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Music only. An Overview of Dementia Capable Care Part 2 ‐ Dementia Capable Care Course #: ID‐2017‐013 1
Music only.
An Overview of Dementia Capable Care Part 2 ‐ Dementia Capable Care
Course #: ID‐2017‐013 1
This webcast includes spoken narration.
To adjust the volume, use the controls at the bottom of the screen. While viewing this webcast, there is a pause and reverse button that can be used throughout the presentation.
The written version of the narration appears to the right of the screen.
An Overview of Dementia Capable Care Part 2 ‐ Dementia Capable Care
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Certificates of Achievement will be available to Administrative Entity staff, Providers, Supports Coordinators, and SC Supervisors after completing all course requirements. Please view and then save or print your certificate in order to receive credit for this course.
For SCs and SC Supervisors, course requirements include successful completion of a pre‐test and post‐test.
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Hello and welcome to the second webcast in the four part series – An Overview of Dementia Capable Care for People with Intellectual Disability.
My name is Frank Schweigert from The Columbus Organization, an ODP Training Partner. Along with the other presenters in this series, I am a Regional Affiliated Trainer with the National Task Group on Intellectual Disabilities and Dementia Practices. We are also Person Centered Thinking Trainers, credentialed through the Learning Community for Person Centered Practices.
This series of webcasts will provide resources and information that you can use to begin supporting people with intellectual disabilities who are at risk for or are experiencing the onset of dementia.
In this webcast, we will be focusing on what is meant by Dementia Capable Care and the importance of a Differential Diagnosis.
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As a reminder, much of the information we present today is copyrighted by the American Academy on Developmental Medicine Dentistry and the National Task Group on Intellectual Disabilities and Dementia Practices. As affiliated trainers for NTG, we are permitted to present this information to you in this webcast.
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The webcast series is divided into four parts.
Part one was an introduction to some basic concepts and misconceptions around aging.
This webcast is Part 2 and will focus on what is meant by Dementia Capable Care and the importance of a Differential Diagnosis
In Part 3 a critical role for caregivers supporting a person with Dementia and Intellectual Disabilities – the Health Care Advocate, will be the focus.
This series will conclude with Part 4, where we will explore the connections to Person Centered Approaches and offer some environmental considerations.
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By the end of this webcast participants will be able to:
• Define the terms Dementia Capable Care and Differential Diagnosis.• Identify three reasons a Differential Diagnosis is important.• Recognize other causes for changes in behavior that are not related to dementia.• Describe the impact of dementia as it related to functional abilities.
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Part 1 of this webcast series provided an overview of some of the basics concepts of aging and challenges to providing good care. In this webcast we will focus on dementia and important concepts of what you need to know and understand to provide Dementia Capable Care.
So let’s start by defining what we mean by Dementia Capable Care.
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Dementia Capable Care is being informed of the potential causes and impacts of dementia in order to provide quality supports and services.
Dementia Capable Care supports the person’s dignity and self‐esteem by focusing on what the person can still do and providing physical and mental activities within their current abilities. The purpose of Dementia Capable Care is to maintain the person’s independence as long as possible while being protected from injury or harm.
A first step in providing Dementia Capable Care is understanding four facts about dementia.
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First – Dementia is the loss of cognitive function (memory, thinking and reasoning) severe enough to interfere with daily functioning.
When supporting people with an intellectual disability it is critical to understand that we are talking about the loss of functioning. We have to be sure that we and the health care professionals compare the person’s current skill levels to their previous skill level. This includes challenges with memory, thinking, and reasoning.
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Second – Dementia is an umbrella term that describes a group of symptoms. Dementia itself is not a specific disease or diagnosis. We’ll explore this a little more in a minute.
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Third – Depending on what is causing the symptoms of dementia (which there could be many), the causes may be treatable (for example dehydration) or irreversible (Alzheimer’s).
Where the causes are irreversible, we can then focus on adaptations and accommodations to minimize the impacts.
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Lastly – Dementia is not a normal part of aging. Dementia is a disease that effects some older people, but we all know people who are in the 70’s, 80’s and 90’s who have no symptoms of dementia.
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As I mentioned a moment ago, dementia is an umbrella term used to describe over 100 conditions that can impair memory, behavior and thinking. Some are reversible and some are irreversible.
The most common form of irreversible dementia is Alzheimer’s Disease. While the exact cause of Alzheimer’s is unknown, it is likely a combination of genetic, environmental and lifestyle factors. It is important to note that with Alzheimer’s, the damage of the disease actually begins 10‐20 years before the symptoms begin to show!
