Archive October 31, 2019

Difficult Behaviors – Part One

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Difficult Behaviors in Dementia:
How to Keep Patients Safe and Caregivers Sane

by Luciana Mitzkun Weston,
Villa Alamar Community Services Director

Part one:
Identifying Difficult Behaviors

At times, people living with Alzheimer’s or other forms of dementia act differently than what would be considered their normal behavior. Whether it be expressions of frustration and stubbornness in the beginning stages of the disease, or resistance to care and agitation in later stages, some changes in behavior should be expected.

Dementia often causes patients to experience confusion in relation to place and time, what to do next, and what others expect of them in social situations. Confusion leads to an increase in feelings of fear and anxiety, which in turn causes a patient to exhibit difficult behaviors. Caregivers are often puzzled and bewildered by these troublesome behaviors.

Some of these behaviors are perplexing, but harmless. Caregivers may even find it amusing when their loved ones start tearing page after page out of magazines and folding them multiple times into increasingly smaller pieces, until they can no longer be folded; some patients move items around the house, continuously rearranging and moving them again; some patients enjoy bursting the bubbles on packing materials, or watching the same TV show over and over again.

Dementia patients find such repetitive actions to be soothing and can continuously engage in performing them for countless hours. Although some of these behaviors can constitute an annoyance to their loved ones, they are merely a manifestation of a patient doing what simple task he can to entertain himself.

If the behavior is not harmful to the patient or others and can be performed without major disruptions to the household, it should not be discouraged. Ensuring that the patient has a safe and comfortable  space for himself to engage in the chosen behavior is the best strategy in this case. Harmless behaviors, although sometimes annoying to caregivers, should not be considered a difficult behavior, but rather seen as an “activity.” Activities are desirable: They keep the person at ease, engaged, and centered in the moment.

On the other hand, some behaviors can pose a risk to the patient’s wellbeing, disrupt the functionality of the household, or interfere with the caregiver’s ability to provide care. Behaviors such as shuffling and moving furniture, dismantling and disassembling electronics, wandering and getting lost in the neighborhood, picking at one’s own skin to the point of creating open sores, or screaming and yelling at odd hours, are certainly behaviors that call for intervention as well as an increase in the patient’s supervision. Such behaviors can pose a risk to the patient’s and caregiver’s health, and significantly decrease the caregiver’s ability to provide care.

As a general rule:

If the behavior is harmful to the patient or others or

if the behavior interferes with the caregiver’s ability to provide care,

it should be considered a “difficult behavior.”

We should also consider that what we define  as a difficult behavior is often a manifestation of some form of stress or discomfort: Your loved one may be over- or under-stimulated, may be in some form of pain (physical or emotional) or may be suffering from depression or anxiety, or even in some cases, be afflicted with an infection or other health condition. Look for the underlying cause. While the behavior itself deserves attention, the cause behind it requires proper investigation and care (we will address these strategies on Part III of this article).

Difficult behaviors in dementia patients are the primary reason caregivers seek Villa Alamar’s memory care services. Indeed, most residents do experience an improvement in the frequency and severity of difficult behaviors after transitioning to Villa Alamar.

This improvement is made possible by the many dementia supportive strategies we have adopted in our community. The environment itself makes a big difference to the residents’ ability to conquer confusion and achieve enjoyment in daily activities. Having freedom to safely stroll indoors and outdoors through patios and paseos, having access to nature (trees, sounds, smells, birds), receiving encouragement to participate in programs that are designed to be achievable, meaningful, and fun for the resident, and having experienced and kind caregivers always close and ready to provide assistance: All these strategies work to suppress confusion and promote wellbeing and social interaction. Less confusion generates lower anxiety levels and reduced urge to act in difficult or inappropriate ways. In the right environment, with careful and consistent stimulation, dementia patients thrive!

Family caregivers can adopt many of these strategies in their own homes to help reduce the occurrences of difficult behaviors and to extend their ability to care for their loved ones in place. 

Next:
Part II: Preventing Difficult Behaviors

Record Visitor Numbers at Senior Expo

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Villa Alamar and Alexander Gardens are Proud Silver Sponsors of the 31st Annual Senior Expo of Santa Barbara

Pictured: Mitch Leichter, Ingrid Lino, and Shandy Newlan. Photo: Mary Brook.

