Person-Centered Approaches to Care - Part 2

This is the Truth, Lies and Alzheimer's Show, brought to you by Global Media Network LLC and Passionate World Talk Radio. Passionate World Talk Radio is a wholly owned subsidiary of Global Media Network LLC, and our motto is to educate, enlighten, and entertain. I'm Ken Paulia, and I'm here to introduce our host Alzheimer's and dementia expert, bestselling author, and world-renowned public speaker Lisa Skinner. We've got a fantastic episode planned for you today. Lisa will be continuing her discussion of the person-centered approach to care concepts. Specifically, she'll be covering reminiscence therapy and life skills stations. And with that, I'm very excited to hand it back over to our host, Lisa Skinner.

Well, thanks so much, Ken. Hello, everybody. Thanks for tuning in to another episode of the Truth, Lies Alzheimer's Show. I am your host, Lisa Skinner, and I'd like to shout out a very warm welcome to all of you who have joined us again today for a new episode. I really appreciate you being here. I hope everybody has had a great week. And I've got some really valuable information for you again today. So if you remember, if you were tuning in to last week's episode, I introduced to you the concept of a person-centered approach to care. And basically what that means is it's a— care design that focuses on each individual person versus focusing on the disease. Because as I've mentioned before, everybody who develops Alzheimer's disease or one of the other brain diseases that causes dementia will experience the process differently. And that is why, as you will come to see, it is so important to focus on each individual person. So, I am going to talk about, on this week's show, reminiscence therapy. What is reminiscence therapy? Well, through reminiscence therapy using photographs, personal possessions with emotional connections, and much-loved songs, these can help trigger memories, memorable thoughts of the past for individuals living with dementia. For those folks, personal identity diminishes as memory, reasoning, and attention continue to slip away. Even as your loved ones become less aware of their surroundings and current events, reminiscence therapy enables them to hold onto long-term cherished memories. If you remember me explaining to you, especially with Alzheimer's disease, The short-term memory is what is damaged first in the brain. And that short-term memory switch, think of it like having a switch that flips on and flips off. Sometimes the short-term memory is on and the person suffering from Alzheimer's disease is thinking perfectly rationally and is very lucid. When that short-term memory switch flips off, they go back into a different period of time in their life. So, their personal identity diminishes. And other aspects of reminiscence therapy can include simple activities like conversations, sensory stimulation to help a loved one become aware of these memories that they once fondly held but are tucked away in that long-term memory bank. The ultimate goal of reminiscence therapy is to help a person with dementia reconnect them to their lives as well as help provide closure and the processing of certain life events. Because people with dementia often feel disconnected, reminiscence therapy will help them feel valued, connected, and heard, as well as help them become more engaged, and then they are more likely to open up. Another thing I described to you that commonly happens with people who suffer from dementia is they withdraw. So, reminiscence therapy clearly helps open them up and become engaged with you. Now reminiscing is not the same as asking someone to remember something from their past. Asking a person with dementia, "Do you remember such and such?" can be a stressful experience for them, especially if they feel pressured or put on the spot. However, if you're looking through old photographs, this may trigger a sudden and fond memory for them. And when a pleasant memory makes its way to the forefront of your loved one's mind and they share it with you, it feels really good to them. And you know what? That feeling lasts much longer than the memory that they just had. And what a great way to bring joy into the life of a person living with dementia. Now, memories can be associated with different parts of the brain, so it's always helpful to offer activities that stimulate the different senses. Here are some suggested reminiscence topics and activities that you can try with the person you're caring for or with your loved one when you're visiting. Talk about child— their childhood and holidays from their earlier life. The more you know about that, the more questions you can ask them or stories you can ask them to tell you. You can ask them favorite playground games or board games to improve memory. Now, we want to tap into all 5 senses. So, we can talk about foods and different smells, their likes and dislikes. You know, smell is actually a really great way to access memories. You can use scent cards or jars using spices or essential oils to remind a person with dementia of their favorite foods and places. For example. Also, making a meal that your loved one has loved through the years, like a special dish from a past holiday celebration, could help them recall the memories associated with that dish. For me, I— that makes me think about candied yams that my grandmother used to make for Thanksgiving. Thanksgiving and Christmas holidays with the yams and the marshmallows that were roasting on the top. And I to this day can smell that dish coming out of the oven and it just brings back the fondest memories for me. So, like everybody else, people relate past memories and fond memories with different smells of food. I know chocolate chip cookies are definitely one for the books. So, whatever you know was maybe a favorite food or drink, like mulled cider is always popular during the holidays, you could test out that and see if it stimulates some fond