Connections: Engagement in Life for Persons Diagnosed with Dementia

8/14/2019 Connections: Engagement in Life for Persons Diagnosed with Dementia

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EllenEllen Phipps, CTRSPhipps, CTRS

Alzheimers Association Central and Western Virginia ChapterAlzheimers Association Central and Western Virginia Chapter

Barbara Braddock, PhDBarbara Braddock, PhDUniversity of VirginiaUniversity of Virginia

CONNECTIONSCONNECTIONS::

Engagement in Life for Persons DiagnosedEngagement in Life for Persons Diagnosedwith Dementiawith Dementia


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CONNECTIONS: VISIONVISION

Families experiencing a diagnosisof dementia will find satisfactionand meaning in their daily lives.


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The Beginning

What on earth can we do all day?

Incidence of dementia increasing

Good Activities resources but.


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Lessons Learned from Home Visitation

LESSONS

LEARNEDFROM HOMEVISITATIONS

Persons with adiagnosis

needed to beengaged in life

Practicalsolutions forengagementwere missing

Caregiversneeded support

Adult Dayprograms, while

an excellentoption, are not

for everyone


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Successful Evidenced-Based Programs

1. Therapeutic

Recreation

2. Montessori-Based Dementia

Programming

3. CognitiveIntervention


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1. Therapeutic Recreation

The primary purposes of recreation services are to

provide recreation resources and opportunities in

order to improve health, well being, and

independence.


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2. Montessori-based Programming for Personswith Dementia

Based on the process developed for disadvantagedchildren by Maria Montessori

Designs a prepared environment

Breaks activities down into steps

Esthetically pleasing objects


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Objects are placed in theenvironment to facilitateorientation and memory, as

well as to encourageengagement in activities.

3. Cognitive Intervention


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COGNITIVEINTERVENTION

MONTESSORI

Phipps Braddock


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The Question

How would it be possible to provide the

training and tools necessary to support

and empower caregivers and offerstrength-based meaningful activities athome?


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DEFINITIONS

Activity

Meaningful Activity

Strength-based


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CONNECTIONS

WHAT MAKES AN ACTIVITIYMEANINGFUL?


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Meaningful Activity

Activities are meaningful when they reflect a persons:

Interests

Lifestyle Education

Current level of function

and are enjoyable to the person!


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STAGES OF THE DISEASE STRENGTH-BASED PROGRAMMING

7STAGES OF AD divided into 3 categories:

EarlyEarlyStageStage

MiddleMiddleStageStage

LateLateStageStage


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SYMPTOMS AND STRENGTHS CHARTEARLY STAGEEARLY STAGE

COMMON SYMPTOMSCOMMON SYMPTOMS

Problems coming up with rightwords

Trouble remembering names

Trouble with performing tasks Forgetting material one has justread

Trouble planning andorganizing

Forget recent events

Mood changes

COMMON STRENGTHSCOMMON STRENGTHS

Able to express oneself verbally Able to converse intellectually Understands spoken language

Able to engage in work Able to self advocate Able to write Able to use memory strategies Long term memory in tact Able to continue use of

technology Sense of smell may be in tact


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SYMPTOMS AND STRENGTHS CHARTMIDDLE STAGEMIDDLE STAGE

COMMON SYMPTOMSCOMMON SYMPTOMS Problems recalling current

address, telephone number

Confusion with date, time Difficulty choosing

appropriate clothing Loss of recent experiencesand surroundings

Changes in sleep patterns Wandering or becoming lost

COMMON STRENGTHSCOMMON STRENGTHS Ability to express some

thoughts, feelings or ideas Able to engage in conversation Visual awareness May be able to write May be able to read some words Able to enjoy some physical

activity Able to recall some past

memories Able to engage in modified work

Able to recall familiar songs Able to gain pleasure from

activity


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SYMPTOMS AND STRENGTHS CHARTLATE STAGELATE STAGE

COMMON SYMPTOMSCOMMON SYMPTOMS

Trouble with bowl and bladder

control Significant personality and

behavior changes Decreased ability to respond to

environment Need total assistance for ADLs

COMMON STRENGTHSCOMMON STRENGTHS

May be aware of the presence of

others May respond to touch Able to hear May be communicating through

facial expressions Able to gain pleasure from

activity


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Bringing it all together: Connections

connecting people withdementia to meaningfulactivity

connecting communitiesfor intergenerational

experiences

connecting volunteerswith persons with

dementia

connecting principles of3 practice fields

stimulating brain cells for

neurological connections


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Bringing it all together: Connections

Person andrelationship-

centered

Home andcommunity-

based

Strength-based

Volunteer andcommunity

partnershipdriven

Supportive tocaregiversandpersons

experiencingmemory loss

Empowering tocaregiversand

personsexperiencingmemory loss


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AIMS OF CONNECTIONS:Provide the necessary training, tools, and support to enable

caregivers to structure strength-based meaningful programs at

home for persons experiencing a diagnosis of dementia

Optimize the home environment for success

Facilitate intergenerational relationships

Reduce caregiver stress through enhanced interaction

Educate volunteers to the unique needs of families dealing with adiagnosis of dementia


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CONNECTIONS

Unique strategies: Home Visitation / Partnered Volunteers

Make the Connection

Assess (LIS; LQ)

Summarize Design focus on three

Guidance / support to family

Implement Color coding / intervention

strategies

Evaluate / Assess


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STEPS TO CONNECTING

ASKASK What are the persons

interests, and lifestyle?

