Effective Strategies and Techniques Every Dementia Caregiver Needs to Know

Lisa Skinner: 00:00:00

Welcome back, everybody to another new episode of the truth, lies and Alzheimer Show. I'm your host, Lisa Skinner, and today I want to share with you some more case studies that highlight various behavioral challenges in people living with Alzheimer's disease and dementia, and then give you effective strategies in case these situations arise. Now, one of the things I want to emphasize, and I've mentioned this many, many times before, on other episodes of the truth, lies and Alzheimer's show is some of the strategies and the techniques that I offer and share with you don't necessarily work for every given situation. And this is why I can't overstate that we all need to assemble a really strong toolbox, because what will happen is I'll give you a suggested strategy for a situation that comes up. You might try it sometimes, and it'll work beautifully and diffuse the situation from escalating any further, but other times it just won't. We're dealing with human beings here, and they have their good days and their bad days, just like the rest of us. So what might be effective in one situation, if that same exact scenario happens again, and you try the technique I share with you, it just might not work that time. So the goal here is to give you enough strategies that if something doesn't work, you have other tools to choose from that are already within your toolbox. And of course, you know it stands to reason that the more of these tools you have to pull from, the better chances you have of diffusing any given situation. And that's the entire goal here, is to just be equipped and prepared as best you can, because these situations can prove to be very difficult, and part of the reason is is that not every solution will always work in any given situation. So here is a case study that the woman suffers from emotional outbursts. And last time I presented this case study episode, I mentioned that these are all true stories of things that actually do come up on a day to day basis at any given time, unexpectedly. Not really sure what the trigger was. They just these behaviors just show up out of the blue. And so this woman, I'll call her ETHEL. She's 81 years old, and she is in moderate stage of Alzheimer's disease. And the challenge here is she experienced a sudden emotional outburst, often crying or becoming angry over minor frustrations, which leaves her caregiver unsure how to respond, and she does this frequently. So here are some intervention strategies for this particular situation, if it happens to you. So one of the things that we'll need to pay attention to and focus on is identify, try to identify what triggered that sudden emotional outburst. It could be one of many, many, many things. So what I recommend is that you as a family member or you as a caregiver, start keeping a journal to track when and why emotion these emotional outbursts occur, identifying specific triggers such as changes in routine or. Unmet needs. And this will be a little challenging at first, until you start to recognize patterns of what sets off the person sets the person off, displaying whatever the behavior might be. And in this case, it's an emotional outburst. And then once you start seeing patterns, it'll be easier as time goes on to you know, if that emotional outburst happens and go, Oh, this triggered it last time, maybe it's the same thing today, but you're going to have to go through a process of elimination to kind of dial that in. So first and foremost, as a caregiver, you definitely want to offer comfort to Ethel or your person through gentle touches and reassuring words and validate those feelings during the Episode activities like listening to soothing music or gardening were introduced to Ethel so she would be able to express her emotions in a healthier way. And then the outcome, hopefully for you, will be similar to this one, because by understanding triggers and providing emotional support, the frequency of Ethel's outbursts actually decreased, leading to a much more peaceful environment and positive outcome for both Ethel and her caregiver. So this case study is a sample or an example of a person with vascular dementia. He's 874, years old, and he just has lost interest in doing any activities. His name's Joe. So Joe was once an avid golfer and socializer, but he started to show disinterest in activities that he previously enjoyed, leading to social isolation. So some intervention strategies for this situation include reintroducing the activities his caregiver gradually reintroduced Joe to golf by visiting the driving range, allowing him to engage without the pressure of a full game. Now, this gentleman had vascular dementia, if the caregivers taking him to a golf course to the driving range, he's probably early on with his cognitive impairments. But this is just an example of an intervention that worked, and you can modify it to the stage that the person you care for is in at the time they organize small gatherings with friends from the golf club, providing familiar social interactions that did spark his interest or renewed interest, and then exploring new activities such as painting or puzzles helped Joe discover New interests that he could enjoy at his own pace, and that is an operative statement. At his own pace, he just doesn't have the cognitive abilities that he once had, and sometimes we forget that about our people that we care for so we have to meet them where they are in their stage. So the outcome for Joe was with gentle encouragement and social support, Joe did begin to participate in activities, again, significantly enhancing his mood and reducing his feelings of isolation, which is so incredibly important for people living with dementia.

