Flashcards in Indirect dementia treatment Deck (18):
Indirect treatment for dementia
- Indirect treatment to Dementia involves treating individuals indirectly through environmental modifications, development of therapeutic routines and activities, and caregiver training.
- Appropriate for individuals in all stages of dementia severity, particularly the caregiver training in communication strategies
- Likely to be used with direct intervention as well
Benefits of indirect treatment
- Broadens quality-of-life
- Functional maintenance of skills
- Prevents helplessness
- Promotes independence
Staying at home for treatment
- 70% of persons with early-to-moderate dementia live at home in the U.S. (van Hoof et al., 2010)
- Good care in an institution is costly
- Care services are not available for some
- Most patients want to remain at home
Modifying the environment
- World Health Organization says that “environmental factors may support or hinder the person with a (chronic) disease”
- For patients with dementia, it is no longer possible to easily adapt to new conditions. The environment must therefore be adapted to the individual’s specific needs.
- Environmental interventions have a direct impact on the functioning and participation, which are affected by dementia.
Modify the home to be
- Familiar environments that provide cues and privacy to the residents
- Familiar décor (from their early adulthood)
- Have quiet spaces for both pt. and caregiver to have breaks
- Object modification: modifications to furniture, utensils, equipment, and other items
- Home modification: modifications to one’s dwelling
- Assistive devices: assistive aids or technologies that specifically address a given health problem
- Task simplification: remaining modifications that support independence at home
Examples of Environmental Interventions
- Eliminate the many choices in the selection of clothing (visual search and attention are hindered by additional visual information)
- Visual cues: Red light at restroom door, colored line on floor leading to restroom, Put (picture) sign on the door, Leave access door open to enhance visibility *not suitable for severe dementia
- Label items in the house (text or pictures) : “hot” “cold” on taps, “mail”, kitchen cabinets or drawers
- Lighting for the pt to see what they are doing, but not overwhelming or glaring
- Make doorhandles large and distinct
- Decrease background noise
- People with dementia have problems with: perception, orientation, and memory.
- When labeling things in the home, avoiding patterns that are distracting or confusing, and using see-through materials and items
- There are many specific caregiver training programs
- They vary in design: classroom instruction, CD-ROM, caregiver’s manual
- By counsel of SLP: giving tips, advice, strategies, and referral of other resources
Educate the caregiver to:
- Speak Slower
- Multimodal input
- Limit number of conversation partners
- Use pleasant tone of voice
- Simplify syntax and vocabulary
- Talk about the Here and Now
- Replace pronouns with proper nouns
- Revise and Restate something misunderstood
- Ask multiple choice or yes/no questions
- Use Direct speech instead of Indirect
- Avoid figurative lanaguage
SLP role in caregiver support group 1
- Caregiver support group can provide caregivers with information, strategies, and encouragement
** Data suggests that Better caregiver = Better patient
- ASHA states that SLPs: are qualified to work with the Dementia population and their families.
- have knowledge of the disease process, the cognitive decline, assessment and treatment.
- are in perfect position to provide support as they have witnessed first-hand the burden on caregivers
SLP role in caregiver support group 2
- Educate caregivers on disease process, cognitive decline
- Answer questions
- Counsel on their transition of new role
- Offer Encouragement
- Refer Caregivers
- Give Compensatory strategies, environmental modifications and tips for routines
- Takes advantage of procedural memory that may be somewhat intact despite deficits in recent memory.
- Honor a loved one by keeping their rituals and preferences of their everyday life the same, as much as you can
- Allows the pt to still do activities of interest
Benefits of routines
- Maintains Functioning: Practicing an activity regularly = increased likelihood of that ability remaining
- Decreases Caregiver Stress: Routines can lessen the stress for those caring for people with dementia, by making the day more organized and less challenging
- Allows for Some Independence: Activities that have been practiced regularly, such as folding laundry, can increase self-esteem and confidence because the person can perform it independently.
- Reduces Anxiety: The predictability of a routine can decrease anxiety, the pt can know what to expect.
Types of routines
- Getting ready for bed
- Morning walk
- Crossword puzzles
- Watering the flowers
Tips for making routines easier
- Break the task down in sections
- Remove distractions and limit choices
- If help is needed, then allow the pt to complete the final step
- Reminders or verbal instructions should be be simple (short sentences, with gestures)
- Do tasks together
- Be aware of your tone of voice, as you don’t want to sound like you are criticizing
- In advanced dementia, try demonstrating, pointing, or gesturing in lieu of verbal cues
- Assistive technology for cognition (ATC) supports orientation, prospective memory, communication, executive functioning, and ADLs.
- Provides reminders
- Alerts caregivers to problems
- Cues and monitors performance
- Exposes patients to virtual environments
- Stimulates communication
- Helps to compensate for sensory loss
- Simple, self-explanatory icons on a touch screen
- Reminders from wake-up time in the morning until bed time
- Can be recorded in a friend or relative's voice, and give instructions for all sorts of activities:
--- picking up the morning newspaper, brushing teeth, preparing or warming pre-prepared meals, laundry and dish washing and myriad other daily activities.
--- Can link to video presentations showing how to operate, for example, the stove, microwave oven or washing machine.