Tag Archives: Memory Care

Alzheimer’s Disease: What Would Maslow Say?

Human needs remain intact regardless of age, situation, or condition.

Abraham Maslow was an American psychologist who taught that survival needs must come before social or spiritual needs. Alzheimer’s disease impacts all these needs, for instance, as in a woman named Faye.

The need for physical survival. Faye relied on caregivers to assist with physical needs. 

The need to have personal security and to feel safe.  Faye didn’t recall recent events, so she didn’t realize where she was. Memories of past experience faded.

The need for a sense of belonging and connection to others. Faye had been active in her church.  The move to a nursing home separated her from familiar people and consequently became withdrawn and anxious.

The need to express feelings and have them acknowledged.  Alzheimer’s decreases a person’s ability to express thoughts. Faye was frustrated because care-partners didn’t understand her.

The need to give to others and to be treated with respect.  We all need to feel useful. We thrive with mutual understanding and respect.  However, people with Alzheimer’s may believe they have nothing to contribute.

The need for a sense of self and a connection to spirit. Many assume that Alzheimer’s robs people of their identity.  Although memory and cognition become impaired, it appears that the person living with dementia seems to retain a sense of self—the essence of who he or she is.

In conclusion, understanding human needs may help us to be a little more empathetic with people living with Alzheimer’s disease.

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 serves as a Master Trainer and training consultant.

Why Touch is Good Medicine in Caring for Persons with Dementia

“Touching as a therapeutic event is not as simple as a mechanical procedure or a drug, because is, above all, an act of communication…the use of touch and physical closeness may be the most important way to communicate to acutely ill (and aged) persons that they are important as human beings…” – Ashley Montagu

Touch is good medicine.  Research supports the beneficial effects of skilled touch as a powerful, yet under-utilized means to address an urgent need:  person-centered care for people with dementia.

Let’s look at the need.  Our aging population is having a major impact on hospitals, long-term care companies, aging and regulatory services and hospice providers.  Clinicians and front-line staff will serve more people over age 75 than any other age group and prevalence of dementia is being seen in every sector of senior services.

  • About one-quarter of all older hospital patients are people with dementia
  • People with dementia constitute about half of all nursing home and assisted-living facility residents
  • An estimated 15 million family and friends in the U.S. provided care to a loved one with dementia in 2013

Touch deprivation leads to feelings of isolation, anxiety, poor trust in caregivers, insecurity and decreased sensory awareness.  Older adults living with chronic illness, dementia and other conditions are especially receptive to touch.  Unfortunately, they are the least likely to receive expressive human touch from health care providers and caregivers.

Touch stimulates the production of oxytocin, leading to feelings of safety, caring, trust and decreased anxiety.  It’s been called the care and connection hormone.  When your brain releases oxytocin, you feel good.

At the same time, cortisol is a hormone that increases when we are stressed.  Studies show that cortisol level decrease after even five minutes of skilled touch.

Instrumental vs. Expressive Touch

Touch in caregiving is NOT the same.  There are two basic kinds of touch that commonly occur during caregiving:  Instrumental touch is necessary to perform a task or procedure such as transferring or bathing.  Expressive Touch is offered spontaneously to show care, concern, reassurance, affection, and empathy.  It has the power to affect our feelings about others, ourselves and the world we live in.  The person receiving the touch feels validated and distress in the moment is eased.

Skilled Touch has a structure and method designed to achieve a desired clinical impact.

Compassionate Presence is both a personal quality and professional skill that can be learned and developed.  With compassionate presence:

  • you connect with individual rather than the disease
  • you connect in the moment as it unfolds
  • you accept the reality and current experience of the person you are serving

“The most important innovation in medicine to come in the next 10 years:  the power of the human hand.” – Dr. Abraham Verghese

Expressive touch provides a feasible, effective tool to respond to behavioral expression in persons living with dementia;  reduce stress for both care partners, and a means to calm, connect and comfort.  With training, it is a powerful tool that is literally in the hands of those caring for our older adults.

Research supports positive changes in physical behavior, mood and expression, resistance to care, and reduced stress for both care partners, leading to greater staff satisfaction.

Skilled touch:

  • alleviates aches and pains
  • provides tactile and sensory stimulation
  • induces a relaxation response
  • supports psycho-social well-being

There is an urgent need to provide more effective and feasible tools to improve dementia care and reduce the use of psychotropic drugs.

We can transform care… it’s in our hands!

