COMMUNICATION STRATEGIES FOR PEOPLE WITH ADVANCED DEMENTIA 3/9/2021 - Champlain Hospice Palliative Care ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
3/9/2021
Wisdom & Innovation
in Hospice Palliative Care
COMMUNICATION STRATEGIES
FOR PEOPLE WITH ADVANCED
DEMENTIA
Bonnie Daros RN, BscN
Psychogeriatric Resource Consultant – Ottawa
Mary Prince RN
Psychogeriatric Resource Consultant – Renfrew County
1
3/9/2021
FACULTY/PRESENTER DISCLOSURE
• Faculty: Bonnie Daros & Mary Prince
• Relationships with financial sponsors:
None
DISCLOSURE OF FINANCIAL SUPPORT
• This program has received financial support from Hospice Care
Ottawa, Carefor Health & Community Services and Bayshore
Home Care Solutions in the form of an educational grant.
• This program has not received in-kind support.
• Potential for conflict(s) of interest:
None
2
3/9/2021
MITIGATING POTENTIAL BIAS
The potential sources of bias identified in slides 2 and 3 have been
mitigated by the scientific planning committee by reviewing the material
presented by the speaker.
In addition, the speaker was provided with a copy of The College of Family
Physicians of Canada’s Identification and Management of Conflicts of
Interest and Transparency to Learners.
OBJECTIVES FOR TODAY’S WORKSHOP
• Late stage and end stage dementia – what to expect
• How to provide comfort while visiting the person
• Examples of different modalities to provide comfort and support
• Sharing good ideas – breakout opportunity
3
3/9/2021
LATE STAGE END OF LIFE DEMENTIA
WHAT TO EXPECT
Loses the ability to communicate Sleeps longer and more often.
with words and does not Becomes rigid and a grasp reflex
understand what others are returns
saying. Behaviour becomes a
form of communication. Possible withdrawal, agitation and
repetitive vocalizations
Needs our complete assistance
with personal care. The person Vulnerable to infections
becomes incontinent, has
difficulty with eating and
swallowing, progressively loses
the ability to walk and becomes
chair/bed bound.
As the brain deteriorates, the body fails
While clinical manifestations may differ initially between the
different types of dementia, the end-of-life phases in all
cases of progressive dementia involve severe physical and
cognitive impairments
Caron et al 2005
4
3/9/2021
ADVANCED CARE DIRECTIVES
Should advanced care directives begin once the
person receives the diagnosis of dementia?
Conversations with families should take place soon
after admission to Residential/LTC and include
discussion about prognosis, the persons
preferences for care and advanced directives. This
conversation should also occur with changes in
frailty or risk of death.
Engel. 2006
“Whether the patient’s surrogates are engaging in advance care
planning or actually in making a real-time decision about
treatment, they need to have a full and realistic understanding
of the experience of dementia. Only by starting with a clear
conception of what dementia entails, what the trajectory of the
disease looks like, and how patients with dementia respond to
medical interventions, is sound decision making possible.”
Gillick. 2012
5
3/9/2021
SUPPORT FOR FAMILIES
Support for significant others should include
education about the disease, understanding the
symptoms their loved one’s are experiencing,
reviewing the goals for care, and attention to
spiritual needs
As risk of death increases, education should include
what to expect with the dying process
We need to help families think of how interventions
will impact quality of life
Gaspard and Roberts. 2009
SIGNS OF PAIN AND DISTRESS
Repetitive Physically
Fidgeting Withdrawal
vocalization responsive
Facial Guarding,
Body posture/ Noisy
expressions/ bracing,
tension breathing
grimaces rubbingg
Autonomic changes:
Reduced or increased BP and pulse,
locomotor activity sweating, skin colour
changes
Regnard et al, 2006
63/9/2021
PREVENTING SUFFERING
Objective assessment is needed in severe dementia when a person becomes
unable to verbally communicate. Important self-report information about
location, intensity, quality and duration of pain are not available to the
caregiver
Assessment tools developed to measure pain in the cognitively impaired
person tend to rely on specific signs and behaviours that indicate the
presence of pain.
Observational tools covering only common distress cues may result in a
person’s unique cues being missed.
It can be difficult to determine if the underlying cause of behavioural
characteristics is physical symptoms or behavioural and psychological
symptoms of dementia (BPSD) – fear, loneliness and lack of connection are
important too!!
PROMOTING DIGNITY
The importance of knowing the life history of the person who is at the
late stage of dementia
Care provided by staff who are knowledgeable and skilled in end-of-life
care
Respecting the persons prior wishes and reviewing the need for
adjustments to the plan of care on a regular basis and with
changes in the level of frailty
Supporting the notion of quality of life until death. Emotional support
not just physical support.
