Reaching Beyond the Shadows

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Reaching Beyond the ShadowsAn Overview of
Dementia
10th Annual Michigan Traffic Safety Summit

• Macomb County Department Senior Citizen Services
• Presented by
• Karen D. Bisdorf
• Kathryn Ann W. Kozlinski

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Aging In America

• 1 in 10 Americans have a family member with a
  cognitive impairment
• 1 in 3 knows someone with dementia
• 2002 - 4.5 million 2010 - 5.1 million
• Census now 65/85 85/105 105/115
• 2030 the baby boomers will have turned 65
• 7.7 million persons will present with a
  dementia-related illness in the US

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What is Dementia?

• Dementia is an umbrella term
• The loss of mental function two or more areas
  of the brain Language, memory, judgement,
  personality, or visualspatial comprehension.Seve
  re enough to interfere with daily life.
• Damage causes the death/malfunction of brain
  cells.

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Dementia Related Illnesses

• Alzheimers Disease
• Lewy body dementia
• Vascular dementia
• Stroke - CVA
• Multi-infarct dementia
• Medication imbalance
• Alcohol/drugs
• Korsakoffs Syndrome

• Parkinsons Disease
• Tumors
• Head injury
• Nutritional
• Environmental
• If it affects the heartIt may affect the brain

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Prevalence of Dementia

• Ages
• 10 percent
• Over 65 years
• 45 per cent
• Over 85 years
• 60 percent
• 90 years and over

• Phases
• Beginning
• 3-5 years
• Middle
• 8-13 years
• Late
• 1-3 years

No cure insidious - progressive disease 2-21
years diagnosis to death 8-12 years hands on
caregiving needed
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Warning Signs

• Profound memory loss
• Misplacing things
• Abstract thinking
• Difficulty with routine tasks
• Change in mood behavior

• Language skills
• Loss of initiative
• Disorientation time/ place
• Poor or weak judgement
• Personality changes

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Circumstances in Which You May Encounter a Person
With Dementia

• False Reports
• Home Invasion
• Theft
• Misplaced items
• Shoplifting
• Victimization
• Scams, Schemes, Swindles
• Abuse Neglect
• Sexual Misconduct
• Indecent Exposure

• Driving
• Appearance of DUI
• Traffic Violations
• Traffic Accidents
• Erratic Driving
• Wandering 60 20
• Lost and Confused
• Walking Driving
• Endangered Adult
• Critical Incidence

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Macomb CountySenior Assessment Request

• Endangered adults
• False reports
• Victimization
• Abuse or neglect
• Unsupervised activities
• Community service referrals

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Communication Guidelines

• Approach from the front when possible
• Approach with respect
• maintain their dignity
• Introduce yourself
• call them by name if possible
• Maintain eye contact
• establish some type of rapport
• Speak in slow distinct tones

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Encounter Tools

• Look for physical and medical needs first
• Look for a medical alert or ID bracelet
• Pay close attention to mood emotion
• Easily redirected if not agitated
• Allow as much space as possible
• Avoid backing them into a corner
• Environmental noise bright light areconfusing

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Communication Tools

• Be clear about your expectations
• Project the feeling that you assume they can and
  will do what you ask of them
• Request their assistance
• Dont order or demand
• Dont push or pull
• Walk beside
• Direct with gestures
• Instructions one at a time

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Communication Tools

• This is a disease of emotions
• Control the emotional environment
• Maintain control-they will mimic you
• Dont argue
• There is no logic- they cant follow your
  reasoning
• Dont try reorientation to time place
• Find out where they are in time
• Work at that level
• Do not lie
• Ask them non-threatening questions

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Signs of Unsafe Driving

• Forgetting how to locate familiar places
• Failure to observe traffic signals
• Slow or poor decisions in driving
• Driving at inappropriate speeds
• Becoming angry or confused while driving
• Night blindness
• Being uncomfortable on the road

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Restricting a Driver

• Family doctor may write a do not drive
  prescription
• Family maintain control access to the car keys
• Disable the car - remove the distributor cap or
  battery
• Park the car on another block or in a neighbors
  driveway
• Discuss unsafe driving practices with insurance
  agent
• Encourage family members to keep a record of
  their observations to share with person, other
  family members and health care professionals

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Why Do People Wander

• Restless - Bored
• Confused about time and place
• Change in physical environment
• Over stimulated environment getting away
• Argument with caregiver
• Fear caused by delusions or hallucinations
• Medication side effects
• Sundowning a biological clock

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Endangered Person

• These persons are not missing
• They are endangered
• Time is of the essence
• Do they have an ID bracelet?
• Are they registered in the
• Alzheimers associations safe return program?

