Quiz Time!...Signs of Depression and Anxiety in Those Living with Dementia:-Often impossible to...

7/31/2020

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http://www.teepasnow.com/presentations

7/31/2020

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Recognizing Symptoms

of Anxiety and

Depression in Those

Living with Dementia


How common is depression

for people living with

dementia?


Poll #1:

Pre-COVID-19, about what percent of

people living with dementia (PLwD) have

significant clinical symptoms of

depression?

A. Less than 5%

B. About 10-15%

C. About 30-50%

D. About 75%

E. I don’t know

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Poll #1:

Pre-COVID-19, about what percent of

people living with dementia (PLwD) have

significant clinical symptoms of

depression?

A. Less than 5%

B. About 10-15%

C. About 30-50%

D. About 75%

E. I don’t know


How common is anxiety for

people living with dementia?


Poll #2:

Pre-COVID-19, about what percent of PLwD

have significant clinical symptoms of

anxiety?

A. About 10%

B. About 25%

C. About 50%

D. About 75%

E. I don’t know

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Poll #2:

Pre-COVID-19, about what percent of PLwD

have significant clinical symptoms of

anxiety?

A. About 10%

B. About 25%

C. About 50%

D. About 75%

E. I don’t know


How common are episodes

of anxiety for PLwD?


Poll #3:

What percent of PLwD have at least one-

two significant episodes of anxious or

depressed affect and behavior a month?

A. About 10%

B. About 25%

C. About 50%

D. About 75%

E. I don’t know

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Poll #3:

What percent of PLwD have at least one-

two significant episodes of anxious or

depressed affect and behavior a month?

A. About 10%

B. About 25%

C. About 50%

D. About 75%

E. I don’t know


Positron Emission Tomography (PET)

Alzheimers Disease Progression vs. Normal Brains

NormalEarly Loss

Late Loss

Normal

Child

Primitive

Brain

Primitive

Brain

G. Small, UCLA School of Medicine.


Best Practice When It Comes

to Engaging Distressed Brains

Build Your Self Awareness &

Observation Skills

Prepare Yourself

Support Change in a Positive

Direction … FOR ALL INVOLVED

Or at Least a Less Negative Place

Get Support for Yourself

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Scale of Emotional States –Distress Amygdala

Low – Amygdala

Active

Alert

Medium – Amygdala

Stressed

at Risk

High – Amygdala in

Control

Endangered

Irritated

Bothered

Angry

Frustrated

Furious

Enraged

Dissatisfied

Blue

Sad

Unhappy

Devastated

Hopeless

Missing ‘it’ – not

getting ‘it’

Missing

freedom/control

Lonely –

Disconnected

Confined/restricted

Abandoned –

Isolated

Imprisoned

Nervous

Anxious

Scared

Worried

Terrified

Panicked

Disengaged

Antsy

Bored

Roaming

Useless –

Purposeless

Frantic

Scale of Emotional States

Low –

Amygdala Active

Alert

Medium –

Amygdala Stressed

at Risk

High –

Amygdala in Control

Endangered

Irritated

Bothered

Angry

Frustrated

Furious

Enraged

Dissatisfied

Blue

Sad

Unhappy

Devastated

Hopeless

Missing some______

Missing

freedom/control

Lonely –

Disconnected

Confined/restricted

Abandoned – Isolated

Imprisoned

Nervous

Anxious

Scared

Worried

Terrified

Panicked

Disengaged

Antsy

Bored

Roaming

Useless –Purposeless

Frantic


How might the current

pandemic situation be

affecting the mental

health of those living

with dementia?

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Poll #4:

What are the current estimates for each of

these conditions for PLwD?

A. About the same

B. Slightly higher

C. About 25% higher

D. Close to 50-65% higher

E. I don’t know


Poll #4:

What are the current estimates for each of

these conditions for PLwD?

A. About the same

B. Slightly higher

C. About 25% higher

D. Close to 50-65% higher

E. I don’t know


Poll #5:

At this point in the Pandemic, about what

percent of PLwD have at least 1-2 episodes

of anxious or depressed affect or behavior

in a day?

A. About 25%

B. About 50%

C. Close to 75%

D. Probably close to 80-90%

E. I don’t know

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Poll #5:

At this point in the Pandemic, about what

percent of PLwD have at least 1-2 episodes

of anxious or depressed affect or behavior

in a day?

A. About 25%

B. About 50%

C. Close to 75%

D. Probably close to 80-90%

E. I don’t know


Is it Depression/Anxiety?

- Often impossible to distinguish/separate

depression and anxiety

- Depression/anxiety is treatable

- Many elders with depression describe

themselves as having ‘memory problems’

or having ‘somatic’ complaints

- Look for typical and atypical depression

- Look for changes in appetite, sleep, self-

care, pleasures, irritability, ‘can’t take

this’ comments, residence or schedule

changes


Depression/Anxiety:

- Onset: recent, weeks to months

- Duration: until treated or death

- Alertness and Arousal: not typically changed

- Orientation Responses: “I don’t know,” “I can’t

say,” “Why are you bothering me with this?”

or “I don’t care”

- Mood and Affect: flat, negative, sad, angry

- Causes: situational (i.e. pandemic), seasonal, or

chemical

- Treatment of Condition: meds, therapy, physical

activity

- Treatment of Behavior: schedule changes and

environmental support, combined with meds

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Signs of Depression and

Anxiety in Those Living with

Dementia:- Often impossible to distinguish and/or separate

depression and anxiety

- Depression/anxiety is treatable

- Many elders with depression describe themselves as having ‘memory problems’ or complain of pain, rather than ‘sadness’

