Category Archives: Senior Care Professionals

Use of Anti-Psychotic Medications: Signs and Symptoms to Watch

Imagine that you are in pain and struggling to determine where the pain is coming from. You can’t find the words to express yourself, so you use the only words you have, but no one seems to understand or help. Imagine being in pain for over an hour, and now someone is asking you to do something you prefer not to do. They are asking nicely, and attempting to move you, but you are hurting and do not want to be moved. You want help and relief from your pain, but the person is not helping, and you feel desperate for someone to understand. What might you do to be heard and understood? You might lash out by screaming, hitting, or biting, depending on how much you are hurting and how much the other person is forcing you to move. What might happen next? If the scenario above took place in a long-term care community, it is probable that anti-psychotic medications would be used to calm or sedate you.

Anti-psychotic medications have been given to calm persons with dementia living in a long-term care community, even though those antipsychotics are not intended to be used for that purpose. Off-label use of anti-psychotic medications can have serious and potentially deadly consequences for anyone taking that kind of medication outside the scope of intended use. For older adults, especially those with dementia, that off-label use can be deadly. According to the National Consumer Voice for Quality Long Term Care“, these kinds of medications, when used for other than their intended purpose, can greatly increase the risk of having a stroke, heart attack, diabetes, Parkinsonism, and falls among persons with dementia. Also, if long-term use of these medications in the long-term care setting is detected, it is likely that they are being used as a chemical restraint instead of managing behaviors, neither of which is acceptable. And yet, it happens.

So, how can you tell if someone is being treated with anti-psychotic medications for behavioral expressions? The National Consumer Voice for Quality Long Term Care provides some guidance. If your loved one is suddenly submissive, is not sleeping, or appears lethargic but previously demonstrated behavioral symptoms, such as agitation, hitting, pacing or any other significant change in behavior, then ask the nursing staff what has changed. Any significant and drastic change should be reviewed and addressed. If you suspect that anti-psychotic medications are being used, next steps can include determining if there are untreated infections, medication reactions, or pain. It may take some time and the work from the nursing home staff, but it is mandatory to explore the possible reasons behind the behaviors to resolve them with something other than anti-psychotic medications.

Off-label use of anti-psychotic medications has happened frequently enough in the long-term care setting that the American Health Care Association (AHCA) is taking steps to address anti-psychotics and their use for persons with dementia. The AHCA Quality Initiative (Initiative) is a statewide attempt to improve quality of care in long-term and post-acute care centers. The Initiative, introduced in 2012, focuses on Hospitalizations, Customer Satisfaction, Functional Outcomes, and Antipsychotics. The Initiative’s goal for Antipsychotics is to safely reduce the off-label use of antipsychotics by 10% or maintain a rate of 8% or less in long stay residents and maintain a rate of 1% or less in short-stay residents by March 2021.

Kathy Dreyer, Ph.D., is the Director of Strategic Projects at AGE-u-cate® Training Institute, which develops and delivers innovative research-based aging and dementia training programs such as Dementia Live® and Compassionate Touch®, for professional and family caregivers; kathy.dreyer@ageucate.com

Validation in Dementia Care: Thank You, Naomi!

Validation helps caregivers step into the world of a person with dementia, creating understanding and empathy.

The most powerful communication tool I’ve learned is Validation. Created by Naomi Feil, Validation is a method of communicating with people with dementia. Stepping into the world of the elder leads to understanding, therefore easing distress.

I’ve distilled the concepts of Validation into two questions.  They help me respond to someone with dementia who is confused and distressed.  First, I ask, “What is this person’s reality at this moment?”  The answer gives me a clue into her world at the moment, and then I can be with her in her world.

Then I ask, “What is she feeling right now?”  I can’t see a motion picture of what’s going on in her mind, but there are clues about how she is feeling. What is her facial expression, body language, or voice intensity telling me?

Now comes the action part.  First, I reflect her reality and then acknowledge the feeling.

Let me illustrate with a story about a woman in a skilled nursing facility where I provided Compassionate Touch® sessions. At around four o’clock, she fretted about getting home to make supper for her family.  Pacing the hall, she asked everyone how to get back home. As time passed, the more anxious and upset she became. The staff was expected to take her to dinner at five o’clock, not an easy task when she was so determined to leave.