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Endangered Persons

• Wont knock on doors Wont flag you down
• They wont answer if you call their name
• They dont think they are lost
• They may not stand out in a crowd
• Will be drawn to water, ditches, culverts
• Will walk in the snow shoeless coatless
• Check the immediate area first
• Then go to old familiar places
• They wander on foot, by car, and by boat

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Survival Rates

• 50 chance to find them alive in the first 16
  hours
• That percentage drops by 10 each hour they are
  lost
• 46 of those found dead died of hypothermia or
  dehydration

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Safe Return Program

• SRP provides identification products
• ID bracelets/necklace /key chains
• 24 hour hotline
• Registration in National data base
• Access to law enforcement agencies
• Direct connect to nationwide Alzheimers
  Association offices

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Safety and Care Tips

• Impaired persons cant be left alone or
  unattended in waiting rooms, offices or vehicles
• Automatic car windows can be dangerous
• The person should sit next to the driver, not
  alone in the back seat of cars without
  protection locks

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Rapid Assessment Look, Listen and Test to
determine the risk

• Look
• Body Language
• Clenched fist, staring or hyper-vigilance,
  inappropriate facial expressions, posture, red
  face
• Psychomotor Activity
• Pacing, wringing hands, rapid breathing, clenched
  teeth, ballistic movements
• Physical Appearance
• Blank facial expressions, Inappropriate clothing,
  disheveled

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Rapid Assessment

• Listen
• Speech content
• What is the person talking about, who is the
  person talking to, are they responding to real
  people and events. Do they have a legitimate
  gripe.
• Speech organization
• Is the person fluent, does he/she jump from one
  topic to another, can he follow a conversation
• Test
• Receptivity
• Can you connect with the person, are they going
  to cooperate, do they react to their name, will
  they follow simple directions

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Good Judgement

• Rapid assessment is completed in a matter of
  moments and does not guarantee freedom from risk,
  or the potential for a catastrophic reaction
• Trust your gut
• Get a history when possible
• What medications are being taken
• History of child or spouse abuse
• History of violence during disputes

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Referral Resources

• Michigan Department of State
• Request for Driver Evaluation
• Form OC88
• Elder Referral-Request for Individual/Family
  Assessment
• Macomb County Senior Citizen Services
• Adult Abuse Hotline
• Adult Protective Services (APS)
• Request for Investigation
• 800.996.6228

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Information or Assistance
Macomb Co. Department of Senior Citizen
Services 586-469-6313 Macomb Co. Adult Day
Service Program 586-466-6817 or
586-469-5579 Alzheimer's Association -Greater
Michigan Chapter 800-621-0379 Alzheimers
Association 24/7 Helpline 800-337-3827 Alzheimer
s Safe Return Nationwide Program 888-572-8566
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Information or Assistance
State of Michigan Insurance Commission Traffic
Associations of Michigan Offer driving
assessments and safe driver classes Duke Family
Support Program, Durham, NC 800-672-4213 North
Carolina Division of Aging 919-733-0440
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Resources
At the Crossroads, A Guide to Alzheimers
Disease, Dementia and Driving Publication
105013 The Hartford, Hartford, CT. 06115 We Need
to Talk, Family Conversations with Older Drivers
Publication 105924 AARP /The Hartford Driving
for Life, A Guide for Older Drivers and their
Families Publication BBBB 000 Michigan
Secretary of Statewww.michigan.gov/sos
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Resources

• Alzheimers Association
• Safe Return Program
• Law Enforcement Official Training book
• Publication PF 203z
• Safe Return Video Law Enforcement
• Safe Return Program Applications
• English Chinese
• Korean Polish
• Russian Spanish
• Vietnamese

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Resources
Michigan Area Agencies on Aging Handout Michigan
Directors of Services to Aging Handout AARP
www.aarp.org AARP Life Answers
www.aarplifeanswers.com National Institute on
AgingP.O. Box 8250 Silver Springs, MD 20907-8250
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Comments
Questions? Concerns? Thank you for the
opportunity of speaking with you today