Alzheimer's Disease & ADRD PDF

State of Florida Department of Elder Affairs
Statewide Education Webinar
Alzheimer’s Disease
and
Related Dementia Disorders
Alzheimer’s Community Care©
Training
Objectives
Improve understanding of Alzheimer’s Disease
and Related Disorders (ADRD)
Recognize the characteristics of Alzheimer’s
Disease (AD)
Understand how ADRD exposes people to abuse,
neglect, and exploitation (ANE)
Learn strategies for communicating with clients
who have ADRD
Normal Brain Anatomy

and
Information Processing
Affected by Alzheimer’s Disease
and Related Dementia Disorders
Alzheimer’s Community Care ©
Cerebrum
Cerebellum
Hippocampus
Brain Stem
Main Brain Areas
Affected by Alzheimer’s Disease
Normal Neurons
Billions of neurons
receive & transmit
special neurotransmitter
chemicals, electrical
impulses, and hormones
constantly.
Neurons are the

“working parts” in each
of the brain sections.
Normal human neurons transmit

signals across the microscopic space
existing between each of them
Neuron A dendrite
(finger)
Neurons process
impulses across the
Synapse space
between each.
Neuron B dendrite
(finger)
Normal Aging
Dementia
and
Normal Aging
and the Brain
Modest decline in the ability to learn new things.
Slight decline in the ability to retrieve information.

Perhaps some difficulty with complex tasks,
however if given enough time is able to complete .
Normal Aging Dementia

Aging is not a disease A group of symptoms
May involve temporary associated with a cause
forgetfulness but later recall Forgetfulness increases with
time: Later recall is rare
Retains ability to reason &
Loss of reason & problem
problem solve solving ability
May forget part of experience Forgets whole experience
but not whole experience Loss of ability to recognize
Recognizes dangerous/unsafe situations
dangerous/unsafe situations Difficulty with abstract
Retains ability to think thinking
abstractly Significant changes in
No significant change in personality, mood and
personality, mood or behavior behavior
Dementia
Decline of two or more cognitive functions of
sufficient severity to interfere with a person’s
daily living activities.
NOT a diagnosis, NOT a disease, NOT due to normal aging

IS a group of signs & symptoms that are
characteristic to each contributing disorder
Could be caused by a treatable condition

or a non- reversible condition
Top 10 Signs Of Dementia

Progressive short-term memory loss
Confusion of time & place
Difficulty with familiar tasks
Misplaced objects
Problems with abstract thinking
Poor judgment & problem solving ability
Lack of initiative & motivation
Personality changes
Mood changes, increased anxiety
Language difficulties
Common Treatable Causes of

Dementia Symptoms
Depression Electrolyte imbalance
Acute infections Acute alcohol abuse
Dehydration Carbon monoxide
Malnutrition Brain lesions
Endocrine imbalance Vitamin deficiencies
Glucose High/Low Toxins - environmental
Medications: contaminates in air,
Prescribed water, soil, housing,
Illegal and OTC tableware, food, toys,
Supplements paint, etc.
Common Non-reversible Causes of

Trauma
Dementia Symptoms
Closed/open head blows, subdural hematoma,
automobile, industrial, all sports, gunshots, etc
Chronic Infections & Diseases
Chronic renal disease, liver failure, severe coronary
artery disease, diabetes, Chronic lung diseases,
multiple sclerosis, cerebral arteritis, neurosyphilis,
sepsis, etc
Chronic Alcohol Abuse
At risk intake – regularly more than 6 drinks per day.
Drink = 1oz liquor or 1 beer or 3 oz wine
Common Non-reversible Causes of

Dementia Symptoms
Alzheimer’s Disease (50-75%)
Vascular Related Dementia (20%)
Lewy Body Disease (15-20%)
Frontal-Temporal Lobe (Pick’s) (10-20%)
Cruetzfeldt-Jacob Infection (Rare)
AIDS Complex (1%)
Parkinson’s Disease (End stage, if at all)
Related Dementia
Disorders and Diseases
Overview
Vascular Dementia
CVA or Stroke
Cerebral vascular attack
TIA or “Mini-strokes”
Transient ischemic attack
Carotid artery
Occlusion or spasm
Intra-cerebral hemorrhage
Aneurysm or blood vessel rupture
Brain tissue experiences lack of blood due to

interruption of flow in arteries and veins.
Alzheimer’sCommunity
Alzheimer’s CommunityCare
Care©
©
Warning Signs
Severe/sudden:
Arm or leg weakness
Facial/mouth drooping
Inability to speak
Loss of consciousness
Headache
Nausea/vomiting
Dizziness
Vascular Dementia
Resource: African-Americans and Alzheimer’s Disease—The Silent Epidemic, Alzheimer’s Association

Non-Controllable Issues: Manageable Issues:
Over 65 Years Old Daily & Traumatic Stress
Genetic History Diabetes
Family History of: Obesity
• Heart disease Smoking
• Cholesterol disorder New High Cholesterol
• Vascular disease New Heart Disease
New High blood pressure
Poor Nutrition
Lack of Activity
Vascular dementia affects African-American
people four times more than other groups.
Vascular Dementia
Strategies of Care
It is possible to reduce the risks by managing the
contributing problems.
Anti-coagulants
Low dose aspirin
Blood Pressure Control
Proper Diet
Adequate activity
Stress Reduction
Cognitive Exercises
Physical Therapy
Supportive Health Care
Cadasil Syndrome
(Genetic Vascular Dementia)
Onset 40-50 years old
Cause: Mutated Notch-3 gene
Major Early Symptoms: Migraine headaches,
mini-strokes (TIA)
Diagnosis: MRI, blood test, artery biopsy
Treatment: As for vascular dementia and
commonly with folic acid supplements
Lewy Body Disease

Cause: Abnormal inclusion in
neuron cells
6-8 years from diagnosis to
death
Major Symptoms
o Recurrent visual
hallucinations
o Agitation & aggression
o Depression
o Sleep disturbances
o Repeated falls
o Parkinson’s type symptoms
Lewy Body Disease

Strategies of Care:
Early physical therapy
Symptom medications
Treat depression
Diminish stimulus
Cognitive exercises
Assistive devices
Avoid antipsychotic medications if possible
Frontal-temporal Dementia
Cause: Deterioration of neurons in
frontal and temporal cerebrum
Life expectation 2-10 years after
diagnosis
Major symptoms
Personality change
Progressive nonfluent aphasia
Semantic dementia
Hyperorality
Movement problems
Frontal-temporal Dementia
Strategies of Care
Behavior management
Symptom medications
Symptom management
Validation therapy
Cognitive exercises
Communication devices
Alzheimer’s disease
is a degenerative,
ultimately fatal,
disorder in which
certain types of
nerve cells in
particular areas of
the brain deteriorate
and die for unknown
reasons.
Association website
Reference: Facts and Figures on Alzheimer’s
Basic Overview
Alzheimer’s Neuron Characteristics:
Tau Tangles
and
Beta Amyloid
Plaques
Neuron cells contain microtubules acting as the

neuron’s life support systems
Microtubules made of multiple protein ‘building
blocks’ and Tau protein ‘stabilizers’
Alzheimer’s disease = Large quantity of Tau ceases to
perform its task of stabilizing proteins in microtubules
Microtubules cease their function & disintegrate
Tau also tangles within the neuron causing further loss
of functioning
Neurons without microtubules or those with Tau
tangles, lose function & die
Amyloid Protein projects through cell membrane into

synapse space - like tiny receiving ‘antennas’
Alzheimer’s disease = An enzyme breaks apart this protein
in continuously escalating amounts
The beta-amyloid protein pieces now float into CSF; stick to
each other, and bind to abnormal places on neurons as
impenetrable plaque
Those neurons are now unable to function due to:
Lack of healthy amyloid precursor protein (‘antennas’)
Interference of normal neurotransmissions by plaques of
sticky beta-amyloid
Neuron dies
Microscopic amyloid protein

“antennas” project from neurons
into synapse space.
Neuron A dendrite
(finger)
Neurons process
impulses across the
Synapse space
between each
neuron.
Neuron B dendrite
(finger)
Alzheimer’s Community Care © courtesy of: WikiMedia
Drawing
Alzheimer’s Community Care © Drawing courtesy of: WikiMedia
Alzheimer’s Brain Changes

