D5ecb08f Af3b 49cf A0dc B3769bea3a49 UnderstandingAlzheimersDiseaseRelatedDementiaOnHire 3-17-20

UNDERSTANDING ALZHEIMER’S DISEASE AND
RELATED DEMENTIA ON-HIRE IN-SERVICE
TABLE OF CONTENTS
SECTION 1: INTRODUCTION
4 OBJECTIVES 4
SECTION 2: ALZHEIMER’S DISEASE 5

NORMAL AGING 5
MEMORY LOSS AND THE ABILITY TO FUNCTION 5
UNDERSTANDING ALZHEIMER’S DISEASE AND RELATED TYPES OF
DEMENTIA 7
ALZHEIMER’S DISEASE VERSUS DEMENTIA 7
ALZHEIMER’S DISEASE 8
VASCULAR DEMENTIA 8
DEMENTIA WITH LEWY BODY (DLB)
9 PARKINSON’S DISEASE
9
FRONTOTEMPORAL DEMENTIA 10
CREUTZFELDT – JAKOB DISEASE 10
HUNTINGTON’S DISEASE 10
WERNICKE – KORSAKOFF SYNDROME 11
INTRODUCTION TO ALZHEIMER’S DISEASE AND OTHER RELATED
DEMENTIA: POST REVEW 12
RISK FACTORS 13
DIAGNOSIS 14
MEDICAL TREATMENTS OF DEMENTIA 15
PHARMALOGICAL INTERVENTIONS 16
ACETYLCHOLINESTEREASE INHIBITORS (AChEis) 17
MEMANTINE 17
DIETARY SUPPLEMENTS 17
ANTIPSYCHOTICS FOR BEHAVIORAL AND PSYCHOLOGICAL
SYMPTOMS OF DEMENTIA (BPSD) 18
NON-PHARMACOLOGIC INTERVENTIONS 19
EDUCATION AND SUPPORT 19
SECTION 2 POST REVIEW 20
SECTION 3: STAGES OF DEMENTIA AND FUNDAMENTALS FOR CARE 21

EARLY STAGE 21
MIDDLE STAGE 22
LATE STAGE 23
PROMOTING ABILITY OR PERSON – CENTERED CARE 24
UNDERSTANDING DEMENTIA AND OTHER RELATED DISORDERS:
POST REVIEW 26
SECTION 4: PROBLEM – SOLVING WHEN DEALING WITH CHALLENGING BEHAVIORS

28 STRATEGIES FOR RESPONDING TO CHALLENGING BEHAVIORS 30
WANDERING AND GETTING LOST 31
SLEEP ISSUES AND SUNDOWNING 32
PARANOIA 33
HALLUCINATIONS 33
Page 1
Understanding Alzheimer’s Disease and Related Dementia On-Hire In-Service Date: 03/20
TABLE OF CONTENTS
MEMORY LOSS AND CONFUSION 34
DEPRESSION VERSUS ALZHEIMER’S 34
AGITATION 36
RUMMAGING AND HOARDING 37
AGGRESSIVE AND CATASTROPHIC BEHAVIORS 38
RESPONDING TO CATASTROPHIC BEHAVIORS 38
SECTION 4: POST REVIEW 40
SAFE ENVIRONMENTS 41
MEDICATION MANAGEMENT 42
DRIVING 43
HOME SAFETY 44
WANDERING 45
FIREARM SAFETY 46
FALLS 46
MANAGING ACTIVITIES OF INDIVIDUAL’S WITH DEMENTIA 48
PRODUCTIVE LIFE TASKS 48
TASKS FOR INDIVIDUAL ACTIVITIES 48
REMINISCENCE THERAPY 49
MUSIC THERAPY 49
ACTIVITIES 50
POST REVIEW 53
GUIDELINES FOR ASSISTING INDIVIDUALS WITH DEMENTIA IN
PERFORMING ACTIVITIES OF DAILY LIVING (ADLS) 54
ASSISTING WITH ACTIVITIES OF DAILY LIVING 55
DRESSING 55
GROOMING 56
BATHING 56
MAKING THE BATHROOM SAFE 57
PREPARING FOR THE BATH 57
DURING THE BATH 58
AFTER – BATH CARE 58
NUTRITION: FOOD AND EATING 59
POSSIBLE CAUSES OF POOR APPETITE 60
MAKE MEALTIMES EASIER 60
MINIMIZE EATING AND NUTRITION PROBLEMS 61
INCONTINENCE 62
CAUSES OF INCONTINENCE 62
TIPS FOR MANAGING INCONTINENCE 63
DENTAL CARE 64
DAILY ORAL CARE 64
POST REVIEW FOR GUIDELINES FOR ASSISTING INDIVIDUALS
TO PERFORM ADLS 66
MULTICULTURAL CONSIDERATIONS 67
Page 2
TABLE OF CONTENTS
ETHICS AND CAPACITY ISSUES 69
STRESS AND THE CAREGIVER 70
RISKS ASSOCIATED WITH CAREGIVING 70
HELPING TO REDUCE THE STRESS FOR CAREGIVERS 70
POST REVIEW 72
PALLIATIVE CARE FOR COMFORT AND QUALITY OF LIFE 73
BARRIERS TO EFFECTIVE PALLIATIVE AND END OF LIFE CARE 74
PRINCIPLES OF PALLIATIVE CARE AND NEEDS OF THE PATIENT
WITH DEMENTIA 74
LATE STAGE DEMENTIA AND PALLIATIVE CARE 75
HOSPICE CARE FOR ADVANCED DEMENTIA 76
PAIN 77
NON-PHARMACOLOGIC INTERVENTIONS 79
PASTORAL CARE AND PREPARING FOR END OF LIFE 80
POST REVIEW 81
RESOURCES 82
APPENDIX: 10 WARNING SIGNS OF ALZHEIMER’S HANDOUT

TABLE 1: POTENTIAL NONPHARMACOLOGICAL STRATEGIES
FIREARM SAFETY
GENERAL GUIDELINES FOR ASSISTING PERSONS WITH ALZHEIMER’S DISEASE
AND RELATED DEMENTIA (ADRD) WITH ACTIVITIES OF DAILY LIVING
SAFETY ASSESSMENT CHECKLIST
TYPES OF DEMENTIA AND FEATURES
FAST SCALE
SUPPLEMENTAL UNIVERSITY COURSES-REFER TO THE UNIVERSITY WEB SITE

TEEPA SNOW: BRAIN CHANGES (AL) 25 MINS (MANDATORY)
TEEPA SNOW: DEMENTIA 101 – ANNUAL MANDATORY (SNF) 6 MINS (MANDATORY)
TEEPA SNOW: CHALLENGING BEHAVIORS (AL) 7 MINS (MANDATORY)
TEEPA SNOW: MEANINGFUL ACTIVITIES (AL) 25 MINS (OPTIONAL)
ANSWER KEYS
Page 3
SECTION 1: INTRODUCTION
In this training you will explore strategies for caring for individuals with Alzheimer’s Disease
and Related Dementia (ADRD) by using person – centered care. Interventions are tailored to
the individual and their specific needs. The plan of care directs and protects the individual’s
privacy, dignity, respect and choice which are key in supporting quality measures.
Caring for individuals with Alzheimer’s disease and related dementia requires you have increased
knowledge to provide quality care. Through this education you will learn how to create a safe,
secure and supportive environment, how to identify and manage challenging behaviors, and ways
that you can help involve the family and caregiver’s in the patient’s care.
OBJECTIVES
Following this curriculum the learner will be able to:

x gain understanding of normal aging, Alzheimer’s disease and related dementia
x identify strategies to help you communicate effectively with individuals with dementia
x describe ways to create a safe, secure and supportive environment for the patient
with dementia
x list appropriate interventions for assisting individuals with dementia in performing
activities of daily living
x demonstrate knowledge of problem solving with individuals with dementia who
have challenging behavior
x describe ways to create a safe secure and supportive environment for a patient
with Alzheimer’s disease and related dementia
x identify common ethical issues related to caring for patients with dementia
x list two stress management strategies that can help the caregiver reduce the effects of
caring for a person with dementia
x understand principles of palliative care and needs of the patient with dementia
Page 4
SECTION 2: ALZHEIMER’S DISEASE
In this section you will learn the difference between normal aging, Alzheimer’s disease and
related dementia
NORMAL AGING
Many people over the age of 65 may experience some form of memory loss when there is
no underlying medical condition or neurodegenerative disorder causing this memory loss.
This is known as “age-associated memory impairment” which is considered a normal part of
aging. An individual who complains of memory loss does not necessarily have warning
signs of dementia.
As individuals grow older, they may experience physiological changes that can cause one to take
longer to learn and recall information. Like being able to recall the name of a movie or the name
of a familiar street. If the individual gives themselves some time, the information will usually
come to mind. Major memory problems are not the same as “age-associated memory loss.” It can
be difficult for care providers to distinguish the difference between normal age-related
forgetfulness and the symptoms that may indicate development of a cognitive problem.
MEMORY LOSS AND THE ABILITY TO FUNCTION
The primary difference between “age-related memory loss” and dementia is that “age-related
memory loss” isn’t disabling. The little memory lapses such as forgetting where a person left
things that they use often like one’s keys has little impact on daily performance.
When memory loss becomes so prevalent that it disrupts one’s decision making or the ability to
perform simple tasks like dressing, bathing or paying bills, then the individual may be
experiencing warning signs of Alzheimer’s disease. Below is a table that highlights some
examples of normal age-related memory changes versus early symptoms of Alzheimer’s
dementia.
Page 5
MEMORY LOSS AND THE ABILITY TO FUNCTION (CONT.)
Normal Age-Related Memory Changes Warning Symptoms of Alzheimer’s

Memory loss that disrupts daily life (i.e., family
Occasionally forgetting things and events, but
members must remind them of dates or
remembering them later
events)
Challenges in problem solving (can no longer

Making occasional errors when managing
track monthly bills or maintain a banking
finances
account)
Occasionally needing help to use microwave Difficulty completing familiar tasks to use the
settings microwave
Confusion with time or place (i.e., the person

Getting confused about the day of the week may forget where they are or has lost track of a
season)
Trouble understanding visual images and
spatial relationships (i.e., problems judging
Vision changes related to cataracts distance or determining color – or contrast
which may cause issues with driving,
especially at night)
Sometimes having trouble finding the right New problems with words in speaking or writing
word (i.e., calling a “watch” a “hand-clock”)
Misplacing things and losing the ability to

Misplacing things from time to time and retrace steps (i.e., losing things and being
retracing steps to find them unable to go back over steps to find them
again)
Decreased or poor judgement (i.e., may use
Making a bad decision once in a while, like
poor judgment when dealing with money or
neglecting to change the oil in the car
paying less attention to grooming)
Withdrawal from work or social activities (i.e.,

Sometimes feeling uninterested in social
withdraws from hobbies, social activities or
obligations
interaction with other’s)
Changes in mood or personality (i.e.,

Becoming irritated when a routine is
becoming confused, depressed, fearful or
disrupted
anxious)
See Appendix at the end of this in-service for the “10 Warning Signs of Alzheimer’s” handout.
Reference: Alzheimer’s Association, 10 Early Signs and Symptoms of Alzheimer’s, 2019, Cited with Permission.
Page 6
UNDERSTANDING ALZHEIMER’S DISEASE AND RELATED TYPES OF
DEMENTIA
The brain contains billions of nerve cells called neurons that coordinate emotion, thought,
behavior, movement and sensation. When stimulated, an electrical impulse travels through the
cell body and releases chemicals called neurotransmitters. The neurotransmitters bind to receptors
on the receiving cells. The receiving cell is stimulated to recreate the impulse and the process
begins again.
In Alzheimer’s disease, plagues develop which are buildups of proteins called amyloid and
neurofibrillary tangles. The presence of plagues and tangles interrupt communication and
impulses between cells that are important for brain function. The end result is that the brain
cells become damaged and lead to the progressive impairment in cognitive function seen in
person’s with Alzheimer’s disease.
ALZHEIMER’S DISEASE VERSUS DEMENTIA
Often, Alzheimer’s disease and dementia are used interchangeably. They are not the same thing.
Dementia is a chronic and persistent disorder caused by a group of symptoms that results from
brain damage to the areas of the brain that control memory, impulse control, language, speech,
reasoning, learning and decision-making. Dementia is not part of normal aging and the term is
used to refer to a variety of disease and conditions that develop when nerve cells in the brain fail
to function.
Alzheimer’s disease is the most common cause of dementia accounting for 60 to 80 percent of
dementia diagnosis*. Many other diseases can cause dementia. Dementia is characterized as
either reversible or non-reversible. Reversible dementia is associated with delirium, depression,
sensory or nutritional deficits, infection, thyroid problems, or drug intoxication. Non-reversible
dementias include primary dementias such as:
x Alzheimer’s Disease
x Vascular dementia as seen in multi-infarct
dementia x Lewy Body
x Parkinson’s Disease
x Frontotemporal Dementia (FTD)
x Creutzfeldt-Jacob Disease
x Huntington’s Disease
x Wernicke-Korsakoff Syndrome
*Reference: Alzheimer’s Association. 2018 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dementia, 2018: 14(3) 367-429. Cited with Permission.
Page 7
ALZHEIMER’S DISEASE
SYMPTOMS
Difficulty remembering recent conversations, names or events is often an early clinical symptom;
apathy and depression are also often early symptoms. Later symptoms include impaired
communication, poor judgment, disorientation, confusion, behavior changes and difficulty
speaking, swallowing and walking.
Alzheimer’s is considered a slowly progressive brain disease that begins well before symptoms
emerge. Some early signs and symptoms may include difficulty remembering recent
conversations, names or events. Apathy and depression are other common early symptoms. In
later stages, impaired communication, poor judgment, disorientation, confusion, behavior
changes, and difficulty speaking, walking or swallowing.
BRAIN CHANGES
Hallmark abnormalities are deposits of the protein fragment beta-amyloid (plaques) and
twisted strands of the protein tau (tangles) as well as evidence of nerve cell damage and death
in the brain.
VASCULAR DEMENTIA
Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common

as a sole cause of dementia than Alzheimer’s.
SYMPTOMS
Impaired judgment or ability to make decisions, plan or organize is more likely to be the initial
symptom, as opposed to the memory loss often associated with the initial symptoms of
Alzheimer’s. This occurs from blood vessel blockage or damage leading to infarcts (strokes) or
bleeding in the brain. The location, number and size of blockages in the brain are directly related
to the severity of symptoms.
BRAIN CHANGES
Brain imaging can often detect blood vessel problems implicated in vascular dementia. In the
past, evidence for vascular dementia was used to exclude diagnoses of Alzheimer’s disease (and
vice versa). That practice is no longer considered consistent with pathologic evidence, which
shows that the brain changes of several types of dementia can be present simultaneously. When
any two or more types of dementia are present at the same time, the individual is considered to
have “mixed dementia”.
Page 8
DEMENTIA WITH LEWY BODY (DLB)
SYMPTOMS
People with dementia with Lewy bodies often have memory loss and thinking problems common
in Alzheimer’s, but are more likely than people with Alzheimer’s to have initial or early
symptoms such as sleep disturbances, well-formed visual hallucinations, and slowness, gait
imbalance or other parkinsonian movement features.
BRAIN CHANGES
Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein. When they
develop in a part of the brain called the cortex, dementia can result. Alpha-synuclein also
aggregates in the brains of people with Parkinson’s disease, but the aggregates may appear in a
pattern that is different from dementia with Lewy bodies.
The brain changes of dementia with Lewy bodies alone can cause dementia, or they can be
present at the same time as the brain changes of Alzheimer’s disease and/or vascular dementia,
with each abnormality contributing to the development of dementia. When this happens, the
individual is said to have “mixed dementia.”
PARKINSON’S DISEASE
As Parkinson’s disease progresses, it often results in a progressive dementia similar to dementia

with Lewy bodies or Alzheimer’s.
SYMPTOMS
Problems with movement are common symptoms of the disease. This may include lack of facial
expression, stiffness and difficulty with walking. If dementia develops, symptoms are often
similar to dementia with Lewy bodies
BRAIN CHANGES
Alpha-synuclein clumps are likely to begin in an area deep in the brain called the substantia
nigra. These clumps are thought to cause degeneration of the nerve cells that produce
dopamine.
Page 9
FRONTOTEMPORAL DEMENTIA
This dementia includes dementias such as behavioral variant frontotemporal dementia (FTD),
Pick’s disease, corticobasal degeneration and progressive supranuclear palsy.
SYMPTOMS
Typical symptoms include changes in personality and behavior and difficulty with language.
Nerve cells in the front and side regions of the brain are especially affected.
BRAIN CHANGES
No distinguishing microscopic abnormality is linked to all cases. People with FTD generally
develop symptoms at a younger age (at about age 60) and survive for fewer years than those with
Alzheimer’s.
CREUTZFELDT-JAKOB DISEASE
Creutzfeldt-Jakob Disease (CJD) is the most common human form of a group of rare, fatal
brain disorders affecting people and certain other mammals. Variant CJD (“mad cow disease”)
occurs in cattle, and has been transmitted to people under certain circumstances.
SYMPTOMS
This disease is generally progresses rapidly and is fatal. It impairs memory and coordination
and causes behavior changes.
BRAIN CHANGES
The symptoms results from misfolded prion protein that causes a “domino effect” in which
prion protein throughout the brain misfolds and thus malfunctions.
HUNTINGTON’S DISEASE
Huntington’s disease is a progressive brain disorder caused by a single defective gene

on chromosome 4.
SYMPTOMS
Symptoms include abnormal involuntary movements, a severe decline in thinking and

reasoning skills, and irritability, depression and other mood changes.
BRAIN CHANGES
The gene defect causes abnormalities in a brain protein that, over time, lead to worsening symptoms.
Page 10
WERNICKE-KORSAKOFF SYNDROME
Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine

(vitamin B-1). The most common cause is alcohol misuse.
SYMPTOMS
Memory problems may be strikingly severe while other thinking and social skills seem
relatively unaffected.
BRAIN CHANGES
Thiamine helps brain cells produce energy from sugar. When thiamine levels fall too low, brain
cells cannot generate enough energy to function properly.
Page 11
INTRODUCTION TO ALZHEIMER’S DISEASE AND OTHER RELATED
DEMENTIA: POST REVIEW
List or circle the best answers for the following questions.
1. List 4 types of
dementia x
x
x
x
2. Name the most common type of dementia in the

elderly: a. Alzheimer’s dementia
b. Vascular dementia
c. Dementia with Lewy Body (DLB)
3. This form of dementia is a rapidly fatal

disorder: a. Parkinson’s Disease
b. Creutzfeldt-Jakob
Disease c. Huntington’s
Disease
4. All of the following are potential warning signs of Alzheimer’s disease versus normal age-
related memory changes except:
a. Challenges in problem solving such as being able to track monthly
bills b. Confusion with time or place such as forgetting where they are
c. Misplacing things from time to time, but able to retrace steps to find
them d. Difficulty completing familiar tasks to use the microwave
5. Mr. Smith is brought into the clinic by his son for an evaluation related to memory loss. Mr.
Smith has lived with his son for over a year now. After a comprehensive assessment by his
primary care physician, he is diagnosed with Alzheimer's disease. His symptoms include: not
always remembering his address, confusion about the day or date of the week, difficulty in
dressing for the appropriate weather such as donning shorts and a short sleeve shirt on a day
when the outside temperature is 32 and it is snowing. He sometimes thinks he is living in
another state where he used to live as a child and asks his son to take him to his elementary
school just down the street to be with his friends, although he cannot remember the name of
the school or any of the names of his friends. What stage of Alzheimer's disease would you
classify Mr. Smith as having?
a. Mild
b. Moderate
c. Severe
Name Date
Reviewed by Date
Page 12
RISK FACTORS
A small, percentage of patients with Alzheimer’s disease have a genetic component. The same
risk factors that contribute to other chronic diseases, such as heart disease and stroke are also
linked to Alzheimer’s disease and other related dementias.
Non-modifiable risk factors include but are not limited to the

following: x Age 65 or older (age is the single most important risk
factor)
x Family history (increased risk if parent or sibling has/had the
disease) x Female gender
x African-American or Hispanic ethnicity
Modifiable risk factors include:

x Cardiovascular risks such as obesity, smoking, sedentary lifestyle, high
cholesterol x Diabetes
x Inadequate social and cognitive
activity x Traumatic brain injury
x Low level of formal education
Reference: Alzheimer’s Association. 2018 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dementia 2018; 14(3): 367-429. Cited with Permission.
Page 13
DIAGNOSIS
In 1984 diagnostic criteria and guidelines were based chiefly on the physician’s clinical
judgment including input from the patient, family and caregivers, results of cognitive tests
and neurological assessments. Today, revised guidelines utilize the same steps for diagnosis,
but also include biomarker testing as indicated per the physician’s judgement.
A bio maker is a biological factor that can measure the presence or absence of a disease or a risk
that the disease may develop. Several biomarkers are being researched for Alzheimer’s to
determine if beta-amyloid are present in the brain as shown in Positron Emission Tomography
(PET) imaging and cerebrospinal fluid testing.
Diagnosing dementia requires a careful and comprehensive medical evaluation. There is no

single test for Alzheimer’s disease. A variety of tools and approaches are used to help make a
diagnosis which includes:
x obtaining an accurate patient history including cognitive, physical, medication usage,
and family history
x mental status evaluation
x asking family to provide input about changes in thinking skills and behavior
x completing physical and neurological exams, cognitive testing and evaluation for
evidence of aphasia, apraxia, agnosia, and executive functioning
x laboratory tests to determine possible reversible causes of dementia
x brain imaging to rule out other potential causes of dementia
symptoms x psychiatric or psychological evaluations as indicated
Looking to the future, biomarker tests will also be important in identifying which individuals in
the early stages of the disease should receive treatments to slow or stop the disease when such
treatments are available.
Reference: Alzheimer’s Association. 2018 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dementia 2018; 14(3): 367-429. Cited with Permission.
Page 14
MEDICAL TREATMENTS OF DEMENTIA*
While there is currently no cure for dementia there are many ways to manage the symptoms.
The physician and the interdisciplinary team should be involved in several aspects of
managing and treating the patient with dementia. Goals of care will be focused on the
following approaches to maximize the patient’s function and quality of life:
x formulating an overall assessment of the patient’s condition and prognosis
x assisting with investigation and causes of and factors contributing to specific
dementia-related symptoms such as behaviors and wandering
x defining the potential benefits and risks of pharmacological and non-
pharmacological interventions
x adjusting or discontinuing medications that may be adversely affecting cognition,
behavior, or physical function
x order targeted testing or further evaluation as indicated to determine possible
reversible causes of dementia
x present options of compassionate palliative and end-of-life care and assist family in
adjusting to the losses that occur as dementia progresses
x promote family education regarding the natural progression of dementia and way in
which family involvement can maximize the patients’ function and quality of life
*Reference: Dementia Practice Guidebook, ©2016 HCR Healthcare, LLC, July, 2016
Page 15
PHARMALOGICAL INTERVENTIONS*
Few medications are approved by the Food and Drug Administration (FDA) or indicated
specifically for the treatment of dementia. Several medication classes may be used to manage the
symptoms of dementia off label, however the patient should be monitored for possible adverse
drug reactions (ADRs) and periodically evaluated for efficacy. Since the elderly are susceptible
to ADRs, the lowest effective dose of a selected medication should be used and discontinuation
considered if the therapeutic goals for the patient are not being met.
Goals of dementia therapy management change as the disease progresses especially when
palliative or hospice care is warranted with end stage dementia. Medications used to treat
symptoms associated with dementia should be evaluated periodically to determine if continued
therapy is warranted and whether the lowest effective dose is being used.
Once the lowest effective dose used is below the FDA approved indication dosing or the
available manufacturer dosage formulation, trial discontinuance should be attempted. This
should be considered for the following drug classes:
x antipsychotics
x anxiolytics
x sedatives
x hypnotics
x mood stabilizers
x antidepressants
Medications with central nervous system (CNS) effects should be used cautiously in patients
with Lewy Body dementia since either paradoxical effect (opposite to the effect which would
normally be expected) may occur or possibly an increased response to the medication.
When medications are being used to manage behavioral and psychological symptoms
of dementia (BPSD), possible cause of the behavior symptoms should be considered before
starting medication therapies. Possible causes may include neurological, physical, psychiatric,
and environmental.
Non-pharmacological interventions should be considered and attempted before starting a new

medication therapy especially when no treatable underlying medical or psychiatric
conditions are noted. Behaviors may be anticipated and accommodated with non-
pharmacological inteventions.
*Reference:
Dementia Practice Guidebook, ©2016 HCR Healthcare, LLC, July, 2016
Page 16
PHARMALOGICAL INTERVENTIONS* (CONT.)
ACETYLCHOLINESTERASE INHIBITORS (AChEis)*
AChEis, including donepezil, galantamine, and rivastigmioe, are FDA-approved for the
treatment of dementia and have been shown to slow the loss of cognitive function decline.
AChEis increase a neurotransmitter in the brain, acetylcholine, that is thought to aid with
cognitive function. AChEis are generally indicated for mild - moderate Alzheimer's dementia
with donepezil also being indicated for moderate - severe dementia. AChEis are not a cure nor
does their use prevent dementia but use may slow the progression of dementia for patients with
cognitive decline not caused by an underlying treatable condition. AChEis are generally started
at low doses and titrated to higher doses as tolerated by the patient to maximize therapeutic
effect.
Since therapy only slows disease progression, discontinuation should be considered when
therapeutic goals are not being met, cognitive function is deteriorating despite treatment or
palliative or hospice care is started.
MEMANTINE
Memantine (Namenda) is approved for the treatment of moderate, severe disease. Memantine
protects brain cells by blocking the effects of excess glutamate. Excessive glutamate is released
in the brain of patients with dementia and is thought to damage brain cells. The benefit of
memantine is generally considered PRGHVWEXWLVWKHRQO\
PHGLFDWLRQDWWKLVWLPHZLWKWKLVHIIHFW&Rā administration with donepezil may have
additional benefit. Similar to AChEis, memantine therapy only slows disease progression.
Discontinuation should be considered when therapeutic goals are not being met, cognitive
function is deteriorating despite treatment, or hospice care is started.
DIETARY SUPPLEMENTS
The Dietary Supplement Health and Education Act defines dietary supplements as a category of
food. However, there is one exception: if a dietary supplement meets the definition of a drug, it is
regulated as a drug. Dietary supplement manufacturers and distributors are not required to obtain
FDA approval. For most benefit claims made in the labeling of dietary supplements, the law does
not require the manufacturer or seller to prove to the FDA's satisfaction that the claim is accurate
or truthful before it appears on the product.
Dietary supplements with claims for treating dementia include coenzyme Q-10,
desferroixamine, ergoloid mesylate, ginkgo biloba, nicotine, melatonin, niacinamide,
nonsteroidal anti-inflammatory drugs (NSAIDS) including aspirin, selegiline, vitamin B12,
and vitamin E. Use of dietary supplements for the treatment of dementia should generally be
discouraged due to limited wide spread acceptance and possible drug interactions with
medications.
*Reference:
Page 17
PHARMALOGICAL INTERVENTIONS* (CONT.)
ANTIPSYCHOTICS FOR BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD)*
Antipsychotics do not have an approved FDA indication for the treatment of dementia or
BPSD and have potentially significant serious adverse drug reactions (ADRs).
The FDA requires manufacturers to include a black box warning in the package insert for all
antipsychotics. A black box warning is the strongest warning that the FDA can require a
manufacturer to include in the labeling and package insert of prescription medications when
there is reasonable evidence of an association with significant risk for negative outcomes
including life threatening ADRs.
Antipsychotics should be used cautiously due to the lack of FDA indication (proven efficacy)
and potential ADRs. The possible causes of Behavioral and Psychological Symptoms of
Dementia (BPSD) symptoms should be evaluated and a patient centered decision should be
made before starting antipsychotic therapy based on the medication potential benefits and
risks.
Non-pharmacological interventions should be considered and attempted before starting a new

medication therapy especially when no treatable underlying medical or psychiatric
conditions are noted. These behaviors may be anticipated and accommodated with non-
pharmacological interventions. Potential ADRs should be monitored.
A diagnosis of BPSD alone may not support initiating an antipsychotic. The patient should
display behavioral symptoms that present a danger to themselves or others. In addition,
symptoms are identified as being due to mania or psychosis (such as: auditory, visual, or other
hallucinations; delusions, paranoia or grandiosity) and, or behavioral interventions have been
attempted and included in the plan of care, except in an emergency.
Gradual Dose Reductions (GDRs) should be considered on a regular basis for dementia
patients ordered antipsychotics to help ensure the lowest effective dose is being used and
evaluate whether continued therapy is warranted. This is especially important due to the
serious possible ADRs that may occur.
*Reference:
Page 18
NON-PHARMACOLOGIC INTERVENTIONS
Non-pharmacological interventions also play an important role as the foundation for strategies
that can guide staff and caregivers when caring for individuals with dementia. Non-
pharmacological interventions can be separated into several categories that can optimize
function in the person with dementia:
x education and support
x activity maximize
function x safety
x advance care planning
EDUCATION AND SUPPORT
Education and support services for individuals with dementia and their caregivers is essential to
sustain the management of the person as they progress through the disease. It is important that
the physician discuss the diagnosis and potential treatments with the individual with dementia
and the caregiver, including goals of care. From the early stages involve the patient in care
planning activities with the ability to express their wishes and decisions to the extent of their
ability. When developing the plan of care, education should be provided to the patient and
caregiver regarding local community-based support service organizations. Community-based
organizations can assist the patient and caregiver in finding support groups and adult day care
programs, as indicated. The adult day care program may offer cognitively stimulating activities
that can benefit the patient with dementia to improve strength, balance and cardiovascular health.
Exercise may also help in managing symptoms such as restlessness.
Assisting the person with dementia in participating in daily cognitively – oriented activities
may be protective as a means of increasing the brains adaptability and preserving cognition.
Additional recommendations that caregivers in the home environment might try to connect
with their loved one and manage behavior may include:
x Engage in planned activities based on the individuals functional ability such as
painting, simple gardening, assisting with simple cooking, or playing a musical
instrument
x Establish a night time ritual that is calming and away from stimulation such as the
noise of the television
x Limit caffeine or alcohol use
x Keep a calendar to help the person with dementia to remember upcoming events or
daily activities
In developing the care plan staff may refer to the ACT on Alzheimer’s Potential Non-
pharmacological Strategies checklist as a reference. This list offers guidance on select non –
pharmacological strategies for targeted behavior by dementia stage.
See Appendix at the end of this in-service for “Table 1: Potential Non - Pharmacologic
Strategies handout.
Page 19
SECTION 2 POST REVIEW
1. There is no single test to make a diagnosis of Alzheimer’s

disease: True False
2. Possible causes of behavioral symptoms should be evaluated before starting

medication therapies:
True False
3. Discontinuation of Memantine (Namenda) should be considered

when: a. Cognitive function is declining despite treatment
b. Hospice care is started
c. Therapeutic goals are not being
met d. All of the above
4. A diagnosis of BPSD alone may not support initiating

an: a. antidepressant
b. sedative
c.
antipsychotic d.
hypnotics
5. Gradual Dose Reductions (GDRs) should be considered on a regular basis for patients
on antipsychotics to ensure the lowest effective dose is being used:
True False
Name Date
Reviewed by Date
Page 20
SECTION 3: STAGES OF DEMENTIA AND
FUNDAMENTALS FOR CARE
Alzheimer’s disease is progressive. The rate of progression varies among patients. On average, a
patient lives four to eight years after diagnosis, although some patients have lived for 20 years
following diagnosis. Alzheimer’s progression is generally categorized into three stages – early,
middle and late.
EARLY STAGE
In the early stages or mild of Alzheimer’s, a patient may function independently. He or she may
still have the ability to drive, work and be a part of social situations. Despite these independent
abilities, the patient may feel as though they are having memory lapses. Family members and
friends may start to notice these lapses.
Early stage symptoms can include the

following: x difficulty finding the right
word or name
x difficulty remembering names when introduced to new
people x increasing difficulty performing tasks in social
settings
x forgetting material that has just been read or
seen x losing or misplacing objects
x increasing difficulty with planning or organizing
Fundamental Strategies of Care – Early Stage:

x don’t make assumptions about a person’s ability to communicate because of an
Alzheimer’s diagnoses. The disease affects each person differently
x don’t exclude the person from conversations with others
x speak directly to the person from the front and identify yourself
x take time to listen to how the person is feeling, what he or she is thinking or may need
x give the person time to respond. Don’t interrupt or finish sentences unless the person
asks for help finding a word or finishing a sentence
x explore which method of communication is most comfortable for the person. This
could include email, phone calls or in-person conversations
x it’s OK to laugh. Sometimes humor lightens the mood and makes communication easier
x be honest and frank about your feelings. Don’t pull away; your friendship and support
are important to the person living with dementia
Page 21
MIDDLE STAGE
The middle stage of Alzheimer’s, sometimes referred to as moderate Alzheimer’s, is typically the
longest stage. As the disease progresses, the patient will have greater difficulty in communicating
and will require a greater level of care.
Middle stage symptoms can include the following:

x forgetfulness of events or about one’s own personal history
x feeling moody or withdrawn, especially in socially or mentally challenging
situations x being unable to recall their own address or telephone number
x confusion about where they are to what day it is
x need for assistance with choosing proper clothing for the season or
occasion x trouble controlling bowel or bladder
x changes in sleep patterns
x personality and behavior changes, including suspiciousness and delusions, or
compulsive, repetitive behavior like hand-wringing or tissue shredding
Fundamental Strategies of Care – Middle Stage:

x allow time for response so the person can think about what he or she wants to say
x engage the person in one-on-one conversation in a quiet space with minimal distractions
x be patient and supportive. Offering comfort and reassurance can encourage the person
to explain his or her own thoughts
x maintain eye contact. It shows you care about what he or she is saying
x avoid criticizing or correcting. Instead, listen and try to find the meaning in what is
being said. Repeat what was said to clarify
x avoid arguing. If the person says something you don’t agree with, let it be
x don’t overwhelm the person with lengthy requests that require complex thinking.
Instead break down tasks with clear, step-by-step instructions
x speak slowly and clearly
x ask one question at a time. Multiple questions can be overwhelming
x ask questions that require a “yes” or “no” answer. For example, “Would you like
some coffee?” rather than “What would you like to drink?”
x give visual cues. To help demonstrate the task, point or touch the item you want
the individual to use. Or, begin the task for the person
x written notes can be helpful when a spoken word seems confusing
Page 22
LATE STAGE
In the late stage of the disease, patients lose the ability to respond to their environment, to carry
on a conversation, and to control movement. The patient may still say words or phrases, but may
have difficulty communicating pain. As memory and cognitive skills continue to decline,
personality changes may take place and patients need extensive assist with activities of daily
living. The patient may rely on non-verbal communication such as facial expressions or vocal
sounds.
Late stage symptoms can include the following:

x extensive assistance required with activities of daily
living x loss of awareness of recent experiences and
surroundings
x changes in functional abilities including ambulation, sitting and swallowing. The patient
may not eat or drink as they approach end-of-life
x increased difficulty with communication. The patient may lose all verbal abilities
Fundamental Strategies of Care – Late Stage:

x treat the person with dignity and respect. Avoid talking down to the person or as if he or
she isn’t there
x use a hand-over-hand technique when performing tasks
x approach the person form the front and identify
yourself
x encourage nonverbal communication. If you don’t understand what is being said, ask
the person to point or gesture
x ensure physical care needs are met
x sometimes the emotions being expressed are more important than what is being said.
Look for the feelings behind words or sounds
x use touch, sights, sounds, smells and tastes as a form of communication with the person
x it’s OK if you don’t know what to do or say; your presence and friendship are
most important
x plan activities that ensure success according to the person’s ability
Page 23
PROMOTING ABILITY OR PERSON – CENTERED CARE
Communication with a person with dementia can be challenging for the staff, family and
caregivers, especially as the disease progresses. Caregivers need to be aware that the patient
may experience changes in their ability to communicate and the impact it can have on the
relationship between the patient and the person delivering care. If caregivers are better informed
of strategies to effectively communicate with the individual, then the caregiver will be better
prepared to adjust their own communication methods in order to meet the needs of the patient.
Use of ability or person-centered care offers guidance on important communication methods that
can enhance one’s ability to interact with the patient with dementia. There is no one definition of
person-centered care. Other terms that have been used are patient-centered, ability-centered or
individualized care. Regardless of the term, the concept refers to care based on the premise that
every person is unique with a different set of abilities and needs. These abilities and need for
support can, and will change, throughout a persons’ life and as they progress through the disease
process.
For the individual with dementia, it is important to know that the needs and abilities of the
patient may change frequently, even throughout the day. The person may become more
confused, disoriented, or active as evening approaches or as changes occur in their
environment or with care givers.
Person-centered care can have a significant effect on decreased behavioral symptoms and
psychotropic drug use in patients with dementia. Person-centered care supplements the patient’s
medical needs. It is recognized that every person who needs care begins with a diagnosis,
medical treatments and medications. But, the medical needs may not always be the first priority.
In person-centered or ability-centered care it is important to recognize that the person being
cared for is not diminished to the diagnosis or medical tasks needing to be performed, but
instead the patient needs to be viewed holistically. What can that person still do, what remaining
abilities do they still have? Staff should identify the individual’s strengths and weaknesses in
order to maintain their level of functional independence, safety and quality of life.
For example, if we look at the diagnosis of dementia, we know that a patient strength of this
disease is that the individual generally retains long-term memory. Their weakness is the lack of
maintaining short-term memory such as what they did 5 minutes or an hour ago. The patient may
struggle and become frustrated and show signs of problem behavior when the care provider
attempts to deliver personal care. But, what if the care provider can tap into the strength of the
patient’s long-term memory and their person-centered preferences, this can be a tool to transition
the patient’s experience of care to a more positive one. By knowing the patient from a holistic
perspective, like what and how they were used to doing things in their daily routine, this can help
the staff better meet the patient’s potential to engage in daily activities to the best of their ability.
Gathering this type of information about the patient is a critical part of developing and tailoring
an individualized care plan. It is important that the care plan is updated as the needs of the
patient changes based on the progression of their disease.
Page 24
PROMOTING ABILITY OR PERSON – CENTERED CARE (CONT.)
There are many different aspects of ability or person-centered care

including: x preserving the patient’s dignity, respect and choice
x viewing the patient holistically as the center of care
x ensuring the patient is physically comfortable and
safe x providing emotional support
x involving, family and caregivers
x coordinating and integrating the care plan
x working together between staff, family and caregiver to ensure good communication
and education related to behavior strategies
x utilizing community resources and services as available
Ensuring that staff, family and caregivers are central to the patient’s care is key in developing
quality outcomes. Person-centered care can also improve the experience of care for the patient
and family.
The following are examples of ways in which staff provide the highest level of person-centered
care in their environment:
x protect the patients privacy and dignity in all things, at all
times x understand the patient’s reality
x see past the patient’s disabilities and find their strengths
x help the patient hold onto and express their individual identities
x help the patient be as independent as possible while continuing to be available for
needed assistance
x enable the patient to make choices
x help the patient compensate for the effects of their illness
x help the patient to feel included, safe, secure, respected, valued, and stay a part of the
social world
x support the patient when they express their feelings
x make an effort to understand the patient’s communication, regardless of form, and
help them to understand staff communication to them
x treat the patient as we would wish to be treated
ourselves x allow the patient to experience joy, comfort,
and meaning
Page 25
UNDERSTANDING DEMENTIA AND OTHER RELATED DISORDERS: POST
REVIEW
1. In the stage, disorientation may occur which can result in the

patient’s ability to carry on a conversation and changes in functional abilities such as
ambulation and swallowing.
a. Early
b. Middle
c. Late
2. Before talking with a patient with dementia approach the

patient: a. from behind
b. from the front and identify yourself
c. always avoids speaking to Alzheimer’s patients since they won’t know you anyway
3. When you are having trouble understanding an Alzheimer’s patient who is in the early
stage of the disease:
a. give the person time to respond; try not to finish their sentence unless the patient asks
for help finding a word
b. walk away
c. argue if you have to in order to get their attention
4. All of the following are successful tips for communicating with a patient in the middle
stage of Alzheimer’s Except:
a. be patient
b. listen and try to find the meaning of what is being
said c. repeat what is said to clarify
d. use multi-step questions and
instructions e. speak slowly and clearly
5. Alzheimer’s accounts for ___________________ percent of

dementia? a. 50-60
b. 5-10
c. 60-80
d. 20-40
6. In the late stage of Alzheimer’s disease all of the following would be most appropriate
except: a. Use a hand over hand technique when performing tasks
b. Ensuring physical care needs are met
c. Encourage activities that are vigorous and challenging
d. Plan activities that ensure success according to their ability
Page 26
UNDERSTANDING DEMENTIA AND OTHER RELATED DISORDERS: POST
REVIEW
7. Person-centered care means all of the following EXCEPT:

a. Interventions must be tailored to individuals and their specific
needs b. The plan of care should never change once it is written
c. Protect the person’s privacy and dignity in all things, at all
times d. Allow people to experience joy, comfort and meaning
Name Date
Reviewed by Date
Page 27
SECTION 4: PROBLEM – SOLVING WHEN DEALING
WITH CHALLENGING BEHAVIORS
Communication is both verbal and non-verbal and shapes how individuals present their thoughts,
desires and actions. For the patient with dementia who may be exhibiting problem behaviors such
as anxiety, verbal outbursts, withdrawal or aggression, the staff, family and caregivers are
essential in preserving the patient’s dignity and self-respect. When the staff, family or caregivers
are faced with a patient’s challenging behavior there are some Best Practices that may help to
improve interactions and promote more person-centered care:
x try to eliminate possible distractions when speaking with the patient such as shutting off
the tv
x look directly at the patient and be sure you have their
attention x talk in a calm manner
x speak clearly and softly
x use short, simple phrases
x allow time for the patient to respond
x use non-verbal communication (demonstrate visually as much as possible) what you
are trying to say
x don’t argue with the
patient x don’t be
condescending
x ask family for input about possible meanings of what is being said
One important part in interacting with the patient with dementia is to know how to approach the
individual physically in a way as to not trigger anxiety. The following is a list of actions in
developing a positive approach:
x approach the patient from the front so they can see you
coming x move slowly to avoid startling the patient
x position yourself at the same level as the
patient x use the patient’s preferred name
Page 28
SECTION 4: PROBLEM – SOLVING WHEN DEALING WITH
CHALLENGING BEHAVIORS (CONT.)
Individuals with dementia may exhibit actions or behaviors that can concern staff, family
and caregivers. Some of these behaviors can include:
x wandering
x looking or searching for
things x exit seeking
x hoarding
x being suspicious or showing signs of
paranoia x repetitive actions
x loud vocalizations that may not make
sense x sleep disturbance
To the patient, these actions or behaviors may be understandable in their mind such as an attempt
to express their basic human need such pain, the need for social contact, a response to
environmental stressors or psychological distress. Some of these behaviors can benefit the patient
such as wandering within a safe, enclosed environment which can help preserve strength and
maintain functional status. But, wandering may be detrimental when it extends to exit seeking or
moving into unsafe spaces such as unlocking an exit door in the home and proceeding to a busy
street. In these cases, interventions are appropriate. Staff needs to assess the action in order to
address the cause of the behavior or unmet needs.
Reframing may be an effective way for staff, family and caregivers to respond to the patient’s
behavior. By reframing the patient’s actions not as a “problem behavior” but as an expression or
attempt to communicate their need or want, allows the caregiver to observe the behavior in order
to determine the root cause of the actions. The caregiver should understand that whatever the
patient is experiencing in their mind is reality. It’s about them and their attempt to express
themselves even if they are resorting to other means of expression. For example, something as
simple as making changes to where the furniture is placed in the room or redirecting the lights
can trigger a change in the patient’s communication either verbally or non-verbally. The
following tips can be used as guidance to identify the cause of the behavior and ways to reframe
the communication:
What:
x Try and identify what caused the behavior
x Assess the behavior objectively. Could it result in harm to the patient or
others? x The behavior may be embarrassing or disruptive, but may not be
harmful
x Avoid correcting, intervening or escalating the behavior. Remain calm and allow the
patient to make their own choices when possible. For example, if the patient would like to
rummage through their closet non-stop, let them
Page 29
SECTION 4: PROBLEM – SOLVING WHEN DEALING WITH
CHALLENGING BEHAVIORS (CONT.)
When:
x Look for patterns of when the behavior occurs
x Ask: What triggered the behavior?
Does the behavior happen at a certain time of the day or night? Could this be sun-
downing as the day turns to darkness?
Where:
x Are there any environmental changes that may trigger the behavior?
x Is their environment noisier than usual or has something changed in their environment?
Why:
x Assess for the root cause
x Why is the patient behaving this way?
x For example, the patient may undress because their clothes are too tight or they may
need to use the bathroom
x Is the behavior a response to a stressor or frustration that they may not be able
to communicate their needs? Could the patient be tired, hungry or in pain?
STRATEGIES FOR RESPONDING TO CHALLENGING BEHAVIORS
There are a variety of strategies and interventions for addressing actions and behaviors in
patients with Alzheimer’s disease or dementia. It’s important to keep in mind that these
behaviors are a product of the disease and do not define the individual. Try to remain flexible,
but if the patient’s actions or behavior becomes a physical danger to themselves or others, then
the staff or caregiver need to intervene. It is important for staff to focus on person-centered care
and a problem-solving approach as strategies for caring with the person with dementia. Staff
should communicate with their supervisor and the physician if indicated to ensure safety. It is
important to document the behaviors and update the care plan as needed. Below are some
strategies that can be helpful when dealing with challenging behaviors.
Page 30
STRATEGIES FOR RESPONDING TO CHALLENGING BEHAVIORS (CONT.)
WANDERING AND GETTING LOST
Six in 10 people with dementia will wander. A person with Alzheimer’s may not remember his
or her name or address, and can become disoriented, even in familiar places. Wandering among
people with dementia is dangerous, but there are strategies and services to help prevent it.
RESPONSE
x Carry out daily activities. Having a routine can provide structure
x Identify the most likely times of day that wandering may occur. Plan activities at that
time. Activities and exercise can reduce anxiety, agitation and restlessness
x Reassure the person if he or she feels lost, abandoned or disoriented. If the person with
dementia wants to leave to “go home” or “go to work,” use communication focused on
exploration and validation. Refrain from correcting the person. For example, “We are
staying here tonight. We are safe and I’ll be with you. We can go home in the morning
after a good night’s rest.”
x Ensure all basic needs are met. Has the person gone to the bathroom? Is he or she thirsty
or hungry?
x Avoid busy places that are confusing and can cause disorientation. This could be a
shopping mall, grocery store or other busy venues
x Use devices that signal when a door or window is opened. This can be as simple as a
bell placed above a door or as sophisticated as an electronic home alarm
x Provide supervision. Never lock the person with dementia in at home alone or leave him
or her in a car without supervision
x Keep car keys out of sight. A person with dementia may drive off and be at risk of
potential harm to themselves or others
References:
Alzheimer’s Association. 2018 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dementia 2018; 14(3): 367-429. Cited with
Permission. Dementia Society of America, Inc., Doylestown, PA, 2019
Home Health Quality Improvement (HHQI), HHQI University, Meeting the Needs of Caregivers and Care-Receivers.
https://HHQIuniversity.org/. Accessed 2019.
Page 31
SLEEP ISSUES AND SUNDOWNING
People with Alzheimer’s and dementia may have problems sleeping or increases in
behavioral problems that begin at dusk and last into the night (known as sundowning).
RESPONSE
x Keep the home well-lit in the evening. Adequate lighting may reduce the agitation
that occurs when surroundings are dark or unfamiliar
x Make a comfortable and safe sleep environment. The person’s sleeping area should be
at a comfortable temperature. Provide nightlights and other ways to keep the person
safe, such as appropriate door and window locks. Door sensors and motion detectors
can be used to alert family members when a person is wandering
x Maintain a schedule. As much as possible, encourage the person with dementia to adhere
to a regular routine of meals, waking up and going to bed. This will allow for more
restful sleep at night
x Avoid stimulants and big dinners. Avoid nicotine and alcohol, and restrict sweets
and caffeine consumption to the morning hours. Have a large meal at lunch and
keep the evening meal simple
x Plan more active days. A person who rests most of the day is likely to be awake at
night. Discourage afternoon napping and plan more challenging activities such as doctor
appointments, trips and bathing in the morning or early afternoon. Encourage regular
daily exercise, but no later than four hours before bedtime
x Try to identify triggers. Limit environmental distractions particularly during the
evening hours (TV, children arriving, chores, loud music, etc.)
References:
Page 32
PARANOIA
A person with Alzheimer’s may become suspicious of those around them, even accusing others
of theft, infidelity or other improper behavior. While accusations can be hurtful, remember that
the disease is causing these behaviors and try not to take offense.
RESPONSE
x Don’t take offense. Listen to what is troubling the person, and try to understand that
reality. Then be reassuring, and let the person know you care
x Don’t argue or try to convince. Allow the individual to express ideas. Acknowledge
his or her opinions
x Offer a simple answer. Share your thoughts with the individual, but keep it simple.
Don’t overwhelm the person with lengthy explanations or reasons
x Switch the focus to another activity. Engage the individual in an activity, or ask for help
with a chore
x Duplicate any lost items. If the person is often searching for a specific item, have several
available. For example, if the individual is always looking for his or her wallet, purchase
two of the same kind
HALLUCINATIONS
When a person with Alzheimer’s or other dementia hallucinates, he or she may see, hear, smell,
taste or feel something that isn’t there. Some hallucinations may be frightening, while others may
involve ordinary visions of people, situations or objects from the past.
RESPONSE
x Offer reassurance
x Use distractions
x Modify the environment
References:
Page 33
MEMORY LOSS AND CONFUSION
In the later stages of the disease, a person with Alzheimer’s may not remember familiar
people, places or things. Situations involving memory loss and confusion are extremely
difficult for caregivers and families, and require much patience and understanding.
RESPONSE
x Stay calm. Although being called by a different name or not being recognized can be
painful, try not to make your hurt apparent
x Respond with a brief explanation. Don’t overwhelm the person with lengthy statements
or reasons. Instead, clarify with a simple explanation
x Show photos and other reminders. Use photographs and other thought-provoking items
to remind the person of important relationships and places
x Travel with the person to where he or she is in time. If the person’s memory is focused
on a particular time in his or her life, engage in conversation about recollections with an
understanding that this is his or her current reality
x Offer corrections as suggestions. Avoid explanations that sound like scolding.
Try: “I thought it was a fork” or “I think she is your granddaughter Julie.”
DEPRESSION VERSUS ALZHEIMER’S
Depression is common among people with Alzheimer’s, especially during the early stage and
middle stages. It can be difficult to diagnose because the two conditions share many of the same
symptoms. Just as treatment is important for a person with depression, it is essential for a person
with Alzheimer’s disease and depression to get treatment for their depression. Some of the
symptoms common to both Alzheimer’s and depression may include:
x feeling sad
x withdrawing or not wanting to be around
others x episodes of crying
x trouble
sleeping x
change in mood
x bouts of irritability
x experiencing a lack of
appetite x feeling tired or
fatigued
References:
Permission. Alzheimer’s Association. https://alz.org/help-support/caregiving/stages-behaviors/depression. Cited with Permission
2019.
Dementia Society of America, Inc., Doylestown, PA, 2019
Page 34
DEPRESSION VERSUS ALZHEIMER’S (CONT.)
When assessing for depression in patients with Alzheimer's disease, doctors may rely on
nonverbal cues and caregiver reports rather than self-reported symptoms. If a person with
Alzheimer's displays one of the first two symptoms in this list, along with at least two of the
others within a two-week period, he or she may be depressed.
x Depressed mood such as displaying sadness, feeling hopeless, discouraged, or being
tearful x Loss of interest in usual activities or a lack of interest in social interactions
x Change in appetite
x Changes in sleep
patterns x Agitation or
lethargy
x Irritability
x Loss of energy
x Feelings of worthlessness, hopelessness or inappropriate
guilt x Recurrent thoughts of death or suicide
Depression can affect quality of life for people with Alzheimer's disease and can lead
to: x worsening cognitive decline
x increased difficulty in performing daily activities of
living x increased dependence on caregivers
For these reasons it is important for the physician to establish a diagnosis of depression in
people with Alzheimer's disease so they can get appropriate treatment.
RESPONSE
x Referral to the primary care physician if symptoms suggest a diagnosis of depression
x Medications: Based on the findings of a depression assessment by the
physician antidepressants may be prescribed. If so, monitor compliance with
the prescribed medication regimen
x Physical Exercise: Help the person exercise regularly, particularly in the morning
x Schedule a predictable daily routine, taking advantage of the person’s best time of
day to undertake difficult tasks, such as bathing
x Try to decrease social isolation by making a list of activities, people or places that the
person enjoys and schedule these things more frequently
Reference: Alzheimer’s Association. https://alz.org/help-support/caregiving/stages-behaviors/depression. Cited with Permission 2019.