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and worked with Ann Catlin, OTR, LMT in the development of the ground-breaking Compassionate Touch® program, used throughout the US, Australia and Canada to improve care for persons with dementia and end-of-life.  

To learn more about the Compassionate Touch® program please visit http://www.AGEucate.com

 

 

 

AAHHHH….. To Sleep Like a Baby Again. Is it Possible?

I know I’m not the only one munching on graham crackers and milk in the wee hours.  For those of you who sleep like a baby and wake up refreshed and energized… well let’s just say the rest of us are green with envy.

Good quality sleep is not overrated.  It’s absolutely essential to our health and well being.  According to Nancy Foldvary-Schaefer, director of the Cleveland Clinic Sleep Disorders Center, “We now know sleep is an active process – all your organ systems behave differently during sleep, restoring themselves.”

During sleep,  our bodies are busy at work repairing itself, cleansing toxins, reducing inflammation.  And in recent years, research has linked higher risks of brain disorders, diabetes and obesity to sleep deprivation.

People living with dementia are certainly not immune to sleep challenges.  Disturbances can be caused by changes in the brain that cause restlessness,  urine or prostate problems, pain or discomfort, sleeping too much during the day, nightmares or environmental factors (for example external noise or feeling too hot or cold).

As dementia progresses, routine becomes more important to one’s feeling of safety and security.  This is certainly true with evening and bedtime rituals.  Not unlike what all of us should practice, here are a few reminders of what may help prepare for a better night’s sleep:

  • Light exercise in early evening, and wind down 90 minutes before bedtime.  Electronic devices should be minimized.
  • Dozing should be discouraged, as this may make falling asleep even more difficult.
  • Avoid tea, coffee, sodas or alcohol should be discouraged, as all of these can have an opposite effect, especially for someone living with dementia.
  • Make sure bed and room temperature is comfortable (cooler is generally better than warmer).
  • A regular routine of listening to soft music, a light back rub or applying aromatherapy lotion may be very helpful in creating a calming atmosphere that may induce sleepiness.

As more holistic therapies for sleep are ushered into person-centered care practices, less use of pharmacological aids will be needed.  Side effects of sleep-inducing drugs can have negative consequences on quality of life for those living with dementia and their care partners.

Pam Brandon is President/Founder of AGE-u-cate® Training Institute.  Their groundbreaking program Compassionate Touch® is a practical and feasible means to reduce behavioral and psychological symptoms of dementia and crete positive engagement of elder, staff and family caregivers.  

www.AGEucate.com

 

Montessori methods – beyond child’s play for dementia care

automobile di latta a molla - setteMontessori’s education method for childhood learning was launched in the early 1900s by Maria Montessori.  It calls for free activity within a “prepared environment”, meaning an educational environment tailored to basic human characteristics, to the specific characteristics of children at different ages, and to the individual personalities of each child. The function of the environment is to help and allow the child to develop independence in all areas according to his or her inner psychological directives. In addition to offering access to the Montessori materials appropriate to the age of the children, the environment should exhibit the following characteristics:

  • An arrangement that facilitates movement and activity
  • Beauty and harmony
  • Cleanliness of environment
  • Construction in proportion to the child and her/his needs
  • Limitation of materials, so that only material that supports the child’s development is included
  • Nature in the classroom and outside of the classroom
  • Order

Thankfully, advances in the field of elder caregiving have moved activities beyond the three Bs (bingo, birthdays and Bible) to more resident centered engagement activities.  Culture change initiatives have definitely helped to push the creative buttons of activity, memory care and  resident engagement leaders to foster the understanding that every person has individual needs and capabilities and a one-size fits all approach simply doesn’t work.

Montessori is NOT a program but a philosophy  based on individualism.  Translating this to eldercare, the Montessori philosophy is neither difficult to understand and certainly not complicated or expensive to integrate.  A few key points to get started is to take time to:

  • Understand the elder’s interests and needs
  • Learn their current physical, social and emotional needs
  • Create opportunities for them to develop their capabilities
  • Encourage positive learning by keeping it simple
  • Develop positive communication skills (slow down, use eye contact, use skilled touch to engage)
  • Use humor and always smile – it will help relieve frustration and build trust between care partners

And lastly remember basic eldercare protocol:

  • Don’t use materials that are childish
  • Limit other stimuli while trying to engage in an activity.  ex: tv off is almost always going to lead to more successful engagement
  • Avoid at all costs, correcting someone but instead guide them gently as they attempt to accomplish a task.
  • Remember there is never a “right” or “wrong” way to do something

www.AGEucate.com