Neurofibrillary TAU TANGLES
and Beta-Amyloid PLAQUES cause:
Loss of connections with other brain cells
Amnesia
Aphasia
Agnosia
Apraxia
Neurons stop functioning
Neurons DIE
The Four A’s Of Alzheimer’s

• Partial or total • Impaired
inability to comprehension
recall past and/or expression
experiences, of verbal or
people, facts or nonverbal language
events.
AMNESIA APHASIA
AGNOSIA APRAXIA
• Inability to use • Inability to perform

one or more previously learned
senses to purposeful motor
identify skills
surroundings
Investigating The
Brain
Sometimes a lengthy sequence
of assessment,
re-assessment and
elimination of possibilities.
Current Assessment Techniques

Gerontologist or Dementia Trained Practitioner
Medical History Electrocardiogram

Common Blood tests: Electroencephalogram P300
Thyroid Brain SCANS:
Liver CAT
Kidney MRI
Vitamin B12 PET
Folate Complete Evaluation
HIV Medical
Syphilis Psychiatric
Neuropsychological
P.E.T. Scan Shows Brain Functioning

Glucose and blood
components are neuron fuel
Stimulated, healthy neurons
use MORE
Dead or damaged neurons
use LESS
PET scan uses colors to
show activity
Red is active, black shows
no activity
ADEAR (nia.nih.gov)
P.E.T. CURRENT RESEARCH

Present radiotracer compounds are very
short-lived and highlight all structures
Research compounds last much longer and
highlight ONLY Beta amyloid plaques
Compounds under human trials 2012:
Amyvid
Pittsburg Compound-B (PiB)
AV-45
The Stages
of
Many multiple stage models have been formulated.
This disease is frustrating and confusing enough,
therefore we use a simple……
Three Stage Model
(Plus One…!)
There is no cure.
There is no effective medical
treatment.
There is no proven prevention.
Therapeutic Care dependent upon
patient behavior/symptoms:
Safety
Cognitive Stimulation
Validation Therapy
Physical Care
Symptom Medications
Therapeutic Activities
“Prodromal” Stage
“before symptoms become evident”…..
Due to scientific research, it is believed

that a person’s own body may show
signs that they are at high risk of
developing Alzheimer’s disease long
before behaviors and symptoms are able
to be recognized by that person or those
closest to them.
Early Stage
May last for 2 years or longer
Deficits usually subtle at beginning
Symptoms may only be noticed by family
or patient
Patient can compensate for most deficits
and may continue to function
independently
In time, may deny or try to cover up
symptoms
Caregiver may ‘enable’ by cover-up
May not be a caregiver
Early Stage
Common Symptoms & Behaviors
Repetitive speech Poor judgment with
patterns money
Memory deficits Substitutes words
Date & time Abruptly stops speaking
disorientation Short attention span
Personality & mood Resists change
changes Won’t make decisions
Takes longer for routine Loss of interest
tasks
Hoards things of no value
Lost going to familiar
places
Early Stage
Caregiver Challenges
• Denial of patient behaviors
• Social stigma and shame
• Enabling / Protecting patient
• Fear of other’s reaction to disease
• Make excuses for patient
• Lack of information on disease
• Unaware of available resources
• Beginnings of anger & denial
• Safeguarding from exploitation
• Perhaps no caregiver
Middle Stage
Previous symptoms & behaviors now become
increasingly obvious and much more difficult to
overlook or hide.
The patient’s declining cognitive abilities, personality

changes and physical issues begin to produce
increasing need for, and dependence upon, others.
The majority of AD diagnoses

are made
when person has reached this stage.
Middle Stage
Continuously repeats stories, words, statements
or motions
Late afternoon restless, repetitive movements
Unable to organize thoughts or follow logic
Reading ability declines
May refuse to speak
Inappropriate financial & legal decisions
Forgets social manners
May accuse, threaten, curse, hit, bite, scream or
grab
Middle Stage
Sensory hallucinations:
Skin/tactile
Visual
Auditory
Makes continual accusing statements
Increasing fatigue
Difficulty/resistant to sitting & positioning
Inappropriate physical behavior
May have delusions
Middle Stage
Caregiver Challenges -
Include all of the early stage challenges, and:
Work through anger and denial
Feelings of loss, grieving
Increasing physical demands of caregiving
Decreasing financial reserves
Lack of companionship
Role reversal/redistribution
Feeling overwhelmed
Loss of freedom
Becoming the caregiver;
No longer a ‘wife, son, daughter, or friend’!
Late Stage
Total dependence on caregiver for
feeding, hydration, grooming, toileting,
positioning
May become confined to bed
May have muscle contractures
May be thin and very weak
However, patient can sense your presence
Late Stage
Unable to recognize Decreased nutritional &
self/close family fluid intake
Decreased, diminished Verbal/physical
& changed aggression
communication Incontinence
Makes gibberish Disorientation
sounds or ‘verbal salad’ Agitation or Lethargy
May not speak at all May cry out when moved
& touched in care
Instincts remain
Late Stage
Common Physical Signs
Increase in Infections Unable to stand

No communication Falls
Skin thins & tears easily Somnolence
Repetitious movements or Seizures
vocalizations Weight loss
Unable to coordinate any
muscle movement
Defective sensory responses
Late Stage
Additional Caregiver Challenges
Caregiver Fatigue
Touch/affection deprivation
Anticipatory Grief
“Shoulda/Coulda/Woulda Syndrome”
Depression
Guilt
Communicating
and
People with Alzheimer’s Disease
and Related Disorders
How People Communicate

Words/verbal
Body language
Gestures
Tone of voice
Facial expressions
Eye contact
Posture
Touch
Withdrawal
59
It’s not WHAT you say,

But HOW you say it.
How Communication is RECEIVED
WORDS VOICE TONE BODY LANGUAGE
0%
7%
38%
55%
93% of ANY communication is NOT VERBAL !!!

60
Effects of ADRD on
Patient’s Communication
Brain unable to process lengthy
sentences and concepts.
Unable to remember the right words
to express their feelings.
May substitute or actually make-up words to
describe familiar objects or people.
Totally forget what they were trying to relate.
Speak a verbal ‘salad’ of tones, vowels and words.
Express frustration or anxiety by cursing.
Negative behaviors, or using offensive words.
61
Effects of ADRD on
Patient’s Communication
Refuse to speak.
Rely on nonverbal, facial, and hand gestures.
Lack of either verbal or non-verbal
communication attempts or responses.
Revert to primary language
(which may not be English!).
Unable to comprehend written words or pictures.
Inability to physically write words.
Sensory perceptions become distorted
and/or diminished.
62
Communicating Verbally with
Early Stage ADRD Patient

Speak slowly Do not shout
Recognize telephone Avoid abstract concepts
issues: Utilize cues & reminders
Microphone interference Avoid pronouns
Sound delay
Do not interrupt
Normal auditory aging
Calm voice tone
Use positive terms
Phrase short statements
Describe concrete
to initiate action
actions
Keep it simple
63
ADRD General
Communication Techniques
Do NOT stare at client
Avoid overstimulation
Use simple gestures
Utilize picture boards
Allow time for brain to process information
Employ events to pinpoint event, not clock
Plan for when patient is most alert
Do not talk about patient as though not present
Background noise to minimum
Plan more time for everything
64
ADRD General
Communication
Techniques
Avoid surprise
One idea at a time
Call patient by name
Use low voice tone
Specific short questions (KISS)
Never argue or disagree
Use their primary language
Recognize patient instincts
Keep their eyes on you 65
Common Cause
of
Communication
Issues
The degeneration of the brain and its

