Dementia Care…A Multidisciplinary Approach
Caring for a loved one with dementia can be emotionally and physically difficult for loved ones. We work as a close-knit team at The Maplewood to assure that comprehensive, high-quality care is provided for our residents and families living with dementia.
What is Dementia?
Dementia is an umbrella term that describes the progressive decline in memory and cognitive function due to certain disease processes that damage or affect the brain. Alzheimer’s disease is a type of dementia that accounts for 60-80% of these disease processes. Other types of dementia include disease processes such as Parkinson’s disease or vascular dementia caused by a stroke. It has been documented that 80% of residents in the nursing home setting are affected by some level of dementia. (Source: Alzheimer’s Association)
Over time, all types of dementia will lead to loss of memory, loss of reasoning and judgment, personality and behavioral changes, and physical decline. There may be extensive memory loss, limited or no mobility, difficulty swallowing, and bowel and bladder issues. The course of dementia varies widely from person to person.
Quality of life is the number one goal when caring for someone with dementia. No matter what degree of dementia a person exhibits, they can always enjoy life through experiencing joy, comfort, daily routine, meaning and growth. Emotions remain until death. A person always wants to feel secure and enjoy comfort.
The Admission Process
Each person is unique and we strive for person-centered strategies. Our goal is to have a flexible, problem solving approach, while working hard to prevent problems before they occur. When an individual comes to stay or live at The Maplewood, every member of our team is involved in the admission and care process from day one. We look to cognitive health, physical health and functioning, behavioral status, sensory capabilities, decision-making capabilities and communication. We create a plan of care for each individual on admission and adapt and change that plan of care as the person’s needs change. Certified nursing assistants (CNAs), nurses, doctors, nurse practitioners, the social worker, physical therapy, occupational therapy, dietary, our care coordinators (MDS), laundry and housekeeping all work together to manage physical needs, nutritional needs, mobility and safety. All members of the care team have insight into the resident’s level of comfort. Dementia is an ever changing and progressive disease.
We strive to keep a calm and peaceful environment. We also strive to maintain consistent staffing at The Maplewood along with a consistent care schedule and regimen for all. This helps minimize behavioral changes due to stress and frustration.
Evaluating Behavior Changes: Potential Causes and Assessment Approaches
Physical and Environmental Factors
The person with dementia often exhibits poor judgment. Mood changes are often evident and displayed by increased confusion, suspicion, depression, fearfulness and anxiety. Depression is the most common mental health issue with the elderly but altered behavior due to pain is common. Pain evaluation is a key component when assessing behaviors associated with dementia. As dementia progresses, the ability to verbalize basic needs and levels of pain decline. As nurses, we look for internal causes of pain such as infection, metabolic changes noted in blood work which may point to physical ailments, as well as external stressors and frustrations due to lack of ability to communicate. All of which may present behaviors including agitation, increased confusion, anxiety and combativeness.
Factors Related to Medications
When physical or environmental causes have been ruled out, we look at medications. We first look at the medications the resident is currently taking, looking at potential side effects of these medications. Many dementia patients are prescribed some type of pain management regimen, whether it’s over-the-counter or prescription medication. Body positioning measures, comfort measures such as heat and cold are also used.
Maplewood utilizes a Rochester-based mental health service provider to assist our staff with evaluating behavioral changes. A nurse specialist in the field of psychiatry meets with the resident, reviews medications and suggests options, incorporating both care intervention techniques as well as medication alternatives. The doctor and nurse practitioner review this information while making decisions on medication alternatives.
Keeping Residents Safe
Safety is a key component when caring for a resident with dementia. The person with dementia has poor safety awareness, their impulse control is altered, sleep disturbances are often present and medication side effects can all cause an increase in safety concerns. Metabolic functioning of the kidneys and liver can cause imbalances that influence physical steadiness and decision-making. Physical therapy staff work closely with the nursing team to evaluate and treat residents. All residents are evaluated on admission by the therapy department to determine the safest transfer and mobility status. Occupational therapy staff evaluate residents and work with daily activity functions such as dressing and eating. Some residents receive restorative therapy. Often the long-term care resident receives therapy to maintain or optimize their daily functioning. When changes occur or are noted by nursing staff, the therapy department is notified and a re-evaluation is conducted.
Residents that have poor safety awareness and at risk for falls are continually assessed, and precautionary measures are implemented and reviewed.
Changes in Appetite
Symptoms of dementia often include a change in appetite. Some show increased eating patterns which include not remembering when they last ate, as well as the loss of ability to read body signals and loose impulse controls.
Under-eating and weight loss are more common symptoms. Residents become easily distracted. Aging and dementia impairs the sense of taste and smell, chewing and swallowing can be affected. These symptoms increase in severity as dementia progresses. Caloric needs change as activity levels change. Dietary and dining services staff members are a major component of resident care at The Maplewood. The dietician routinely monitors intake, weights and diet. Staff in the dining room monitor behaviors and eating issues. Nursing staff routinely monitor weights and take part in bi-monthly meetings for skin and weight management. This meeting includes the director of nursing, the assistant director of nursing, nurse managers and the dietary manager.
Occupational therapy is available for swallowing evaluations and to determine proper consistency of food and fluids if chewing and swallowing become an issue. Daily oral care is done by the nursing team, and a dental hygienist routinely evaluates long-term care resident.
For all aspects of care related to our long-term care residents, quarterly reviews are done by the entire Maplewood team including the social worker, physical therapist, nursing staff, dietary staff, activities staff and the MDS care coordinators. The doctor reviews each resident and their orders too – quarterly, and as-needed for medical issues.
As daily routines are developed, it is important to include activities and visitors. Our recreation staff and volunteers work to involve the resident in sensory experiences and socialization such as music, book reading, travel and movies.
At The Maplewood, a sense of structure and familiarity are an integral part of patient-centered care. Keeping consistent routines for waking, care, mealtimes and bedtimes are important. Involving the resident in their care and explaining care and procedures to the level the person can understand is also important. When interacting with someone living with dementia, it is important to:
- Make the person feel safe rather than stressed
- Keep directions short, simple and clear
- Simplify options, to minimize confusion
- Be flexible
- Call the person by name
- Speak slowly
- Used closed-ended questions needing a “yes” or “no” response
- Use generalizations when specifics will upset the person, for example: “she’s not here right now”, rather than “she passed away last year”
- Use repetition as necessary due to recall issues
- Smile, make eye contact, use touch and gestures when communicating.
As family members, adjusting to a loved one with dementia is not easy. Emotions of anger and grief may be experienced. We are here to support you. The Maplewood team is like a family. Consistent care, comfort, and optimal emotional and physical health are our main goals for all of our residents.