What is her reality?  It’s time for her to get home to make supper for her family.  In her mind, her family would be back soon, and she needed to be there for them. Now that I understood where she was at the moment, I could be with her in her world.  What is she feeling? She seemed frustrated and increasingly angry and fearful.

I walked with her, asking simple questions about her family and what they liked to eat for dinner.  I acknowledged her feelings, saying, “it’s so frustrating to be late.” I used humor, “my son thinks he will just starve if I’m five minutes late with a meal!” She nodded and laughed with me.  At one point, I reassured her with touch by gently stroking her back and holding her hand. She became more present in the immediate moment, and she let go of her fixation on getting home.

What created the shift in her was not so much what I said, but rather that she felt seen and heard, therefore, validated. We walked again, but this time to the dining room where she joined her friends for dinner!

How do you feel when someone validates you?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and now serves as a Master Trainer and training consultant.

World Alzheimer Report: Private Sector Response

Let’s not wait for the public sector to develop plans to address the dementia crisis. The private sector can and should play a large role.

This expert is from the Alzheimer’s Disease International website referencing the World Alzheimer Report of 2019.

“The report reveals the results of the largest attitudes to dementia survey ever undertaken, with almost 70,000 people across 155 countries and territories completing the survey. It spans four demographic groups: people living with dementia, carers, healthcare practitioners, and the general public.”

Further, the analysis of the study was carried out by the London School of Economics and Political Science (LSE).

Specifically, some of the key findings of the report include:

  • Almost 80% of the general public are concerned about developing dementia at some point, and 1 in 4 people think that there is nothing we can do to prevent dementia
  • 35% of carers across the world said that they had hidden the diagnosis of dementia of a family member
  • Over 50% of carers globally say their health has suffered as a result of their caring responsibilities even while expressing positive sentiments about their role
  • Almost 62% of healthcare providers worldwide think that dementia is part of normal aging
  • 40% of the general public think doctors and nurses ignore people with dementia

Call to Action for Private Sector

In addition, the report lists several calls for action, many of which rest with local, state, and national governments and agencies thereof.  However, the private sector can do a lot to address the disheartening vital findings. People are hurting, suffering, concerned, and uneducated about dementia.

Conversations at my faith community are under-way about how to minister to persons with dementia and their caregivers. Educate citizens about dementia to demystify, normalize, and create an environment of understanding and acceptance.  This is an excellent place to start.

In conclusion, call upon local experts to help start the conversation within your circle of influence and ask questions.  Success will come with each small step.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  In addition, she is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Coping with the Emotional Toll of Moving a Parent to Assisted Living

Family caregivers need support to handle the emotional toll.

My friend Lana is on the emotional roller coaster of moving her mom to assisted living. Coupled with holiday stress, it’s taking quite a toll. Like most seniors, Lana’s mom would rather live in her own home. However, her functioning declined to the point that she fell several times, leading to multiple trips to the emergency room. Lana fretted over the decision to look for another living arrangement for her mom. Fortunately, guidelines helped identify when it was time.

Assisted living may be called for if a senior has difficulty performing tasks of daily life, such as:

  1. Basic personal care tasks, such as bathing, dressing, toileting, eating.
  2. Paying the bill, handling the mail, preparing meals, cleaning, and transportation outside the house.

Furthermore, a worsening medical condition may lead to a lack of activity, falls, incontinence, and poor nutrition, as was the case with Lana’s mom. After yet another hospitalization, it was time; however, the emotional toll has been heavy with grief, doubt, regret, and guilt.

Author Liz O’Donnell offers these strategies to ease the transition.

  1. Give it time. It takes from three to six months to adjust.
  2. Ask friends or family to help.
  3. Expect setbacks. Ups and downs are typical. Allow yourself to feel discomfort with the fact you can’t fix it.
  4. Be a good listener of your parent’s concerns and feelings.
  5. Surround your loved one in familiar belongings from home. Limit new things. The situation is all new.
  6. Advocate for your parent to help build a team. Let them know who your parent is and what her preferences are.
  7. Set boundaries. Decide what you are willing and able to do and stick with it.

Finally, Kathy Dreyer’s recent blog post offers these words of wisdom from her own experience of managing the emotional toll of moving her mom to a facility.  “Let go of what you can. Acceptance can bring relief, whether it is in accepting help or accepting changes.”

What do you believe is essential to help ease the emotional toll of moving a loved one to long term care?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and now serves as a Master Trainer and training consultant.