Who was Maria Montessori?

In a few weeks I’ll be visiting Sydney, Australia to attend and teach at the Montessori Environments for Dementia International Conference. In the time leading up to the conference, I thought I would share with you some information about the Montessori philosophy and why it is successful for people who are living with dementia. 

  

“The environment must be rich in motives which lend interest to activity and invite the child to conduct his own experiences.”  Maria Montessori

 

Who was Maria Montessori?

 

Maria Montessori, acclaimed for her revolutionary educational methods, was born in 1870 in Italy. Having an immense thirst for knowledge from early childhood, Maria entered an all-boys technical school at the age of 13 and from there gained admittance to the University of Rome’s medical school.  After graduating in 1896, Maria became the first female doctor in Italy, paving the way and becoming a role model for women of all ages.

Specializing in pediatrics and rehabilitative medicine, Maria opened a childcare center in 1907. She designed learning materials and a classroom environment around the children’s natural desire to learn. She believed that education is a natural process carried out by the child and is not acquired by listening to words but by experiences in the environment.  Her school rapidly became a success and by 1910, Montessori schools were renowned worldwide. The “Montessori Method”, as it is now called, is used as a way to approach dementia care.

 

Tips for Better Communication

            For all of us, not just someone with dementia, the ability to communicate and express our needs is of utmost importance. In order for someone with dementia to have a good relationship with a care partner, healthy and frequent communication is a key ingredient. If your loved one with dementia begins to lose social skills, he or she might become more withdrawn or isolated. As the person without dementia, you are the one capable of understanding and changing your approach when it comes to communication. If your loved one with dementia is having increased difficulty communicating, capitalize on what skills remain to compensate for any lost abilities. Think about what has changed and what is preserved.

 

 

Below are some simple strategies to help encourage communication and connect with your loved one with dementia more effectively:

 

Always speak respectfully using adult language.  As a professional care partner, refrain from using childlike speech and always treat a person with dementia as an adult. There are other ways to convey affection without disparaging the person with dementia. Smile, address the person by name, and shake his or her hand instead.

 

Keep the pitch of your voice low.  Sometimes when a person doesn’t immediately understand, we have a habit of speaking louder to get our point across. Raising your voice only distorts speech and will more often than not upset the person being spoken to. To keep communication from getting difficult, speak in a warm, friendly manner.

 

Be aware of body and facial gestures and expressions. People with dementia pay attention to nonverbal messages of all kinds. Use these effectively to further encourage communication. The opposite is also true. As a care partner, pay attention to your partner’s body and facial gestures as well. Their nonverbal messages will communicate what they are not able to communicate verbally. In addition, eye to eye contact represents that their attention is focused on you.

 

Keep the conversation going. When speaking to someone with dementia, it is up to you to keep the conversation going. Introduce topics that he or she is familiar with or enjoys to talk about. Do not worry about their responses, just be happy to engage with them.

 

Do not ignore rambling. Remember that rambling speech is a form of communication too. Even if it seems like gibberish, listen for key words and pay attention to any form of nonverbal communication.

 

Avoid arguing, quizzing, or confronting. Having conversations that include these types of communication will often make the person angry or confused. Accept person with dementia’s values, beliefs, and reality. Doing so will reduce negative communication.

 

Use a prompt to get the conversation going. A prompt as simple as eye contact or saying the person’s name is an easy way to get their attention. When giving an instruction, be very specific and demonstrate exactly what you would like the person to do.

 

 

            By combining all of these strategies, your loved one with dementia will want to participate in conversations more and as a result be a happier individual.

 

© Jennifer Brush, may not be reprinted or distributed without permission

 

Good News about Medications for Dementia

                                          

I am pleased to introduce you to Rachel Wynn, MS CCC-SLP is speaker, writer, activist, and speech-language pathologist specializing in geriatric care. I invited her to share some of her thought about about medications and dementia.  She blogs at Gray Matter Therapy, which strives to provide information about geriatric care including functional treatment ideas, recent research, and ethical care. Find her on Facebook, Twitter, or hiking with her dog in Boulder, CO.