Multiple businesses and organizations joined together this October 2nd to offer valuable information and services to local seniors at the 31st Annual Senior Expo, a Santa Barbara tradition.

The event took place at the Earl Warren Showgrounds and counted with 120 exhibitors and 300 volunteers, workers, and exhibitor associates.

A record number of visitors (over 1000) attended the Expo, where they were able to gather information on a variety of services including health, transportation, and financial planning.

Memory care and assisted living are some of the major concerns for seniors in Santa Barbara. Our Villa Alamar and Alexander Garden teams were there to provide firsthand information on quality assisted living and memory care services.

We were also represented at the event’s planning level. Our Associate Executive Director, Joseph Newlan, LVN is a member of the event’s all-volunteer planning committee while also, in collaboration with Jeanne West, RN, co-coordinator and recruiter of nurses for the flu-shot clinic.

Jeanne was the driving force behind the creation of the flu-shot clinic back in 2001, when it was first offered at the Senior Expo with vaccines donated by Cottage Health. The clinic became a big success and its creation is accredited for doubling the number of visitors at the Expo, which at the time was dwindling.

This year the flu-shot clinic at the Expo gave visitors 764 vaccines over a 3-hour period, and counted with the help of 16 nursing students and 16 nurses (RNs and LVNs), among them our beloved Resident Services Director, Shandy Newlan, LVN (who is also Joseph’s wife).

Shandy herself administered 42 shots on that morning.  “I really enjoy these clinics,” she said, “It is a joy to be able to help so many people in one single event.”

In 2020 Joseph will be taking over the duties of coordinating and recruiting nurses for the event, while Jeanne, who is also the Community Engagement Manager at Hospice of Santa Barbara, will be dedicating herself to inter-agencies recruitment and coordination.

Back for the third time this year, the Caregiver’s Cafe was offered as a relaxing place to receive support and information. Caregivers received consultations and information on services and strategies for their individual needs, including in-home help, assisted living, and caregiver support.

Other valuable resources available included blood pressure screening by Santa Barbara Neighborhood Clinics, glaucoma screening by Lions Sight & Hearing, hearing screening by Miracle Ear® of Santa Barbara, and bone density scans by OsteoStrong.

Hailed as one of the best Senior Expos to date, the event’s committee led by the Family Service Agency deserves recognition for its flawless organization and for the quality of the services provided.

The staff and management of Villa Alamar and Alexander Gardens are proud of having collaborated for the success of this year’s event and are looking forward to contributing to the 2020 Expo!

CAREtrends: Creating a Dementia-Friendly Home

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by Luciana Mitzkun Weston, Villa Alamar Community Services Director

Dementia relates to an overall loss of cognitive abilities, often affecting memory, reasoning, organization, language, attention, abstraction, and perception.

Deficits in most of these areas can be easily identified by the caregiver. We can all understand the difficulty someone might have with word finding or performing a multi-step task, such as planning the week’s meals. However, caregivers seem to have a much harder time understanding difficulties in perception and, in particular, visual perception.

Visual perception is an important brain activity that most of us don’t even realize we are performing. We trust our eyes to capture images of the world we live in, and we rely on these images to be correct representations of our environment. Seeing appears to be instantaneous and effortless.

Our brains, however, are constantly processing these images, recognizing and charting them against previously acquired knowledge. The brain unconsciously analyses the position of each image, its movement, size, color, and shape, and finally reconstructs those pieces into our own view of the world.

Basically, what we see is what our brains make of the visual images our eyes capture. This is visual perception, and it is a unique experience for each of us.

Visual perception is often affected as dementia progresses. Although the brain continues to work hard to make sense of visual information, it begins to misinterpret what the eyes see.

This kind of misinterpretation may cause some unforeseen challenges to caregivers, who do not notice the perceptual difficulties because perceiving is something we all do without ever noticing it. We take it for granted.

An environment designed for the comfort and care of dementia patients must accommodate for changes in visual perception. Lighting, visual contrasts between floors and walls, and the use of color can help people with dementia better navigate their surroundings.