Page 35
DEPRESSION VERSUS ALZHEIMER’S (CONT.)
x Acknowledge the person’s frustration or sadness, while continuing to express hope that
he or she will feel better soon
x Reassure the person that he or she will not be
abandoned x Celebrate small successes and occasions
x Support groups can be helpful, particularly an early-stage group for people with
Alzheimer’s who are aware of their diagnosis and prefer to take an active role in seeking
help or helping others; counseling is also an option, especially for those who aren’t
comfortable in groups
AGITATION
Agitation is a broad term referring to a variety of verbal, vocal or physical behaviors that
may be inappropriate or disruptive to others. The person may make constant requests for
attention.
RESPONSE
x Listen to the frustration. Find out what may be causing the agitation, and try to understand
x Provide reassurance. Use calming phrases such as: “You’re safe here;” “I’m sorry that
you are upset;” and “I will stay until you feel better.” Let the person know you are
there
x Shift the focus to another activity. Try using art, music or other activities to help engage
the person and divert attention away from their anxiety and frustration
x Modify the environment. Decrease noise and distractions, or relocate
x Find outlets for the person’s energy. The person may be looking for something to do.
Take a walk or go for a car ride
x Check yourself. Do not raise your voice, show alarm or offense, or corner, crowd,
restrain, criticize, ignore or argue with the person. Take care not to make sudden
movements out of the person’s view
Reference: Alzheimer’s Association. https://alz.org/help-support/caregiving/stages-behaviors/depression. Cited with Permission 2019.

Page 36
RUMMAGING AND HOARDING
Rummaging and hoarding behaviors are common behaviors associated with Alzheimer’s
disease. While these behaviors may seem meaningless to the caregivers, these behaviors can
actually serve as a coping mechanism for the person in the middle stage of the disease. When
speech and the ability to comprehend decline the individual tries to find another way to interact.
To the individual with Alzheimer’s this behavior serves as a way to decrease anxiety and
interact. The act of grasping and holding objects becomes another way to communicate a need
when it cannot be done verbally. Restricting these activities can lead to increased frustration.
Maybe the individual can search and grasp a fork, although, they are unable to tell you verbally
what function the fork serves, this may be their attempt to convey they are hungry and want
something to eat.
In managing the challenges of rummaging and hoarding, it is a better practice to try and control
the environment versus controlling the behavior. Provide a safe place to rummage or allow the
individual to have a safe place of their own to keep their objects such as a box or a drawer that
can be filled with their meaningful items. When the person grasps a familiar object you may get
a clue that this is the item that they are trying to use to translate their need or what they are
searching for. This may be one strategy to connect non-verbally with the individual and where
they are in their world.
RESPONSE
x Try to determine what may be causing the behavior
x Remove valuable items that could be misplaced or hidden by the
person x Be sure dangerous or toxic products are locked up and out of
reach
x Remove spoiled food from the refrigerator or cabinets
x Keep the person from going into unused rooms in order to limit the space in which they
can rummage
x If the individual tries to hide items outside of the environment, such as the garage or
yard, make sure the exit doors of the residence are locked and exits are secured
x Keep trash cans out of sight as the person may not remember the purpose of the trash
container and my try to rummage through it. If possible keep the trash cans covered
and out of sight
x Keep mail and correspondence in a special place where the person cannot rummage
through them or possibly lose or through away mail. Consider giving the person a
personal box or chest where they can rummage freely. Remind them often that this is
their personal storage space.
Reference: National Institute on Aging ADEAR Center. NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center.
2017. www.nia.nih.gov/alzheimers. Free publications about Alzheimer’s disease and related dementias for families, caregivers and health
professionals.
Page 37
AGGRESSIVE AND CATASTROPHIC BEHAVIORS
Aggressive behaviors are defined as a disturbance in behavior that is emotionally intense. They
may be sudden and with no apparent reason. The behavior may be physical or verbal. A
physical acting out is evidenced by hitting, kicking, biting, kicking, grabbing others or throwing
objects. Verbal actions can include screaming, shouting, cursing, or sobbing frantically.
These behaviors can occur for a variety of reasons such as the person being unable to express
their unmet needs, or increased stimulation in the environment. The actions may be a result of
the individual experiencing pain, hunger/thirst, temperature, the need to go to the bathroom or
secondary to a medical illness or infection. The most common triggers for causing catastrophic
reactions are at times when personal hygiene tasks are being performed such as bathing or
dressing. Evening time is the most frequent time of day that aggressive or catastrophic reactions
may occur. The individual may be experiencing paranoia or hallucinations which may make
them afraid of others or even familiar caregivers.
RESPONDING TO CATASTROPHIC BEHAVIORS
The person with dementia may not understand what you are saying to them, but how you
approach them and how you speak to them can impact their reaction. Below are some
approaches you can use to decrease the chance of a dementia catastrophic reaction.
RESPONSE
x Don’t invade their personal space. A one-on-one approach is best. Approach them from
the front if possible.
x Call their name
x Try to identify the immediate cause. Think about what happened right before the
reaction that may have triggered the behavior
x Rule out pain as a source of stress. Pain can cause a person with dementia to act aggressively
x Focus on feelings, not the facts. Rather than focusing on specific details, consider
the person’s emotions. Look for the feelings behind the words or actions
x Don’t get upset. Be positive and reassuring. Speak slowly in a soft tone. Don’t argue
x Limit distractions. Examine the person’s surrounding, and adapt them to avoid
similar situations
x Know the person’s preferences (i.e., do they respond to touch or does this increase
their agitation)
professionals.
Page 38
RESPONDING TO CATASTROPHIC BEHAVIORS (CONT.)
x Shift the focus to another activity. The immediate situation or activity may
have unintentionally caused the aggressive response. Try something different
x Assess the environment and remove offending triggers if necessary (i.e., has
their environment been rearranged)
x Remember the person’s identify and life history which they may be living out in the
present actions (i.e., you don’t need to leave to go to work today, I have a job you can do
right here). By reframing and redirecting their attention you may be able to diffuse their
reaction
x Prevent escalation by backing off and avoiding confrontation. If the patient does not
present a danger to themselves or others, observe from a distance to allow them to settle
down without intrusion before proceeding. Notify the physician and supervisor or have
another staff member or caregiver call if you are unable to leave the patient
x Avoid touch unless you need to guide or reassure and only if it has a positive
effect x Avoid restraining the individual
x Set signals with other staff or caregivers that you need help such as developing hand
signals as to when to close doors or remove others who may be within the environment.
Remain calm
professionals.
Page 39
SECTION 4: POST REVIEW
1. Strategies for caring for someone with dementia should include

using: a. Person-centered care and a problem-solving approach
b. Person-centered care and a problem-prevention
approach c. Policy-centered care and a problem-solving
approach
d. Policy-centered care and a problem-prevention approach
2. Individual’s with Alzheimer’s and dementia may have increases in behavioral problems
that begin at dusk and last into the night known as:
a. delusions
b. sundowning
c.
hallucinations
3. Depression is one of the most common emotional responses with Alzheimer’s, especially
during the early and middle stages
True False
4. A person with Alzheimer’s may become suspicious of those around them, even accusing
others of theft or improper behavior. This behavior is known as:
a.
hallucinations b.
sundowning c.
paranoia
Name Date
Reviewed by Date
Page 40
SAFE ENVIRONMENTS
As dementia progresses the need for ensuring and maintaining the safety of the patient living
with this disease is essential. Patients in early to middle phases are at increased risk for harm
related to challenges such as:
x medication
management x driving
concerns
x potential safety concerns in the home such as cooking, appliance or power
equipment problems
x wandering behavior or getting
lost x unsafe storage or use of
firearms xfalls
x living alone
When performing the initial assessment, staff may incorporate the Safety Assessment Checklist
(refer to Appendix) to identify safety-related concerns with the patient. If the patient is unable to
respond appropriately secondary to memory or cognitive decline it is important to consult with
family or caregiver to obtain an accurate report of the patient’s status. The results of the Safety
Assessment are discussed with the interdisciplinary team to develop a person-centered care plan
addressing these issues. Issues that are identified both at the start of care and throughout the
progression of the disease require periodic reassessment about whether goals and preferences are
being met or not. If goals are not met, then revisions need to be made and documented. All staff
are included in the care plan process, especially the members of the team that spend the most
time with the patient so the goals of the care plan can be shared in a systematic way.
Page 41
SAFE ENVIRONMENTS (CONT.)
It’s important to keep the person safe from potential hazards in the environment and to ensure
that the individual with dementia feels secure. Environments that might be safe for an
individual with intact cognition may not be safe for the person with dementia. Due to changes
in the brain for individuals with dementia there can be problems with judgment, problem
solving, sensory issues secondary to vision and or hearing, and issues secondary to balance and
physical ability. For these reasons, the physical environment needs to be considered part of the
persons therapy. Many things in the environment can affect the behavior of the person with
dementia so it is important that staff monitor how the person responds to things within their
environment that could be potential stressors.
Below are some additional strategies to assist staff, families and caregivers to maintain safety
within the environment:
MEDICATION MANAGEMENT
x In the early stage of the disease the patient may need help to remember to take
their medications. Staff should educate caregivers to:
- Use a pill box or pill organizer and keep a list of the medications with the dosage
amount prescribed by the physician, route(s) and dosing schedule
- Establish a routine such as giving the medications with meals or a certain time of the day
x Staff should review all prescribed medications including vitamins and herbal
supplements. Talk with the physician or pharmacist to identify possible drug
interactions.
x As the disease progresses staff should be knowledgeable of these tips and educate
caregivers to:
- Use simple language to instruct the patient how to take the medicine(s)
- If the patient refuses to take the medications, stop and try again in a short time
to redirect the patient to take the medication
- If swallowing is a problem, staff should talk with the physician and pharmacist
about changing the medication to a liquid form or crushing the medication and
mixing it with food
- Be aware of the potential side effects of the medications
- Keep the medications in a safe place and if necessary, lock the medications up in a
secure cabinet to avoid potential overdose
- Keep the number for the poison control available in a handy place. Call 911 if
overdose is suspected
Page 42
DRIVING
When an individual with dementia is not able to think clearly, be alert in order to react quickly
when faced with a surprise on the road or make safe driving decisions, then he or she should no
longer drive. The problem is that the individual may not realize they have a problem or may not
want to stop driving. The risk of being injured or killed in a motor vehicle crash increase.
Caregivers need to be aware of the risk this may pose if the person with dementia seems
unwilling to relinquish their keys.
If there are concerns regarding the patient’s safety during driving, the staff may want to ask
some questions of the family or caregiver to gather more information. These questions may
help to open the discussion:
x is their loved one still driving?
x do they consider their loved one a good driver?
x has their loved one been involved in any recent accidents, including fender benders, or
have they been issued any tickets within the last 6 months to one year?
x do they have any concerns about being a passenger while they have been riding with
their loved one?
Based on the responses contact the physician to discuss concerns regarding the individual’s
driving. Additional safety considerations that may need to be discussed with the
interdisciplinary team include:
x communicate with the physician about the potential need for the individual to perform a
safe driving road test at their State Division of Motor Vehicle office. Based on the results
of this evaluation, the physician may need to have an open discussion with the patient,
family and or caregiver regarding concerns that the patient should not be driving in order
to protect the patient’s safety and the safety of others in the community
x communicate with the family or caregiver regarding the need to take away the car keys
or to remove the car
x refer the family or caregiver to the Local Area Agency on Aging for information
about possible transportation services in the community
Reference: National Institute on Aging. www.nia.nih.gov/alzheimers. https://www.nia.nih.gov/health/driving-safety-and-alzheimers-disease.