 

Let me just state my bias up front. In my personal life, I avoid taking medications. Rather than take pain reliever for a headache, I drink water. The headache is likely due to dehydration (which is common at high altitude) or sinus distress (and water thins mucous being produced). I avoid medications, but I am not anti-medications. In fact, I take a medication every day and will likely for the rest of my life, because my body requires it. Personally, I believe medications aren’t often necessary, especially as the first intervention.

 

As a speech-language pathologist, it is not within my scope of practice to give recommendations regarding medications. However, it is within my scope of practice to understand how medications affect the body, especially when there may be side effects impacting cognition or swallowing.

 
Medications but no therapy?

One of the things I have found quite concerning is meeting someone new to my care community and seeing the list of medications they are on. They may be on a cholinesterase inhibitor and antipsychotic medications for dementia, but they have never participated in any therapy (speech-language pathology, occupational therapy, or neuropsychology). This is concerning, because there are so many benefits to therapy throughout the course of dementia.

 

In the earlier stages, therapists develop individualized compensatory strategies and routines to help people maintain their independence as long as possible. In the middle to late stages of dementia, therapists work on changing the environment to increase a person’s independence and quality of life. These interventions don’t cure dementia (but neither do any of the current medications on the market); however, they are individualized to help improve quality of life, independence, and safety without side effects.

Antipsychotic medication effects in the elderly

Antipsychotic medications are not without side effects. Common side effects of antipsychotics in the elderly include [1]:

• anticholinergic reactions
• parkinsonian events
• tardive dyskinesia
• orthostatic hypotension
• cardiac conduction disturbances
• reduced bone mineral density
• sedation
• cognitive slowing

We rightfully spend great time and energy on fall prevention efforts. How many of those antipsychotic side effects would contribute to an increased risk for falls? Most of them. Besides falls, in people with dementia sedation and cognitive slowing would complicate matters. Yet, these are very common side effects.

 
CMS sets goal to move away from antipsychotics

Given my stance on medication, especially in the treatment of dementia, I was very pleased to see this press release from the Centers for Medicare & Medicaid Services [2]. The press release states the goal CMS set to reduce use of antipsychotic medications in nursing homes by 25% by the end of 2015 and 30% by the end of 2016. This is excellent news.

 

Want even better news? Patrick Conway, MD and CMS chief medical officer said, “In partnership with key stakeholders, we have set ambitious goals to reduce use of antipsychotics because there are - for many people with dementia - behavioral and other approaches to provide this care more effectively and safely.” (emphasis mine).

 

As an advocate for person-centered healthcare, Dr. Conway’s words make my heart happy. He said, “Ultimately, nursing homes should re-think their approach to dementia care, reconnect with the person and their families, and use a comprehensive team-based approach to provide care.”

 

Way to go CMS! Now let’s chat about how CMS reimburses for these therapy services that can achieve excellent results without the side effects of antipsychotic medications…

 

References:

1. Masand, P.S. (2000). Side effects of antipsychotics in the elderly. Journal of Clinical Dementia Care Exceeds Goal to Reduce Use of Antipsychotic Medications in Nursing Homes: CMS Announces New Goal. Newsroom Center. CMS.gov, 19 Sept. 2014. Web. 19 Sept. 2014.Psychiatry, 60(8), 43-49.
2. Centers for Medicare & Medicaid Services. National Partnership to Improve

 

 

I Care Wins Gold Medal!

I Care by Brush & Mills Wins Award

in 2014 National Mature Media Awards Program

 

I Care: A handbook for care partners of people with dementia was a gold medal winner in the 23rd annual National Mature Media Awards Program.

 

The program, presented by the Mature Market Resource Center, a national clearinghouse for the senior market is the largest of its kind.  The 23^rd annual National Mature Media Awards recognizes the nation’s finest marketing, communications, educational materials, and programs designed and produced for older adults.

 

I Care received a Gold Award in the category of Healthcare Book. The awards were created to annually recognize the best materials produced for those who are 50 and older, the nation’s fastest-growing population group.

 

“We were delighted to take part in the Mature Media Awards Program this year, and were

honored to be selected as a winner,” says Mills and Brush.

