, retirement often
00:27:13
means loss of the community you worked in perhaps for decades.
00:27:18
So keep connected to others by taking classes, volunteering,
00:27:23
hanging out with friends, or picking up a sport. The second
00:27:29
recommended advice is to keep active. It's never too late to
00:27:35
begin an exercise routine, even if you didn't do it in pre
00:27:39
retirement, or if you fell off the wagon at same point, get up
00:27:44
and get going again. The third one, keep your stress to a
00:27:51
minimum. There are many, many ways to keep stress at bay. A
00:27:56
few of them are get a good quality sleep and do your best
00:28:03
not to introduce any new stressors in your life. And then
00:28:09
finally, keep working. Ideally, you're in a situation where you
00:28:15
you might not have the financial need for a typical nine to five
00:28:19
day like you did when you were working, free retirement, but
00:28:24
you have just as much to contribute to society as the day
00:28:29
before you retired. If it brings you joy, consider volunteering
00:28:35
contract work or a part time job in the field you love.
00:28:39
Regardless of pay, you'll reap the benefits of connectedness
00:28:44
and cognitive acuity and typically accompanying work,
00:28:49
hopefully without all the stress. So I think that's some
00:28:53
pretty good advice. I have known a lot of people who have retired
00:28:58
and then just seem to cognitively decline within years
00:29:02
of retiring. So I think this is some really sound advice to
00:29:06
follow for those of you who want to stay sharp even in your
00:29:12
retirement years. So that's what I have for you today. I want to
00:29:19
thank you again for listening. We always have so much to cover
00:29:24
in our current episode and upcoming episodes. And as you
00:29:29
know, I really it's so important for me to provide you with
00:29:33
information that you will find helpful and valuable throughout
00:29:38
this journey. Remember, and I can't emphasize this enough,
00:29:44
dementia awareness occurs every day. The kindness is the ability
00:29:51
to speak with love, listen with compassion and act with
00:29:55
patience. These are all very necessary. Attributes to have in
00:30:01
order to outlast Alzheimer's disease. This show is all about
00:30:07
you and how my experiences, expertise and strategies can
00:30:13
help you and your loved one have an easier time while struggling
00:30:17
through this disease. I know how difficult it is, therefore I
00:30:23
would love it if you would send me your comments and suggestions
00:30:26
on what topics you'd like me to cover on this weekly show. I
00:30:31
genuinely look forward to receiving your thoughts and
00:30:34
ideas, and in the meantime, take care of you, talk to y'all next
00:30:39
week.