functions brought on by Alzheimer’s
disease and related dementia disorders.
66
Wandering
Pacing
and
Exit Seeking Behavior
67
Wandering
or Becoming Lost
To the ADRD patient, they may be
performing a ‘normal’ activity -
something their damaged brain
felt within reason at the
beginning moment of the action -
but now their brain’s cognitive
deficits prevent them from
recognizing they are lost, or
being able to return to where they
began.
68
Alzheimer’sCommunity
Alzheimer’s CommunityCare
Care©
©
Wandering
60% of persons with dementia will become
separated from their home/caregivers at
some point during the disease process,
either by foot or in a vehicle.
(Ref: Alzheimer’s Association)
Pacing
A continual or ceaseless
ambulation/propelling
movement for which their
cognitive deficits prevent them
controlling or discontinuing.
Indoor
Outdoor
Nocturnal
“Sundowning Behavior”
Usually in middle stage AD
Can be in ‘mixed dementia’ diagnosis
Patient awareness influence
Patient’s internal clock – diurnal rhythm
Increase in activity
Afternoon
Nocturnal
Anxiety and frustration increases
Caregiver stress increases
Safety for both jeopardized
Exit-seeking Behavior
“Mission” to another place
May involve triggers
ADRD patient:
Watches exits & people using them
Seeks contact with exits
Touches handles, hinges repeatedly
Manipulates movable household objects
Moves about in patterns
Strength not required
Unexpected resourcefulness
Driving
People with ADRD should
NOT operate any vehicle.
Balance
Visual acuity
Reaction response
Hearing ability
Spatial perceptions
Executive functions:
Abstract thinking
Safety /Judgment
73
Florida’s
‘Silver Alert’
To aid local law enforcement agencies
in the rescue or recovery
of a missing person
who suffers from irreversible
deterioration
of intellectual faculties
and is driving a car.
74
74
Silver Alert
Call law enforcement immediately
There is NO required waiting period
Have recent, full-face photo of patient
available
Photo of or complete description of vehicle
Vehicle license number
Notify everyone on caregiver’s ‘emergency
plan’
ADRD Wandering, Pacing, Sundowning or

Exit-seeking Behaviors
Not a conscious choice
Client is unable to cease behavior
Instincts may contribute to behavior
Unexpected resourcefulness
Unable to recognize hazardous
situations/actions
Environmental triggers may influence
behavior
76
ADRD Wandering, Pacing Or Exit-seeking

Triggers
Medication reactions
Anxiety
Unmet needs
Stimulation of visual cues
Dehydration or toileting need
On a ‘mission’
Reacting to others
Do not want care offered
77
ADRD Wandering, Pacing Or Exit-seeking

Interventions
Secure the environment - NOW
Plan for the event to happen
Seek advance help commitment from neighbors,
friends, etc.
Always on the clients body:
• Identification
• Locator device
Remove Access to Vehicle
Determine triggers & remove
Utilize distraction
Provide toileting
Investigate pain or infection possibility
Reassess medications
78
Common
Cause of
Becoming
Lost

79
CAUSES OF UNSAFE WANDERING BEHAVIOR
Wandering is a safe and healthy behavior for many nursing home residents. For some
residents, wandering about the halls may reflect a need for exercise, activity, or to relieve
stress. Many residents wander seeking stimulation that is relevant to their past or interests.
Being mobile is a positive activity, for physical, mental, and emotional well being. Residents
should be encouraged to engage in these behaviors when it they are in the resident’s best
interests.
However, when this behavior causes or is likely to cause harm to the resident or other
residents, it becomes an unsafe behavior that the facility must address. When the wandering is
disruptive to other residents and has an impact on their quality of life, for example, when
residents enter the rooms of other residents or disrupt the belongings of other residents, the
facility must also intervene. In its most extreme form, wandering may result in elopement.
Unsafe wandering within the facility, and eloping from the nursing home, are both behaviors
that all nursing homes have a responsibility to prevent.
Unsafe wandering is wandering that is disruptive to other residents or places the

wandering resident or other residents at risk of harm.
Elopement occurs when a resident successfully leaves the nursing facility undetected
and unsupervised, and enters into harm’s way.
Residents attempt to elope from the facility for a variety of reasons that may not always be
immediately apparent. Factors that contribute to these actions include:
• agitation, anxiety, boredom, or stress;

• disorientation to surroundings;
• past patterns (leaving to go to work or meet the school bus); and
• links or associations (the individual seeing a door or their hat or coat).
Some literature suggests that elopements are especially pronounced during the first few weeks
after a resident’s initial placement in a nursing home because it is such a significant change in
the individual’s familiar environment. Monitoring the resident’s behavior during this time is
important.
Elopement is not an issue exclusively related to dementia residents. Cognitively intact

residents may also attempt to elope. The reasons for these residents seeking to leave the
facility are as complex as those of other residents and require specific interventions relating to
the cause.
Frequently, these residents are younger and may not be as physically compromised as others.
Frustration with the lack of other available discharge locations, boredom, and the perceived
lack of freedom and individuality often cause younger, cognitively intact residents to attempt to
elope from the facility. Other significant issues often related to younger residents are
substance abuse problems and noncompliance with facility rules and regulations.
2
Balancing the protection of residents and the preservation of resident rights presents some
unique challenges for facilities for all residents, perhaps more so for this type of resident.
Interventions to manage wandering behavior to prevent elopement and other at-risk behaviors
may be very different for this population of residents than for other residents of the facility.
Nursing facilities can, and should, address these resident-related issues. However, unsafe
behaviors, including elopement, have often resulted from a facility’s failure to address resident
issues, and from gaps in a facility’s program to identify and manage wandering behavior, and
to prevent unsafe behaviors, including elopement.
All residents need to remain involved in their community and are guaranteed this right as part
of both Federal and State regulations. Nursing facility systems must include strategies that
ensure resident safety, while respecting and supporting the rights of residents to be mobile, be
involved in their community, and maintain dignity.
The characteristics of systems that have proven to effectively achieve this goal are discussed
throughout the following section of this document.
3
KEY COMPONENTS OF AN EFFECTIVE SYSTEM TO ADDRESS
UNSAFE WANDERING
Systems that effectively identify and manage wandering behavior, that prevent and respond to
unsafe behaviors are multidimensional. They are flexible so that they can be administered to
meet the individual needs of each resident. However, these strategies are effective in four
critical areas: leadership, assessment/care planning, policies & procedures/staff training, and
environment.
Leadership
The governance body/owner(s) and senior leaders of a nursing home are responsible for the
ethics, vision, actions, and performance of the organization. Senior leaders are responsible to
the governance body/owner(s), residents, and families for their actions and performance. An
organization’s leaders, with support and guidance from governance bodies/owner(s), set the
tone, directions, and expectations for the facility to be a high-performing organization.
Common elements of high-performing and effective health care organizations are:
• The delivery of patient-focused care;

• A priority for organizational and personal learning;
• A focus on recognizing and valuing staff;
• Managing by fact and for innovation;
• A commitment to social responsibility; and
• A systems-based perspective focused on results, value, and quality improvement.
None of these elements can exist without visionary leaders who establish these concepts as
organizational priorities and devote appropriate resources to those activities. These elements
are key to implementing and maintaining an effective approach to managing wandering
behavior.
Leadership: Resident Elopement/Unsafe Wandering
Leaders ensure the creation of strategies, systems, and methods for achieving excellence in
all aspects of resident care. Nursing home leaders must maintain resident safety while
respecting a resident’s right to live life and make independent decisions. This is challenging
when addressing resident safety and wandering.
Leaders are responsible for identifying, creating and overseeing the implementation of all
organizational processes related to the management of wandering behaviors. The leadership
determines the culture and philosophy of a facility. If the leadership is committed to preventing
unsafe wandering and elopement, it must communicate that commitment to staff and
implement systems that are consistent with that commitment.
4
Effective leadership will engage all staff to determine possible solutions. The management of
wandering behavior is the responsibility of everyone working at the facility, including
housekeeping, dietary, and maintenance. Residents and families should also participate in
decisions.
Leaders must identify the need for, demand creation of, and oversee the implementation of
organizational processes that respond to every aspect of this issue.
The aforementioned elements drive an organization’s prevention of and response to an

elopement event. An effective response is ensured through the knowledge, education,
and practice of staff using the organization’s systems and processes.
Effective leadership impacts each of the other components of successful wandering behavior
management strategies. The principles identified in each category are critical to establishing
and supporting an organizational culture that respects resident rights, and serves to assure
and sustain quality of care and improvement of resident outcomes.
Leadership: Policies and Procedures/Staff Education & Training

