Caring for the patient –
through their eyes
Dr Chandini Sharma
Geriatriccenteroftulsa@gmail.com
The Story
Dementia friendly community
• Waterville WI
• The whole community is learning who to behave with members of
community who have dementia
• Patients too are not resistant or hesitant in their
acknowledgement.
• Businesses are learning, transport is learning
Humor and dementia
Spouse caregivers who had humor as a strategy to handle behaviors
and day to day activity were 18% less likely to have stress.
Humor and well-being in spouse caregivers of patients with Alzheimer's disease
DNSc, RN, CS Martha D. Buffum
Caregiver to wear a bracelet
Social Relationships and Mortality Risk: A Metaanalytic Review
50% increased likelihood of survival for
participants with stronger social
relationships
Julianne Holt-Lunstad, Timothy B. Smith, J. Bradley Layton, Department of Psychology,
Brigham Young University, Provo, Utah, United States of America
Socialization
Laughter is the best medicine
We have evidence
Successful aging?
Am I lying to the patient
Moderately advanced dementia patients are removed from reality.
Their world is different than ours
Meet them half way in their world
Since their reality is different its ok to fib, at times, to divert the
situation
Learn to forgive yourselves
STM vs LTM
• In their moderate stages they may not even remember what their
choices or preferences were…
Glass half full
The family and the patient always state how much function is
spared….
Hope for the best but prepare for the worst.
• Lowest score counts
• Structure
• Be the talking calender
Recognize the difference between Dementia
and Delirium…
Apathy and depression
Decision making capacity
Take advantage of the early stage to get person to address advance
directives
As also to elicit a roadmap of the future QOL issues
Try not to burden them with difficult decisions.
Confabulation confounds…..
Forget the word ‘Remember’
‘Felt like a fraud’
Caregivers, keep your communication
channels open
• Patient worries about how you are doing. So let them know you
are OK
• They also worry about being left by their caregivers.
Six sub stages of Caregiving
• Expectant caregiver
• Freshman caregiver
• Entrenched caregiver
• Pragmatic caregiver
• Transitioning caregiver
• Godspeed caregiver
When repeating, keep the sentence structure
the same.
Being sure of anything is so difficult
•
.
They feel they are being judged
What about self confidence
Second childhood
Geriatriccenteroftulsa@gmail.com
Choose Humor
For those who choose humor their patient does better
Laughter may be good medicine for elderly dementia patients -- and best of all, it doesn't have side effects.
Australian humor therapist Jean-Paul Bell was originally a clown doctor working with sick children, but now he
makes the elderly laugh through a program called Play-Up.
Bell was also the key humor therapist in a Sydney-based study into the impact of humor therapy on mood,
agitation, behavioral disturbances and social engagement in dementia patients, a study that showed those who
took part seemed happier.
"The whole idea behind the Play-Up program and what we're doing at the Arts Health Institute is encouraging
them to play more because we believe that they've got potential to keep playing right until you take your last
breath," Bell said.
He set up the Arts Health Institute to train aged-care staff in fostering playful relationships with their patients,
particularly those with dementia.
The study, called the SMILE study, took place over three years, involving 36 nursing homes and 400 residents.
Dressed in a bright blue jacket with brass buttons and shoulder tabs, Bell uses a combination of games, jokes
and songs -- accompanying himself on a ukulele -- to get the elderly to laugh.
In addition to seeming more content, the dementia patients involved in the study seemed less agitated by 20
percent, said lead researcher Lee-Fay Low at the University of New South Wale's School of Psychiatry.
"Twenty percent sounds like a small effect but it's about the same amount, the same effect as you would get if
you gave them an antipsychotic medication -- medication you would use to treat schizophrenia, bi-polar
disorder," Low said.
Talk outline
• It is a dyad
• Weave thru the patient and caregiver perspective
• Share some insights into the world of the dementia patient