When designing or evaluating a dementia-friendly home beware of floors with three-dimensional patterns (such as in tiles) that can cause the person to become uncertain of her footing which can cause them to trip and fall. Dark-colored areas on rugs can be misinterpreted as holes in the ground and become an impassible barrier. Mirrors can also be problematic. They reflect images that people with cognitive impairment may not recognize as their own and may interpret their reflection as a “strange person in the room constantly watching me”. This kind of experience can be scary and set in motion a negative mood that lasts for the rest of the day.

It is important to make things as simple and clear as possible. Eliminate clutter and other elements that might be contributing to confusion and agitation. Slight modifications to accommodate perceptual deficits can greatly enhance the sense of well-being and confidence of a person with dementia.

Villa Alamar is meticulously designed to provide residents with clear pathways and support their ability to move through different environments, thus promoting feelings of self-reliance and well-being. Residents walk confidently from rooms to outdoors, dining rooms to social activity areas, while experiencing sounds, scents, artworks, and nature features that are both soothing and stimulating.

The easiness with which our residents navigate our community and the sensory-richness of our carefully maintained environment are some of the reasons why our home is uniquely qualified to care for dementia patients.

If you’d like to learn more about creating a dementia-friendly home, please contact us and schedule a tour. We look forward to offering you a tour and will be happy to show you what makes Villa Alamar a model in dementia care.

Call to schedule a tour:

805-682-9345

 

Researches Define Disease that Resembles Alzheimer’s

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A brain disorder that mimics Alzheimer’s disease has for the first time been defined: Limbic-predominant Age-related TDP-43 Encephalopathy, or LATE.

Alzheimer’s disease is characterized by beta-amyloid, a protein that forms into hardened plaques in the brain and causes neuron death. The main symptom of Alzheimer’s is dementia, which is loss of cognitive functions—thinking, remembering, and reasoning—and every-day behavioral abilities. It is difficult to obtain an official diagnosis. For most people, Alzheimer’s can only confirmed after death, with a brain autopsy.

In the past, Alzheimer’s and dementia were often considered to be the same.

Now there is rising appreciation that a variety of diseases and disease processes contribute to dementia. Each of these diseases appear differently when a brain sample is examined at autopsy. However, in advanced age, a large number of people have symptoms of dementia without the telltale signs in their brain at autopsy. Emerging research seems to indicate that the protein TDP-43—though not a stand-alone explanation— contributes to that phenomenon.

TDP-43 (transactive response DNA binding protein of 43 kDa) is a protein that normally helps to regulate gene expression in the brain and other tissues. Prior studies found the presence of TDP-43 in most cases of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia, which are relatively uncommon diseases. A significant new development seen in recent research is that misfolded TDP-43 protein is very common in older adults. Roughly 25 percent of individuals over 85 years of age have enough misfolded TDP-43 protein to affect their memory and/or thinking abilities.

TDP-43 is also commonly associated with severe shrinkage of the hippocampal region of the brain—the part of the brain that deals with learning and memory. Hippocampal shrinkage causes cognitive impairment that can be very similar to the effects of Alzheimer’s.

The problem for researchers is that many people with characteristics of LATE disease—memory loss and confusion—are involved in clinical trials for Alzheimer’s that target beta-amyloid. When these trials fail, it may be because they do nothing to address TDP-43.

“Recent research and clinical trials in Alzheimer’s disease have taught us two things: First, not all of the people we thought had Alzheimer’s have it; second, it is very important to understand the other contributors to dementia,” said Nina Silverberg, Ph.D., director of the Alzheimer’s Disease Centers Program at NIA. In the past many people who enrolled in clinical trials were not positive for amyloid.

“Noting the trend in research implicating TDP-43 as a possible Alzheimer’s mimic, a group of experts convened a workshop to provide a starting point for further research that will advance our understanding of another contributor to late life brain changes,” Silverberg explained. In addition to U.S. scientists, experts included researchers from Australia, Austria, Sweden, Japan, and the United Kingdom with expertise in clinical diagnosis, neuropathology, genetics, neuropsychology and brain imaging.

