CHAPTER 1 UNDERSTANDING ALZHEIMER’S DISEASE AND RELATED DISORDERS
Learning Objectives………………………………………………………………………………………………………………………………………… 2
What Is Dementia?…………………………………………………………………………………………………………………………………………… 3
About Reversible Symptoms of Dementia…………………………………………………………………………………………………. 9
The Dementia Brain Is Different………………………………………………………………………………………………………………… 12
Neurofibrillary Tangles and Amyloid Plaques………………………………………………………………………………………… 13
The Most Common Cause of Dementia — Alzheimer’s Disease………………………………………………………………. 14
Alzheimer’s Disease: Commonly Asked Questions……………………………………………………………………………….. 15
CHAPTER 2: CHARACTERISTICS OF ALZHEIMER’S DISEASE
Learning Objectives……………………………………………………………………………………………………………………………………… 21
Dementia: It’s Different for Each Person………………………………………………………………………………………………….. 22
The Stages of Alzheimer’s Disease…………………………………………………………………………………………………………. 22
Review: The Stages of Alzheimer’s Disease…………………………………………………………………………………………. 29
Agnosia: A Difficult Symptom……………………………………………………………………………………………………………….. 31
CHAPTER 3: COMMUNICATING WITH RESIDENTS WITH ALZHEIMER’S DISEASE
Learning Objectives……………………………………………………………………………………………………………………………………… 34
The Effects of Dementia on Communication…………………………………………………………………………………………… 35
Damage to the Brain……………………………………………………………………………………………………………………………………… 36
Communication with Residents Who Have Dementia……………………………………………………………………………. 37
Verbal Communication Skills…………………………………………………………………………………………………………………. 38
Strategies for Improving Your Verbal Communication Skills………………………………………………………….. 39
Sensory System Changes Affect Communication Skills for Residents with Alzheimer’s Disease.44 Non‐Verbal Communication Skills…………………………………………………………………………………………………………………. 46
Non‐Verbal Communication for Residents with Dementia………………………………………………………………. 47
10 Strategies for Improving Non‐Verbal Communication Skills……………………………………………………… 47
Validation® Method and Its Use in Communicating with Residents with Alzheimer’s Disease 53
Memory Loss and Confusion—Using Validation®……………………………………………………………………………. 53
Avoid These Communication Pitfalls……………………………………………………………………………………………………. 55
Communicating with Residents Who Are Non‐Communicative or Non‐Responsive………………………. 56
An Additional Resource………………………………………………………………………………………………………………………….. 56
DVD: “Communicating with Residents Who Have Alzheimer’s Disease”……………………………………… 56
CHAPTER 4: FAMILY ISSUES
Learning Objectives……………………………………………………………………………………………………………………………………… 60
Who Are the Family Members of Assisted Living Residents?………………………………………………………………. 61
Be Prepared to Meet New Residents and Their Families……………………………………………………………………….. 62
What Can You Do to Help…………………………………………………………………………………………………………………………….. 62
Family Members Experience Stress…………………………………………………………………………………………………………… 64
Interacting with Frustrated Family Members…………………………………………………………………………………….. 65
Strategies for Assisting Frustrated Family Members………………………………………………………………………… 65
When Frustration Builds………………………………………………………………………………………………………………………….. 66
How Can I Help Family Members Who Are Experiencing Stress?…………………………………………………….. 67
Strategies for Involving Family Members……………………………………………………………………………………………….. 68
Involving Families Who Do Not Live in Your Area……………………………………………………………………………… 70
Grief and Loss…………………………………………………………………………………………………………………………………………………. 71
Coping With the Losses Caused By Dementia…………………………………………………………………………………….. 71
The Five Stages of Grief and Mourning…………………………………………………………………………………………………. 72
Attitudes Toward Loss and Death…………………………………………………………………………………………………………. 74
Caregiver Response and Support in Each of the Five Stages……………………………………………………………. 75
CHAPTER 5: MAINTAINING AN APPROPRIATE ENVIRONMENT FOR RESIDENTS WITH ALZHEIMER’S DISEASE
Learning Objectives……………………………………………………………………………………………………………………………………… 79
Structure and Routine…………………………………………………………………………………………………………………………………… 80
Dementia‐Capable Caregivers Must Be CREATIVE………………………………………………………………………………… 81
The Assisted Living Environment and Dementia……………………………………………………………………………………. 82
Using Outdoor Space………………………………………………………………………………………………………………………………… 83
Resident Security: A Specialized Dementia Care Program in Assisted Living……………………………………. 84
The Resident’s Right to a Safe Environment………………………………………………………………………………………. 85
Three Common Causes of Resident Incidents…………………………………………………………………………………….. 85
Play it Safe: Form a Safety Committee………………………………………………………………………………………………………. 89
Monthly Safety Rounds……………………………………………………………………………………………………………………………. 89
Incident Reports – Tracking and Trending……………………………………………………………………………………………….. 94
Using the Analysis to Improve Safety……………………………………………………………………………………………………….. 94
CHAPTER 6: ETHICAL ISSUES AND ALZHEIMER’S DISEASE
Learning Objectives……………………………………………………………………………………………………………………………………… 98
The Philosophy of Assisted Living……………………………………………………………………………………………………………… 99
