Dementia can be a challenging area for caregivers; the behaviors can be difficult to manage, not to mention understand their underlying meaning, because they DO have an underlying meaning. Through a 3 stage division of dementia, behaviors (both adverse and preserved) we can better understand the symptoms and behaviors and increase the success and positivity of our interactions.
In the mild stage we see an increase in word finding difficulty. You may hear them utilize vague descriptors such as, “that thing” or, “over there”. In a test sub component, this could be measured using a generative naming task such as naming as many animals as they can think of within a minute. Often at this stage individual are in denial of any short term memory (STM) loss; however word finding difficulty frequently parallels that of STM loss. Instances such as forgetting to take new medications, or recalling details from a recent conversation are examples of this. Executive functions such as financial and medication management may also begin to show decline. Lastly, you may notice that the individual has difficulty with attention or scanning his/her environment for an object (i.e. glasses). What can we do? What functions would be resolved or significantly improved if s/he had a better memory? For example, organize the environment in simple format for placing keys, glasses, shoes, etc. to eliminate consistent ‘misplacing’; reorient him/her to increase/maintain independence and control of their environment. Next, take a close look at sensory integration. Too much stimuli (television, radio, call/door bells), along with individuals engaging in conversation with them, can be overwhelming and eventually frustrating. Attempt to minimize environmental stimuli. This doesn’t and shouldn’t be dramatic; for example, when you enter the room, turn off or mute the television before trying to discuss what else needs to be picked up at the grocery store.
In the moderate stage patients are with a much greater fall risk, and ADLs (activities of daily living) are largely impacted. This population has increased wandering or plundering around in their room; they are easily distracted. They may not recognize family as well or consistently, and orientation to the immediate environment is limited. Nonrecognition of simple objects within their environment, such as a spoon or fork may impact self feeding, word finding is even more impaired than that exhibited in the mild stage, thus requesting these items will be difficult. There is a decrease in the initiation of communication, feeding, dressing, and asking for help. Our goal? Orientation to surroundings (bathroom, closet, etc.) , developing environmental modifications and compensatory skills to maximize highest level. It is important to evaluate auditory processing time; that is, how long it takes for directives or questions to be processed, to allow additional response time as indicated. A simple task is asking him/her to count to 10. Address word finding strategies such as Spaced Retrieval or use of visual aids.
Lastly, the severe stage of dementia. Visual attention is limited to 10-12″ beyond his/her face. This is especially important to remember when presenting objects and when entering new activities (i.e. bathing), as these individuals are easily startled and can be agitated; often they ‘don’t see it coming’. Thus, combative behavior is frequently exhibited in response to startling actions, or when sustained attention demand (i.e. feeding) is too great. Fall risk is high as visual perception is poor- these patients may be reaching for inanimate objects, perception of low color contrast items is reduced. How can we help? Approach individuals from the side, using low volume and simple phrasing/words related to the ‘here and now’ activity. Increase color contrast (you can purchase colored utensils on the web) to increase object recognition and patient participation. Assess actions that precede negative behaviors. At this point, negative behaviors ARE their communication means. Maximize comprehension of environmental stimuli to maximize successful and acceptable behavioral responses.
Popular ways to document.
From one speechie to another, I appreciate the sharing of documentation phrases for goals and justifying therapy needs! Let’s face it, after a while, the same ones get old, and there are new ways explaining your impact on the patient as WHOLE. In dealing with the above topic, one i particularly like is:
“Patient presents with negative behaviors impacting … (function)… SLP intervention to develop skills and/or environmental modifiers to … compensate, decrease adverse behaviors, increase sense of independence/ participation in … to maximize highest level. “