As it turns out, LATE is an under-recognized condition with a very large impact on public health. It is estimated that nearly one million people diagnosed with Alzheimer’s are actually affected with LATE. Older adults (85-95) are at greatest risk for LATE and the public health impact of the disease is believed to be at least as large as Alzheimer’s in this group. LATE affects multiple areas of cognition, ultimately impairing activities of daily life. Additionally, based on existing research, LATE progresses more gradually than Alzheimer’s. However, LATE combined with Alzheimer’s—which is common for these two highly prevalent brain diseases—appears to cause a more rapid decline than either would alone.

“It is important to note that the disease itself is not new. LATE has been there all along, but we hope this report will enable more rapid advancement in research to help us better understand the causes and open new opportunities for treatment,” said Dr. Silverberg.

For more information about participating in Alzheimer’s disease and related dementias clinical research, visit the NIA website.

Source: NIA Guidelines proposed for newly defined Alzheimer’s-like brain disorder, 

 

CAREtrends: Dancing Helps Keeping Your Brain Young

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Do your want to slow down the signs of aging and keep your brain active? So pick up your dancing shoes!

As we age, a number of brain changes occur, including a decrease in brain size, a reduction in blood flow, and a decline in communication between brain cells. These changes can interfere with cognitive functioning, especially learning and memory.

Numerous studies have found that physical activity can help to reduce cognitive decline in later life and exercising regularly has been linked to a slower decline in memory and thinking skills for those 50 and over.

But which forms of exercise are most effective against brain aging? Studies show that older people who routinely partake in physical exercise can reverse the signs of aging in the brain, and dancing has the most profound effect.

According to Dr Kathrin Rehfeld, lead researcher at the German center for Neurodegenerative Diseases, Magdeburg, Germany, exercise has the beneficial effect of slowing down or even counteracting age-related decline in mental and physical capacity. “In our studies,” she says, “we found that two different types of physical exercise (dancing and endurance training) both increase the area of the brain that declines with age. In comparison, it was only dancing that lead to noticeable behavioral changes in terms of improved balance.”

The complex mental coordination that dance requires activates several brain regions (cerebellum, somatosensory cortex, and  basal ganglia) triggering movement, rational, musical, and emotional responses. This strengthens neural connections and can improve our memory. Older adults who dance have bigger hippocampus (a part of the brain responsible for memory consolidation) and better balance.

Dance and ageing research has also shown its positive impact on the neurology in healthy and dementia groups, indicating that dance could be used as therapy to improve visual perception and spatial memory, which are areas of cognition commonly affected by dementia. Additionally, dancing has the following benefits:

  1. Dance is a stimulating mental activity that connects mind to body, increasing feelings of well-being. The essence of dance is joy: It simply makes you feel good!
  2. Dance develops flexibility and instills confidence, increasing muscular toning, agility, and diminishing the risks of falls.
  3. Dance increases awareness of where all parts of the body are in space. Dance focuses attention on eyes, ears, and touch as tools to assist in movement and balance, further diminishing risks of falls.
  4. Dance breaks isolation and stimulates social interaction, which helps in the fight against depression.
  5. The basis of dance is tempo, beat, and rhythm, all which stimulates the mathematical functions of the brain and the formation of new synapses.

The UCSD pioneer Alzheimer’s Diseases expert, Neurologist Dr. Robert Katzman, who died in 2008, was a stanch advocate of dancing as a way to stave off cognitive decline. He once said: “Freestyle social dancing, such as foxtrot, waltz and swing, requires constant split-second, rapid-fire decision making, which is the key to maintaining intelligence because it forces your brain to regularly rewire its neural pathways, giving you greater cognitive reserve and increased complexity of neuronal synapses.” Cognitive reserve acts as your brain’s savings account which provides you with increased resilience against memory loss.

Building your brain’s neural complex works in much the same way as exercise, to get fitter you have to train regularly. So, the more dancing you do, the greater your cognitive reserve. And don’t worry about having to attend dance classes: You benefit from just going out dancing. Your improvisational skills on the dance floor is enough to fire up the rapid decision-making needed to forge new neural pathways.