• Leaders encourage staff to implement systems that maximize excellent care and services.
This is accomplished by adopting state-of-the-art procedures, innovations, evidence-based
approaches, and best practices.
• Leaders ensure that a resident safety program is implemented throughout the organization
to integrate the actions of all disciplines and departments.
• Leaders and their staff adhere to the established policies, procedures, regulatory, and legal
requirements of care for resident safety. To address unsafe wandering, these may include
resident assessment, management of behavior, defining “missing resident”, response
system which includes reporting, search, and rescue, and elopement drills.
• Leaders encourage creativity and accountability, support individuality, recognize good work
in their staff members, and provide proper supervision.
• Leaders facilitate the perspective that learning must be embedded in the daily operations of
the organization. This means that learning:
♦ Is a regular part of daily work;
♦ Is practiced at personal, departmental/work unit, and organizational levels;
♦ Results in solving problems at their source (“root cause”);
♦ Is focused on building and sharing knowledge throughout your organization; and
♦ Is driven by opportunities to effect significant, meaningful change. Sources for learning
include staff’s ideas, input, best practice sharing, and benchmarking.
5
• Leaders recognize and educate staff about the importance and value of a resident’s family
and social supports to creating a safe environment for a resident. This value is
demonstrated when the staff members learn about a resident’s personal history and
understand how it influences the resident’s current behavior. Together and with this
knowledge, staff and families can collaborate on care planning and implementation to
maintain a safe environment.
Leadership: Assessment/Care Planning

• Leaders assure appropriate and timely assessments for all residents; this includes
assessment of the risk of unsafe wandering and elopement behaviors.
• Leaders affirm the importance of person-centered care by establishing systems to ensure
that resident’s choices are elicited, valued, and met through care plans.
• Leaders identify and promote long-term investments associated with health care
excellence. Investment in creating and sustaining an assessment system focused on health
care outcomes is critical.
• Leaders emphasize the importance of each resident’s quality of life by meeting their need
for security and care, by supporting their personal growth, and by promoting their
intellectual and spiritual health and social well-being.
Leadership: Environment
• Leaders are responsible for creating a physical environment consistent with the
organization’s mission and with the goal of enhancing quality of life for each resident. In
short, this means creating a “home” for each resident.
• Leaders oversee the maintenance of safe, clean, and appealing surroundings that adhere to
codes of safety, public health, and local law. This includes operational details such as the
characteristics of the physical plant, interior and exterior environs, entrances, and the
reliance on technology.
Leadership: Quality Improvement

• Leaders teach a systems-approach to quality improvement by encouraging teamwork,
interdisciplinary collaboration, and reliance on proven quality improvement tools. A systems
perspective means managing your whole organization, as well as its components, to
achieve success.
• Leaders set performance improvement priorities and identify how the organization adjusts
priorities in response to unusual or urgent events. Success in today’s health care
environment also demands agility; a capacity for rapid change and flexibility.
• Leaders measure and assess the effectiveness of performance improvement and safety
activities. They emphasize the importance of teamwork and interdisciplinary practices that
utilize a continuous quality improvement methodology. Analysis entails using data to
determine trends, projections, and cause and effect that might not otherwise be evident.
6
As these principles suggest, effective leadership establishes a culture of care and systems that
balance resident individuality, respect, and dignity with high quality care and resident safety.
To prevent unsafe wandering behavior, leaders should establish the management of
wandering behavior as a priority and develop a system through the creation of policies and
procedures. This includes training staff on those policies and procedures to implement the
system, and ensuring ongoing competency of staff through continuous training, drills, and
evaluation. Those systems begin with resident assessment and care planning.
Assessment/Care Planning
All facilities are required to assess/reassess residents and develop care plans based on the
needs identified in the assessment. While the process may differ from facility to facility, the
outcome should be the same. That is, the facility shall ensure that all residents have a care
plan that fully addresses their specific needs assuring the highest quality of care and most
meaningful quality of life. In order for this to occur the care plan has to be individualized. As
much information about who the resident is, what their background is, their likes and dislikes,
and their patterns and routines should be determined.
Upon admission, each resident’s assessment should include an evaluation of the risk of
elopement and unsafe wandering. In the initial assessment when the facility may not be fully
familiar with the resident, the information pertaining to a resident’s risk may have to come from
family or from a prior provider. It is understandable that families may be reluctant to share
important information about the resident’s wandering or other behavioral issues if they sense
this information may be potentially threatening to the resident’s admission. This is unfortunate,
as the knowledge of this information is critical to the facility in developing a care plan.
It is important for the facility to gather, from whatever sources are available, information about
the resident’s past patterns and routines so that risk of unsafe wandering behavior can be
understood. Since unsafe wandering often occurs shortly after admission, a period in which the
resident is monitored to determine if this behavior is an issue is necessary. If the resident does
wander or attempt to elope, information about the patterns of the resident, time and place the
unsafe wandering occurs, and behaviors that precede the unsafe wandering can be identified
and used to modify the care plan as appropriate.
The following factors need to be considered as part of the assessment:

• Is the resident independently mobile?
• Is the resident cognitively intact?
• Does the resident have competent decision making capability?
• Does the resident wander?
• Does the resident have exit-seeking behavior?
• Is there a past history of unsafe wandering or exiting a home or facility without the
needed supervision?
• Does the resident accept their current residency in the facility?
7
• Does the resident verbalize a desire to leave?
• Has the resident asked questions about the facility’s rules about leaving the facility?
• Is there a special event/anniversary coming due that the resident normally would
attend?
• Is the resident exhibiting restlessness and/or agitation?
The care plan is developed based on the results of the assessment. All care plans should be
shared with the staff that is expected to carry them out. This is challenging, considering staff
changes, use of per diem staff, and changes in care plans resulting from resident improvement
or deterioration. However, in some of the Department of Health’s citations, staff’s lack of
knowledge of the resident’s risk status or care plan contributed to the unsafe behavior and
resulting harm. Had staff been aware of these factors, the adverse resident outcome could
have been avoided.
Facilities must have a dynamic care planning process that ensures that staff members
are aware of the resident needs as well as any changes made by the clinical team. While
staff training on the broad issues around unsafe wandering and elopement is important,
resident specific small-unit meetings may also provide more individual resident information that
the staff requires.
Care plans to manage wandering behavior should include activities that are relevant to
the resident’s interests and background. This will help address boredom or lack of
stimulation. It will also contribute to care for the resident at specific dates (anniversaries,
birthdays) that might be traumatic or cause anxiety in the resident. Accounting for resident
background will also help reduce or prevent unsafe behavior, such as keeping a resident who
was a school bus driver busy when the school year is about to begin.
They should also consider time of day. Studies demonstrate that unsafe wandering is more
likely to occur at four times in a day: after every meal and at the afternoon change of shift.
Therefore, care plans can reduce the risk of unsafe behaviors by incorporating planned
activities such as supervised walks or task oriented projects for the residents during these
times.
Any effective care plan -- whether a problem-oriented type or a resident-centered plan

developed from the resident’s perspective -- is interdisciplinary in nature. Developing and
implementing care plans for wandering behavior involves all disciplines and departments. In
addition, facilities should consider expanding the role of recreation to address causative factors
such as boredom, stress, and anxiety, which may be at the root of unsafe wandering for some
residents. As always, family should be involved as well.
8
Two keys to successful assessment and care planning are the establishment of policies and
procedures for these activities, and effective staff training on the policies and procedures.
These ensure a standard and uniform approach that will result in consistent and accurate risk
assessment, and the development of appropriate care plans that will be carried out with
knowledge of facility philosophy and individual resident circumstances. Establishing
appropriate policies and procedures and ensuring staff competency on them are critical to the
success of the wandering behavior management system.
9
Common ADRD
Patient Emotional Behaviors
Anxiety and Agitation
Combativeness and Aggression

