Bernier, 2009

The Elevator Stops At OZ: Entering The World of Dementia

Dr. Sherri Bernier, Ed.D.

Bernier, 2009

Abstract

There’s no place like home… Harr and Kasayka (2000) state that

“to create comfortable and secure environments and programs that foster human dignity and individuality, we must understand how the ‘the power of place’ influences the preservation of resident personhood”

Bernier, 2009

Achieving a harmonious environment and enhancing the “quality of life” in those afflicted with dementia must include opportunities for freedom of choice, sensory stimulation, and social interaction. Allen-Burge, Stevens, and Burgio (1998) contended that challenging behaviors associated with dementia include behavioral deficits such as the functional domain of peer interaction. It is imperative that all healthcare disciplines be educated and trained to

Bernier, 2009

“enter the world of dementia” in the quest to cultivate pleasant relationships and to decrease agitation in those they serve. This method supports innovated techniques and creative interventions for the helping professional in the field of dementia care.

Bernier, 2009

Achieving a harmonious environment means promoting:

Autonomy: freedom of choice A sense of control Socialization Sensory stimulation Least restrictive surroundings Caregivers trained to meet both emotional and physical needs of the person afflicted with dementia

Bernier, 2009

The Approach:

Remember when interacting with someone who has dementia, you are entering “their world” Always approach from the front It is of the utmost importance to make eye contact so that the person remains focused

Bernier, 2009

Dining

Early afternoon dinners are recommended due to “sun-downing” Finger foods for those in mid-latter stages of the disease; i.e. chopped ham and pickle Pasta that can be eaten with a spoon; i.e. elbow macaroni

Bernier, 2009

Environmental Safety:

Well lit rooms Furniture should not clutter living space Lock away small items that could easily be put into pockets or mouth; i.e. silverware, keys, small easily swallowed or breakable items Be cautious of the noise level

Bernier, 2009

Supporting Language

Become familiar with the cognitive impaired person’s vocabulary: frequent used words When words are not used appropriately, do not correct the person Be attentive to the person’s body language Keep conversations simple and direct Encourage person to speak using gestures,cues, and supportive devices

Bernier, 2009

Dealing with Poor Judgment and Insight

Limit choices Encourage fidelity: trust and loyalty Do not use authoritarian or judgmental approaches Dismiss yourself at the first display of aggressive behavior

Bernier, 2009

Behavior Interventional Studies

Holmberg (1997) -Walking Program-71% reduction in agitation Buettner et al.(1996)-Recreational Therapy-30% decrease in staff incident reports of aggression Williams et al.(1994)-In-service Training-significant decrease in incident reports Gerdner (2000)-Music Therapy-65% decrease in observed agitation Hussian (1988)-Stimulus Enhancement-85% reduction in frequency of observed behaviors Cleary et al.(1988)-Special Care Units-53% decrease in agitation level

Snowden, Sato, & Roy-Bryne (2003)

Bernier, 2009

Communicating in the “Time-Line” of the Dementia Resident

By asking open-ended questions, find out where in ‘time’ the resident is at that present moment Enter into the resident’s moment; i.e. if the resident is crying about a person such as a parent, ask questions about the event that is going on By entering their world, we may decrease agitation and can become part of a pleasant interaction