What Does It Mean to Encourage Independence?…………………………………………………………………………….. 100
What Does It Mean to Maintain Dignity?……………………………………………………………………………………………. 102
What Does It Mean to Promote Individuality?………………………………………………………………………………….. 104
Ethical Principles of Care………………………………………………………………………………………………………………………. 105
ALZHEIMER’S & DEMENTIA CARE — Level Two
CHAPTER 1: BEHAVIOR MANAGEMENT
Learning Objectives……………………………………………………………………………………………………………………………………. 112
Assessment: Problem‐solving Approach to Challenging……………………………………………………………………… 113
Behaviors……………………………………………………………………………………………………………………………………………………… 113
Common Causes of Individual Problems…………………………………………………………………………………………… 114
What About the Caregiver…………………………………………………………………………………………………………………….. 115
Challenging Behaviors Associated with Alzheimer’s Disease……………………………………………………………… 117
- Thought Disturbances……………………………………………………………………………………………………………………….. 118
- Emotional Difficulties………………………………………………………………………………………………………………………… 121
An Additional Resource…………………………………………………………………………………………………………………………. 122
DVD: “Agitation…It’s A Sign”…………………………………………………………………………………………………………………. 122
- Functional – Behavioral Problems…………………………………………………………………………………………………… 123
Defining the Problem……………………………………………………………………………………………………………………………… 127
Strategies and Techniques for Dealing with Challenging Behaviors……………………………………………….. 128
Three Strategies for Changing a Resident’s Behavior……………………………………………………………………… 128
You Can Change the Environment………………………………………………………………………………………………………. 132
Helpful Suggestions………………………………………………………………………………………………………………………………… 134
Solutions for Difficult Behaviors………………………………………………………………………………………………………….. 136
When a Resident Wanders………………………………………………………………………………………………………………………… 138
An Additional Resource…………………………………………………………………………………………………………………………. 139
DVD: “Wandering…Is It A Problem?”………………………………………………………………………………………………….. 139
Handling Inappropriate Sexual Behaviors…………………………………………………………………………………………….. 140
The Right to Be Free From Restraints or Seclusion…………………………………………………………………………….. 141
Diversional Activities as an Alternative to Restraints……………………………………………………………………… 142
Suggestions for Diversional Activities………………………………………………………………………………………………… 143
CHAPTER 2: ASSISTANCE WITH ADLS FOR RESIDENTS WITH ALZHEIMER’S DISEASE
Learning Objectives……………………………………………………………………………………………………………………………………. 146
Using Personal Care Strategies to Manage Resistanceto Care…………………………………………………………… 147
Assisting with ADLs for Residents with Alzheimer’s Disease…………………………………………………………………… 148
Another Resource…………………………………………………………………………………………………………………………………… 156
DVD: Resisting Care…Putting Yourself in Their Shoes……………………………………………………………………. 156
CHAPTER 3: ACTIVITIES FOR RESIDENTS WITH ALZHEIMER’S DISEASE
Learning Objectives……………………………………………………………………………………………………………………………………. 160
The Purpose of Activities…………………………………………………………………………………………………………………………… 161
The Value of Activities……………………………………………………………………………………………………………………………….. 162
The Therapeutic Nature of Activities………………………………………………………………………………………………………. 162
Anything Can Be a Great Activity…………………………………………………………………………………………………………. 164
What Activities Should Not Be……………………………………………………………………………………………………………… 165
Small Groups for the Memory‐Impaired………………………………………………………………………………………………… 166
Individual Activities……………………………………………………………………………………………………………………………………. 168
Stage‐Related Activities…………………………………………………………………………………………………………………………….. 169
Listening to Meet the Residents’ Needs…………………………………………………………………………………………………… 172
CHAPTER 4: STRESS MANAGEMENT FOR THE CAREGIVER
Learning Objectives……………………………………………………………………………………………………………………………………. 176
Taking Care of Yourself……………………………………………………………………………………………………………………………… 177
About Self‐Care……………………………………………………………………………………………………………………………………….. 178
Examples of Self‐Care…………………………………………………………………………………………………………………………….. 179
Five Things to Do for Yourself……………………………………………………………………………………………………………… 180
What Happens If You Do Not Take Care of Yourself?……………………………………………………………………….. 184
CHAPTER 5: MEDICAL INFORMATION
Learning Objectives……………………………………………………………………………………………………………………………………. 188
Medications Used to Treat Alzheimer’s & Related Dementias………………………………………………………….. 189
Treating Behavioral Symptoms……………………………………………………………………………………………………………….. 191
Medication and Its Effects…………………………………………………………………………………………………………………………. 195
The Importance of Good Nutrition………………………………………………………………………………………………………….. 196
Observing, Encouraging, Reporting, and Suggesting……………………………………………………………………………. 197
The Importance of Drinking Fluids………………………………………………………………………………………………………….. 199
Water as a Nutrient………………………………………………………………………………………………………………………………… 199
What Does Hydration and Dehydration Look Like?…………………………………………………………………………. 201
Your Role in Resident Fluid Intake……………………………………………………………………………………………………… 202
Observing, Encouraging, Reporting, and Suggesting……………………………………………………………………….. 202