2017. This information is part of the National Institute on Aging’s ADEAR Center for information and free publications about Alzheimer’s
disease and related dementias for families, caregivers, and health professionals.
Page 43
HOME SAFETY
For patients with dementia who are residing in the home environment, staff should assess the
home setting for potential triggers that could put the individual at risk for injury. If needed,
request a home safety referral by a physical therapist if the individual is using an assistive device
such as a walker and there is concern that the individual is not using the device safely. There
may be a need for an occupational therapist to perform a home safety evaluation to assess
functional abilities and to identify potential risks such as the need for proper grab bars in
bathrooms.
As the disease progresses, overall function may decrease which may place the patient at
increased risk for injury. Staff should identify potential risks and educate the caregivers to:
x Limit clutter
x Remove rugs and other fall
hazards x Install non-intrusive alarm
systems
x Place black mats in front of exit doors
- A black mat gives the illusion that there is a hole in front of the door and can deter
the dementia patient from exiting the door
x Increase lighting to reduce confusion and restlessness at
night x Keep alcohol, matches, lighters and guns in a locked
cabinet x Install an automatic shut-off on the stove
x Secure and lock doors to garages, basements, utility rooms and shed. Secure and lock
up all poisonous chemicals, paints or cleaning supplies that could be swallowed by
mistake
x Maintain safe boundaries
x Limit window openings to six inches to avoid possible elopement
x Monitor the hot water temperature in hand sinks, showers and tubs
- Most stages regulate water temperature ranges in residential care settings. In
general, the hot water from fixtures should be no more than 105 degrees
- Dementia patients may not be able to distinguish which faucet is hot water and
may accidentally burn themselves by turning on the wrong faucet
Page 44
WANDERING
Individuals with dementia are at risk for wandering. No matter where the patient resides it is
important to limit access to hazardous area in the environment. These strategies may help to
lower the risk*:
x Identify the time of day that the patient is most likely to wander
x Install locks on exterior doors and consider placing slide bolts at the top or bottom of doors
x Avoid going to places that may trigger anxiety or confusion for the patient such as trips
to the shopping mall or venues with large crowds
x Install an alarm device on exterior doors to signal when the door is opened
x Avoid leaving the patient unsupervised, especially in a new or unfamiliar surrounding
x Have a plan such as a people to call on for help. Have a recent close-up photo and
updated medical information for the patient in the event this would be needed by the
police
x Keep a list of the places that the individual may wander
x Enroll the individual in a Medic Alert + Alzheimer’s Safe Return Program
x If the person does wander, search the area for no more than 15 minutes and then call “911”
Reference: Alzheimer’s Association, 10 Early Signs and Symptoms of Alzheimer’s, 2019, Cited with Permission.
Alzheimer’s Association, Medic Alert + Alzheimer’s Safe Return Program. 2019. https://alz.org/help-support/caregiving/safety/medicalert-
safe-return
Page 45
FIREARM SAFETY
Firearms and other weapons can be found in households across the country. In most situations,
their presence creates no problems for responsible gun owners and others in the household.
However, if someone in the home has Alzheimer’s or another dementia, firearms can pose a
significant risk for everyone. For example, as the disease progresses, the person may not
recognize someone he or she has known for years and view him or her as an intruder. With a gun
accessible, the result could be disastrous. Even if the person has experience with guns, his or her
current abilities will be altered because the safe use of firearms requires complex cognitive
abilities and quick decision-making skills, which may be compromised due to dementia. Refer to
the following strategies from the Alzheimer’s Association regarding firearm safety* (also see
Appendix on Firearm Safety):
x Consider removing guns from the home to protect the patient and family from an accident
x It is critical that there be an open discussion between the staff and family members
about weapons in the home along with documentation of the discussion
FALLS
Patients with dementia are at higher risk of falls for a variety of reasons. Conditions causing
neurological impairments in perception or cognition and progressive loss of physical functioning
which result in changes in motor function, stance, or gait contribute to an increase in falls.
Additional individual risk factors include depression, fatigue, history of falls, postural
hypotension, incontinence, and prolonged immobility. Use of certain medications may increase
a patient’s risk of falls.
Environmental factors may also contribute to risk conditions

including: x confusing environment and clutter
x inadequate cueing, such as posting unclear or confusing directional
signs x improper footwear
x unsafe equipment
x floors that are uneven, slippery, or have
glare x inadequate lighting
References:
© 2019 Alzheimer’s Association®. All rights reserved. This is an official publication of the Alzheimer’s Association but may be distributed
freely and without charge by unaffiliated organizations and individuals. Such distribution does not constitute endorsement of these parties or
their activities by the Alzheimer’s Association.
Page 46
FALLS (CONT.)
The goal for the patient with dementia is to promote safety and preserve mobility while reducing
risk of falls and fall-related injuries. Goal achievement is linked to patient assessment. Initial
patient assessment provides a foundation, as patients are at a greater risk of falls when first
entering a new environment. A comprehensive assessment involves collection of information
from the patient as well as family or caregivers and includes:
x history and patterns of
falling x strategies used to
prevent falls
x identification of patient risk factors including, but not limited to, functional and
cognitive status
x evaluation of environmental conditions
Develop the care plan, based on the patient assessment, to promote patient mobility and safety
while reducing the risk of falls and fall-related injuries. Update the plan with the progression of
dementia. Ensure preventive interventions based on patient risk factors are built into the care plan
to include, but are not limited to:
x individualized toileting schedule
x appropriate use of assistive devices, such as walker or cane
x promotion of a regular sleep-wake schedule which is matched to the patient’s lifelong
habits x non-slip footwear or floor treatments
x environment free of clutter with clear paths to doorways and
bathrooms x good lighting
x commonly used articles within reach
Rehabilitation therapy professionals may assist with reducing falls and fall-related injuries by
providing a more in-depth evaluation of the patient’s functional mobility and ability to use
safety awareness and compensatory strategies.
Reference:
Page 47
MANAGING ACTIVITIES OF INDIVIDUALS WITH DEMENTIA
PRODUCTIVE LIFE TASKS
Patients with dementia often enjoy tasks related to past roles. Engaging individuals in
familiar, productive activities can help establish routines to structure their day and help them
feel valued, enhancing their quality of life.
x dusting
x wiping
tables x
setting tables
x grooming, washing hands and face, applying lotion or simple make-
up x watering or grooming plants
x folding towels, napkins,
etc. x sweeping
x opening mail
x counting out or passing out materials for an activity
TASKS FOR INDIVIDUAL ACTIVITIES
Simple, repetitive tasks can offer diversion and instill a sense of purpose. The use of
familiar materials and tasks promotes self-esteem through success experience.
x matching: socks, gloves, pot holders
x sorting: cards by suit, washcloths by color,
silverware x folding: towels, scarves, baby
clothes
x stacking: measuring cups or spoons by size, plastic cups by
color x winding yarn
x matching lids to
Tupperware™ x placing silk
flowers in vases
x polishing
silver x
sanding wood
x adult coloring
x putting together flashlights
Reference: Dementia Practice Guidebook, ©2016 HCR Healthcare, LLC, July, 2016.
Page 48
MANAGING ACTIVITIES OF INDIVIDUAL’S WITH DEMENTIA
TASKS FOR INDIVIDUAL ACTIVITIES (CONT.)
x puzzles: large piece jig-saw, shape sorter, cereal box or calendar

puzzles x untying: knotted scarves, shoelaces
x fine motor games and tasks: pegboards, bolts and screws, adult busy
aprons x reading: adult easy reader or picture books
x writing: connect the dots, circling letters in a word search
book x doll therapy: baby dolls or stuffed animals for
comfort
x music listening
REMINISCENCE THERAPY
Reminiscence therapy is an ordered process of reflection on significant life events. Memory

aids including pictures, objects, music, video clips, movies, and periodicals can be used to
trigger the patient's memories. Reminiscence therapy has been shown to be useful in
improving communication, retaining identity and self-worth, and reducing symptoms of
depression among patients with dementia.
It can also help staff members to better understand a patient's past life experiences, which
can lead to a closer relationship, and can allow family members to enjoy being involved in
the care of their loved one as they recall positive life events together. As dementia
progresses, patients often respond better to one-onāone reminiscence therapy that focuses
more on the emotions associated with past events rather than on attempting to recall
specific life memories.
MUSIC THERAPY
Individuals with dementia often retain the ability to sing familiar songs and play musical
instruments late into the course of the disease. Research has demonstrated that music therapy
can be helpful in enhancing communication, increasing cognitive function, and controlling
behavioral symptoms. Asking family members about what types of music the patient with
dementia has enjoyed throughout his or her lifetime is a good starting point.
Often, patients are engaged by music that was popular when they were between the ages of 18
and 25 years. In the later stages of dementia, individuals may respond more positively to music
from their childhood. In addition to listening to music, many patients with dementia enjoy
singing and making music with instruments.
Page 49
ACTIVITIES
The activities that make up a patient’s day should reflect the patients’ preferred lifestyle while
providing a sense of usefulness, pleasure, and success. Honor the patient’s individual abilities
and include both daily routine activities (ADLs, meals) as well as scheduled (on the calendar
of events) and unscheduled (spontaneous or independent) activities that a patient engages in
from morning through bedtime seven days a week.
Engaging patients in purposeful, enjoyable activities throughout the day

can: x reduce negative behaviors
x provide a sense of accomplishment, purpose
x provide connection to other people,
community x offer another way to
communicate feelings
x help retain personhood and
identity x encourage laughter, fun
x help to organize, direct the day
Daily Plan
A daily activities plan is a key strategy to meet the many special needs of patients. A daily
plan consists of structured and unstructured opportunities, is based on familiar pleasant
activities and interests, is planned, organized, and sequenced to normalize each day and
provide meaningful interactions with others.
The purpose of a daily plan is to assist patients with expressing themselves as the person they
know themselves to be and in a way that accommodates their disability and honors their
abilities, values, habits, and familiar roles. The daily plan includes everything the patient
experiences during the day, including productive activities that make the patient feel useful and
needed, leisure activities that are fun, and personal-care activities through which the patient can
express independence. Supporting remaining abilities, minimizing failure, supporting dignity
and enabling pleasure provides the opportunity for successful group and individual involvement
for the patient. The patient’s prior lifestyle, occupations, preferences and interests also influence
the content of the daily plan.
Page 50
ACTIVITIES (CONT.)
Guidelines for Daily Programming

x provide a balance of activities, incorporating the three basic types of programs in
the daily program
- personal care (e.g., ADLs, hydration, toileting, eating)
- productive tasks (e.g., homemaking and work-related
tasks) - leisure interests (e.g., active games, socializing,
reminiscing)
x group programs offered are based upon gender, cultural needs, and functioning levels
x use normalization tasks to offer the patient a sense of purpose and reinforce a positive
self-esteem (e.g., putting out silverware or placemats for meals, sorting laundry,
sweeping the floor. gardening)
x use equipment that reflects the purpose and type of activity being provided to support
the patient awareness of what is expected (e.g., cooking in a kitchen using cooking
utensils)
x use memory enhancement techniques such as cueing and reminiscing
Page 51
ACTIVITIES (CONT.)
All activities (scheduled, daily routines, and unscheduled) are important and potentially
beneficial to patients. How an activity is presented and delivered or the end result of that activity
is just as important if not more important than what activity the patient is doing; for example,
the goal of a cooking class is not only to make cookies, but to give the patient a meaningful
experience of participating in the steps of the cooking process.
Important factors to remember are:

x recognize that everything a patient does is an activity and that a variety of activities
make up one's daily routine
x make the most of daily routine activities and recognize that personal care activities
such as bathing, dressing or eating are important daily activities
x ensure that each patient has time to engage in a wide variety of meaningful activities
and enjoy a blend of pursuits allowing for companionship, solitude, engaging activity or
passive involvement
x build on and integrate the patient’s background, education, social status, work
experience and relationships
Recognize that, to be meaningful, an activity should meet several key criteria:

x have a purpose that the patient can appreciate (Does the patient know what they are
doing and why?)
x be done voluntarily; (Does the patient really want to do this or are they being coerced?)
x respect the patient’s age and social status and avoid activities that look or feel childish or
are socially inconsistent with the patient’s status.
x take advantage of the patient’s retained abilities
x geared to the patients attention span and
tolerance x ensure an opportunity for success
Page 52
POST REVIEW
1. Maintaining safe boundaries and installing an alarm device on exterior doors are two
strategies for home safety when caring for a person with dementia
True False
2. All of the following items should be included as part of the patient assessment when
developing the care plan to promote patient safety and reduce the risk of falls except:
a. history and patterns of falls
b. patient risk factors, both functional and cognitive
c. delay referral to occupational therapy for a home safety evaluation until a fall-related
injury occurs
d. history and patterns of falls
e. current strategies used to prevent falls
3. A structured daily activities plan does not need to be a key strategy to meet person –
centered needs of the patient with dementia.
True False
4. The daily activities plan should include:

