Re-Imagining Dementia: A Well-Being...
Transcript of Re-Imagining Dementia: A Well-Being...
![Page 1: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/1.jpg)
Re-thinking Dementia:
A Well-Being ApproachG. Allen Power, MD
Leadership LTC Conference
9 November 2019
![Page 2: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/2.jpg)
Disclosure
The presenter has no affiliations
that would constitute a conflict
of interest for this presentation.
![Page 3: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/3.jpg)
Perspectives
‘The only true voyage of discovery . . .
would be not to visit strange lands, but to
possess other eyes, to behold the
universe through the eyes of another, of
a hundred others, to behold the hundred
universes that each of them beholds,
that each of them is . . .’
- Marcel Proust
![Page 4: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/4.jpg)
My Story…
![Page 5: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/5.jpg)
THE ‘BIG SECRET’:
Antipsychotic overuse is not a
long-term care problem!
![Page 6: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/6.jpg)
The Pill Paradigm
![Page 7: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/7.jpg)
The Biomedical Model of
Dementia
![Page 8: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/8.jpg)
Fallout from a Narrow Biomedical View
Looking to pills
for well-being
Stigma Disempowerment
“Dementia Care” ‘BPSD’
![Page 9: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/9.jpg)
Biggest Danger of Stigma →
Self-Fulfilling Prophecies
Kate Swaffer
![Page 10: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/10.jpg)
Old Thorazine Ad
How much have things really
changed since then??
![Page 11: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/11.jpg)
Do We Hold People Living with
Dementia to a Higher Emotional Standard than Ourselves??
You and I People with Dementia
Walk, explore, do our ‘steps’, get bored and leave
‘Wander’, ‘elope’, ‘exit-seek’
Get restless when forced into others’ rhythms
‘Sundown’
Shop in bulk ‘Hoard’
Get angry, sad, anxious or frustrated
Exhibit ‘challenging behaviours’
Don’t like being locked up, bossed around or touched by strangers
Are ‘resistive’, ‘agitated’, or ‘aggressive’
![Page 12: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/12.jpg)
The Problem with BPSD
Relegates people’s expressions to brain disease
Ignores relational, environmental, and historical factors
Pathologises normal expressions
Uses flawed systems of categorisation
Creates a slippery slope to drug use
Does not explain how drug use has been successfully
eliminated in many care homes
Misapplies psychiatric labels, such as psychosis, delusions
and hallucinations
Has led to inappropriate drug approvals in some countries
![Page 13: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/13.jpg)
Words and Actions May Represent…
Unmet needs / Challenges to well-being*
Sensory Challenges*
New communication pathways*
New methods of interpreting and problem solving*
Expressions of agency*
Response to physical or relational aspects of environment*
May be perfectly normal reactions, considering the circumstances!*
(*NO medication will help these!)
![Page 14: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/14.jpg)
Shifting ParadigmsHow would you respond if you were told:
‘Over 90% of people living with dementia will experience a
BPSD during the course of their illness.’
VS
‘Over 90% of people living will dementia will find
themselves in a situation in which their well-being is not
adequately supported.’
![Page 15: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/15.jpg)
A New Model
(Inspired by the ‘True Experts’…)
![Page 16: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/16.jpg)
A New Approach Rests upon
Three Pillars
‘Experiential model of dementia’
Well-being as a primary outcome
Transformation of the living/care environment
![Page 17: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/17.jpg)
A New Definition
‘Dementia is a shift in the way a person experiences the world around
her/him.’
![Page 18: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/18.jpg)
Where This ‘Road’ Leads…
![Page 19: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/19.jpg)
In Other Words:
Everything changes!
![Page 20: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/20.jpg)
A New Primary Goal:
Enhance Well-being
![Page 21: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/21.jpg)
One Framework for Viewing
Well-being
➢Identity ➢Connectedness➢Security➢Autonomy➢Meaning➢Growth➢Joy
‘The Eden Alternative Domains of Well-Being℠’
adapted by Power (2014)
![Page 22: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/22.jpg)
Advantages of Focusing on
Well-Being
![Page 23: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/23.jpg)
Helping Restore Well-Being for
People Living with Dementia
![Page 24: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/24.jpg)
So what does this have to do
with ‘culture change’??
Everything!!
![Page 25: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/25.jpg)
Why it matters…
No matter what new philosophy of care we
embrace, if you bring it into an institutional system,
the system will kill it, every time!
We need a pathway to operationalise the
philosophy—to ingrain it into the fabric of our daily
processes, policies and procedures.
That pathway is culture change.
![Page 26: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/26.jpg)
Transformational Models of Care
![Page 27: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/27.jpg)
Checking the CowsWhy ‘Nonpharmacological Interventions’
Don’t Work!!
![Page 28: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/28.jpg)
One’s own home can be an
institution…Stigma
Lack of education
Lack of community / financial support
Care partner stress and burnout
Inability to flex rhythms to meet individual needs
Social isolation
Overmedication in the home
![Page 29: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/29.jpg)
A well-being approach can be used for both:
Ongoing support and care
Decoding distress
![Page 30: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/30.jpg)
![Page 31: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/31.jpg)
Filling the ‘Well-Being’ Glasses
![Page 32: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/32.jpg)
The Key…
Turn your backs on the ‘behaviour,’
and find the ‘ramps’ to well-being!
![Page 33: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/33.jpg)
True Stories…
Angela Norman, NP
UAMS
![Page 34: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/34.jpg)
Arkansas Health Care Foundation
Pilot: Dr. Norman approached one provider and asked
for 4 homes struggling with antipsychotic use
Began to work with staff on enhancing well-being
domains for all elders proactively and then shifting
systems to support.
In 6 months, 3 out of 4 homes had a relative reduction
of their antipsychotic rate of >60%, and increased staff
satisfaction. All continue to improve, one now >90%
relative reduction.
Angela: ‘I believe this proactive approach is the key. It
has changed my practice!’
![Page 35: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/35.jpg)
Arkansas (cont.)
Dr. Norman’s team took the Well-Being
Approach to the 25 highest-prescribing homes in
the state.
In six months, antipsychotics were reduced by a
relative rate of 49% among these homes.
Team is supporting staff from ~100 homes across
the state: Almost NO Geri-psych transfers in over
6 months
Other states are asking Dr. Norman to come and
teach the approach
RIA/Power to formally study approach in 2020
![Page 36: Re-Imagining Dementia: A Well-Being Approachleadershipltc.providencehealthcare.org/sites/silver... · Re-thinking Dementia: A Well-Being Approach G. Allen Power, MD Leadership LTC](https://reader033.fdocuments.in/reader033/viewer/2022060214/5f0568617e708231d412d01a/html5/thumbnails/36.jpg)
Dr. Richard Taylor
‘People talk about person-centred care. But if the view of the person doesn't change, then centering on
them actually makes it worse.’