memories for your loved one. Some other Ideas are pets and animals. We call pet therapy. You can either use stuffed animals or you can use real animals. People often had pets in their younger years and love petting dogs and cats. You can talk about their family, their friends, and other relationships like Tell me about your wedding day and see if they remember that day and start telling you the story. Don't push them if they don't remember though. Their school days. Old photographs and family albums. Pictures or keepsakes that bring back memories are another excellent way to reminisce. Photos of families, friends, and important events are all wonderful choices. As well as photos of things that will remind your loved one of their favorite hobbies. Music is powerful. You can put together a playlist of favorite songs they enjoyed when they were younger, maybe in their teenage years or in their adult years. You can show them album covers and say, Oh, tell me this story. Just remember, try to refrain from saying, "Do you remember this?" Ask them in an open-ended way, "Tell me the story about this." Music for people with dementia helps people relate to emotions and past experiences. You can listen to your loved one's favorite songs with them. You can have Sing along or play music on simple instruments like ringing bells, tambourines, or even tapping on a drum. Activities involving touch like painting, pottery, crafts. Doing things like frosting cupcakes or cookies is really special. Bring in some already-made cupcakes. Have your loved one frost it, and then y'all get to eat the cupcakes or the cookies, and it is a memorable experience. You know, touch can remind someone of the past, including activities like drawing, painting, pottery, knitting, and sewing. And even if your loved one now finds it difficult to do the entire task, because maybe they're in the later stages of their dementia, still doing things like having them touch the paintbrushes, swirling watercolors together, and playing with fabrics can definitely evoke strong emotions. Some other topics you can talk about, especially with men, would be Sports cars, pop culture, especially from their younger years, beauty products, looking through magazines. And then you can also create memory boxes together. And what are memory boxes? Memory boxes contain personal objects from the person's past and can be used in several ways, like Triggering positive memories. Helping family members and friends stay connected to their life through conversation prompts that can provide insight into a person's life story. That's what that idea is all about, providing prompts that'll trigger insights and reconnect them to their lives. The idea is that these prompts may trigger a memory or a sense of identity, and that person then can share their thoughts and feelings as they arise. Again, open-ended questions work best as they are more likely to create discussion. Now let me tell you a real-life situational story from my book, Truth, Lies Alzheimer's: Its Secret Faces, that illustrates illustrates this very concept of reminiscence therapy. This story is a true story from my days of working with— in elder care, and I call this story "The Bedroom Litigator." Tom had only been in the memory care section of the assisted living facility for a short time. Prior to that, he had been living with his daughter after his Alzheimer's diagnosis. However, he had declined to the point where he needed full-time care. Every day since he was placed there, Tom was constantly irritated and anxious and was desperately looking for something. "What's wrong, Tom?" one of the caregivers asked him one day. "I can't find my dang office," he replied in a panicky voice. "Oh, honey, you don't have an office anymore. Just go back to the dining room with your friends." Tom, clearly agitated, snapped back at her and said, "Shut up. You don't know what you're talking about." Tom, you see, was obsessed with getting to work every weekday morning since he moved into that memory care unit. The staff tried everything they could think of to redirect his attention to something else, but nothing worked. He was dogged and determined, just as he had been during his career as one of Washington, D.C.'s top litigation attorneys. He was convinced that he was needed at his office. Well, the facility's memory care director, her name was Louise, had recently attended a conference on a new approach to treating neurotic behaviors associated with brain disease called reminiscence therapy, which is the recreation of a patient's personal environment as a scene or object that they would recognize from their past. So, with the help of Tom's family, Louise recreated a section of Tom's bedroom in the dementia unit to look like his office did from when he practiced law years earlier. Well, the experiment worked like a charm. Every day after breakfast, Tom would say, "Okay guys, I've got to get to work now." and he disappear into his office until the evening. Of course, the staff checked on him regularly and were pleased to see him working diligently at his desk. His family members also visited him regularly and were relieved to see him happy and no longer agitated. The reminiscence therapy completely changed his behavior. For those afflicted with brain disease, the mental and physical resources they relied on before has now robbed them of the ability to make the new transition. Reminiscence therapy definitely helps alleviate the uncertainty of shedding the skin of their former selves and provides a smoother transition into the next— and often final stage of their lives. Now, the story I just read to you called The Bedroom Litigator is a great example of common behaviors that can be triggered when a person's short-term memory is so diminished that they become disoriented to time and place and believe they are living in a different past period of their life. Just like Tom did. Now, his disease also led to personality changes such as irritability, anxiety, an