a. Leisure activities (socializing,
reminiscing) b Personal – care (ADLs,
toileting, dressing)
c. Activities that include prior interests, hobbies, work-related
interests d. All of the above
5. Meaningful activities should meet several criteria, list three:
Name Date
Reviewed by Date
Page 53
PERFORMING ACTIVITIES OF DAILY LIVING (ADLS)
Dementia is progressive and as the individual’s cognitive ability decreases their functional
impairment will increase making it more difficult for them to perform personal care tasks
independently. The need for supportive care will expand to requiring assistance with the
normal things we have been able to do independently in our everyday lives. These tasks are
known as Activities of Daily Living (ADLs) and include: bathing, dressing, grooming,
toileting, walking, transferring and eating. As dementia progresses, different challenges will
become apparent. For example, the difficulty to dress oneself will usually become more
problematic during the middle stage of the disease. Toileting and incontinence issues occur
more towards the moderate to late stages.
When providing person-centered care, it is important that staff and caregivers promote the
persons dignity, independence and individuality. These are basic rights when delivering care
for all individuals in all cultures and societies.
x Dignity is focused on aspects of privacy, respect, and autonomy. In the case of the person
with dementia, providing personal care can be frightening. Simple acts like removing
their clothes to take a bath or shower may make them feel exposed and vulnerable. The
person’s stage of the disease may have progressed to the stage that bathing has become
confusing and too complicated to understand. Or the person may not recognize their daily
caregiver secondary to their stage of cognitive decline. The person may resist having
their clothes removed and may become combative. In this instance the caregiver will
need to anticipate basic needs, provide reassurance and provide a calm pleasant manner to
avoid the patient from erupting into challenging behavior. As personal care is delivered it
is helpful to identify ways to enhance the person’s ability to achieve their maximum
independence. As they perform an activity of daily living, caregivers should be positive
and praise the person for being able to complete the task even if it is only a small success
such as being able to wash their face. This simple task can make them feel fulfilled and
relieve anxiety.
x Independence and Individuality focus on preserving the individual’s identity as they
rely on others for assistance. As providers, have we gathered information or pertinent
history from the family on what the individual’s preferences may be related to personal
choice or the process in which they have been used to completing an ADL? The goal of
providing hands-on-care with any ADL is to have a positive outcome for the patient and
the caregiver who provides the care. Even when they can no longer communicate
verbally, many can still understand and feel emotions and empathy. They may feel
insulted by disrespectful terms of endearment such as “sweetie.” It’s important to use a
person’s given name which shows respect and helps preserve their individual identity.
Page 54
PERFORMING ACTIVITIES OF DAILY LIVING (ADLS) (CONT.)
The basic activities of daily living should be part of the person’s daily routine, done at the same
time and in the same order each day, if possible. Developing a structured and planned routine to
assist the patient in performing daily activities can help reduce their stress, potential agitation
and improve mood. When planning the patient’s activities consider:
x how did the person used to structure their day?
x what times of day does the person function best?
x what are the person’s likes, dislikes, strengths and abilities based on the stage of
their disease?
x allow time to perform the activities so as not to rush or cause the patient to feel
frustrated with the task
Always use clear communication before beginning to assist the patient with their self-
care by following these simple strategies:
x introduce yourself
x explain what you are about to do before you begin
x give the person enough time to understand what you are telling them
ASSISTING WITH ACTIVITIES OF DAILY LIVING
Dressing and Grooming
DRESSING
Maintaining the appearance of a person with dementia can promote positive self-esteem. As the
disease progresses, it may be frustrating for the person to choose their clothes or to remember
how to put them on. It will be important to allow for enough time for dressing and grooming to
reduce any anxiety or frustration that might occur. Below are some tips that the Alzheimer’s
Association offers to simplify the process.
x Simplify choices. Keep the closets free of excess clothing. A person may panic if
clothing choices become overwhelming. If appropriate, give the person an opportunity
to select favorite outfits or colors, but try offering just two choices
x Organize the process. Lay out clothing in the order that each item should be put on.
Hand the person one item at a time while giving simple, direct instructions such as "Put
your arms in the sleeves," rather than "Get dressed"
Reference:
Alzheimer’s Association. https://alz.org/help-support/caregiving/daily-care/dressing-grooming. 2019. Cited with Permission.
Page 55
ASSISTING WITH ACTIVITIES OF DAILY LIVING (CONT.)
DRESSING (CONT.)
x Pick comfortable and simple clothing. Cardigans, shirts and blouses that button in front
are easier to work than pullover tops. Substitute Velcro® for buttons, snaps or zippers,
which may be too difficult to handle. Make sure that clothing is loose fitting, especially at
the waist and hips, and choose fabrics that are soft and stretchable
x Choose comfortable shoes. Make sure the person has comfortable, non-slip shoes
x Be flexible. If the individual wants to wear the same outfit repeatedly, buy duplicates or
have similar options available. Even if the person’s outfit is mismatched, try to focus on
the fact that he or she was able to get dressed. Keep in mind that it is important for the
individual to maintain good personal hygiene, including wearing clean undergarments,
as poor hygiene may lead to urinary tract or other infections that further complicate care
GROOMING
Grooming such as the person forgetting how to use a comb can also be challenging for
the individual with dementia. To assist the person, follow the recommendations below:
x continue grooming routines. If the person has always gone to the beauty shop or a
barber, continue this activity. If the experience becomes distressing, it may be possible to
have the barber or hairstylist come to the person's home.
x use favorite toiletries. Allow the person to continue using his or her favorite
toothpaste, shaving cream, cologne or makeup.
x perform tasks alongside the person. Comb your hair, and encourage the person to
copy your motions.
BATHING
Bathing can be one of the most difficult ADL’s that staff and caregivers face. Individuals with
dementia may become resistant because the patient may not remember why bathing is done or
they may perceive the experience as intrusive or uncomfortable. They may also feel a threat to
their independence and privacy. When providing this care, it’s important for staff and caregivers
not to take disruptive behaviors personally. The key is to remain calm and patient and be
prepared to be flexible if the person with dementia wants to do things “their way.” Be ready to
assist as needed, but try to offer the level of help necessary. As the disease progresses, the
following approaches may help to prevent and manage resistance.
Reference:
Page 56
MAKING THE BATHROOM SAFE
It's important to make the bathroom as safe and comfortable as possible. Install grab bars, place
non-skid mats on floors, use a tub bench or bath chair that can be adjusted to different heights,
watch for puddles and lower the thermostat on your hot-water heater to prevent scalding
injuries. Also, take care to never leave the person with dementia alone in the bathroom, use
products made of non-breakable materials, and keep sharp objects (i.e. tweezers, scissors) out
of reach.
PREPARING FOR THE BATH
x Give the person choices. Ask: "Would you like to take a bath or a shower?" or "Do
you prefer to bathe now or in 15 minutes?"
x Fill the tub with 2 to 3 inches of water. Then assess the person's reaction to getting in.
It may be better to fill the tub after the person is seated
x Be sure the person has a role. Have the person hold a washcloth or shampoo bottle
x Be aware that the person may perceive bathing to be threatening. Have activities
ready in case the person becomes agitated. For example, play soothing music or sing
together. If the person resists bathing, distract him or her and try again later
x Always protect the person's dignity and privacy. Try to help the person feel less
vulnerable by covering the person with a bath blanket while undressing. Let the person
hold a towel in front of his or her body, in and out of the shower or tub, to help ease
anxiety
x Have a familiar person of the same sex help, if that is more comfortable. Cover or
remove the mirrors if a reflection leads the person to believe there's a stranger in the
room
x Set a regular time for bathing. If the person usually bathes in the morning, it may
confuse him or her to bathe at night. Determine what time of day is best for the person
with dementia. Then set a routine
x Gathering bathing supplies. Have large towels (that you can completely wrap around
the person for privacy and warmth), shampoo and soap ready before you tell the person
that it's time to bathe
x Making the room comfortable. Pad the shower seat and other cold or
uncomfortable surfaces with towels. Check that the room temperature is pleasant
x Placing soap, shampoo and other supplies within reach. Try using hotel-sized
plastic containers of shampoo, and have a washcloth ready to cover the person's eyes
to prevent stinging
x Monitoring water temperature. The person may not sense when the water is
dangerously hot or may resist bathing if the water is too cool. Always check the water
temperature, even if the person draws his or her own
Reference:
Page 57
DURING THE BATH
x Simplify the bathing process. Try different approaches to make bathing easier. For
example, sew pockets into washcloths to help the person hold on to the soap, or use
soap that washes both hair and body
x Coach the person through each step. For example: "Put your feet in the tub." "Sit
down." "Here is the soap." "Wash your arm"
x Use other cues to remind the person what to do. Try using a "watch me" technique
or lead by example. Put your hand over the person's hand, gently guiding the washing
actions
x Use a tub bench or bath chair. Having the person sit while showering may be easier
and safer. Look for a chair that can be adjusted to different heights
x Be sure to cleanse hard-to-reach areas. Wash between folds of skin and under the
breasts. It is important that genital areas are cleansed, especially if incontinence is a
problem
x Sponge bathe as an alternative. Don't worry about the frequency of bathing. Sponge
baths with a washcloth can be effective between showers. You may want to try non-
rinse soap products, which can be used with warm towels and applied under the guise
of providing a “massage"
AFTER – BATH CARE
x Check for rashes and sores, especially if the person is incontinent or unable to move
around x Seat the person while drying off skin and putting on fresh clothes
x Be gentle on the skin. Pat skin dry instead of rubbing. Apply lotion to keep skin soft
Reference:
Page 58
NUTRITION: FOOD AND EATING
Regular, nutritious meals may become a challenge for people with dementia. As a person's
cognitive function declines, he or she may become overwhelmed with too many food choices,
forget to eat or have difficulty with eating utensils.
For a person with dementia, poor nutrition may increase behavioral symptoms and cause
weight loss.
The basic nutrition tips below can help boost the person with dementia's health and your health
as a caregiver, too.
x Provide a balanced diet with a variety of foods. Offer vegetables, fruits, whole
grains, low-fat dairy products and lean protein foods
x Limit foods with high saturated fat and cholesterol. Some fat is essential for health
— but not all fats are equal. Go light on fats that are bad for heart health, such as butter,
solid shortening, lard and fatty cuts of meats
x Cut down on refined sugars. Often found in processed foods, refined sugars
contain calories but lack vitamins, minerals and fiber. You can tame a sweet tooth
with healthier options like fruit or juice-sweetened baked goods. But note that in the
later-stages of Alzheimer's, if loss of appetite is a problem, adding sugar to foods may
encourage eating
x Limit foods with high sodium and use less salt. Most people in the United States
consume too much sodium, which affects blood pressure. Cut down by using spices or
herbs to season food as an alternative
People with Alzheimer's or dementia do not need a special diet. As with anyone, eating a
well-balanced, nutritious diet is important for overall health.
As the disease progresses, loss of appetite and weight loss may become concerns. In such cases,
the doctor may suggest supplements between meals to add calories.
Staying hydrated may be a problem as well. Encourage fluids by offering small cups of water
or other liquids throughout the day or foods with high water content, such as fruit, soups,
milkshakes and smoothies.
Reference:
Page 59
NUTRITION: FOOD AND EATING (CONT.)
POSSIBLE CAUSES OF POOR APPETITE
x Not recognizing food. The person may no longer recognize the foods you put on his
or her plate
x Poor fitting dentures. Eating may be painful, but the person may not be able to tell
you this. Make sure dentures fit and visit the dentist regularly
x Medications. New medications or a dosage change may affect appetite. If you
notice a change, call the doctor
x Not enough exercise. Lack of physical activity will decrease appetite. Encourage
simple exercise, such as going for a walk, gardening or washing dishes
x Decreased sense of smell and taste. The person with dementia may not eat because
food may not smell or taste as good as it once did
MAKE MEALTIMES EASIER
During the middle and late stages of Alzheimer's, distractions, too many choices, and
changes in perception, taste and smell can make eating more difficult. The following tips can
help:
x limit distractions. Serve meals in quiet surroundings, away from the television and
other distractions
x keep the table setting simple. Avoid placing items on the table — such as table
arrangements or plastic fruit — that might distract or confuse the person. Use only
the utensils needed for the meal
x distinguish food from the plate. Changes in visual and spatial abilities may make it
tough for someone with dementia to distinguish food from the plate or the plate from the
table. It can help to use white plates or bowls with a contrasting color place mat. Avoid
patterned dishes, tablecloths and place mats
x check the food temperature. A person with dementia might not be able to tell if
something is too hot to eat or drink. Always test the temperature of foods and
beverages before serving
x serve only one or two foods at a time. Too many foods at once may be
overwhelming. Simplify by serving one dish at a time. For example, mashed potatoes
followed by meat
x be flexible to food preferences. Keep long-standing personal preferences in mind when
preparing food, and be aware that a person with dementia may suddenly develop new
food preferences or reject foods that were liked in the past
x give the person plenty of time to eat. Remind him or her to chew and swallow
carefully. Keep in mind that it may take an hour or longer to finish eating
Reference:
Page 60
NUTRITION: FOOD AND EATING (CONT.)
MAKE MEALTIMES EASIER (CONT.)
x eat together. Make meals an enjoyable social event so everyone looks forward to the
experience. Research suggests that people eat better when they are in the company of
others
x keep in mind the person may not remember when or if he or she ate. If the person
continues to ask about eating breakfast, consider serving several breakfasts — juice,
followed by toast, followed by cereal
During the middle and late stages of Alzheimer's, allow the person with dementia to be
as independent as possible during meals. Be ready to help, when needed.
x Make the most of the person's abilities. Adapt serving dishes and utensils to make
eating easier. You might serve food in a bowl instead of on a plate, or try using a plate
with rims or protective edges. A spoon with a large handle may be less difficult to handle
than a fork, or even let the person use his or her hands if it's easier
x Serve finger foods. Try bite-sized foods that are easy to pick up, such as chicken
nuggets, fish sticks, tuna sandwiches, orange segments, steamed broccoli or cauliflower
pieces
x Use a "watch me" technique. For example, hold a spoon and show the person how to
eat a bowl of cereal
x Don't worry about neatness. Let the person feed himself of herself as much as
possible. Consider getting plates with suction cups and no-spill glasses
MINIMIZE EATING AND NUTRITION PROBLEMS
In the middle and late stages of Alzheimer's, swallowing problems can lead to choking and
weight loss. Be aware of safety concerns and try these tips:
x educate the family to prepare foods so they aren't hard to chew or swallow.
Grind foods, cut them into bite-size pieces or serve soft foods (applesauce, cottage
cheese, scrambled eggs)
x be alert for signs of choking. Avoid foods that are difficult to chew thoroughly, like raw
carrots. Encourage the person to sit up straight with his or her head slightly forward. If
the person's head tilts backward, move it to a forward position. At the end of the meal,
check the person's mouth to make sure food has been swallowed. Learn the Heimlich
maneuver in case of an emergency
x address a decreased appetite. If the person has a decreased appetite, try preparing
favorite foods, increase physical activity, or plan for several small meals rather than three
large ones. If the person's appetite does not increase and/or he or she is losing weight,
consult with the doctor. Keep in mind, as the person's activity level decreases, he or she
may not need as many calories
x educate the family to only use vitamin supplements on the recommendation of a physician
Reference:
Page 61
INCONTINENCE
Many people will experience incontinence (a loss of bladder or bowel control) in the later
stages of Alzheimer's and other dementias. There are many causes, as well as ways to help
manage incontinence. How you respond can help the person with dementia retain a sense of
dignity.
CAUSES OF INCONTINENCE
Incontinence can be caused by many factors, including an inability to recognize the need to use
the restroom, forgetting where the bathroom is located, medications, stress, certain physical
conditions, clothing that is difficult to remove and constipation.
If a person with Alzheimer's or other dementia has recently started to lose control of his or
her bladder and bowels, the first and most important step is to determine possible causes.
If incontinence is a new problem, consult with the doctor to rule out potential causes such
as a urinary tract infection, weak pelvic muscles or medications.
Consider medical conditions, medication side effects and obstacles that may be causing
or contributing to the problem:
Medical conditions that can cause incontinence:

x Urinary tract infection, constipation or prostate problem
x Diabetes, stroke or a muscular disorder such as Parkinson's disease
x Physical disabilities that prevent the person from reaching the bathroom in time
Medications and diuretics that can cause incontinence:

x Sleeping pills and anxiety-reducing drugs that may relax the bladder muscles
x Drinks such as cola, coffee and tea, which can act as diuretics; a diuretic increases urination
Be supportive
x Reassure the person to reduce feelings of embarrassment. Find ways to preserve dignity.
For example say, “Anyone can have an accident” instead of saying, “You wet yourself”
x Be matter-of-fact; don't scold or make the person feel
guilty x Respect the need for privacy as much as possible
x Do not withhold fluids. This can cause dehydration, which can lead to a urinary tract
infection, increased incontinence and agitated behavior. You may, however, want to
limit fluids before bed
Reference:
Page 62
INCONTINENCE (CONT.)
CAUSES OF INCONTINENCE (CONT.)
Communicate
x Encourage the person to tell you when he or she needs to use the toilet
x Watch for nonverbal cues, such as restlessness, making unusual sounds or faces,
pacing, sudden silence or hiding in corners. These cues may indicate the need to use
the toilet
x Use adult words rather than baby talk to refer to using the toilet
x Learn the person’s trigger words or phrases for needing to use the toilet. The person
may use words that have nothing to do with toileting (e.g., “I can’t find the light”), but
to that person, it means going to the bathroom. Communication challenges often
increase in the late stage of the disease
x Some people do well when they are reminded to go to the bathroom on a regular
schedule, perhaps every two hours
Make it easy to find and use the toilet

x Clear the path to the bathroom by moving
furniture x Keep the bathroom door open so the
toilet is visible
x Make the toilet safe and easy to use. Raise the toilet seat, install grab bars on both sides,
and use nightlights to illuminate the bedroom and bath
x Consider a portable commode or urinal for the bedroom in case of nighttime
accidents x Remove plants, wastebaskets and other objects that could be mistaken for a
toilet
x Remove throw rugs that may cause a person to trip and fall
TIPS FOR MANAGING INCONTINENCE
Watch for nonverbal cues such as tugging on clothing, restlessness, facial expressions,
pacing, sudden silence or hiding behind furniture. These cues may indicate the need to use
the toilet.
1. Identify when accidents occur, then plan for them. If they happen every two hours, get
the person to the bathroom before that time
2. Remind the person to use the bathroom just before his or her usual time
3. Try setting a regular schedule for toilet use. For example, help the person to the
bathroom first thing in the morning, every two hours during the day, immediately after
meals and just before bedtime
4. Choose clothing that is easy to remove and to clean
5. Consider using incontinence products, such as waterproof mattress covers,
incontinence pads on the person's bed, padded undergarments or adult briefs
Reference:
Page 63
INCONTINENCE (CONT.)
TIPS FOR MANAGING INCONTINENCE (CONT.)
6. Give the person plenty of time in the bathroom to empty his or her bladder and
bowels 7. Run water in the sink or give the person a drink to stimulate urination
8. Check the toilet to see if the person has urinated and/or moved his or her bowels
DENTAL CARE
As Alzheimer's progresses, the person with dementia may forget how to brush his or her teeth
or forget why it's important. Staff and caregiver(s), may have to assist or take a more hands-
on approach. Proper oral care is necessary to prevent eating difficulties, digestive problems
and infections.
DAILY ORAL CARE
In the early stages of Alzheimer's, dental care focuses on prevention. Getting check-ups and
cleaning and flossing teeth regularly can prevent the need for extensive procedures later on, when
the person with dementia may be less able to tolerate them.
During the middle and late stages of Alzheimer's, oral health may become more challenging.
The person may forget what to do with toothpaste or how to rinse, or may be resistant to
assistance from others.
x Provide short, simple instructions. Explain dental care by breaking directions into
steps. "Brush your teeth" by itself may be too vague. Instead, walk the person through the
process. Say: "Hold your toothbrush." "Put paste on the brush." Then, "Brush your teeth."
x Use a "watch me" technique. Hold a toothbrush and show the person how to brush
his or her teeth. Or, put your hand over the person's hand, gently guiding the brush. If
the person seems agitated or uncooperative, postpone brushing until later in the day.
x Keep the teeth and mouth clean. Very gently brush the person’s teeth, gums, tongue
and roof of the mouth at least twice a day, with the last brushing after the evening meal
and any nighttime liquid medication. Allow plenty of time and find a comfortable
position if you must do the brushing yourself. Gently place the toothbrush in the
person's mouth at a 45 degree angle so you massage gum tissue as you clean the teeth.
If the person wears dentures, rinse them with plain water after meals and brush them daily to
remove food particles. Each night, remove them and soak in a cleanser or mouthwash. Then,
use a soft toothbrush or moistened gauze pad to clean the gums, tongue and other soft mouth
tissues.
x Try different types of toothbrushes. You may find that a soft bristled children's
toothbrush works better than a hard bristled adult's brush. Or that a long handled or
angled brush is easier to use than a standard toothbrush. Experiment until you find the
best choice. Be aware that electric dental appliances may confuse a person with
Alzheimer's.
Reference:
Page 64
DENTAL CARE (CONT.)
DAILY ORAL CARE (CONT.)
x Be aware of potential mouth pain. Investigate any signs of mouth discomfort during
mealtime. Refusing to eat or strained facial expressions while eating may indicate mouth
pain or dentures that don't fit properly
x Coordinate care. Provide the dentist with a list of all health care providers who are
caring for the person with dementia, as well as a list of all medications. Certain
medications can contribute to dry mouth and other oral health issues
x Keep up with regular dental visits for as long as possible. This will help prevent
tooth decay, gum problems, pain and infection
Reference:
Page 65
POST REVIEW FOR GUIDELINES FOR ASSISTING INDIVIDUALS TO
PERFORM ADLS
1. When providing person – centered care it is important to promote the