 

Gold, Silver, Bronze and Merit certificates were awarded in 29 categories. Categories included marketing communications, publications, educational/training programs, editorial and art/design. Entries included brochures, newsletters, magazine and newspaper articles, web-based and mobile resources, radio and television advertising, books, and annual reports. The winners were selected by a distinguished panel of judges from across the United States, which represent years of expertise working in the mature market.

Simple Tips for Care Partners - Ideas for Taking Care of YOU!

During difficult times, it can be hard to think about anything other than what’s going on, but try not to become so consumed by stress that you overshadow your needs for well-being. Try modifying schedule to include time to take care of yourself. Beginning today, carve out some free time for just for YOU. Even if your loved one with dementia only requires minimum assistance right now, schedule some time to do something that is important to you. Try to schedule time once a week, at a minimum, though most people will need more. No one should have less. Stay consistent for your sake, but more for the sake of your loved one with dementia.

 Pick a day and time each week. Hire a companion or ask a friend or family member to stay with the person while you go out and do something on your own. Make sure that time is spent doing things that will refresh you. Many care partners feel guilty for leaving the person at home while

they go out and visit with friends, attend a book group, or participate in a sport they enjoy. It is critical to realize that if you are not happy and healthy, you can never be an effective care partner. If you don’t take breaks for your enjoyment, you will experience resentment, anger, and fatigue.

Here are some ideas:

• Tap into your higher power. Spiritual practice provides a sense of inner peace, a feeling of being centered and calm. Make time every day, even if it is only five or ten minutes, to pray, read spiritual passages, sing your favorite hymn, or participate in a religious ritual that is meaningful to you.
• Meet a friend for coffee.
• Take a weekly exercise class.
• Join a book group.
• Get a haircut or a manicure.
• Take a walk in the park.
• Play with your grandchildren.
• Check out some books or take a free class at the library.
• Go to the movies.
• Attend church.
• Write in a journal.
• Talk with someone in person, by phone, or through the Internet.
• Don’t give up activities that are important to you.
• Eat nutritious meals.
• Get plenty of sleep.
• Participate in a sport you enjoy

Think Positive Thoughts

 Many people find that saying positive affirmations or mantras throughout the day helps reduce stress and fatigue. A mantra is a sound or words that are used to help create focus during meditation. Many people find repeating mantras to be a helpful stress-reduction technique, whether or not they meditate. Create your personal positive mantra or affirmation, and repeat it frequently. Research has shown that positive thoughts and emotions change the neurochemicals in the brain that affect our mental, physical, and spiritual health. Saying an affirmation an affirmation first thing in the morning starts you off in a positive mood and affects your decision-making for the day. If you forget to do this when you get out of bed, don’t worry; mantras are helpful in stressful situations too. An affirmation could help prevent you from lashing out at someone and bring you back to a calm state.

 Some mantras that others have found effective include:

• This too shall pass.
• Tomorrow is another day.
• With God, all things are possible.
• I will accept the things I cannot change.
• I will look for the good in every day.
• Life does not have to be perfect to be wonderful.
• I have much to celebrate.
• I believe I can be kinder to myself.
• My pace is perfect.
• I am in control of my thoughts.

I realize this is all easier said than done, but if you start today and gradually make a bit more time for yourself each week, you’ll be happier, healthier, and a much better care partner.

© 2014 Jennifer A Brush, may not be reprinted or distributed without permission

The Importance of Personalization in Long Term Care Communities

The Importance of Personalization in Long Term Care Communities

By Jennifer Brush, MA, CCC/SLP

An individual's possessions represent a lifetime of memories, achievements and activities. It is vital that new residents be allowed to bring some of their favorite and special items of furniture and belongings with them when moving into a residential setting. Care communities can recognize the importance of these belongings by not treating them as objects we allow residents to bring with them, but as part of the right to continue to create an environment that they find suitable and worth living in (Calkins, 1997). More and more care communities are implementing policies that not only allow, but encourage possessions to be moved in with residents including beds, furniture, art, and memorabilia. Personal items and decorations should be able to be stored and displayed both in bedrooms and common areas that are shared with other residents.