Hallucination, Delusion, Paranoia
80
Anxiety…
Excessive, exaggerated concern/worry
Centered on everyday life events
Reasons may not be obvious to others
Child/adult with chronic disorder HAS anxiety
ADRD is a chronic disorder
Reference: NIMH, National Institute of Mental Health.gov
81
Agitation…
…… unpleasant state of extreme
emotional excitation, increased tension,
and/or irritability.
With the ADRD patient, agitation
behavior tends to be an expression of
unresolved anxiety.
Reference: NIMH, National Institute of Mental Health.gov
82
….physical or verbal behavior intended to

resist, dominate, withdraw from or deter
interactions
…. in ADRD person, commonly a
response to unresolved anxiety,
frustration, triggers or instincts.
Reference: Encyclopedia & Dictionary of Medicine, Nursing & allied Health, 7th Edition; Saunders
83
Common ADRD Emotional
Behaviors
Sudden mood change Yelling/screaming
Continuous verbalizing “Sundowning”
Twitching & wiggling Cursing & swearing
Nail biting/picking Increased pacing
Constant manipulation Continual rubbing of
or removal of clothing a body part
Hitting/kicking Throwing objects/food
Shredding Hiding
Grabbing objects or Trembling
people Biting & spitting
Restlessness 84
Common Triggers
Anxiety, Agitation, Combative & Aggressive Behaviors
Being surprised Medications

Feeling threatened Reacting to others
Loss of control Frustration
Sensory overload Infection
Loss/insecure feeling Pain/discomfort
Fatigue Sleep deprivation
Vision/hearing issues Early Stage: Knowledge
Balance problems that something is wrong !
Bullying
85
Hallucinations,
Delusions and
Paranoid Behaviors
Persons With ADRD
86
ADRD very different from Mental Illness
ADRD Mental Illness

Brain cells are in the Behaviors due to
process of dying or have transmission issue within
died, causing behaviors. their intact brain.
Person does not have the Most have the tissue
actual brain tissue capacity capacity to learn, and to
to learn anything, including control their behaviors.
control of their behaviors. Certain medications may
Specific medications may allow their intact brain to
act to modify brain cell function more normally by
functions for a short time, if acting on specific cells.
target neurons are alive.
87
Hallucinations
…..are sensory experiences that cannot be
verified by anyone other than the patient
experiencing them.
Any sense may be involved – auditory,
visual and tactile are most common.
Very real to person
More than one sense may be involved.
Person may sense things that are not
there while awake and conscious.
Resources: Healthline.com – Connect to Better Health 88
Understanding Difficult Behaviors, Thomas Bissonnette RN
Common ADRD Hallucination

Behaviors
Hearing voices or unidentifiable sounds
Feeling bugs, snakes, other creatures
crawling, burning or chewing on the skin
Seeing people, patterns, lights, strange
beings, or objects
Smell or taste hallucinations are rare in
the ADRD patient
89
Delusion
….. Is an unshakable belief in something
known to be untrue.
Beliefs defy normal reasoning
Person remains convinced even when
overwhelming proof is presented to dispute
beliefs
The false belief is not related to the person's
cultural or religious background or their level of
intelligence.
Belief is very real to person
Resources: Healthline.com – Connect to Better Health
90
Common ADRD Delusion
Behaviors
To the patient, these feelings are very REAL
No “trigger” is needed
The ADRD brain is not able to distinguish reality
from delusion due to dysfunctional or dead
neurons
Common statements by the person can indicate
feelings or beliefs that are: Persecutory,
Grandiose, Jealous, Erotomanic or Somantic
ADRD patient may demonstrate multiple types of
delusion behaviors
91
Common ADRD Delusion
Behaviors
PERSECUTORY – “The people who deliver my
meals-on-wheels put sedatives into my food.”
GRANDIOSE – “I am a big lottery winner.” or
“Have received a letter I won a car.”
JEALOUS – “My wife is having an affair with that
man and is leaving me.”
EROTOMANIC – “Dolly Parton is in love with me,
sends me emails every day and wants to have my
baby.”
SOMATIC – “I caught kidney failure from that lady
in the next bed.”
92
Paranoia
…. Is the feeling that a person, an alien,
an organization, a government or the
world is "out to get" them
Feels others are always talking about them when they
are not present
Causes intense feelings of distrust, agitation and can
sometimes lead to overt or covert hostility or
combative behavior
Resources: Healthline.com – Connect to Better Health

93
Common ADRD Paranoia
Behaviors
Suspicion – All others want to do them harm.
Self-referential Thinking - Everyone else is constantly
talking about them.
Thought Broadcasting - Others can understand what
is in their minds.
Thought Withdrawal - Others have stolen ideas from
their minds.
Thought Insertion - Others are putting ideas directly
into their minds.
Ideas of Reference - Media is speaking directly to
only them.
94
Common ADRD Triggers

Hallucination, Delusion, & Paranoia
Hearing/sight impairment
Strange environment & travel
Infection or dehydration
Pain or sensory stimulation
Past traumatic event(s)
Unfamiliar caregiver
Medications
Disease process itself – NO trigger needed
95
Useful Interventions
At First Onset:
INVESTIGATE THE CLAIM…!!!
Healthcare Provider Evaluation for:
Medication reactions
Infection
Prostate issues
Vision/Hearing
Pain/discomfort
96
Useful Interventions
After Initial Diagnosis:
Reduce sensory stimulation
Mask unsettling noises
Turn off TV
Remove children & noisy pets
Soothing music
Utilize Validation Techniques
Provide assurance of your help and presence
Do not try to reason with client
97
Validation Therapy
The basic principle of the therapy is the concept
of validation ……that the other's opinions are
acknowledged, respected, heard, and that they
are being treated with genuine respect rather
than marginalized or dismissed… (regardless
whether or not the listener actually agrees with
the content).
Resource: The Validation Breakthrough: Simple Techniques for

Communicating with People with 'Alzheimer's-Type Dementia; Naomi 98
Feil; Feil Publications
Validation Therapy
Used in Alzheimer’s disease and related
disorders treatment
Recognizes the brain is not intact or functional
Accepts that learning is not possible
Behaviors become evident as disease
progresses
Client unable to comprehend cause and effect
Promotes dignity for the client
Supports the instinct of trust in the caregiver
Not valid treatment for mental illness
99
Resource: The Validation Breakthrough: Simple Techniques for Communicating with People with 'Alzheimer's-Type Dementia; Naomi Feil; Feil Publications
Reality Orientation Therapy

Different than Validation
Used in mental illness treatment
Patterns the intact functional brain
Constant repetition
New desired behavior introduced as needed
Many parents utilize this therapy to raise their children
A “cause and effect” approach
Cause & Effect Approach not valid with ADRD

because the clients brain is dysfunctional or
dying.
Technique Comparison
REALITY ORIENTATION VALIDATION THERAPY
Continually oriented to present Non-confrontational care
reality Not argumentative/contradictory
Person, place, time & activity Works within the patient’s reality
Always addressed by name Caregiver a nurturing facilitator –
Reminded of others names not authoritative instructor
during interactions Patient has an empathetic
Utilized during all waking hours listener
Attempts to force an Accepts that patient cannot have
atmosphere of consistency insight into own behavior
Verbal is primary Non-verbal is significant
communication method communication method
101
Using Validation Therapy…..

If patient says they have lost something?
Help them to search for it. Supply a substitute.
If the patient indicates there is someone
watching them? Move them to another space.
Advise you will alert the authorities. Advise
there was just..(janitor, lawn service, etc).. In
that location.
Patient indicates there is something crawling
on them? Assist them to look at each body
part they feel is affected. Offer to help them
change position or clothing. Provide distraction.
102
Useful INITIAL Caregiver Actions For
INTENSE Patient Behaviors

Action: Rationale:
1) Remain calm 1) Patient can sense & react
to your emotions
2) Back away 2) Nonthreatening body
language
3) Do not restrain or 3) Instincts react negatively
‘corner’ patient
4) Do not argue/reason 4) Patient brain NOT capable

of understanding or
changing
103
INTENSE Patient Behaviors

Action: Rationale:
5) Assure your safety 5) Cannot help others if you
are unsafe
6) Request assistance 6) Do not try to improve
situations alone
7) Patient demonstrating
7) Assure other’s safety
unwanted behavior and
others
8) Utilize pillow as wedge
8) Visual and tactile safe
between people object
104
INTENSE ADRD Patient Behaviors

Action: Rationale:
9) Safely remove risky 9) Unsafe objects increase risk
items of injury
10) Plan for quiet space 10) Better atmosphere for
client calmness
11) Approach with your 11) Less threatening and less of
body presented a target
sideways
12) Place self at patient 12) Provides patient focus and
eye level is nonthreatening
105
INTENSE ADRD Patient Behaviors