73/9/2021
FACILITATING CARING
Quality of life is an important concept in decision making.
Involvement in informed decision making
-Participation allows the caregivers to:
1) Feel that they are contributing to the wellbeing of their relative/friend
2) Better understand the disease progression
3) Be reassured and feel supported
4) Be better prepared for the eventual death of their loved one
5) Assist the caregiver in ways to make emotional connections
Caregivers want to know how to show caring towards the person with
dementia at the end of their life.
Caron et al. 2005
STRATEGIES FOR SUCCESS
Others must become detectives to figure out what the person is trying
to communicate.
There is always meaning behind the behavior.
Person-centered approach helps to value the individual’s unique
history and encourages understanding as the individual progresses
in their disease.
Other techniques may enhance communication (massage, music, pets,
aromatherapy).
Non-verbal communication is most important. Everyone communicates
by emotion and touch. Sometimes smiling or holding a hand
conveys more than words.
83/9/2021
STRATEGIES FOR SUCCESS
AT ANY STAGE
DementiAbility Methods
2 Day course found at www.dementiability.com
“The goal is to engage each and every person in all aspects of daily life,
thereby enabling abilities, engaging each person in a wide range of
meaningful activities and helping every individual to be the best
he/she can be. The focus is on exposing abilities according to needs,
interests, preferences, habits, strengths and skills and a prepared
environment.”
Elliot, E 2018
MUSIC
Alive Inside Documentary Clips
Johnny (41:30-46:08)
https://www.youtube.com/watch?v=aN_Cpd_NpMY&t=2494s
Client with late stage dementia
https://www.youtube.com/watch?v=aN_Cpd_NpMY&t=935s
93/9/2021
VISITING WITH SOMEONE WHO HAS
DEMENTIA
It is important to continue to
visit
As remaining abilities fade,
the person with dementia may
no longer recognize or recall
visits from you, friends and
relatives. Visiting is a primary
way to stay connected with the
person with dementia and
provide them with comfort,
reassurance and stimulation.
Alzheimer Canada. The Alzheimer Journey: At the Crossroads (workbook).
www.alzheimer.ca
Bell, V. & Troxel, D.(2009-revised) The best friends approach to Alzheimer’s
care. Baltimore: Health Professions Press
KEEP IN MIND…
The person with dementia is doing the best
that they can
Not to take things personally, something may
have happened before your arrival, if the
person is upset leave them for a short
while then return
Use distraction, changing the person’s focus
may help to relax them
A visit with a good feeling at the end is the
goal
For the person with dementia, the value is in
the feeling he or she gets from the visit,
not the amount of time spent
103/9/2021
VISITING WITH SOMEONE WHO HAS
DEMENTIA
Introduce yourself and why you are there.
Despite the person being mostly non-verbal nearer the
end of life, understand that they are still there.
Encourage the family or friends to:
Merely sitting together is good
Listening to music/ singing
Prayers if meaningful to them
Read or tell a story to the person
Giving a compliment
Joining an activity – even if just to watch
Looking at a photo album
Giving a manicure or holding hands
Take the person outside
Gladys Wilson and Naomi Feil
https://www.youtube.com/watch?v=CrZXz10FcVM
113/9/2021
VISITING WITH SOMEONE WHO HAS
DEMENTIA
Watch for signs of fatigue or that If leaving is upsetting to the
the person is becoming upset. person you are visiting it is best
This could include irritability and not to inform the person of your
restlessness. They may be only intentions. Engage the person
able to tolerate shorter in an activity then quietly make
interactions. your exit when the person is
busy and distracted. You may
need to ask for help from the
staff.
THINGS TO REMEMBER
A person’s feelings remain…even
when they have dementia. Later
in the illness, feelings may be
how someone makes sense of
what’s going on around them.
Everyone communicates by emotion
and touch. Sometimes smiling
or holding a hand conveys more
than words.
123/9/2021
PET THERAPY – REAL OR NOT
OTTAWA THERAPY DOGS
WWW.OTTAWATHERAPYDOGS.CA/
25
PET THERAPY
133/9/2021
SNOEZELEN
Snoezelen Multi Sensory Environments
http://www.snoezelen.info/
https://www.youtube.com/watch?v=ckj_4r0
9zHc
CUDDLE (DOLL) THERAPY
143/9/2021
SHARE YOUR GOOD IDEAS
Breakout – 5 min
Discussion – 5 min
15You can also read