persons: a. dignity
b. independence
c. individuality
d. all of the above
2. To reduce the risk of frustration that may occur when staff or caregivers assist the patient
with dressing tasks, simplify the process by (list 3):
3. To reduce the risk of behavior issues when staff or caregivers assist the patient with
bathing, simplify the process by (list 3 strategies):
4. Best Practice Strategies to making meal times easier can

include: a. allow plenty of time to eat
b. be flexible to food
preferences c. check the food
temperature
d. limit
distractions e. b
and c
f. a, b, and c
g. all of the above
5. When a person with dementia is resistant to assistance from others when brushing teeth,
the staff or caregiver may use the following strategy to assist with the task:
a. Walk away
b. “Watch me” technique
c. Argue with the patient to perform the task
Name Date
Reviewed by Date
Page 66
MULTICULTURAL CONSIDERATIONS
The older adult population in the United States is now more diverse. In caring for persons with
dementia, staff need to be aware of possible racial, ethnic, and cultural differences when caring
for their patients and the caregivers they serve. This can be important because depending on the
culture this may determine differences in the way caregivers are affected by emotional distress
and their coping abilities as they care for their loved one. In some cultures, caregivers may be
more acceptable to a range of coping strategies and social support to reduce their stress. For
example, the caregiver may think, “I just accepted the behavior and moved on with it,” or “I
asked for advice often.” But in some cultures, asking for more social support may not be
something that they are used to seeking or even wanting to consider as a means of coping with
interpersonal conflict.
x Identify the "primary caregiver" within the family/caregiving unit. This may not be the
same individual in all cultures. This will help staff to understand the diversity of
caregivers within the different racial, ethnic, or cultural groups. For example, in Latino
family’s stress may be more likely to arise from conflict to the family unit rather than due
to a negative impact of caregiving on an individual
x Cultural values may differ from caregiver to caregiver. Staff need to be aware of the
belief system within the patient and family unit in order to avoid barriers in
implementing the plan of care
x Staff should be aware of perceived psychosocial barriers on the part of the patient and
family that may affect the quality of care the person with dementia may receive such as:
- Social stigma and feelings of failure by the caregivers that the person has developed
this disease
- Lack of knowledge on the part of the patient and family as to the services that the
staff can provide
Reference: HCR ManorCare. Ensuring Effective Communication with Persons with Hearing, Vision, and Speech-Impairment
Disabilities and Persons with Limited English Proficiency (LEP). 2019.
Page 67
MULTICULTURAL CONSIDERATIONS (CONT.)
- Fear of the cost of the services

- Refusal of the patient to accept care
- The time it takes for the caregivers to understand the challenges they face and the
time it will take to arrange for appropriate accessible resources
x Strategies to Better Serve Multicultural Patients, Families and
Caregivers*: - Ask questions to better understand the family and
caregiver beliefs
- Include the family and caregivers in the development of the care
plan - Recognize the patient’s primary caregivers
- Understand the cultural needs of the patient, family and caregivers based on their
views of aging, dementia and caregiving
- Assess the patient’s language needs and determine if any language assistance service
and language interpreting services are necessary
- Free auxiliary aids and language assistance will be made available to patients and
their companions when necessary for effective communication
- Staff will document the need for language assistance and or auxiliary aids
- Staff will ensure that caregivers having contact with the patient or companion are
made aware of the individual’s needs for language assistance or auxiliary aid
services so effective communication will be achieved
- Staff caring for the patient with dementia may experience certain
communication problems at various stages of the disease including:
* Difficulty in word finding. Try and use familiar words repeated from their culture
* Inability to describe familiar objects such as comb or fork. As above staff should
try and use familiar words repeated from their culture
* Losing train of thought. Staff should try and reframe the idea or words to
refocus the patient to what is it they are trying to convey or need
* Difficulty organizing words logically. Staff may rely on gestures more than
speaking to communicate. Keep sentences and questions concise
* Pay attention to non-verbal cues such as facial expressions and body language
when communicating with the patient, family or caregiver
Reference: HCR ManorCare. Ensuring Effective Communication with Persons with Hearing, Vision, and Speech-Impairment
Disabilities and Persons with Limited English Proficiency (LEP). 2019.
Page 68
ETHICS AND CAPACITY ISSUES
Issues of informed consent and the ability to make informed decisions may occur after the
diagnosis of dementia is made by the physician. These issues can impact executing legal
documents and making care decisions such as those related to advance directives. Being able to
make an informed consent requires the individual be capable of understanding their diagnosis,
prognosis and the course of treatment to be expected. The capacity to make medical decisions
involves the individual being able to understand the disease, the treatment required, the choices
of treatment and the ability to choose the choice of treatment he/she prefers.
When addressing issues such as informed consent and the capacity to make medical decisions it
is also important that the individual understand the nature of a document, who it affects and to
who authority has been given. In this way, questions that should be addressed can be dealt with
early on when the patient still possesses the capacity to make decisions. A person with early
dementia should be able to manage the decisions of a living will and durable power of attorney
(POA)for health care. As the disease progresses and the dementia patient declines it will become
harder for the patient to make decisions regarding their care. If the living will or durable POA
were not drawn up in the early stage, the legal recourse may be a court appointed guardianship.
Early attention to advanced care planning will increase the chances that the person who is living
with dementia will have designated their individual preferences and wishes that they would like
honored once they are no longer able to communicate as the disease progresses. The physician
and social worker can assist in referring the patient and family to appropriate advanced care
planning resources.
Page 69
STRESS AND THE CAREGIVER
In general terms, the definition of caregiver refers to a person who provides care for the
physical and emotional needs of a family member or friend. Caregivers of people with
dementia are more likely to provide a higher level of care for a longer period, sometimes
providing care for over 80 hours of care per week. This can include helping with one or more
activities of daily living (ADLs) such as bathing, dressing, feeing and assistance with toileting
needs. It may also involve providing help with shopping, meal preparation, transportation and
managing finances. Caregivers of individuals with dementia are usually adult children, most
often women, spouses or other relatives.
RISKS ASSOCIATED WITH CAREGIVING
Many risks have been identified with caregiving for individuals with dementia. These include:
x Physical risks caused by the prolonged physical demands of caregiving with the
caregiver having less time to rest and less time to care for their own preventive health
x Social risks caused by social isolation secondary to the time-consuming and demanding
tasks associated with taking care of the person with dementia
x Psychological risks can occur secondary to the high emotional stress in the caregiving
role. Financial risks can occur when the caregiver spends out of pocket for the care that
the person with dementia needs. Issues such as having to adjust work times, early
retirement, or having to take time off to provide care can equate to financial sacrifices
Caregivers play a critical role in providing care to individuals with dementia in our health care
system today. A large majority of persons with dementia live in the home and are cared for by
family caregivers. Caregivers who report feeling stressed, depressed or anxious are more likely
to seek placement for their loved one in a facility.
HELPING TO REDUCE THE STRESS FOR CAREGIVERS
As the patient’s disease progresses, identifying caregiver needs, strengths and available
resources are important to determine appropriate goals and interventions that will help minimize
the effects of stress for the caregiver. Staff can help in prioritizing the parts of caregiving that
seem to be creating the most stress to the caregiver. A first step in managing stress is
recognizing the symptoms that lead to stress. These can include:
x Physical symptoms may present as fatigue, difficulty with sleep, weight changes,
gastrointestinal problems, headaches, increased blood pressure and increased
muscular tension
x Emotional symptoms may include feeling hopeless and fearful, the need to withdraw
from others, lack of interest in social activities, poor self-confidence, depression and
anxiety
x Behavioral symptoms may present as difficulty in managing work schedules,
changes in mood, irritability toward other members of the family or peers at work
Page 70
STRESS AND THE CAREGIVER (CONT.)
When caregivers neglect self-care they are vulnerable to stress known as compassion fatigue. By
recognizing symptoms related to increased stress, staff may help by assisting the caregiver to
identify reasons as to why they may feel overwhelmed. Staff may open the conversation by
asking some simple questions to start the discussion. An example of this script may be:
x What things in your life or work right now make you feel overwhelmed?
- Demands of long hours as a caregiver with little support or times for respite
- Inability to find a balance between home, work or family obligations. (This could
be especially true if the caregiver is an adult with school aged children and the
caregiver is also faced with trying to assist with caregiving needs for a parent).
- Financial strain
- Juggling work and the hours needed to be involved and provide care for your loved
one with dementia
Once problems have been identified the interdisciplinary team can help caregivers to connect
with support groups, counselors or a clergy member at church to brainstorm about ways to
reduce the stress and strain the caregiver is experiencing.
Page 71
POST REVIEW
1. When working with patients with multicultural needs, it is important to assess the
patient’s language needs to determine if any language assistance services and language
interpreting services are needed.
True False
2. Free auxiliary aids and language assistance will be made available to patients and families
when necessary.
True False
3. Early attention to will increase the chances the

person with dementia will have designated their individual preferences and wishes they
would like honored once they are no longer able to communicate:
a. completing a mini-mental
exam b. advanced care planning
c. obtaining a court appointed guardian
4. When caregivers neglect self-care they are vulnerable to stress known as
:
a. social determinant
b. repetition disorder
c. compassion
fatigue
5. A first step in helping the caregiver to manage stress is to recognizing

____________________ that lead to stress:
a. symptoms
b. the need to complete a gap
analysis c. strengths and abilities
Name Date
Reviewed by Date
Page 72
PALLIATIVE CARE FOR COMFORT AND QUALITY OF LIFE
Palliative care is for anyone diagnosed with a life-limiting illness, including dementia. The focus
is on maintaining the persons quality of life by helping to alleviate pain and distressing
symptoms. Palliative care can be an option at any time during the disease progression. Palliative
services should be available to persons with dementia in the same way they are available to
individuals who do not have dementia.
Palliative care should be person-centered, and family focused. Patients can receive palliative
care alongside treatments, even in the early stages of dementia. For example, regarding
pharmacotherapy, the patient and family may want the patient to receive anti-dementia
medications early in the disease, but when it is unclear that these medications continue to offer
benefit in advanced dementia, discontinuation may be considered.
Hospice care is care at the end of life. Hospice care supports the later stages of a life-limiting
illness. Its purpose is to provide comfort and improve quality of life by addressing the patients’
physical, psychological, social and spiritual suffering. To be eligible to elect the hospice benefit
under Medicare, the beneficiary must be entitled to Part A of the Medicare benefit and be
certified by a physician as terminally ill. A beneficiary is considered to be terminally ill if the
medical prognosis for life expectancy is six months or less if the illness runs its normal course.
Page 73
PALLIATIVE CARE FOR COMFORT AND QUALITY OF LIFE (CONT.)
BARRIERS TO EFFECTIVE PALLIATIVE AND END OF LIFE CARE
x Poor communication between physician, interdisciplinary team and the family and or
caregivers related to issues such as: progression of the disease, failure to discuss end of
life issues among family and the staff (i.e., tube feedings, antibiotic use)
x Lack of Advanced Directives
x Relationship issues between staff, patient and family in establishing goals of
care x Failure on the part of the family or caregivers to recognize treatment
futility
x Hesitancy of the physician to discuss end of life issues and care with the family
and caregivers when the patient’s disease advances
PRINCIPLES OF PALLIATIVE CARE AND NEEDS OF THE PATIENT WITH DEMENTIA
Early interaction with a palliative team can help the patient and family explore all of their options
for treatment, including helping in the development of the plan of care even for end – of – life
care. The need for palliative care in this population is critical due to the increasing functional and
cognitive decline over time which is coupled with the extensive need for caregiving. Increased
caregiving burden and stress are associated with this long-term illness. Through palliative care,
the patient and family can receive appropriate and necessary education that will help them to
express their wishes in order to make appropriate decisions for supportive care needs and for end
of life care planning. Needs that may be addressed may include, but are not limited to:
x goals of care for pain and symptom management
x assistance in decision-making which is based on the wishes and capabilities of the
patient and family
x understanding and support of caregivers
x identification of social issues that may be undermining effective care (i.e., safe
housing, language barriers, access to food, ability to maintain follow-up primary
care,
x ethical issues in dealing with a vulnerable population with cognitive
impairment x ability to access community resources to support caregiver
burden
x development of an advanced care plan to reduce in appropriate interventions as the
individual enters the end stage of terminal illness (i.e., feeding tubes, lab draws,
continuation of antibiotics for recurrent infections, cardiopulmonary resuscitation)
Page 74
PALLIATIVE CARE FOR COMFORT AND QUALITY OF LIFE (CONT.)
LATE STAGE DEMENTIA AND PALLIATIVE CARE
As the patient’s cognitive and functional abilities decline and caregiver burden increases in the
late stage of the disease, the tendency for emergency room visits and hospitalizations increases
related to acute illnesses (i.e., aspiration pneumonia, falls, pain). Introducing palliative care
consultation during these times can be helpful to focus on dementia-specific care issues. When
the palliative care team addresses these issues communication, decision making for family
caregivers, palliative care treatment plans and clinical outcomes are enhanced. Some of the care
issues that can be discussed between the palliative care team and family can center on:
x dementia staging
x cognitive and functional assessment
x physical symptom and pain
management x safety concerns
x neuropsychiatric symptom management
x discussion of prognosis, goals of care, advanced
directives x caregiver burden, needs and education
Page 75
HOSPICE CARE FOR ADVANCED DEMENTIA
Estimating how long a person with advanced stage dementia will live is nearly impossible. A
general guideline is required in order to establish a person’s eligibility for receiving hospice care.
To qualify for most programs, an individual must have a terminal condition and a life expectancy
of six months or less if the disease runs its normal course. However, not all life-threatening
diseases progress as predicted. This can often be the case regarding dementia. Families of
loved ones with dementia can attest to the fact that a loved one’s condition can improve or
worsen daily. Physicians and hospice staff who are knowledgeable about dementia, especially in
the later stages, can help families determine when it is time to seek out comfort care.
Familiarity with Medicare’s Hospice Guidelines for dementia patients is instrumental in

