Keep it Flexible Restructuring Caregiving Approaches

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Keep it Flexible Restructuring Caregiving
Approaches

• Alexandra Morris
• March 2009

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Objectives

• Cognitive Changes in PWD
• Goals of Caregiving
• Roots of Caregiver Stress
• Caregiver Cognitive Restructuring
• Understanding Dynamics of Typical Dementia
  Related Behavior Challenges
• Dementia and Living in the Moment

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Dementia

• Global, progressive deterioration
• Memory
• Language
• Executive Functioning
• Behavior
• Visual/ Spatial

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PET ScansNormal AD
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Manage Behavior Help Person Remain Calm and in
Control
Manage Daily Life Keep Person Enjoyably Involved
The Main Work of the Caregiver
Manage Own Well-Being Caregiver Self-Care
Manage Resources -- Including Family Resources
for Care
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Roots of Caregiver Stress Burden

• Level of functional disability, cognitive
  impairment, and problem behaviors of PWD
• Lack of social support
• Lack of resources , respite, time
• Caregivers own ill-health
• Lack of caregiver skills
• Difficulty recognizing the effects of the disease
  and to accept the effects are real
• Activity

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Caregiver Cognitive Restructuring In Others
Words Letting Go
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If something is bothering you, move toward it
rather than away from it

• feelings like disappointment, embarrassment,
  irritation, resentment, anger, jealousy, and
  fear, instead of being bad news, are actually
  very clear moments that teach us where it is that
  were holding back. They teach us to perk up and
  lean in when we feel wed rather collapse and
  back away. Theyre like messengers that show us,
  with terrifying clarity, exactly where were
  stuck. This very moment is the perfect teacher,
  and, lucky for us, its with us wherever we are.
• Buddhist nun , Pema Chodron

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Letting Go of Unhelpful Thoughts

• Shoulding Yourself I should have known
  better. I should do more. I shouldnt get
  upset. Should statements can also be directed at
  others or external events. He should be able to
  do that. It shouldnt be this way.
• Black and White Thinking When things do not work
  out as well as you had hoped, think about the
  experience as a partial success (shades of grey)
  and learn from it.
• Identify the Distortion Write down your thoughts
  and look for distortions. i.e. All or nothing
  thinking, overgeneralization, labeling

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Cognitive Dissonance

• Letting go of PWD/ Staying Connected
• Taking care of PWD/ Taking Care of Self
• PWD is Gone/ But Not Gone

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Understanding Dynamics of Dementia Behavior

• Confusion
• PWD is responding to cues as they understand
  them.
• PWD is doing the very best that they can.

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Emotions

• Emotional reaction depends on perception
  understanding
• As confusion increases, emotions become more
  confused
• Emotional expressions are messages
• Difficult behaviors can come from difficulty
  expressing emotions

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Practical Examples

• Repetitive Questions. Who owns the problem?
• Other Than Health or Safety Issues
• Practice the So What Principle
• Bathing, Personal Grooming, I Wont Go
• Take Gentle but Firm Control

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Living in the Moment

• Wrinkles should merely indicate where the smiles
  have been.
• Mark Twain

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Sit beside me

• Life story example Talk about their interests
  in dog shows, baseball, reading the local
  newspaper or playing a hand of cards or game of
  dominos
• Sensory Hold hands or apply hand lotion
• Reminisce What was it like when you were growing
  up in New Orleans?
• Appreciate What is All Around You Nature, Music,
  Poetry

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• The Summer Day
• Who made the world?
• Who made the swan, and the black bear?
• Who made the grasshopper?
• This grasshopper, I mean
• this one who has flung herself out of the grass,
• the one who is eating sugar out of my hand,
• who is moving her jaws back and forth instead of
  up and down
• who is gazing around with her enormous
  complicated eyes.
• Now she lifts her pale forearms and thoroughly
  washes her face.
• Now she snaps her wings open, and floats away.
• I don't know exactly what a prayer is.
• I do know how to pay attention, how to fall down
• into the grass, how to kneel down in the grass,
• how to be idle and blessed, how to stroll through
  the fields,
• which is what I have been doing all day.
• Tell me, what else should I have done?
• Doesn't everything die at last, and too soon?
• Tell me, what is it you plan to do

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Never refuse to do a kindness unless the act
would work great injury to yourself, and never
refuse to take a drink- under any
circumstances.Mark Twain