Other common forms of irreversible dementia are Dementia with Lewy Bodies, Vascular Dementia, Parkinson’s Disease and Fronto‐temporal Dementia.
Each type of dementia has different characteristics and the type of dementia can impact what medications are used.
For example:• A person with Dementia with Lewy Body can experience visual hallucinations but can be
sensitive to certain antipsychotics typically prescribed for hallucinations.• A person with Fronto‐temporal Dementia can experience profound personality changes
and loss of inhibitions but does not respond to the use of common Alzheimer's medications such as Aricept.
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So take a moment to think about your own life.
Have there been times where you couldn’t remember something important or even something trivial?
Have there been any times where you have gotten lost?
Have there been times when your personality has changed? Maybe you have become more stubborn or sensitive than normal?
Have there been times when you have had difficulty completing a normal daily task?
Does this mean you have dementia? No.
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What are some other potential reasons you might have had problems with memory loss, getting lost, having difficulty doing a normal task or experienced a change in personality?
Use the text box on the screen to write your ideas. When you are ready, click the submit button to continue.
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Any one of these symptoms could be related to you having a nasty cold, or lack of sleep due to a sick child, or increased stress at home or work, or a medication you are taking.
We’ll be talking about this more later, but it is important to recognize that just because you experience one or more of these symptoms, does not indicate or confirm a diagnosis of dementia – there’s more to it than that.
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This slide illustrates some of the basic behavioral and functional symptoms that can be attributed to dementia. Just because you or someone you support may experience one or more of these symptoms, that does not indicate or confirm a diagnosis of dementia.
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Dementia affects all aspects of functional ability. It affects memory, language, focus, judgement, the senses, and the ability to sequence.
As a person ages, you may see changes in their behaviors, where they become more stubborn, irritable or defensive. Individually, these changes could be the result of many influences and might impact one or two areas of functional ability. It is only when these changes impact all aspects of the person’s functional ability, that dementia could be the cause.
Remember though that dementia is an umbrella term for symptoms that can result from a number of causes.
So what is causing these symptoms?
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Just because a person might be displaying symptoms of dementia does not mean that they have dementia. There are other diseases and conditions that commonly occur as we age and those symptoms can mimic the symptoms of various dementias.
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More than 100 disorders , from the side effects of medication to urinary tract infections, can mimic dementia‐like symptoms. Some of these conditions are not serious, but they're often missed or misdiagnosed. When these conditions are caught early enough, they may actually be reversible.
So how can we tell the difference between dementia and conditions that can mimic dementia?
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When considering if a person may be experiencing dementia, ruling out other possibilities is vital. Understanding the Three D’s ‐ Dementia, Delirium and Depression is a good first step.
• Dementia is typically a gradual process. The decline in functional abilities takes months to years.
• Delirium is a sudden behavioral change which may fluctuate as the day progresses. It is likely a result of a medical/ physiological cause that can be corrected. For example dehydration, infections like a urinary tract infection, or too much or too little medication can cause a sudden change in behavior.
• Depression is an unexplained change in mood, lethargy, change in appetite or sleep, or unnecessary worry over trivial issues that lasts for over two weeks.
As a family member, Direct Support Professional, Supports Coordinator, or any other caregiver, you are not the health care professional that is responsible to diagnose the cause of the dementia, delirium, or depression. However you still play a vital role. By knowing the person well and understanding the possible different causes and symptoms and then sharing this information with the Health Care Professionals, you help to ensure that they can make the best diagnosis possible.
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For individuals with an intellectual disability, there is always a risk of diagnostic overshadowing; attributing the potential symptoms of dementia to the person’s intellectual disability or other existing diagnosis.
Thinking back to Albert, because people with Down Syndrome have a greater risk for developing Alzheimer’s Disease, the diagnosis of depression, heart condition and vision problems could have been “overshadowed” by his intellectual disability.
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The key to differentiating between ID and dementia is that while the behavioral presentation may be similar, there has been a loss of function from previous ability.
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For individuals with dementia, some of the early symptoms can include reduced interest in social or preferred activities. Increased sadness, irritability and restlessness can also be seen. The onset of seizures in adulthood, not related to other causes can also be a symptom of dementia as well as changes in coordination and excitability.
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People with an intellectual disability may not notice changes in themselves or be able to talk to someone else about these changes.
