Paying Attention

A person with Alzheimer’s disease or other related forms of dementia experiences changes in his or her ability to pay attention to things. Attention is the process of focusing on a specific stimulus for a particular length of time.

• Selective attention is the ability to focus on a single stimulus or process at one time while ignoring irrelevant or distracting information.
• Sustained attention is the ability to focus attention over extended periods of time.
• Divided attention is the ability to focus on more than one stimulus or process at one time or the ability to attend to multiple stimuli at the same time.

Research suggests that attention is the first non-memory area to be affected by Alzheimer’s disease or other related forms of dementia, even before deficits in language or visuospatial functions (skills that enable us to visually perceive objects and the spatial relationships among objects).

Consider the person with Alzheimer’s disease or other related forms of dementia who you know. What difficulties with daily tasks that might be related to attention deficits may have occurred in early stages?

It appears that divided attention and aspects of selective attention are very vulnerable, while sustained attention is relatively preserved in the early stages of the disease. As a result, a person may be able to enjoy focusing on a jigsaw puzzle for an extended period of time in a quiet environment free from distractions, but an environment with significant amounts of noise, movement, or visual clutter will be over-stimulating and create difficulties locating a desired item, focusing on an activity, or remembering the sequence of tasks.

As a care partner, you’ll need to look for things that may cause distractions and try to limit or avoid those situations. For example, if you are going out to dinner with friends, choose an early time before the restaurant is full and ask for a table that is away from noise and traffic patterns. This will help the person with dementia focus on the conversation.

Creating cues or templates can also help a person focus, attend to, and complete a task. Think of a cue as a reminder, signal, or hint. Cues are part of the environment or material near the person that helps focus attention. Cues can be statements such as, “Take your medicine” or they can be symbols such as an X or an arrow pointing to where to begin reading.

Templates are guides that help someone complete a task. For example, a utensil tray in a drawer is a template. It has a cutout shape for each different piece of flatware, making it very clear where each piece should go. A common template used for a person with memory impairment is a placemat with an outline of the plate and each picture of a utensil printed on the placemat. This is something that can easily be easily be made at home and covered with contact paper. This type of template shows the person that there is a place for everything and allows him or her to independently set the table without having to rely on memory skills. The point of using cues and templates is to allow the person to rely less on the impaired memory system (declarative memory) and more on the spared or preserved memory (procedural memory).

Next time a person with dementia has difficulty focusing, try removing distracting objects and using cues or templates to help direct the focus to the task.

© 2014 Jennifer Brush, do not reprint or distribute without permission.

Noise Pollution

Individuals with dementia have difficulty filtering out irrelevant noise from the environment and focusing on relevant sounds pertinent to their communication partner. When noise bothers people with dementia it can cause them to become agitated and restless. Background noise hinders communication because it affects the ability of people with dementia to hear and focus on tasks requiring cognitive attention. It is particularly disturbing for those who wear hearing aids since these devices amplify background noise. Pay attention to both people-generated and environmental sources of noise. Some are easier to address than others. Noise common to long term care settings and hospitals includes other people, running water, cell phones, overhead pagers, and appliances such as televisions, radios, icemakers, heating and cooling systems, vacuum cleaners, and floor buffers.  These types of noise should be reduced or eliminated whenever possible to allow people to maximize their hearing.

Background noise can become especially problematic in the dining areas because people often raise the volume of their voices to compensate for high background noise (Lane & Tranel, 1971). The increased sound level from louder conversations adds to the background noise, which can cause conversation with dining companions to be extremely difficult (Lane & Tranel, 1971). Sound reverberates off all hard surfaces on the ceiling, walls, and floor, leading to higher levels of background noise. As a result, older adults, and particularly clients with dementia, will not hear as well in a room filled with hard surfaces.

Reducing noise reverberation will help reduce demands on the already impaired hearing and communication systems.
Here are some environmental modifications to reduce reverberation:

• Incorporate acoustic treatments, such as acoustic ceiling tiles and acoustic panels on walls, can help reduce background sound levels and make the dining experience more pleasant and successful. 
• If there are many windows, which is a hard surface that bounces noise instead of absorbing it, use full drapes or curtains around them. The folds of the fabric will help absorb some noise. Full drapery treatments have better acoustic benefits than just valances or vinyl blinds. If sound in the room is a significant problem, also consider using lined draperies. 
• Furniture and other movable items can reduce sound if they are soft or porous. 
• Introduce small hands-free personal communicators that replace overhead paging and cell phones, the noise generated by overhead pages can be significantly reduced.