Action: Rationale:
13) Keep patient eyes 13) Promotes client focus &
upon you stimulates recognition
14) Sing to patient 14) Stimulates new brain

activity & calms
15) Therapeutic 15) Plan for POSITIVE patient

“Creativity” response
106
Intense ADRD Patient Behaviors
16) The only instance in which any type of

physical force or intimidation should even be
considered with an ADRD patient is if there is -
immediate life-threatening
- danger to the patient or someone else.
Be prepared to utilize other common interventions

presented as the patient becomes calmer.
107
Primary Caregiver - 2012

Usually close in age to patient
Cultural & ethnic influences
Extended family issues
Body aging issues similar
Reaction & Protective feelings/behaviors:
anger – depression – loss – enable – deny - grieve
May experience own cognitive issues
Could be naive of need to protect from ANE
Possibly resistant to assist efforts/persons
Lack of Primary Caregiver - 2012

No family/friends immediate vicinity
Possibly family/friends out-of-town
Perhaps “under-the-radar” reclusive until an event
Reaction & Protective feelings/behaviors:
anger – depression – loss – withdrawal
May deny/be unaware own cognitive issues
Could be naive of need to protect from ANE
Possibly resistant to assist efforts/persons
May require guardianship process
Summary
When an untreatable disease/disorder causes
dementia symptoms, understanding the
capabilities & limitations of the person affected is
critical to being able to protect & assist them.
Their brain is no longer intact, and is unable to
function normally. The patient is now at increased
risk for all types of abuse, neglect and
exploitation – from self or others.
ADRD’s and their effects on people & our society
will increase greatly unless significant medical
treatment options are found.
Common
Cause Of
Undesirable
Behaviors

111
Thank you for attending this Webinar
Presentation Adapted From

State of Florida
Department of Elder Affairs
Approved Curricula
AD 270 and AD 271
113
OCTOBER 19, 2012
10 A.M. – 12 P.M.
THE 2012 STATEWIDE
Hosted by
the Florida Department & Related Dementias
of Elder Affairs
WEBINAR
HANDOUTS
Florida Department of Elder Affairs 2012 Statewide

Alzheimer’s Disease & Related Dementias Webinar
TABLE OF CONTENTS
Topic Page
Normal Brain Aging Vs. Not So Normal................................................ 2 - 3
Top 10 Signs Of Dementia.................................................................. 4
Dementia, Alzheimer’s And Related Diseases Overview..................... 5 - 6
The Four A's of Alzheimer's................................................................ 7
Staging Alzheimer’s Disease............................................................. 8 - 9
Communication And Alzheimer’s Disease......................................... 10 - 11
Pacing/Exit-Seeking/Sundowning Behaviors..................................... 12 - 13
Challenging Behaviors And Helpful Approaches.............................. 14 - 15
1
NORMAL BRAIN AGING vs. NOT SO
NORMAL….?
Normal brain aging is NOT a disease. As we approach our 40’s, all of our body systems begin to slow down
and the tissues lose some of their elasticity. We usually begin to notice things we ‘used’ to do so well. By the
time we are approaching our 60’s we may wish to have more spices in our foods, or need eyeglasses, or want
to wear socks to bed or call our daughter by our wife’s name. Normal brain aging!
Have you had temporary forgetfulness with later recall ability? You are 52, and cooking dinner for
the spouse coming home about 6pm. When you sit down to eat, you realize that you have forgotten to pop
the biscuits into the oven. You are busy talking with your golf partners and forget to write down the scores
from the last hole; but notice at the next tee, and can recall the scores. You can’t locate the exact row where
you parked the car at the mall until you think about it more and use the ‘button’ to make the alarm sound two
rows away. Normal brain aging!
NOT SO NORMAL…. Your golf partners have begun to take turns keeping score; teasing you about
talking too much or forgetting too often. Perhaps you’ve taken the can of biscuits out of the refrigerator and
later find them in the cupboard with the cereal; and similar things have occurred recently. You are searching
for your parked car at the mall, where you are sure you parked it outside the entrance to Macy’s – however
you parked outside of Sears – and this has happened a couple of times in the last few months.
The person retains the ability to reason & solve the problems of everyday living. You
remember that you need to get gas in the car. You remember how to get to the Publix store that is between
your home and your sisters.
NOT SO NORMAL…. The car has run out of gas 4 times this year while you were trying to go
somewhere, and you are surprised each time. You are driving to visit your sister, who lives 5 miles away, and
you forget where you were going – again this month.
Someone may forget part of an experience but not the whole experience. Your husband cannot
recall the names of the couple you met and went on a number of shore-trips with on a cruise taken for your
20th wedding anniversary last year. He does seem to remember most of the rest of the cruise details that you
remember. Normal brain aging! (Or perhaps, he does not choose to retain that information, unlike you?)
NOT SO NORMAL… You are telling your wife about speaking with her sister Pam, in Publix today about
her son’s wedding last week, and she asks you…’who is Pam again?’. You ask your husband if he would like to
go back to the Ale House for the lobster dinner special he liked so much last Friday, and he says – ‘We went
out to eat last week?’
People recognize dangerous and unsafe situations. You take the time to unplug the curling iron
before you leave the bathroom in the morning. You unplug the jig-saw before changing the blade.
NOT SO NORMAL…. You are in the garage putzing at cleaning the workbench, and hear the tea kettle
whistling away in the kitchen for longer than a minute. You did not put it on to boil. Your wife is sitting in the
living room looking out the window at the birdfeeder and says ‘the cardinal is not coming back’, when you ask
her if she hears the kettle whistling, she says ‘if you wanted some tea, why didn’t you tell me, I would have
made some for us’?
2
There is a modest decline in the ability to learn NEW things. Imagine the trauma of replacing your
cell phone, computer, electric range, dishwasher or clothes washer - and being forced to learn how to operate
a new model. It takes us longer, but we can become adept with the new equipment. Normal brain aging!
NOT SO NORMAL…. You downsized from a house to an apartment a year ago; when coming home
from Publix, you still find yourself turning down your ‘old’ street – and you get lost for long periods of time
getting to Publix.
A slight decline in the ability to retrieve information from our brain is expected. We hesitate &
take a bit longer to recall the name of the movie star in the movie we are watching on TV. But, we do
remember it in a few minutes. Normal brain aging!
NOT SO NORMAL… After living in the same house for 20 years, you have found yourself wondering
how to drive to the church on Sunday. Your husband says: ‘This is the fifth Sunday in a row that you have
asked me which way to turn to get to church. I knew I should have driven today.’
Perhaps some difficulty with complex tasks will emerge as we age. However, if given
adequate time we are able to complete the task. A good cook for 20 years, your husband can make
Sunday morning brunch better than anyone else, and does so for your domino-playing group once a month.
Eggs (any way), waffles, bacon, juice, pancakes, quiche, coffee, mimosa and many other items made up his
special brunches. But, sometimes you must make a last-minute trip to the store to get something he has
forgotten to pick up. Normal aging process!
NOT SO NORMAL…. Over the last year your husband has done things like: burned the oatmeal, served
nearly raw eggs, warmed up the grapefruit juice and served it in mugs, put dominos into the pancake batter
and dumped tea bags into the coffee maker. He laughs it off and tells you he is just overwhelmed at work
worrying about his retirement date coming up.
Alzheimer’s Community Care

www.alzcare.org
3
TOP 10 SIGNS OF DEMENTIA
What is DEMENTIA…???
Dementia is a group of signs & symptoms that are characteristic to the contributing disease or disorder
that causes them to appear. When two or more of a person’s cognitive functions have been impaired by that
disease or disorder to the point that the behaviors interfere with a person’s daily living activities, that person is
said to have – “dementia, due to _ _ _ _ _ _ _”.
Dementia is NOT due to normal aging, NOT a diagnosis, and NOT a disease. It could be caused by a
manageable condition, or caused by a non-reversible problem. The top ten signs of dementia listed below are
not arranged in any particular order.
Progressive short-term memory loss

Confusion of time & place
Difficulty with familiar tasks
Misplaced objects
Problems with abstract thinking
Poor judgment & problem solving ability
Lack of initiative & motivation
Personality changes
Mood changes, increased anxiety
Language difficulties
What do I need to know about DEMENTIA…???