Lisa Skinner: 00:09:54

The next story, the scenario is difficulty with personal care. Care, and we see this a lot in people living with Alzheimer's disease and dementia. And this lady, Sarah, she's 79 years old, and she's just in her early stage of Alzheimer's disease, but the behavioral challenge is that Sarah resisted assistance with personal care tasks such as bathing and dressing, leading to hygiene issues and caregiver frustration. So a great intervention strategy, and I have seen this work over and over and over again, and I've actually talked about it pretty frequently, is creating a regular routine. A consistent daily routine was established for Sarah, incorporating personal task care tasks at the same time each day to foster predictability, and this is such an important approach to people with cognitive impairment, because they thrive on familiarity and a routine represents familiarity so really important to to incorporate a consistent daily routine. But what the kid what her caregivers did was they offered her choices in clothing and grooming products, which ended up empowering her and ultimately reduced her resistance. It gave her back a little bit of her independence, and felt like she had a say in things. And then they praised Sarah for her cooperation and independence during personal care, which reinforced positive behavior. So the outcome for Sarah was with a structured routine and choices, she became more willing to engage in personal care, improving her her hygiene and overall well being. Is that going to work every single time somebody becomes resistant to wanting to take a bath or a shower, get dressed or brush their teeth or all the other personal hygiene services we provide for the people we're taking care of? No but this is a fundamental, proven technique that has shown to work, but you might need to have a few other strategies and techniques in your toolbox to pull out if that doesn't work in at any given time. Michael is a 77 year old man with Alzheimer's disease in his moderate stage, and the behavioral challenge here was due to his cognitive decline and his frequent forgetfulness. Now, Michael routinely and frequently forgot names of family members and significant events, and that led to tremendous frustration and embarrassment during family gatherings. So the caregiver their intervention strategy for this particular episode created a memory book filled with photos and names of his family members, along with significant events for Michael to reference. Um gently gave gent gentle reminders about family members and events during conversations, using cues to jog his memory. And it was effective. Then they encouraged Michael to share stories about his life, and this helped reinforce connections with his family, allowing for cognitive engagement. And that's an ultimate goal for us. The outcome from Michael was in using these memory aids and storytelling not only helped him remember his family members better, but also strengthened his emotional connections with them. This late. She's 80 years old, and she has Lewy body dementia, and she has been having some reactions to medications that she's on. So the behavioral challenge was in that she was having paradoxical reactions to certain medications, which stands to reason why she had was showing and displaying increased agitation and anxiety instead of relief. So what that caregiver did was monitored these negative reactions by maintaining detailed notes on every time she was given the medication and the reaction that followed, and then shared this information with her health care provider, the caregiver, worked closely with health care professionals to adjust her dosages and switch medications, finding alternatives that better suited her needs, and then by trying some different holistic approaches versus pharmaceutical approaches, and she tried aromatherapy and relaxation techniques like hand massages, those were introduced to help manage her anxiety without relying solely on medication. So the outcome for in this scenario was through careful monitoring and collaboration with this woman's health care providers, her medication regimen was optimized, leading to decreased agitation and improved overall well being. Here is a study that looks at or case scenario that looks at compulsive behaviors, which happen a lot. This is Steve. He's 82 years old, and he has fronto temporal dementia. And if you don't, if you're not aware, fronto temporal dementia is the brain disease that attacks the temporal lobe of our brain, which is in the front part of our head, and it really will impact our emotions, our thought processes, our ability to reason situations out. And in most cases, in a lot of cases of Frontotemporal dementia, the person ends up reacting on pure, raw emotion because they've lost a lot of the ability to differentiate between a big deal and something that's not that big a deal, like we do when we have a healthy brain, everything tends to be a big deal to them in a lot of situations. So Steve developed compulsive behavior, and some of the things that he was doing was he was repeatedly checking doors and windows, which of course, created distress for both himself and his caregivers. So the intervention strategy that his caregivers tried was to offer a structured routine, which again is a consistent daily routine established to provide structure. It worked in this particular behavioral situation, and it actually ended up reducing his need for compulsive checking behaviors. The caregivers provided reassurance that the doors and the windows were secure and that reduced his anxiety related to his safety, he was concerned about his safety