obsession with an idea that wasn't real, as well as becoming easily angered and aggressive. The caregiver solution defused Tom's behaviors and allowed him to reengage with his surroundings in a calm and positive way. Tom's short-term memory was almost completely erased at this stage of his disease. There was absolutely nothing anyone could have done to convince him that he was now living in a dementia care facility and that he no longer had a career as an attorney or an office to go to every day. He believed that he did. And trying to change his reality would have been futile for his caregivers, and it would have continued to exacerbate the situation. With an overall prevalence of about 30%, agitation is the third most common neuropsychiatric symptom in dementia. After apathy and depression. Confusion is one of the leading causes of anger and aggression in Alzheimer's and dementia sufferers, as we heard in the story, The Bedroom Litigator. Confusion can be triggered by lost trains of thought, mixed-up memories, or a sudden change in the environment, such as a change from one caregiver to another, believe it or not. As we heard in Tom's story, treatments like reminiscence therapy help patients cope with the loss of their core selves. For Alzheimer's patients like Tom, the best thing we can do is to keep them safe, keep them engaged, and keep them comfortable in the last years of their lives. You see, it's our memories that keep us plugged into the work and play of our lives. What we do, and how we do it. It also allows us to understand how we fit into the social fabric because it's our memories that store the key habits, beliefs, and values that makes each one of us unique and vital. Now, unfortunately, dementia profoundly affects a person's ability to keep their world in order and therefore impacts their the way they live in that world and how they get along with other people in it. Most people become confused when situations go beyond the limits of their thinking ability, and as this— excuse me— and as this disease progresses, the mind's ability to avoid confusion declines because they lose the normal filters and protections that they once had when their brains were healthy. Success in Tom's story was about finding a creative way to join his reality. You remember I talked about that on last week's episode. And your loved one may have a different preoccupation than Tom had, but the lesson here is that with a little insight into what's driving the preoccupation and a little creative troubleshooting, You too can find a way to put your loved one at ease. For most people living with Alzheimer's disease, their recent memories are the first to fade away. By sharing memories from the past through reminiscence therapy, people with dementia can feel more positive and less stressed or agitated. Through basic activities and a little prompting, including asking simple questions, looking at photos, singing, playing songs, talking about a family anecdote, your loved one may be able to recall memories from their childhood and beyond. Reminiscing about these memories can definitely help people with dementia feel more confident and even a lot happier. So engaging with them in a conversation surrounding these memories can also help relieve boredom as well as feelings of loneliness, depression, and despair. Research has shown that reminiscence therapy can actually help with depression by focusing on the positive and rewarding aspects of their past and support uplifting thoughts. Now, I just want to mention one caveat to reminiscence therapy. You never know which memories might surface when reminiscing about the past. If an unhappy memory emerges through the conversation or through the play, prompts and cues that we've been talking about, just remember to respond with kindness and understanding to ensure that your loved one remains safe, calm, and at ease. If something negative does come up, use your judgment as to whether it's best to listen and offer support or to gently steer them towards a happier memory. So I think we are just about out of time for today's episode. So I'm going to introduce to you what life skill stations are on next week's episode, and I have a true life situational story to share with you at that time that reflects on a life skill station. Skill situation story. So with that, I'm going to turn the mic back over to Ken for some closing thoughts, and I will be right back.

Thank you for listening to The Truth Lies in Alzheimer's Show with your host Lisa Skinner. This program can be found on our website at passionateworldtalkradio.com under the shows tab. You can also search for us on YouTube, and if you're on Facebook, look up Lisa under Lisa Skinner Author. If you're interested in Lisa's books or training programs, you can find those at truthliesalzheimers.com, along with all major booksellers. And we especially recommend the audio version of Lisa's book, Truth, Lies Alzheimer's: Its Secret Faces. If you like to listen to books while you drive or exercise, that's a great choice. And with that, I'll turn it back over to Lisa to take us home.

Thanks, Ken. One last note, I can't emphasize enough how much I— it means to me for y'all to know that this show is about you and how my experiences, expertise, and These strategies will hopefully be able to help you and your loved one have an easier time while struggling through this disease. I know how difficult it is for everybody. Therefore, I would love it if you would send me your comments and suggestions on what topics you'd like me to cover on this weekly show. You can send them to my email at dementiawhisperer1@gmail.com. Also, if you're listening to this on YouTube or if you got here through our social media page, please leave your comments or questions, and I promise I'll do my best to address them. I will certainly look forward to receiving your thoughts and ideas, and in the meantime, I want to say Take care of you. Talk to y'all next week. Bye-bye.