Review each of the signs above and visualize the behaviors that someone would be exhibiting that
would demonstrate that sign of dementia. Now apply that behavior in the ordinary tasks we all need to
perform in our daily lives. Is it possible to exist alone, in safety & good health, for very long?
Imagine YOURSELF with these risks: Burning one’s self trying to cook, not being able to take prescribed
medications correctly, inability to clean one’s body, being abused physically or emotionally by someone else,
inability to recognize friends & family members, neglect from others, inability to distinguish between
toothpaste and hair cream, becoming lost in familiar places, exploitation, driving accidents, financial scams,
feeling constantly confused, inability to pay utility bills, sleeping or lethargy for days, inability to initiate
contact with friends & family, and so on.
Whatever the cause for dementia in a person, a team of dementia-specifically trained professionals
should evaluate and treat the disease or disorder with everything available to maintain the patient’s
functioning and dignity. The person suffering from the dementia symptoms requires access to services and
assistance to maintain their lives in a safe and healthy manner. Community services are available to people
suffering from dementia symptoms and provide the education needed to understand and help. Research in a
telephone book or on the internet, and newspaper can be very helpful. Contact local and state governmental
agencies, religious groups and others who can assist, or know where to find assistance.

www.alzcare.org
4
DEMENTIA, ALZHEIMER’S AND
RELATED DISEASES OVERVIEW
What is Dementia?
Dementia is the loss of at least two intellectual functions (such as thinking, remembering and reasoning)
severe enough to interfere with a person’s daily functioning. It is not a disease in itself, but rather a group of
symptoms that may accompany certain diseases or physical conditions. It is not a normal part of aging. The
cause and rate of progression of dementia symptoms vary. Conditions which may cause or mimic dementia
include depression, brain tumors, nutritional deficiencies, head injuries, hydrocephalus, infections (AIDS,
meningitis), drug reactions and thyroid problems. It is imperative that anyone experiencing memory deficits
or confusion undergo a thorough diagnostic work up. This requires examination by a physician experienced in
dementia-related issues, appropriate imaging procedures, and detailed laboratory testing. The examination
should include a reevaluation of all medications. The results of the total evaluation will determine the types of
care the patient needs!
Alzheimer’s is the most common of the dementia disorders. Alzheimer’s disease is a progressive,
degenerative disease that attacks the actual brain cells, and results in impaired memory, thinking and
behavior. Symptoms include gradual memory loss, decline in ability to perform routing tasks, disorientation in
time and space, impairment of judgment, personality change, difficulty in learning, and loss of language and
communication skills. As with all dementias, the rate of progression in Alzheimer’s patients varies from
person to person. From the onset of symptoms, the life span of an Alzheimer’s victim can range anywhere
from 8 to 20 years. The disease eventually leaves its victims unable to care for themselves. While a definite
diagnosis is possible only through the examination of brain tissue, usually done at autopsy, it is important for a
person suffering from any symptoms of dementia to undergo a thorough clinical examination. New tests,
including PET scan with enhanced radiotracers and laboratory tests on CSF (cerebrospinal fluid) may now
enable physicians to identify the probability earlier in the disease. Approximately 20% of suspected
Alzheimer’s cases prove to be a medical condition other than Alzheimer’s, and those are sometimes treatable.
Vascular Dementia
Vascular dementia is a deterioration of mental capabilities caused by multiple brain attacks (strokes or
infarcts). The onset of symptoms may be relatively sudden as many small strokes can occur before dementia
symptoms are actually noticed. These strokes may damage areas of the brain responsible for a specific
function as well as produce generalized symptoms of dementia. As a result, vascular dementia may appear
similar to Alzheimer’s. It is not reversible or curable, but recognition of an underlying condition (high blood
pressure, carotid artery stenosis, coronary artery disease) often leads to a specific treatment that may modify
the impairment. Vascular dementia is usually diagnosed through neurological examination and brain scanning
techniques. Computerized axial tomography (CAT scan) or magnetic resonance imaging (MRI) can identify
impaired areas in the brain. Ultrasound examinations of the carotid arteries and cardiac/cerebral arteriograms
are also useful.
Parkinson’s Disease
Parkinson’s disease is a progressive disorder of the central nervous system, which affects more than one
million Americans. Individuals with Parkinson’s lack the substance dopamine, which is important for control of
muscle activity. It is often characterized by tremors, stiffness in limbs and joints, speech impediments and
difficulty in initiating physical movement. Late in the course of the disease, some patients develop dementia.
5
Conversely, some Alzheimer’s patients develop symptoms of PD. Medications such as Levodopa, which
converts into dopamine once inside the brain, and Depreynl, which prevents degeneration of dopamine-
containing neurons, are used to improve diminished symptoms or reduce the physical motor system issues,
but do not correct the actual mental changes that occur.
Huntington’s Disease
Huntington’s disease is an inherited, degenerative brain disease. It affects the mind and then the body. The
disease symptoms usually begin during mid-life. Symptoms are characterized by sharp intellectual decline, and
spastic irregular and involuntary movements of the limbs or facial muscles. Other symptoms include
personality changes, memory disturbances, slurred speech, impaired judgment and psychiatric problems.
Diagnosis of Huntington’s includes an evaluation of family medical history, recognition of typical movement
disorders and CAT brain scanning. Genetic testing is currently available; a genetic marker linked to
Huntington’s has been identified on chromosome 4. There is no treatment available to stop the progression of
the disease, but the movement disorders and psychiatric symptoms may be helped by drug therapy.
Creutzfeldt-Jakob Disease
Creutzfeldt-Jakob disease is a rare, fatal brain infection caused by a transmissible organism, called a prion.
Early symptoms include failing memory, changes in behavior, and lack of coordination. The disease progresses
rapidly; mental deterioration becomes pronounced, involuntary movements (especially muscle jerks) appear,
and the patient may become blind, develop weakness in the arms or legs, and ultimately lapse into a coma.
Death is usually caused by other (pneumonia, urinary tract) infections in the bedridden, unconscious patient.
A definitive diagnosis is obtained through an examination of brain tissue, usually at autopsy.
Frontal Temporal Lobe (Picks Disease)

Picks disease is usually difficult to diagnose as it is often confused with having a psychosis. Eliminating the
other possible disorders can help focus on FTD. Disturbances in personality, behavior and orientation may
precede and initially be more severe than memory defects which is why it is often called “Alzheimer’s in
Reverse”. The patient may be well aware of their abnormal behaviors and develop severe depression. A
definitive diagnosis is usually obtained at autopsy.
Depression
Depression is a psychiatric disorder marked by continuing/severe sadness, inactivity, difficulty in thinking and
concentration, feelings of hopelessness, and sometimes - suicidal tendencies. Many severely depressed
patients will have some mental deficits including poor concentration and attention. When dementia and
depression are present together, intellectual deterioration may be exaggerated. Depression, whether present
alone, or in combination with dementia, can often be diminished with proper treatment.
Diffuse Lewy Body Disease

Diffuse Lewy Body disease is another degenerative brain disorder, and is tied with vascular disease as second
most common cause of dementia disorders. Lewy bodies are small round inclusions that are found within
neuron cells. These Lewy bodies are found in both Parkinson disease and Alzheimer’s disease. Symptoms
include cognitive impairments, fluctuations in level of alertness, visual hallucinations, severe motor defects,
reduced facial expression (immobile, mask-like face), shuffling gate, tremors, rigidity, unsteady gate and
balance. Falling is a major safety concern.

www.alzcare.org
6
7
STAGING ALZHEIMER’S DISEASE
Alzheimer’s disease is staged according to the manifestation of symptoms that mark the patient’s deteriorating
condition. The chart below indicates characteristic symptoms during the early, middle, and late stages of the disease.
Early Stage Middle Stage Late Stage

Memory Short-term memory loss Unawareness of all recent Total memory loss of
Difficulty remembering events recent and distant events
names, words, or thoughts Ability to recall distant Inability to recognize self
Misplacing familiar items, past intact in mirror
such as eyeglasses or keys PLUS: Any/all Early Stage PLUS: Any/all previous
Forgetting telephone symptoms symptoms
messages
Missing appointments
Getting lost on familiar trips
Language Decreased communication Continual use of repeated Significantly reduced