Lisa Skinner: 00:19:35

when these compulsive behaviors do emerge, caregivers redirected Steve to engaging activities such as playing cards or doing puzzles to get his mind on something else. And the outcome for Steve with the interventions that his caregivers implemented, was. As with a structured routine and reassurance, Steve's compulsive behaviors were minimized, leading to a much calmer environment. So again, collecting a variety of tools to assemble in your toolbox that any of these situations, if they might arise, and the chances that they will are pretty good, you have more than one option to try to try to diffuse the situation. So let me give you a few more. This one happens frequently, and this woman, her name is Joan. I'll call her Joan. She's 78 and she suffers from incontinence, and as a result, extreme embarrassment, which is understandable. She's aware she's incontinent, and she's in the moderate stage of Alzheimer's disease. And what happened to Joan is she began experiencing incontinence, leading to feel feelings of embarrassment and reluctance to participate in social activities. So what the caregivers did for her was they established a regular bathroom schedule and encouraged Joan to use the restroom at set times, which ultimately reduced the frequency of accidents the caregivers also provided discrete and comfortable incontinence products, which helped Joan feel more secure during outings, and also reassured her that incontinence is common in people living with dementia, encouraging her to participate in social activities without fear of embarrassment. So the outcome for Joan was positive. So by engaging or implementing a consistent schedule and supportive products, Joan felt much more confident and engaged socially, experiencing fewer accidents and a greater enjoyment in participating in activities. She wasn't just completely overwhelmed with the worry of, am I going to have an accident? I've seen this strategy used so many times in care homes, where people who do have incontinence problems are put on a toileting schedule. And it's effective. So that's one thing that y'all can try. Adam is an 83 year old man, and he lives with vascular dementia, so he's had strokes or mini strokes, and his behavioral challenge is that he is often fixated on past events, frequently reliving memories of his military service, which sometimes leads to distressing emotions for him. So the intervention strategy that worked for Adam was that the caregivers facilitated discussions about Adam's military experiences. This is called memory sharing, allowing him to express his feelings and thoughts by talking about his military experiences and processing those feelings and thoughts then they created a Memory Box, which contained photos and memorabilia from his service in the military, which provided for Adam a tangible way to engage with his past positively when fixation leads to distress, caregivers can gently redirect conversations to more current topics or activities that the person has enjoyed. And the outcome for Adam was by allowing him to share his memories in a supportive environment, the caregivers helped him process his emotions, leading to reduction in distressing fixations. The next example is in. Displaying anger and frustration. And this is Lola. She's 78 years old, and she's in her early stage of Alzheimer's disease, and what Lola was displaying is expressed anger and frustration, particularly when a task became overwhelming or challenging, impacting her interactions with her caregivers. So their intervention strategy was to provide supportive empathy and patience and validating her feelings, and this is important, without dismissing them, they validated them. They acknowledged they understood what she was feeling and why she was feeling the way she was feeling. Then they broke her tasks down into smaller, manageable steps, providing assistance as needed, to reduce frustration during during daily activities. And that worked for Lola. Then they praised Lola for her efforts and successes, no matter how small they were, which boosted her confidence and her motivation. So in this scenario, the outcome was with placing these supportive strategies in putting them in place, Lola's outbursts of anger decreased, and she actually became more willing to engage in daily tasks with a positive attitude, because the way they went about structuring The tasks lifted her concern of failing, which just is a constant reminder of her cognitive challenges. So that was effective. This gentleman named Clark. He's 80 years old, and he also lives with Frontotemporal dementia, and he socially withdrew as a result of the impact that the brain disease was having on the temporal lobe of his brain. He became completely withdrawn. He preferred to isolate himself rather than engage with family or friends. So the caregivers, what they did for him was he, they personally invited him to small family gatherings, emphasizing the importance of His presence and the enjoyment of his company. That's sweet. Then they planned activities that align with his interests, such as gardening or watching sports, to encourage his participation. The caregivers then facilitated connections with familiar faces, ensuring that interactions were comfortable and enjoyable to Clark. So the outcome in this example was that gradually, Clark began to engage more with his family and friends, thus reducing his feelings of isolation and enhancing his overall quality of life. I'm going to share one more with you. This is a little unusual, but it does happen. I've seen it myself. And this woman, I'm going to call her Emily. She's 82 years old, and she suffers from Alzheimer's disease, and her behavioral expression is in overeating and compulsive eating.

Lisa Skinner: 00:29:21

That's what she exhibited, compulsive eating behaviors, often consuming excessive amounts of food and then becoming angry and irritable and distressed if she was denied the food. So the intervention strategy for her was to implement structured meal times, established regular meal and snack times to create a predictable eating schedule, helping to manage her cravings. They made healthy snacks readily. Available for her, and they also allowed her to snack between meals without over indulging. So the other strategy they used was they involved her in meal preparation by providing her with a sense of purpose and distraction from her compulsive eating habits. I've seen this implemented so many times, and it's it's very effective. So the outcome for her was with these structured meal times and healthier options her overeating and compulsive behaviors decreased, which, for her, promoted better nutrition and better overall health. Seems like she was afraid that if she didn't eat something and indulge in it, then that was probably the last meal she might ever get. And with the strategies they implemented, she realized there would always be food for her. And it kind of, you know, helped with those behavioral expressions. So I don't want to overwhelm you by giving you too many tools and too many strategies. It's a lot to digest, but I'm going to continue providing these for you, so eventually you will have an arsenal of tools in your toolbox to use when these situations arise. So that'll be our episode for the truth lies in Alzheimer's today. I'm Lisa Skinner, your host, and I want to take a moment to thank everybody for spending part of your day with me. And as always, I look forward to having you back for next week's episode of the truth lies in Alzheimer's show. So till then, I'm Lisa Skinner, your host, and I hope you all have a wonderful and positive and blessed week. See you next week, bye, bye.