Typical screening and evaluation tools used with the general population, such as neuro‐psych tests involve complicated memory tests and paper and pencil tasks. These types of tests may not be feasible for people with an intellectual disability and often require skillsthe person would have never performed well at, even at baseline.
As someone supporting this person, the key for you is being able to compare where the person is now with where they were previously. Recognizing how significant the change is and effectively communicating this to the health care professional is critical. In Part 3 of this series we will share a screening tool that you can complete that can help identify behavioral and functional changes to the health care professionals.
Most importantly, it’s essential to know that a number of conditions may look like dementia, but they are not. As we mentioned earlier, many of these conditions are treatable and the symptoms that looked like dementia can be reversed. Ruling out the other potential causes before diagnosing the changes as a form of dementia is known as a Differential Diagnosis.
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Because of the complexity of making a diagnosis for individuals with an intellectual disability, the likelihood of Diagnostic Overshadowing increases. A Differential Diagnosis that rules out other treatable conditions that may be causing the symptoms and provides appropriate treatment and supports, will maintain the highest quality of life and functioning for the individual.
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Many of the symptoms related to Alzheimer’s Disease are included in this graphic. Memory loss, disorientation, misplacing items, and changes in personality, to name a few. Any one of these symptoms could be the result of a problem other than Alzheimer’s and should be ruled out as a result of the differential diagnosis.
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The process of a differential diagnosis considers the various conditions that can mimic the symptoms of dementia. Many of these conditions are not only treatable, but once treated, the symptoms can be reversed.
Before and after a differential diagnosis is made, those supporting the person need to observe and report changes in function and behavior. Caregivers also need to be prepared to share this information with the practitioner at the appointment and to follow‐up with the health care provider and others as needed after the appointment.
Guided by this partnership, health care providers and caregivers can make better decisions related to additional screenings, assessments, interventions and supports the person needs.
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On this slide you see the stages of progression in Alzheimer’s Disease over time. This is not hard and fast as each person is unique and how the disease progresses will be different for each person.
Even if the result of the Differential Diagnosis is Alzheimer’s, where the loss of skills is not reversible, understanding the progression of Alzheimer’s can be beneficial to those supporting the person.
Armed with this understanding, the information collected and provided by the caregivers can help the entire team to:• track and understand the progression of the disease for the person they support• identify what additional supports or interventions may be needed now • plan for the supports or interventions that will be needed in the future
As a result, the health care providers and caregivers will be in a better position to assist the person in being able to continue to age in place for as long as possible; with the least amount of disruption and most opportunities for the best quality of life.
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If you recall from Albert’s story in Part 1, when he had his first geriatric assessment in 1996, he was not diagnosed with Alzheimer's but they did discover several conditions that were contributing to his decline and were able to treat him. For the next 15 years Albert was able to continue to be successful in his life and do many of the things he enjoyed.
However, in 2011, those supporting him began to observe some additional behavioral changes. He was not keeping up his appearance as he used to. He was reporting having seen his deceased mother and aunts.
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Albert also began to refuse to ride the bus to and from work, his sleep patterns changed and his wandering increased.
Before his health care professionals finally arrived at a differential diagnosis of Alzheimer’s, those supporting Albert ensured that they were able to identify the specific changes they were seeing, worked with the health care professional to consider other possible causes for these changes and provided this information at his health care appointments.
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In this webcast we have learned that Dementia Capable Care means being informed of the potential causes and impacts of dementia in order to provide quality supports and services.
Providing Dementia Capable Care includes recognizing when other diagnoses can mistakenly influence health care decisions. Diagnostic Overshadowing can be avoided by providing information to support a Differential Diagnosis that considers other potential causes for the changes seen, provides supportive treatments and services and helps to maintain the health and quality of life for the individuals we support ‐ like Albert.
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This concludes Part 2 of An Overview of Dementia Capable Care for People with Intellectual Disability.
Part 3, Health Care Advocacy can be found where you accessed this webcast.
Please be sure to complete all four parts of this series in order to receive a certificate of achievement.
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The primary content of this webcast was developed by and is the property of the National Task Group on Intellectual Disabilities & Dementia Practices (NTG). This content is copyrighted by the American Academy on Developmental Medicine Dentistry on behalf of the NTG and its use in this webcast is in compliance with NTG’s fair use standards.
The webcast was produced by the Pennsylvania Department of Human Services, Office of Developmental Programs in partnership with The Columbus Organization.
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