Personal possessions also aid staff on their journey of getting to know the residents, their tastes, family, and special memories of travel and a well lived life. This is even more important in the case of those suffering from communication difficulties such as dementia and expressive aphasia.  Often persons with communication impairment cannot tell their own life story, travel memorabilia and family photos can communicate, to some extent, about the past.



One of the key reasons for personalization of a person’s environment is to help them remember people, places and objects by compensating for deficits in declarative memory. Having familiar items around makes it feel like home and provides more distinctive spaces, providing orientation cues for all individuals. For example, one will recognize a favorite chair and be able to experience the joy of leaning against the much loved cushions in the sitting room, or sipping tea out of one’s own china cup can make a huge difference to someone’s feeling of well-being.



Displaying personal items in a lit glass display case next to the bedroom door can help residents find their room. The more significant the objects or the stronger the memory associated with the objects, the better these objects assist people with locating their room (Namazi, Rosner, and Rechlin 1991).  Some researchers have found that using a large photograph (8 by 10) of the person helped in locating their rooms (Nolan et al, 2002).



One option is to ask the resident’s family to bring a picture from home to hang on the bedroom door. It can be an earlier picture of the resident or a photo from a special occasion like a wedding. Often, a person will not recognize a current picture, but will recognize a favorite pet, childhood home, or other object such as a trophy or favorite knick-knack from home. Whatever items you decide to use for personalization and orientation, make sure you test for recognition by the resident.  Ask the person if he knows who or what is in the picture, if he likes the item, or if he would like to have it on his door. The person should always have a choice in how his room is decorated and what pictures are displayed.




So, take a walk down memory lane and gather some favorite bits of the past, personalization is a wonderful way for an individual to feel more connected with their new home and have better orientation in a different environment.  



(c) 2014 Jennifer A Brush.  May not reprint or distribute without permission

More Praise for I Care

Thank you to Martha Stettinius, author of Inside the Dementia Epidemic: A daughter's memoir, for her thoughtful review.

5.0 out of 5 stars Essential Reading -- The Best Description Available of Why It's Important to be a "Care Partner", July 1, 2014

By 

Martha Stettinius

This review is from: I Care: A Handbook for Care Partners of People with Dementia (Kindle Edition)

According to the authors, a "care partner" is someone who receives as well as gives care and affection. While care “giving” can seem one-sided (and never-ending), a care “partnership” is reciprocal and rewarding. "When someone helps care for someone else, we call him or her a caregiver. This is a natural title and one we all understand; however…this title implies that there is nothing left for the person with dementia to contribute.”

Too often we assume as caregivers that a person with dementia is “gone” or incompetent. A person living with dementia is still “here,” still capable of experiencing a full range of emotions, needs, likes and dislikes. They can usually continue to make some decisions in the early stages of dementia, and then, through the final stages of dementia, share love and affection, even if it’s just holding hands or offering a hug or a smile.

Care partners learn, over time, how to support their loved one as a whole human being, not as a dementia “patient.” Care partners also learn—and this is no small thing—to pay attention to their own needs, to care for themselves. The one-sided nature of care “giving” can encourage people to become martyrs and do too much, while care partnerships encourage people to balance their partners’ needs with their own.

“I Care” includes many well-written stories by people who see themselves as care partners. These anecdotes are some of the best parts of the book. One husband of a woman with Alzheimer’s, for example, writes that “dementia has not robbed” his wife “of her personality, and it has not robbed us of each other. We have simply become partners.” His explanation of how they became care partners is quite moving.

Elsewhere in the book Brush and Mills share excellent tips about how to communicate with a person with dementia, find meaningful activities, and encourage socialization. One of my favorite parts is a sample letter in which a care partner writes to her husband’s friends, reassuring them that they are still a vital part of her and her husband’s life, and encouraging them to continue to visit.

Much of the dementia care information in “I Care,” such as tips for making your home safer for a person with dementia, can be found in other guides, but the authors bring a certain hopefulness and lightness of spirit, and specific clinical observations of care partnerships, that make their book unique.

If you have been diagnosed with dementia, care for a person with dementia, or work with people with dementia, “I Care” is one of the best descriptions you will find of care partnerships, and essential reading.