Dementia Home Care

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Dementia Home Care:

Dementia Home Care RIAZ.K.M Assistant professor Govt. College Of Nursing Thrissur.

Overview:

Overview Epidemiology Age associated Cognitive Changes Non-pharmacologic Treatments Drug Treatments

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Epidemiology Prevalence: 1% at age 60 Doubles every five years 30-50% by age 85 Prevalence curve flattens out at about age 90 4 th leading cause of death in the elderly Life expectancy after diagnosis 3-15 years

Other Causes of “Cognitive Impairment”:

Other Causes of “Cognitive Impairment ” Huntington’s Post-anoxic B12 Hypothyroidism Hypercalcemia Alcohol/thiamine Infections HIV Syphilis Lyme’s Encephelopathy Uremic Hepatic

Age Related Cognitive Changes:

Age Related Cognitive Changes More trouble with difficult tasks when distracted Slower information processing Some decline in process oriented manipulative aspects of short term memory Primary problem in long term memory is recall, not recognition Most common complaint: word (name) finding

Non pharmacologic Treatment:

Non pharmacologic Treatment Advance directives (for health care and finances) early Follow state laws on reporting and driving Not all gloom and doom Quality of life may be quite good during much of course Every patient does not develop every problem associated with dementia Some problems get better with time

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Evaluation of Patient MMSE or other cognitive tool helpful to follow Functional assessment every 6-12 months Behavioral interview with each visit (sleep, wandering, eating, hallucinations, agitation) Evaluation of Caregiver Alzheimer Association Referral Depression, coping, abuse potential, need for placement or community resources

Behavioral Problems:

Behavioral Problems Identify and characterize problem behavior: have caregiver keep behavior log Consider: delirium, depression, pain, sensory impairments Try ABC approach Antecedent: What brings it on? Behavior: Why is it a problem? For self ? Safety? Others? Social norms? Consequences: Positive (attention) or negative

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Break down activities that may be overwhelming into simple tasks Use structured activities and routines to combat boredom and provide external structure Change environment rather than patient (e.g. disable stove, make all clothes pull-on sweats in matching colors) Quiet voice, simple words and sentences Music Touch

Caring for Dementia Patients:

Caring for Dementia Patients Educate Yourself Keep Your Patience Ensure Their Safety Clarify the Time Engage Them in Activities

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Educate ourselves

Drug Treatment of Behaviors:

Drug Treatment of Behaviors Identify target symptom (hallucinations, anxiety) Anti-cholinesterase drugs may help behaviors and probably have best SE profile Neuroleptics help agitation in RCTs (NNT = 5) Medication trials largely empiric: donepezil, trazadone, valproate and mood stabilizers, buspirone, SSRIs, benzodiazepines Frequent re-evaluation and drug holidays

Community Resources:

Community Resources Alzheimer’s day care programs Respite programs Support groups Legal and financial assistance Case management services

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Keep Your Patience

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They are prone to mood swings, violent behavior, and hallucinations. maintain your patience, continuing to speak to her in a calm, soothing voice. divert her attention walk away from the situation until she is calm never disagree with what she is saying or attempt to convince her

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Ensure Their Safety

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Have fewer objects on the floor and remove superfluous furniture Remove sharp objects like knives (keep them locked) Remove objects that could break and hurt the patient, such as crystal vases, glass, and porcelain plates. Keep them locked and take out only when using. Remove furniture with sharp edges. Remove any rugs or carpets that can cause tripping Make sure there are no wires on the floor that can cause tripping Make sure the floor is not slippery If the house has steps, make sure the steps are not slippery, and that the end of the steps is clearly marked Ensure all electric connections are safe and that there are no exposed wires

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Clarify the Time

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confusing night and day, resulting in backward sleeping patterns. blinds open during the day, enabling her to see the light, closing them at night so she knows it's time to sleep. place large numbered, digital clocks throughout the house, or in their room, so she can see the time clearly.

Engage Them in Activities:

Engage Them in Activities

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Life Story Work - find out as much as possible about the person’s background, their culture, their life history – what that person liked to do, the music preferred, favourite movie, hobbies etc. The Memory Box – have you started yours? What would you put in your memory box?

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