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normal physical aging

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sensory changes, cardiovascular changes, skeletal changes

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normal cognitive aging

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declarative memory, procedural memory

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human capacity to learn

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encoding-> sensory memory-> declarative memory-> procedural memory

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factors that impact memory

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stress, fatigue, mental health, drug use, hormonal dysfunction, enviornment toxins, inflammation, hypothyroidism, dietary deficiency, infections, tumors, vitamin B12 deficiency

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Reversible Memory Loss Delirium

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high BP, fluid imbalance, med. side effects, malnutrition, low blood sugar, dysfunction thyroid, anemia, lunch disease

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Dementia ( memory loss)

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umbrella term for a set of common symptoms caused by a number of diseases

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dementia loss of of mental functions include:

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thinking, reasoning, judgement

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Symptoms of Dementia

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frequent short term memory loss,difficulty performing familiar tasks, problems with language, problems misplacing things or putting things in inappropriate places, disorientation to time and place, poor or decreased judgement, decreased problem solving, problems with abstract thinking, loss of initiative, change in mood or behavior

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Common Diagnosis resulting in Dementia

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lewy body, wernicke korsakoff, parkinsons, FTD/ Picks Disease, Vascular Dementia, Mixed, Alzheimer's

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1o Warning Signs of Dementia

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Challenges in planning or solving problems, changes in mood or personality, confusion with time or place, decreased poor judgement, difficulty completing familiar tasks, memory loss that disrupts daily life, misplacing things and losing the ability to retrace steps, new problems with words in speaking or writing, trouble understanding visual images or spatial relationships, withdrawal from work or social activities.

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Characteristics of Alzhiemer's

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Progressive, Degenerative, Irreversible, affects the hippocampus, impaired memory , impaired thought processes, behavioral changes, deepening confusion about the events time and place, unfounded suspicion about family or friends, progressive return of primitive motor reflexes and patterns

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Neurological changes of the brain

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cerebrum( remembering, problem solving) Cerebellum ( controls coordination), brain stem ( HR, BP)

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Neurological changes of the cortex

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outer layer of cerebrum, generates thought, forms and stores memory, interprets sensations in the body, helps to control voluntary movement

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Neurologic changes

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Chemical functions: Norepinephrine ( concentration, energy, alertness) Serotonin ( memories, obsessions, compulsions) Dopamine ( pleasure, reward, motivation, drive) Norepinephrine & seratonin ( control anxiety, impulse, irritability) Seratonin & Dopamine ( appetite, sex drive, and agression) Dopamine & norepinephrine ( help attention)

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Anatomical neurological changes

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Structural: dendrites used for transmitting messages , plaque: blocks external messages, Tangles: prevents messages from originating from cells.

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Assessments used on Dementia clients

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Allen cogntive scale, ACL & GDS, Mini mental state exam (MMSE), Montreal cognitive assessment, The short Blessed (SBT), St. Louis University Mental Status (SLUMS), Cognitive Performance Test (CPT), Routine Task Inventory (RTI), Assessment of Motor and Processing Skills (AMPS), Functional Independence Measure (FIM), Disability Assessment for Dementia ( DAD), Performance Assessment of self care skills (PASS), etc...

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Occupational Therapists as specialists

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Part of a team, evaluate work/cognitive demands of activity, grade tasks into appropriate steps,instruct caregivers on proper cueing and support, create careplans to communicate properly across all disciplines.

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Treatment planning for Dementia patients

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What can the person still do, what assistance do they need to do it, what are they at risks for, what can still be changed (muscle strength, ROM, balance, environment,etc..)?

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Skilled observation for Dementia patients

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Behavior Profile: What exactly is happening, why has the behavior happened, what was the antecedent, who is involved, where is the behavior exhibited, when does the behavior usually occur??

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Common Goals of Interventions

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Hip precautions, home exercise program, adaptive dressing and bathing, use of adaptive equipment, press the call light if they need anything

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Factors that impact treatment

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attention span, limited ability to follow directions, sequencing,perception and sensory processing, body awareness, emotional responses:fear and paranoia

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Positive Physical Approach

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1. Greet before you Treat, Don't ask ppl if they remember you. 2. Appropriate visual cue: high wave & smile -approach from the front, midstage peripheral vision progressing to monocular vision 3. stop and allow person to see you before entering personal space (3-6 ft)

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Positive Physical Approach - Verbal Cues

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Verbal cues should be short, tone should be friendly and respectful, pace should be as natural as possible but slow down a bit,pitch should be lower.

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Positive Physical Approach- Touch & body positioning

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-Hand under hand position: rotate hand to grasp the person's thumb in the same position as people about to arm wrestle -Place yourself at eye level

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Interventon- dressing

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lay out the clothes for them, put an entire outfit on one hanger, hand them clothing in the correct order, provide simple choices, short arm in sleeves or legs in pants ( know routine history), may need 5 of the same outfit

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Intevention-toileting

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provide warmth, eliminate drafts, be aware of how person performed tasks in the past, give proper context to desired activities

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Intervention- Grooming and Hygiene

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Activity analysis for brushing teeth, -feet forward, bridging, hand over hand -eliminate background noises and distractions

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Intervention Bathing

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use bathing routine history, be careful with words you say ( let's wash up vs. its time for you to take a bath), let them hold something to distract them, when washing hair avoid water and soap in their eyes, keep in mind they may prefer the hair parlor, cover up the body parts not being used

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intervention feeding

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food preferences/restrictions-vegetarian, ethnic food, low sodium or sugar, assess each resident for the best environment ( family style eating ,music, quiet), work with dietary to provide most appropriate food, train CNA hand over hand positioning using 2 pts of contact, sweet taste buds.

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Intervention feeding transfers

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count together, listen! use rythm to help teach functional transfers

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Processing cues

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give ppl with dementia 30-90 seconds to process verbal cues, repeat exact same words

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common concerns of patient with dementia

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needing to find car keys, car, purse, needing to go home, someone kidnapped my dog or my child, my family doesn't know where i am.

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Helpful phrases

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"im sorry, i was trying to help" "im sorry, this is hard" "what do you need" "tell me more about that" "what do you want to do with it"

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Therapeutic Lying

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avoid orienting to reality, orient to task...Enter their world, get in their shoes first, be a detective not a judge, listen and repeat, don't push your agenda, active and reflective listening

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