What are the personsCURRENT abilities?

What is enjoyable to theperson?

OBSERVE:OBSERVE: Cognitive Ability Checklist

(CAC)

Leisure Interest Survey (LIS) Life Story Conversation

Starters (LSCS)

SUMMARIZESUMMARIZEFocus on strengths


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TOOLS

Leisure InterestSurvey (LIS)

Life StoryConversation

Starters (LSCS)

Being in themoment

CognitiveChecklist

Color-Coded

Information

Summary

Sample Activity

Charts


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DESIGNING THE PROGRAM

Select 2 3 Activities from the I Column of theLeisure Interest Survey (a comprehensivechecklist of activities)

Determine the Color from the cognitive checklist(looks at cognition, language, orientation &memory, attention span)

Create Activity Stations our use mobile Activity

Tool Kits


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Be Flexible

Being in the moment for persons in later stage

If the chosen activity does not work, try another


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ACTIVITY CENTERS

Example: RED ACTIVITY CENTERCare for the animals

RED ACTIVITY CENTER

Wash hands and wipe off thebathroom counter with spray and cloth


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CONNECTIONS

BLUE ACTIVITY CENTER

Make a tuna sandwich for lunch

GREEN ACTIVITY CENTERIndoor herb garden smell and touch


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3. Cognitive Intervention

The environment is heldconstant by developingconsistency in

caregivers and volunteers;

routines and schedules;location of activity centers; andmaterials.


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CONNECTIONS

Preliminary data shows: 11 of 12 participants successfully

engaged in selected activities Caregivers reported increased

confidence in structuring activities inthe home

Preliminary data shows: 11 of 12 participants successfully

engaged in selected activities Caregivers reported increased

confidence in structuring activities inthe home

Future work: Data analysis Training / In-services

Training Manual Funding Opportunities Faith Communities

Future work: Data analysis Training / In-services

Training Manual Funding Opportunities Faith Communities

Evaluate at each step | Adapt as needed


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Student visitations funded through the UVA Office of theVice Provost of Academic Affairs

ADRAF GRANT funding from Virginia Center on Aging foradditional research

Project supported by Sue Friedman, President & CEO ofAlzheimers Association, Central and Western VirgniaChapter; and Randall Robey, Program ChairCommunication Disorders, University of Virginia

Participants and their family members

Acknowledgments


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Bayles, K.A. & Tomoeda, C.K. (1997). Improving function in dementia and other cognitive-

linguistic disorders. Austin, TX: Pro-Ed. Bourgeois, M.S. (1990). Enhancing conversation skills in patients with Alzheimers disease

using a prosthetic memory aid. Journal of Applied Behavior Analysis, 23, 31-64.

Bourgeois, M.S. (1991). Communication treatment for adults with dementia. Journal ofSpeech and Hearing Research, 34, 831-844.

Bourgeois, M.S., (1992). Evaluating memory wallets in conversations with persons with

dementia. Journal of Speech and Hearing Research, 35, 1344-1357. Bourgeois, M.S., Camp, C., Rose, M., W hite, B., Malone, M., Carr, J., & Rovine, M. (2003).

A comparison of training strategies to enhance use of external aids by persons withdementia. Journal of Communication Disorders, 36, 361-378.

Camp, C., Judge, K., Bye, C. Fox, K., Bowden, J., Bell, M., et al. (1997). Anintergenerational program for persons with dementia using Montessori methods.

Gerontologist, 37, 5, 688-692. Helstrom, I., Nolan, M., & Lundh, U. (2004). We do things together: A case study of

couplehood in dementia. Dementia: The International Journal of Social Research andPractice, 4(1), 722.

References


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References

Judge, K.S., Camp, C.J., & Orsulic-Jeras, S. (2000). Use of Montessori-based activities for

clients with dementia in adult day care: Effects on engagement. American Journal ofAlzheimers Disease, 15, 1, 42-46.

Keady, J., & Nolan, M. (2003). The dynamics of dementia: Working together, workingseparately, or working alone. In M. Nolan, U. Lundh, G. Grant, & J. Keady (Eds.), Partnershipsin family care: Understanding the care giving career (pp. 1532). Maidenhead: OpenUniversity Press.

Kessels, R.P.C., & De Haan, E.H.F. (2003). The effects of errorless and errorful learning onage-related memory loss. Journal of the International Neuropsychological Society, 9, 577.

Mahendra, N., Hopper, T., Bayles, K., Azuma, T., Clearly, S., & Kim, E. (2006). Evidence-based practice recommendations for working with individuals with dementia: Montessori-based interventions. Journal of Medical Speech-Language Pathology, 14, 1, 15-25.

Phipps, E., & Braddock, B.A. (2008, unpublished). Dementia intervention care: A trainingprogram.

Wilson, B.A., Baddeley, A., Evans. J.J., & Shiel, A. (1994). Errorless learning in therehabilitation of memory impaired people. Neuropsychological Rehabilitation, 4, 307-326.

Vernooij-Dassen, M., & Moniz-Cooke, E.D. (2005). Editorial. Dementia: The InternationalJournal of Social Research and Practice, 4(2), 163169.


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Ellen Phipps, CTRSVice President Programs & Services

Alzheimer's Association Central & Western Virginia

The Jordon Building

1160 Pepsi PlaceCharlottesville, VA 22901

Phone: 434-973-6122 Fax: 434-973-4224

[email protected]/cwva

CONTACT

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Connections: Engagement in Life for Persons Diagnosed with Dementia