At Villa Allamar, music and dancing are important components of our wellness program. Please check our Activities Calendar on a regular basis and join us for cognitive strengthening, feel good social events!

 

Married with Caregiving – a Loving Couple’s Challenge

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By Luciana Mitzkun Weston

Couples enjoy activities together, such as a meal, movies, travel, walks, or visits with friends and family. Couples engage in supportive conversations, sharing their views, daily experiences, and a good laugh at the end of the day. Together they become a strong social unit, developing a unique way of communicating with one another and creating they own history and identity—raising families, developing social relationships, attending social engagements, making a home. Dementia, however, may affect every one of those relationship-building blocks that couples so lovingly cultivate together, often over a lifetime.

Alzheimer’s disease and other forms of progressive dementia often have a profound impact on spousal relationships. While one spouse gradually becomes a care receiver and the other a caregiver, the very nature of their bonding ties begins to change.

Changes in perception, memory, and attention tend to render many previously enjoyed activities unsuitable to dementia patients. Caregiving spouses will find that they must adapt their own activities in order to accommodate their partners’ ability to participate. Dementia affects communication skills and patients are no longer able to share those private conversation moments in the same way, creating a void for their caregiver partners. Patients may decrease they interest in participating in social activities, distancing themselves from friends and family, even forgetting precious memories of a cherished marital history.

A decline in shared activities, loss of a spouse’s emotional support, and the erosion of verbal communications between the couple—taken together, these factors will ultimately impact intimacy. The very nature of the relationship is affected as dementia-related symptoms begin to alter mood, behavior, and ability to conduct personal interactions. Caregiver spouses are also deeply affected by these changes, often reporting feelings of increased loneliness and a longing for having the vanishing relationship back to where it was.

Expressions of affection are essential to our well-being, and the need for closeness does not diminish with age or cognitive decline. Dementia patients seek and thrive in closeness, although in different ways than prior to the on-set of dementia. Spouse caregivers, yet again, need to adapt to their loved one’s changes to allow for loving expressions.

Difficulties in intimacy for couples affected by dementia are common and can be expected, although it is not possible to predict what specific dementia-related changes any particular patient will experience. Each patient experiences dementia symptoms in unique ways, and each couple will have its unique challenges. Moreover, depending on the progression of the patient’s underlying disease, changes can be fluctuating or temporary, which brings an additional element of unpredictability and insecurity to the relationship.

However challenging all of these changes may be, it is important for the health and well-being of both spouses to nurture the relationship, maintain a sense of intimacy, and allow for expressions of love and affection. When communications skills decline, touch becomes an even more powerful means for couples to convey affection. People with dementia need to feel loved, to feel safe, and to feel accepted. Loving touch and affection from their spouses can bring them a lot of comfort and even help lessen some of the negative behavioral and psychological symptoms of dementia.

All couples facing dementia will need to find new ways to nurture and promote closeness, and many times the caregiver spouse is the one who bears the greatest share of the responsibility for keeping the relationship alive. This is a recurrent topic in conversations among spouse caregivers, who, in the support groups they attend, often exchange valuable information about coping strategies and how they preserve their relationship throughout the progression of dementia.

Fundamentally, all methods of enhancing communication between spouses can potentially help promote intimacy and preserve the relationship. There are a variety of programs and workshops available for couples affected with dementia, designed with the purpose of increasing communications and togetherness. Programs that stimulate communication between spouses through shared artistic expression, including visual arts, musical, and body work, are particularly beneficial.

Some dementia-related symptoms that may be affecting the relationship can be addressed and alleviated with appropriate medical therapy. Spouse caregivers should be encouraged to discuss relationship challenges with the doctor and seek possible treatment options.

Although caregivers will never be able to restore a relationship to what it was before, there is much that can be done to help nurture the relationship and keep both partners emotionally fulfilled and supported.

Relationships are complex and multifaceted, and very vulnerable to changes in each partner. Caregivers must keep in mind that although dementia takes much from their loved ones, there is still much left in them. Ways of expressing love may change, but love remains intact. And each moment may bring a new and precious way to honor and express it. Understanding dementia and making room for loving moments to flourish may well be the key to a successful marriage and a successful partnership in dementia.