Human ears can hear a wide range of sounds from a very quiet whisper to a loud jet engine. Any sound above 85 dB can cause hearing loss; 130 dB sound causes pain. Noise levels between 43 and 80 dB have been found to disrupt math abilities, problem-solving skills, and cause frustration in healthy adults (Hansell, 1984). The decibel (dB) is a logarithmic unit used to measure the relative intensity of sound. On the decibel scale, the smallest audible sound (near total silence) is 0 dB. A sound 10 times more powerful is 10 dB. A sound 100 times more powerful than near total silence is 20 dB. A sound 1,000 times more powerful than near total silence is 30 dB. Distance affects the intensity of sound. If a person is far away from a sound, the intensity or power is greatly diminished.

Here are some common sounds and their decibel ratings taken while standing near the sound source:

• Near total silence: 0 dB
• A whisper: 15–25 dB
• Quiet residence: 35 dB
• Light traffic at 10 feet: 55 dB
• Normal conversation: 60 dB
• Vacuum cleaner: 65 dB
• Lawnmower: 90 dB
• Car horn: 110 dB
• Rock concert or a jet engine: 120 dB
• Gunshot or firecracker: 140 dB

Remember to always consider the potential noise in an environment for people with dementia.  The quieter the environment, the easier it will be for people to communicate.
© 2014 Jennifer Brush, this may not be reprinted or distributed without permission

Welcome

 Welcome and thank you for visiting our blog.  This is our first entry.  We hope that you will stop by here regularly to read our thoughts about dementia care and share your comments and ideas with us.  We enjoy connecting with families, health care professionals, and people who are experiencing life with dementia. 

Kerry is a dementia coach who started working with people with dementia in 2002.  I have been excited about what people with dementia CAN do since the first day I started working with them!  Whether I was engaged with them cooking, doing kickboxing, putting together a play, writing for a newsletter or just plain having a fun time together.  This perspective is what motivated me to return to school for my masters expecting to run a nursing home one day.  I felt that would put me in a position to train others to see this other side of this population.  While my journey looked different, this is exactly my role everyday now!  My work carries me throughout all kinds of settings from assisted livings to hospitals, from hospice to convents!  Wherever large groups of people with dementia gather, I hope to be there with them! 


Along the way, I began to carve out time to work directly with families.  As a coach, I help to educate and encourage family members who are taking care of someone they love with this disease.  Writing I Care has been a tremendous help to families already.  Often, I would walk out of a meeting with a family and think, “I need to send them part of chapter 3”.  Jennifer and I have worked so well together and think the same way, making this work a real joy and a real encouragement to us. We are excited that I Care is available to professionals in the field and to families that in their homes! 


Jennifer is a speech-language pathologist who has worked with people with dementia for over 20 years.  At my very first job after graduate school I was very fortunate to have a mentor who taught me the importance of getting to know each client as a person with a rich history, likes, dislikes, interesting experiences, hobbies, children, tragedies, etc.  I learned to view the clients who came to me for speech therapy services not as a person with a disorder that needed to be fixed, but as a person with strengths who had many skills and interests.  Very quickly, I grew to look forward to hearing the stories of and spending time with my clients. 


Early in my career I became frustrated that health care professionals were not doing enough with and for people with dementia to help them be successful in their daily life. In many of the nursing homes where I worked, people with dementia were idle and staff complained that they exhibited “behaviors.”  I decided to focus on research that would help people with cognitive impairment learn new information and functioning more independently.  I have published many articles about this research and look forward to sharing what I have learned in future blogs.  I feel honored and privileged to have written I Care with Kerry so that we may share some of what we have learned with others. 


Our hope in writing  I Care is for you and your loved one with dementia is to have a fulfilling, loving, and nurturing relationship and to minimize any depression and stress you might feel when caring for someone you love. Every chapter has many useful and practical suggestions to help you feel empowered, rather than defeated, while dealing with the daily trials of dementia.


I Care will help you change how you think about dementia. If you change how you think about the condition, you will change your approach. Your attitude toward dementia and toward your loved one will have a huge impact on your perception and how the disease will affect your life.


Through years of experience working with people with Alzheimer’s disease and related dementias, we have learned what is necessary to prepare for the future while living in the present, how to make the most of your day, where to look for help when you need it, how to communicate effectively with someone with memory loss, and where to make changes in your home so it is safe. I Care clearly explains the essential information you need to be the best care partner you can be. As you gain more understanding regarding the unique needs of someone with dementia and initiate the strategies we suggest, your overall stress will lessen and your sense of being overwhelmed will diminish.


Although Alzheimer’s disease and other forms of dementia present daily challenges, we have confidence that this book will help you focus on the joys of what still is, rather than what is not. Despite the despair that many families speak of, we believe there is more to the story and therefore want to offer you hope. There will be days (hopefully many) when you will laugh; there will be days when you will be surprised by your own strength; there will be days when you learn new things about the person you have known for most of your life; there will be days when you realize your great love for this person; and there will be days when you will be acutely aware of his or her great love for you.


Despite how your relationship with dementia started, you now have the opportunity to enjoy what might arguably be some of your best days yet and some of the best days for your loved one as well!