Introduction to Dementia

Introduction to Dementia

by

Presenter: Dorothy Colby, Hale Kū‘ike Director of Community Engagement & Positive Approach to Care® Trainer

Date: 10/1/20

Recording length: 1 hour

Sponsors: Hale Kū‘ike and Catholic Charities Hawai‘i

Description:

  • Dementia changes the sensory input systems. What does the world look, sound and feel like for someone living with dementia?
  • Visual, verbal and touch processing are all affected. How can we get connected despite these changes?
  • How can we become “care partners” instead of “care givers” in this dementia journey?

When we think about dementia changes, the focus is typically on memory changes. In fact, the entire brain and all its functions are affected by the diseases that cause dementia, not just the memory center. If we want to have effective communication and meaningful connections with someone living with dementia, we need to understand how other brain functions are affected.

As human beings, we want to see what is coming to feel safe. If there is a sound outside our vision, we turn and look. If we feel a touch we didn’t expect, we turn and look. When we are taken by surprise by something we see, hear or a touch, our fight-fright-flight response kicks in. Once we determine it is not a threat, then we can quickly start to relax and return to our calm baseline.

People living with dementia are no different. If they are taken by surprise, their fight-fright-flight response also kicks in, but because of their brain changes, it is much more challenging for them to process if something is not a threat and return to a calm state. If we do not want to kick off that fight-fright-flight response, we need to make sure we get a visual connection first before coming in to talk or touch.

The occipital lobe of the brain processes what we see in the world. We have a central field of active vision, and a wide peripheral awareness that is our safety vision. With all dementias, peripheral awareness narrows drastically, leaving a very narrow tunnel of active vision. The person simply is unaware of activity and objects outside that tunnel. It can be like looking at the world through a pair of binoculars. This often leads to trip and fall hazards and getting surprised by care partners touches.

The temporal lobes that process language are also affected. You might notice that a person living with dementia has trouble finding words or forming coherent sentences. This is paired with a change in comprehension. We talk and the person living with dementia hears us, but they cannot understand the content of your speech. Rhythm and musical abilities are preserved. So even though someone might not be able to speak, they can sing the words of old songs, prayers or poems they knew when they were young.

The Positive Physical Approach™ (PPA) and Hand Under Hand™ (HUH) techniques help us get connected in positive way. Their simple steps keep us in a person living with dementia’s narrow field of active vision, help us adjust our language to their changing language skills, and to get permission before touching. It is a dynamic assessment tool that allows us to build our relationship with the person we are trying to support, so that we can be “care partners” in everything we do. It helps us do “with” instead of “to” a person.

To learn more about dementia-related sensory changes, PPA, HUH and communication techniques, you can view our recorded webinar, “It’s All in Your Approach — Making Positive Connections.” You can also download the workshop slide deck and PAC Resource Cards.

For more information about PAC, visit www.teepasnow.com.

by

Presenter: Dorothy Colby, Hale Kū‘ike Director of Community Engagement & Positive Approach to Care® Trainer

Date: 9/10/20

Recording length: 1 hour

Sponsors: Hale Kū‘ike and Catholic Charities Hawai‘i

Description:

  • The only constant in dementia is that it is ever changing. How does it progress?
  • How can we connect with what abilities remain, and not just focus on the loss?
  • How can we adjust our care, support, and expectations throughout our journey of living with dementia?

When we think about dementia, we often first think of all the lost abilities — memory, language, judgement, motor skills, and more. Commonly used dementia progression scales, such as the Global Deterioration Scale, are very good at documenting the losses and rating the person at a level of increasing incompetence. The grading system on these scales are either numeric (1–7, 1–3, etc.) or comparative (mild, moderate, severe, etc.). What these scales do not do, is measure what abilities remain throughout the dementia progression. They do not recognize that people living with dementia can still live a rewarding life all through their journey.

The GEMS brain changes model developed by Teepa Snow is based on the Allen Cognitive Scale. Unlike traditional models, the GEMS focuses on the skills and abilities a person still has, not what they have lost. Instead of looking at people as less, care partners can learn to see what the person living with dementia still has left and is still able to do.

The GEMS model recognizes six brain states, each a unique and precious gem. Our healthy normal aging brains are included in the GEMS model. We are the Sapphires who can be flexible and think things through and support all the other GEMS.

GEMS
  • Sapphires: True Blue — Slower BUT Fine
  • Diamonds: Repeats and Routines — Cutting
  • Emeralds: Going — Time Travel —Where?
  • Ambers: In the moment — Sensations
  • Rubies: Stop and Go — No Fine Control
  • Pearls: Hidden in a Shell — Immobile

The GEMS model can help us understand about what it means to be living in a world with Sapphire, Diamond, Emerald, Amber, Ruby, or Pearl cognitive and physical abilities. All individuals, whatever their state of being, in the right setting and with the right care, can shine!

To learn more about dementia progression patterns, GEMS™ and the Positive Approach to Care®, you can view our recorded webinar, “GEMS™, More Than Just Loss — Dementia Progression Patterns.” You can also download the workshop slide deck, GEMS printable poster, and PAC Resource Cards.

For more information about PAC, visit www.teepasnow.com.

by

Presenter: Dorothy Colby, Hale Kū‘ike Director of Community Engagement & Positive Approach to Care® Trainer

Date: 9/3/20

Recording length: 1 hour

Sponsors: Hale Kū‘ike and Catholic Charities Hawai‘i

Description:

  • You are noticing brain changes in someone you are caring for, is it dementia?
  • What does normal healthy brain aging look like?
  • How can we better connect with and support those we care for who are living with dementia?

As we age, we all experience physical changes, including changes to our brains. With normal healthy aging, it may take us a bit longer to remember a name or to learn a new skill. Normal aging means slowing down a bit, NOT losing function!

Dementia is NOT a part of normal healthy aging. Dementia is the umbrella term for a group of symptoms caused by diseases or brain damage. It generally includes a loss of memory, problem-solving, language and other cognitive skills that are severe enough to interfere with daily living and independent life. There are over 50 different diseases that can cause dementia. The most common are Alzheimer’s Disease, vascular dementia (strokes), Lewy Body dementia, Frontotemporal dementia, Parkinson’s Disease, and alcoholism. All the dementia-causing diseases damage brain cells, cause brain shrinkage, and lead to a loss of brain wiring. The entire brain is affected, not just the memory center. These brain changes are irreversible, progressive, and eventually terminal.

While there may be no cure for dementia, there are care techniques and approaches that can make a positive difference for the person living with dementia, and their care partners. Using the Positive Approach to Care® (PAC) philosophy and techniques can make it possible for someone to live well with dementia.

If we can understand the brain changes that come with dementia, we can come as close as possible to seeing the world through their eyes and understand the challenges of living with dementia. We can understand and focus on what skills remain, not just what is lost. PAC skills can help us change our impulsive reactions into thoughtful responses that improve everyone’s quality of life.

People who are living with dementia are doing the best they can every moment of the day. We need to remember which one of us in this relationship has the healthy aging brain! We are the ones who can be flexible, learn new skills, and build a support team for ourselves and the person we love.

To learn more about normal aging, dementia and PAC skills, you can view our recorded webinar, “Normal vs. Not Normal Aging — Understanding the Difference. You can also download the workshop slide deck and PAC Resource Cards.

For more information about PAC, visit www.teepasnow.com.