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Behavioural Challenges in Dementia Trevor Janz MD Residential Care Medical Director for Interior Health East Dementia: Definition A progressive neurologic impairment of thinking and memory that affects a person’s ability to perform activities of daily living. Prevalence increases with age Age 65 to 74 • 37% Age 75 to 84 • 20% Over 85 years • 50% Types of dementia Alzheimer’s Vascular 50 to 70% 25 to 40% • Short-term memory loss • Gradual progression • Abrupt on-set • Stepwise progression • Gait & balance issues • Difficulty speaking & swallowing • Poor judgement • Depression Types of dementia Lewy bodies/Parkinson’s • • • • • • 15% Slowed movement Gait problems Visual hallucinations Fluctuations in ability Sensitivity to medications Frontotemporal • Changes in: • Personality • Behaviour • Speech & language • Often younger (onset in 60’s) • Intact memory & some thinking Dementia imposters Delirium Depression Drugs Drinking alcohol Deficiencies (thyroid, B12, Thiamine) Dementia affects Thinking Feeling Memory and problem solving Our emotional life Willing Our behaviours & abilities in the world Thinking Memory loss Hallucinations & delusions Orientation (time, place, person) Language Organizing & planning Problem solving Feeling Frustration (simple tasks) Paranoia Depression Fear of loss of control Anxiety Willing Difficulty with simple tasks Loss of interests in hobbies & projects Apathy & loss of motivation Social withdrawal & isolation Behavioural Changes Repetitive questions/comments Head turning sign Indecision or impulsiveness Restlessness or agitation Verbal or physical outbursts Inappropriate behaviour Sexual disinhibition Stages of dementia: Early Early memory loss Problems Driving Shopping Cooking Managing money Requires caregiver to manage at home Stages of dementia: Middle Increasing support required to manage: Dressing & grooming Bowel & bladder Feeding Admit to residential care Stages of dementia: Late Swallowing difficulties Weight loss Increasing contractures & rigidity Infections (bladder, pneumonia) Forget how to: Walk Talk Recognize loved ones Behavioural challenges All behaviour is communication Agitation Aggression unmet needs self-protecting from danger Resident centered care Know resident, seek to understand behaviours, anticipate needs Relationship centered care If resident senses they are: Safe Respected Understood Liked & loved Then quality of life for both resident and care giver will be better Use short term memory to your advantage: Divert Distract Re-direct Use creative “non-fiction” Start with the facts and create a compelling story [email protected] [email protected] (250) 352-1208 Thank you Slides by Deanne Taylor
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