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First Responder Dementia Guide

The purpose of this guide is to provide information pertinent to interactions with persons with Dementia to make the interaction safer, and easier. First responders report interacting with persons with Dementia on a regular, or even daily, basis. This guide will cover four of the most common situations including: Wandering Driving Abuse and Neglect Firearms

Please note: The terms Alzheimer's Disease and Dementia may be used interchangeably in this guide, however, there is a difference. Alzheimer's is a type of Dementia, but there are similarities to other forms of Dementia that can be utilized in interacting with an affected subject.

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What is Alzheimer's Disease? There are a number of commonly held beliefs, some fact, some myth, regarding Alzheimer's and Dementia. Age - while it is more common to find Dementia among older persons, it is not a condition that is normal to the aging process. Individuals as young as 40 can be diagnosed with Dementia. Nursing Homes - persons with Dementia do not live only in nursing homes. In fact, it is estimated that about 70% of affected individuals live in the community, many of whom have not been diagnosed. Confusion - persons with Dementia often become disoriented, which can place themselves and others at risk. Memory Loss - the aging process results in some memory loss, however, in persons with Dementia, this decline is abnormally pronounced.

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Recognizing Persons with Dementia It is likely that you may have passed a person with Dementia without realizing it. In some cases, there are only very subtle differences between the average person and a person with Alzheimer's or other Dementia. If any of these traits are recognized, a conversation may help to provide more clues to their current state. Age - as age increases, so does the likelihood that they are affected. Facial Expression - persons with Dementia may have a blank or confused look. Attire - inappropriate attire could be a sign (ex. mismatched clothes, light clothing in cold weather, etc.) Gait - an affected individual's gait may appear unbalanced or as a shuffle. Actions - a person with Dementia may be too close to the side of a busy road or taking otherwise unsafe actions.

Communication Tips for Persons with Dementia or Alzheimer's Disease Having the ability to effectively recognize a person affected by Dementia and approach them safely will help reduce time and risk. Tips to remember: Approach from the front Introduce yourself Speak slowly Use simple language Pay attention to body language Minimize distraction

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Wandering Wandering presents a significant risk to the affected subject and others. If a wanderer is not found within 24 hours, the risk of serious injury or death is 50%. Recognizing Alzheimer's and Dementia patients is essential to minimizing risk. Nearly 70% of Dementia patients wander The subject may not be appropriately dressed for the weather, which could be life threatening Wandering may lead the subject to unsafe or unfamiliar areas (ex. a busy road or highway, the woods, etc.) Wandering is not just on foot, subjects may use various transportation methods. This can make the situation even more unsafe for the individual and others and it can be more difficult to find the person within a reasonable amount of time.

Wandering Search Tips If a call is received regarding a person with Dementia that has wandered from a home or facility, there may be recognizable patterns that can aid in locating the subject. Where to start looking: Radius - start nearby including rooms, garages, and wooded areas Locations - check previous residences and places of employment. Paths - follow roadways, paths and areas a short distance from the road. Look for Turns - many subjects walk straight and turn when they reach an obstacle.

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Driving, Firearms and Shoplifting Normal behavioral patterns will be altered as Alzheimer's and Dementia progress to later stages. A subject may lose the ability to safely and effectively perform in a variety of situations.

Driving At some point, an affected individual may have to stop driving due to: Impaired judgment and reaction time Decreased awareness Impaired understanding of procedures Disorientation and the chance of becoming lost

If a subject with Dementia is found driving, many of the same procedures as approaching one that is wandering apply, including: Identify yourself and why you stopped the car Speak simply and guide conversation Issue a citation Do not allow the individual to drive home Contact caregivers to address vehicle access Contact the DMV for testing and renewal

In some cases, the individual may wander while driving. In these instances, issue an alert to departments in the surrounding area and request that the family contact credit card companies in case they are used.

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Firearms Weapons that are handled inappropriately pose a significant risk to the individual and those around them. Persons with Alzheimer's or Dementia may have significantly affected judgment, awareness, and personality. In some cases, unloading the weapon or removing the firing pin may not be enough to avoid an unsafe situation. Risks of Firearms Reactions - a subject may mistake familiar persons for a threat. Disorientation - sounds, and even the television could be misinterpreted and provoke a dangerous response. Anxiety - it is common for persons with Dementia to become overly frightened or angry causing them to react with excessive emotion.

Shoplifting Though not entirely common, it is possible that a person with Dementia could be found shoplifting. In these cases, the subject may not remember taking the item, or they may believe that they have already paid for it. These instances can create confusion and frustration for the individual, the store and responding officers. De-escalate - do your best to keep all parties calm. Resolve - discourage the merchant from pressing charges. Discuss - contact the caregiver and discuss the situation with them.

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Abuse and Neglect Whether inflicted by a stranger, caregiver or by the individual themselves, abuse and neglect are an unfortunate reality for many persons with Alzheimer's and other related forms of Dementia. These issues can come in the form of physical, psychological, sexual or financial occurrences. Knowing the signs and the corresponding appropriate response can help to prevent serious harm. Abuse - knowingly depriving goods or services essential to an individual's care, or inflicting physical or psychological harm upon the individual. Neglect - failure to provide the necessary duties, goods or services to the individual in need. 66% of abuse victims are female 77% of abuse victims are Caucasian 89% of abuse cases are domestic

Abuse and neglect incidents are difficult to manage as they are not always inflicted by another party, but sometimes by the individuals themselves. In some cases, neglect can result from a caregiver being overwhelmed or incapable of performing the required care for an affected individual. Signs of Neglect Common signs of neglect include: Dehydration Malnutrition Hyper/Hypothermia Poor living conditions Improper hygiene Inadequate clothing Lack of living aides Untreated medical conditions

In cases of neglect, the first step is typically to reach out to the caregiver, social services, adult protective services or the Alzheimer's Association. However, if the subject appears to be in immediate danger, arrange transport to the nearest medical facility for treatment.
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Financial Abuse A frequent case of abuse among those affected by Dementia is financial abuse. This could be committed by a friend, relative, or even scam artists. Common red flags that could indicate financial abuse include: Spending - abnormal spending patterns may signal some kind of financial abuse. Unpaid bills - regular monthly payments become delinquent. Purchases - loans, large purchases, unnecessary items, not buying common items. Representatives - someone influencing spending such as friends and relatives.

In the case that financial abuse is suspected, a report should be filed with adult protective services.

Caregiver Abuse When responding to cases of abuse, keep in mind that in some cases the abuser may be the caregiver or the affected individual. In many cases, this type of abuse isn't a malicious action, but in response to the level of frustration and lack of support. Potential causes of abuse include stress, isolation, depression, lack of support or even abuse by the person with Dementia. The confusion and fear experienced by a person with Dementia can cause them to react to what they are feeling negatively and become abusive verbally and/or physically. The person with Dementia may feel abandoned, intimidated, frustrated or even suspicious of the caregiver.

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