assessing the patient’s current status of disease in order to determine if they are a candidate for
hospice services. The Reisberg Functional Assessment Staging (FAST) scale is one of the criteria
recognized by Medicare (Refer to Appendix). The hospice physician and members of the
Interdisciplinary Group (IDG) can use this scale to assess if a dementia patient is eligible for
hospice enrollment. The scale consists of 16 items that rank the progression of dementia
symptoms in seven different stages. Stage 7 indicates severe dementia and means a patient
suffers from incontinence and is unable to dress, bathe, walk, or use the restroom without help.
They may also be unable to speak meaningfully or express their own thoughts.
Because the progression of dementia is often a long-term gradual decline, family members may
not seek help until their loved ones are very close to the end-of-life. While the physician must
make the official determination of life expectancy, families may request a hospice evaluation if
their loved one exhibits the following signs:
x Constant, elevated levels of anxiety and stress and or increased signs of pain
x Complete dependence on others for assistance with activities of daily living (ADLs),
such as eating, bathing, grooming and toileting;
x Complete inability to walk without assistance
x Ability to only speak a few intelligible words and phrases
Page 76
PAIN
The assessment and management of pain is a cornerstone of effective palliative care, especially,
for the individual with dementia.
Pain is a highly subjective and personal experience which is impacted by one’s previous
experiences with pain as well as by cultural and spiritual beliefs. Because of the lack of
objective markers, pain can easily be under-recognized and undertreated in patients with
dementia.
The following are some reasons why under-recognition and under treatment may occur:
x tendency to normalize pain, aching and soreness is seen as part of everyday life
during aging
x pain is an individual experience which can be expressed differently by each patient
x pain is less likely to be reported by patients with dementia. This can be caused by a
decline in speech ability which leads to difficulty with communicating thoughts,
feelings, and needs. The patient may also have difficulty understanding questions, may
not recall they have been in pain, or understand what the feeling of pain is
x medication is less likely to be requested by patients with dementia
x some practitioners have a mistaken idea that all pain medications will increase
confusion in the patient with dementia
x mistaken impression that all pain medications are addictive, can lead to families
requesting that medication not be given or staff under-medicating a patient if
PRN medications are ordered
Inadequately treating pain may lead to problematic behaviors and inappropriate use of
antipsychotic medications, such as sedatives and tranquilizers. Pain can decrease functional
ability and worsen memory problems. It may disrupt the patient’s sleep, causing depression
and social withdrawal.
Dementia does not alter the functional experience of pain. Often, especially in the mid to late
stages of dementia, the patient will express pain through their behaviors. Consistent staffing
can assist with identification of patient in pain. The first hint of a patient being in pain may
be a subtle change in behavior or mood. It can be helpful to make note of these subtle
changes and what circumstances cause them to occur (i.e., sitting, standing, only at rest).

Page 77
PAIN (CONT.)
Pain can be observed in a number of ways:

x behavior changes – fidgeting, restlessness, repetitive behaviors, pacing or
wandering, unusual aggression or anger
x mood changes – depression and withdrawal
x facial expression – frowning, sad, grimacing, tense, frightened
x body language – guarding, bracing, rubbing, holding the painful part of the
body x speech – shouting, screaming, crying, groaning
x signs on physical examination – alterations in skin integrity, arthritis or deformities in
the joints, changes in vital signs, food refusal, loss of appetite, changes in mobility,
constipation, urinary retention
It is important to rule out problems that can be easily treated. Constipation or urinary tract
infections occur in this population and can potentially cause distress. Sitting or lying in one
position and uncomfortable or tight clothing or shoes can lead to pressure sores. The weight loss
associated with the later stages of dementia may lead to ill-fitting dentures and sore gums. Falls
may lead to undiagnosed fractures.
An effective pain management intervention plan addresses five dimensions

that counter the pain cycle. These are:
x analgesia
x inflammation
x neuropathy
x muscle relaxation
x mood and behavior
The Pain Assessment in Advanced Dementia (PAINAD) scale is used for patients who cannot
verbally communicate about their pain. This is the preferred scale for patients with dementia.
The PAINAD scale evaluates the realms of breathing, independent of vocalization, negative
vocalizations, facial expression, body language, and consolability. The observations are
converted to a numeric 0 -10 scale. Observe the patient for five minutes before scoring the
behaviors.

Page 78
PAIN (CONT.)
PAINAD* Directions: Observe the behavior in each category. Add up the “scores” to obtain
a number on a scale of 0-10.
Items* 0 1 2 Score
Breathing Normal Occasional labored breathing. Short Noisy labored breathing.
Independent of period of hyperventilation Long period of
vocalization hyperventilation.
Cheyne-Stokes
respirations.
Negative None Occasional moan or groan. Low-level Repeated troubled calling
vocalization speech with a negative or out.
disapproving quality Loud moaning or groaning.
Crying
Facial expression Smiling or Sad. Frightened. Frown Facial grimacing
inexpressive
Body language Relaxed Tense. Distressed pacing. Fidgeting Rigid. Fists clenched.
Knees pulled up. Pulling or
pushing away.
Striking out
Consolability No need to Distracted or reassured by voice or Unable to console, distract
console touch or reassure
TOTAL
PAINAD Scale: Used with Permission provided by the Hartford Institute for Geriatric Nursing, College of Nursing, New York University.
NON-PHARMACOLOGIC INTERVENTIONS
As noted previously on page 19, interventions include non-pharmacologic as well as

pharmacologic. Non-pharmacologic approaches used as initial interventions can minimize the
need for medications, permit use of the lowest dose or result in discontinuation of medication.
x patient education x exercise or
x relaxation therapies x
x counseling positioning
x music, art x aromatherapy
therapy x x massage
ultrasound x imagery
x nerve blocks x meditation
x transcutaneous electrical nerve stimulation (TENS)
If a patient has pain or a condition that is likely to cause pain, the medical practitioner is
contacted to review the pain medical care initiative. If a patient has evidence of pain or a
condition with recurring episodes of pain, the physician is notified to obtain orders for pain
medication.
Page 79
PASTORAL CARE AND PREPARING FOR END OF LIFE
Pastors and Spiritual Care Coordinators (SCC) can play a vital role in supporting dementia
patients and their families. This is achieved by:
x Sustaining the spiritual and emotional needs of the caregivers
x Assist in planning religious activities that can provide comfort for the person with
dementia and their family
The Pastor and SCC can be instrumental in gaining insight into the patient’s illness and personal
religious history to provide care practices that can offer comfort and consolation. The burden of
caregiving can be draining to the caregivers who are often isolated in the home setting. For
patients residing in the home, members of the spiritual team can make on-going home visits
which is the most important service they can provide to the demented person and their families.
Families caring for individuals with dementia experience a mixture of emotions such as
frustration, anger, grief and guilt. The empathy and fellowship of the faith community are key
interventions they can share with the patient and families.
Below are some suggestions for how spiritual care providers can offer some interventions that
may be beneficial to the spiritual needs of the patient with dementia and their families:
x Teach comforting touch such as holding hands. Providing a calm, comforting touch
can convey a sense of reassurance
x Make visits on a scheduled basis
x Play or sing familiar hymns or songs that can provide comfort. Include family members
by asking them to share what favorite hymns their loved ones enjoy. While the patient
may not be able to sing along with the words, they may begin to reminisce and hum the
tune which can be therapeutic and calming
x Sit with the patient to relieve the caregiver
x “Facts” versus “Feelings” can be important. While the patient may not remember where
they went to church, what they did for a living or the names of their children, they may
recall things that they enjoyed doing or things that were important to them during their
lifetime. The pastor or SCC might tell a short that relates to the things the person once
enjoyed. Triggering these memories and feelings may provide them comfort and
relaxation. Avoid pressing the person for exact dates and specific details as this may
generate anxiety when they can’t access exact facts
x “Join in” to the patient’s world versus trying to reorient them. For example, the patient
may think the pastor or SCC is their son. The best strategy is to participate in where they
are in their world. Often this intervention can avoid triggering a behavioral reaction
x Offer home visits for the patient and family to provide communion/prayer/spiritual
comfort. This can be especially helpful when the family is unable to attend their faith-
based service
Page 80
POST REVIEW
1. Early interaction with the can help the patient and

family explore options for treatment:
a. Neuropsychiatrist
b. Hospice Interdisciplinary
Group c. Palliative Team
2. The scale is used for patients who cannot

verbally communicate about their pain.
a. Wong Baker Faces
b. Pain Assessment in Advanced
Dementia c. Numeric
3. In adequately treating pain may lead to problematic behaviors and inappropriate use
of antipsychotic medications.
True False
4. For patients residing in the home, members of the spiritual team can make
which is the most important service they can
provide to the patient and family?
a. An initial evaluation only
b. On-going home visits on a scheduled basis
c. To continue to use their current faith-based pastor and not introduce a new spiritual
care person
Name Date
Reviewed by Date
Page 81
RESOURCES
Alzheimer’s Association, 10 Early Signs and Symptoms of Alzheimer’s, 2019. Cited with Permission.
Alzheimer’s Association. https://alz.org. Safety Assessment Checklist. 2019. Cited with Permission.
Alzheimer’s Association. https://alz.org/help-support/caregiving/daily-care/dressing-
grooming. 2019. Cited with Permission.
Alzheimer’s Association. 2018 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dementia
2018; 14(3): 367-429. Cited with Permission.
Alzheimer’s Association, Medic Alert + Alzheimer’s Safe Return Program.
2019. https://alz.org/help-support/caregiving/safety/medicalert-safe-return
© 2019 Alzheimer’s Association ©Firearm Safety. All rights reserved. This is an official
publication of the Alzheimer’s Association but may be distributed freely and without charge by
unaffiliated organizations and individuals. Such distribution does not constitute endorsement of
these parties or their activities by the Alzheimer’s Association.
Dementia Society of America, Inc., Doylestown, PA, 2019
HCR ManorCare. Ensuring Effective Communication with Persons with Hearing, Vision,
and Speech-Impairment Disabilities and Persons with Limited English Proficiency (LEP).
2019.
Home Health Quality Improvement (HHQI), HHQI University, Meeting the Needs of
Caregivers and Care-Receivers. https://HHQIuniversity.org/. Accessed 2019.
National Institute on Aging. www.nia.nih.gov/alzheimers.
https://www.nia.nih.gov/health/driving-safety-and-alzheimers-disease.
2017.
This information is part of the National Institute on Aging’s ADEAR Center for information and
free publications about Alzheimer’s disease and related dementias for families, caregivers, and
health professionals.
National Institute on Aging ADEAR Center. NIA Alzheimer’s and related Dementias
Education and Referral (ADEAR) Center. 2017. www.nia.nih.gov/alzheimers. Free
publications about Alzheimer’s disease and related dementias for families, caregivers and
health professionals.
PAINAD Scale: Used with Permission provided by the Hartford Institute for Geriatric
Nursing, College of Nursing, New York University.
Reisberg, B. Functional assessment staging (FAST). Psychopharmacology Bulletin, 1988;
24:653-659 Copyright© 1984 by Barry Reisberg, M.D. Reproduced with Permission.
Page 82
APPENDIX
Page 83
Page 84
Page 85
Reproduced (for Adapted) from ACT on Alzheimer’s© developed tools and resources
Page 86
© 2019 Alzheimer’s Association®. All rights reserved. This is an official publication of the Alzheimer’s Association but may be distributed
freely and without charge by unaffiliated organizations and individuals. Such distribution does not constitute endorsement of these parties or
their activities by the Alzheimer’s Association.
Page 87
Page 88
GENERAL GUIDELINES FOR ASSISTING PERSONS
WITH ADRD WITH ACTIVITIES OF DAILY LIVING
(ADL’S)
1. Work with each patient as an adult, deserving of respect.
2. Maintain a clean, simple environment.
3. Pay attention to each person’s reaction to caregiving.
4. Encourage independence.
5. Maintain privacy as required.
6. Keep a regular routine.
7. Stay flexible and patient.
8. Use simple, clear communication techniques.
9. Accept it when the patient periodically cannot perform ADL’s.
10. Do not talk about the patient as though he/she is not present.
11. Break tasks into steps to match the patient’s abilities.
12. Praise the patient for their accomplishments!
SOMETIMES SLOWING DOWN IS THE FASTEST WAY TO ACCOMPLISH THE GOAL
Page 89
Reference: Alzheimer’s Association. https://alz.org. Safety Assessment Checklist. 2019. Cited with Permission.
Page 99
Page 100
Page 101
Page 102
Page 103
Page 104
Page 105
Page 105

D5ecb08f Af3b 49cf A0dc B3769bea3a49 UnderstandingAlzheimersDiseaseRelatedDementiaOnHire 3-17-20

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

D5ecb08f Af3b 49cf A0dc B3769bea3a49 UnderstandingAlzheimersDiseaseRelatedDementiaOnHire 3-17-20

Uploaded by

Copyright:

Available Formats

UNDERSTANDING ALZHEIMER’S DISEASE AND

RELATED DEMENTIA ON-HIRE IN-SERVICE

SECTION 2: ALZHEIMER’S DISEASE 5

SECTION 3: STAGES OF DEMENTIA AND FUNDAMENTALS FOR CARE 21

SECTION 4: PROBLEM – SOLVING WHEN DEALING WITH CHALLENGING BEHAVIORS

APPENDIX: 10 WARNING SIGNS OF ALZHEIMER’S HANDOUT

SUPPLEMENTAL UNIVERSITY COURSES-REFER TO THE UNIVERSITY WEB SITE

Following this curriculum the learner will be able to:

MEMORY LOSS AND THE ABILITY TO FUNCTION

Normal Age-Related Memory Changes Warning Symptoms of Alzheimer’s

Challenges in problem solving (can no longer

Confusion with time or place (i.e., the person

Misplacing things and losing the ability to

Withdrawal from work or social activities (i.e.,

Changes in mood or personality (i.e.,

ALZHEIMER’S DISEASE VERSUS DEMENTIA

Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common

As Parkinson’s disease progresses, it often results in a progressive dementia similar to dementia

Huntington’s disease is a progressive brain disorder caused by a single defective gene

Symptoms include abnormal involuntary movements, a severe decline in thinking and

Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine

List or circle the best answers for the following questions.

2. Name the most common type of dementia in the

3. This form of dementia is a rapidly fatal

Non-modifiable risk factors include but are not limited to the

Modifiable risk factors include:

Diagnosing dementia requires a careful and comprehensive medical evaluation. There is no

Non-pharmacological interventions should be considered and attempted before starting a new

ACETYLCHOLINESTERASE INHIBITORS (AChEis)*

ANTIPSYCHOTICS FOR BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD)*

Non-pharmacological interventions should be considered and attempted before starting a new

EDUCATION AND SUPPORT

1. There is no single test to make a diagnosis of Alzheimer’s

2. Possible causes of behavioral symptoms should be evaluated before starting

3. Discontinuation of Memantine (Namenda) should be considered

4. A diagnosis of BPSD alone may not support initiating

Early stage symptoms can include the

Fundamental Strategies of Care – Early Stage:

Middle stage symptoms can include the following:

Fundamental Strategies of Care – Middle Stage:

Late stage symptoms can include the following:

Fundamental Strategies of Care – Late Stage:

There are many different aspects of ability or person-centered care

1. In the stage, disorientation may occur which can result in the

2. Before talking with a patient with dementia approach the

5. Alzheimer’s accounts for ___________________ percent of

7. Person-centered care means all of the following EXCEPT:

STRATEGIES FOR RESPONDING TO CHALLENGING BEHAVIORS

WANDERING AND GETTING LOST

SLEEP ISSUES AND SUNDOWNING

MEMORY LOSS AND CONFUSION

DEPRESSION VERSUS ALZHEIMER’S

DEPRESSION VERSUS ALZHEIMER’S (CONT.)

Reference: Alzheimer’s Association. https://alz.org/help-support/caregiving/stages-behaviors/depression. Cited with Permission 2019.

DEPRESSION VERSUS ALZHEIMER’S (CONT.)

Reference: Alzheimer’s Association. https://alz.org/help-support/caregiving/stages-behaviors/depression. Cited with Permission 2019.

RUMMAGING AND HOARDING

AGGRESSIVE AND CATASTROPHIC BEHAVIORS

RESPONDING TO CATASTROPHIC BEHAVIORS

RESPONDING TO CATASTROPHIC BEHAVIORS (CONT.)

1. Strategies for caring for someone with dementia should include

Reference: National Institute on Aging. www.nia.nih.gov/alzheimers. https://www.nia.nih.gov/health/driving-safety-and-alzheimers-disease.

Environmental factors may also contribute to risk conditions