- Look for typical and atypical depression

- Look for changes in appetite, sleep, self-care, pleasures, irritability, “I can’t take this” comments, schedule changes


Likely Profiles of

Depression/Anxiety in

Elderly:- Combination causes

- First episode in late life not uncommon

- Re-emergence of previous undiagnosed

depression

- Resistance to seeking help

- If situational depression not addressed, it

often escalates

- Depression = somatic pain complaints


At this point -

be ready for and expect

anxious or depressed

symptoms

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Assess and Offer Support

Each Time You Interact:

- Use your greeting to screen for affect

- Use empathy – acknowledge reactions

- Listen and try to figure out the meaning

of the message

- Explore – using “this or that” or “this or

something else options”

- Transition – redirect attention and action

to something, someone, some place


Accept, Acknowledge and

Respond to Signals of

Emotional Distress:

Irritated – Angry - Furious

Blue – Sad - Hopeless

Missing Someone – Lonely – Abandoned

Missing Freedom – Trapped - Imprisoned

Anxious – Scared - Terrified

Not engaged – Bored – Purposeless

Distracted - Antsy – Exit seeking


Start with “How are you?”

Use a visual cues and simplified

words/sounds

- Thumbs up

- Thumbs neutral

- Thumbs down

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Use Reflection to Confirm:

- Acknowledge messages

- Affirm you got the messages

- Consider what need is unmet or emotion

is being shared

- Consider a response…


Maybe an “I’m Sorry” might

help:- “I’m sorry, I disappointed you”

- “I’m sorry, this is making you feel…..”

- “I’m sorry this is happening, it shouldn’t

have happened”

- “I’m sorry this is so hard… I hate it for

both of us!”

- “I’m sorry I am trying to help, it’s not

working for you!”


Reducing the Risk by

Changing:

Patterns - Programming -

People - Places - Props

- Renew Cues

- Renew Rhythms

- Renew Expectations

- Renew You

- Try One Thing New

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For Improved Mental Health, People

Living with Dementia Need:- Daily Routine!!!!

- Help to fill their day with meaning

- A Balance of:

- Productive activity: feeling valued

- Leisure activity: having fun

- Self-care activity: wellness, health, personal care

- Restorative activity: sleep, rest, and re-energizing

- A Match-Up for Preferences:

- Large Group, Small Group, 1:1, Alone

- Active versus passive

- Sensory options: visual, auditory, tactile, olfactory,

gustatory


Communication and Connection

Strategies While Using PPE :

- Bring visual props and cueing items that can be left with

the person or properly sanitized

- Demonstrate with motions what you are trying to convey

- Move your body while in supportive stance to demonstrate

what you are wanting the person to do

- Break things down into short and simple pieces if the

person is not able to comprehend the messages

- Use an open-embrace, exciting posture to catch attention

and seek admission

- Slow your motions down and listen and look for a

reflection that indicates the person is getting what you

are offering, before moving on


Beliefs:

People living with dementia are doing the

best they can – COVID is making people

anxious and depressed!

Let’s accept, acknowledge, respond

Then help them transition onward!

Let’s dance with our partner

What we choose to do matters

We must be willing to change ourselves

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Be on the Lookout for

Delirium!- Delirium can be dangerous and deadly

- Get a good behavior history, look for change

- Assess for possible pain or discomfort

-Assess for infections

-Assess for med changes or side effects

-Assess for physiological issues: dehydration, blood chemistry, O2 sat

-Assess for emotional or spiritual pain


Delirium:

- Onset: sudden, hours to days

- Duration: short, can be either cured or leads

to death

- Alertness and Arousal: fluctuates, hyper or

hypo-arousal

- Orientation Responses: highly variable

- Mood and Affect: highly variable

- Causes: physiological, psychological

- Treatment of Condition: identify and treat what

is wrong

- Treatment of Behavior: manage for safety only,

it is short-term, so don’t mask symptoms


Likely Causes of Delirium in

Elders:

- Infection: COVID-19, UTI, URI, sepsis

- Dehydration

- Drug: effect, side effect , interactions,

sudden stop, mis-taking

- Sleep deprivation: poor sleep

- Oxygen deprivation or imbalance

- Pain or discomfort: including impaction

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Other Causes of Delirium:

- Sensory deprivation: vision, hearing, balance

- TIAs or little strokes in brain

- Alcohol use

- New Onset Illness: diabetes, hypothyroidism

- Nutritional Issues: intake or processing

problems

- Anesthesia: post-surgical


Meeting Needs Helps

Hydration and Nourishment –

balance what’s good for me with what I like

Create and use rhythms –

sleep arouse active rest arouse active rest

arouse active rest - sleep cycles

Support Elimination – help address & manage waste

Offer Comfort: 4Fs 4Ss

Pain reduction:

• Physical – body

• Emotional – relationships

• Spiritual – belonging/purpose


How Can We Help?

Communication and Connection

Strategies While Using PPE:

-Pause at door of room or more than six feet away

to make connection and communicate before

putting on mask

-Practice ‘smiling’ with your eyes and full body

rather than just your mouth

-Make sure you have gloves on and pulled over

sleeve cuffs before approaching to do Positive

Physical Approach/Hand-under-Hand

-Wear a covering (i.e. an apron or scrub jacket)

that has pockets to put things in, such as extra

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other applicable international, federal, state and local laws, with ALL rights reserved. No part of this may be copied, or

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express permission from Positive Approach to Care.

Copyright 2017, All Rights Reserved

Teepa Snow and Positive Approach to Care

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Quiz Time!...Signs of Depression and Anxiety in Those Living with Dementia:-Often impossible to...

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