Unaffected speech words or phrases vocabulary
Reduced vocabulary Slowed speech with Inability to read
Difficulty in finding pauses and interruptions Need for repeated
appropriate words Inability to complete instructions/cues
Making irrelevancies sentences or continual Severely limited
Decreased verbal need to revise speech vocabulary (use of one or
communication PLUS: Any/all Early Stage two words) or inability to
symptoms speak
Repetition of words or
sentences without
understanding their
meaning
Total loss of
comprehension
PLUS: Any/all previous
symptoms
Mood and Mood swings Frequent mood swings Frequent agitation

Behavior Withdrawal or depression Increased self- Obliviousness to
Easy distractibility absorption/insensitivity others/environment
Need to seek out familiar Little display of warmth Inability to recognize
people and surroundings Need to pace or wander caregiver
Less initiation and Increased agitation, PLUS: Any/all previous
spontaneity suspicion, hallucinations, symptoms
Denial of forgetfulness and and delusions
confusion Sleep disturbances
PLUS: Any/all Early Stage
symptoms
8
Coordination Good control over Loss of coordination and Total inability to walk, sit,
and motor coordination and motor skills balance smile, or swallow
Skills Slowed reaction time Difficulty walking Possible stuporous or
Possible inability to perform Difficulty writing (often comatose condition
vital vehicle operation skills illegible) Inability to raise head
PLUS: Any/all Early Stage Inability to smile
symptoms PLUS: Any/all previous
symptoms
Cognitive Increasing difficulty handling Difficulty making decisions Little observable cognitive
Skills finances (such as paying Inability to perform simple function
bills, balancing checkbooks, arithmetic
or making change) Difficulty concentrating
Beginning difficulty Inability to follow a story
performing complex but Need for instructions to
familiar tasks (such as perform tasks
playing bridge or golf, video Poor judgment
games, cellphone) Loss of sense of time or
Inability to work place
symptoms
Self-care Ability to complete activities Need for assistance with Need for total assist in
of daily living with little or no deciding what to wear, performing activities of
assistance putting on clothing, daily living
Beginning of difficulties in bathing Possible total reliance on
prioritizing activities Fear of bathing others for care
appropriately Inability to remember the
bathroom’s location
Urinary and fecal
incontinence
symptoms

www.alzcare.org
9
COMMUNICATION and
ALZHEIMER’S DISEASE
Communication: Is the way information is shared or ideas exchanged. All plants and animals
communicate; within their own species and with other species. When a human conveys a message, they
expect a response. Verbal & non-verbal methods of communication are valid and important, especially for
humans.
The senses play a vital role in human communication. If sight or hearing are declining or defective our
ability to perceive our surroundings is adversely affected. When a patient with a dementia disorder also
suffers from sensory deficits, the combination can be overwhelming for them and trigger negative behaviors.
Summer months in Florida can be a time of increased need to be able to communicate effectively with
Alzheimer’s patients. Our patients very often have the instincts that warn of approaching storms, as well as
the reactions to their arthritis-affected joints and sinus’ telling them of weather changes. These indicators and
the frequent rain storms, with much thunder & lightening, can be very upsetting to our patients. Hurricane
and tropical storm events can be even more distressing for the patient (and the caregiver)! Many of them
simply do not have the brain neurons to be able to understand and cope with what they are feeling during
these events.
How Alzheimer’s Initially Interferes with the Patient’s Communication

Brain unable to process lengthy sentences and concepts.
Unable to remember the right words to express their feelings.
May substitute or actually make-up words to describe familiar objects or people.
Totally forget what they were trying to communicate.
Speak a verbal ‘salad’ of tones, vowels and words.
Express frustration or anxiety by cursing or using offensive words.
Speak less often.
Rely on nonverbal, facial, and hand gestures.
Lack of either verbal or non-verbal communication attempts or responses.
Revert to primary language (which may not be English!).
Unable to comprehend written words or pictures.
Inability to physically write words.
Sensory perceptions become distorted and/or diminished.
General Communication Tips

Treat the person as an adult. Although the patient with dementia may be confused, they deserve to be
treated with respect.
Modify the environment. Calm & quiet is best. Temperature comfortable? Lighting too bright?
Allow the patient to make those choices for which they are able. Maintain patient independence as
much as possible.
Simplify instructions. Short phrases. One direction at a time. Use their first name.
Do not expect the patient to be able to provide correct answers to detailed questions.
Never try to reason or argue with a patient. Their brain cannot change.
Be sensitive to picking up their feelings. Learn to read their gestures & behaviors for clues to their
feelings.
10
Steer clear of negative phrases. “Let’s go over here.” – not – “I have already told you that you can’t go
there.”
Provide encouragement & positive reinforcement. Imagine not knowing who or where you were.
Wouldn’t you need encouragement also?
Demonstrate patience. Give the patient time to respond to what you have communicated. Count to 10
slowly in your mind. If the patient has not indicated a response to your communication by then – you may
need to repeat it, only more precisely, with fewer words.
Do not scold or use sarcastic voice tones. The patient does not have the brain capacity to intentionally
make you frustrated. However, they may be able to use instinct to detect your true feelings and react to what
they perceive.
Avoid surprising the person. Approach from the front. Only speak after their eyes recognize your
presence, or you use gentle touch to contact them.
Be sure to hug, kiss and touch the patient as much as they can tolerate. Contact deprivation may
influence negative behaviors in the patient.
Establish a familiar routine/schedule. Schedules are your friend. They help both you & the patient to
feel focused and in control by accomplishing the tasks on it. Tasks not accomplished can be re-scheduled,
again & again!
Make the environment as positive as possible. Gloomy surroundings will be recognized instinctively by
the patient.
Reduce noise and overly bright light.
Play soothing music at a low volume.
Keep a nightlight on. If the shadows do not adversely affect the patient.
Use your face/body language as a reinforcement to verbal communication.
Keep patient’s favorite ‘calming’ items available. A doll, blanket, token, stuffed animal or cloth.
Sing to the patient. Any tune that is happy and not too fast in tempo. Lullaby’s, nursery rhymes show
tunes.
Sit down near to them. If they are seated on the floor, you should be too!
Promote a nap/rest period in place of the focus on stimulus.
Redirect patient to acceptable activity. Offer a favorite food (ice cream?) or activity (pet the dog?).
Telephone Communication Tips

If at all possible, avoid speaking on the telephone with a patient displaying dementia symptoms except
for short greetings.
Be aware of the time ‘lag’ in cell phone voice transmissions. Older ears don’t process cell phone
transmissions as acutely as younger ears, and adding dementia to that interaction really increases the
confusion in brain processing.
Important information should not be relayed to an Alzheimer’s patient via telephone.
The patient may not be able to connect a telephone conversation with making or keeping a future
appointment.

www.alzcare.org
11
PACING/EXIT-SEEKING/SUNDOWNING BEHAVIORS
Pacing can be defined as a continual or ceaseless ambulation/physical propelling movement for which
the brain’s cognitive deficits prevent the patient from discontinuing. Exit-seeking seems to involve a patient
in very resourceful and energetic actions to allow them to continue on a continuing important mission in
another place that their impaired brain perceives is very important. Patients with Frontal-Temporal Lobe
Disease are the dementia disorder patients that most commonly demonstrate pacing and exit-seeking
behaviors. Sundowning Syndrome is a condition in which agitation, increased activity and irritability may be
demonstrated by a patient during late afternoon hours and after the sun sets; many dementia disorder
patients experience this syndrome.
The patient does not choose to exhibit these behaviors, and their brain cannot learn to stop them. The
degeneration of the brain’s neurons is the cause of the behavior. Medications provided to reduce pacing/exit-
seeking may produce lethargy, impair their senses and increase the risk of falling – but cannot stop the
deteriorating brain from the need to cause the behavior.
Pacing is not always an undesirable behavior in the early stages of the disorder. In a safe environment
it can be a stimulating and therapeutic source of healthy, pleasurable activity, exercise, and entertainment
which can occupy the patient for hours at a time. Often, the physical exercise of pacing enhances the patient’s
ability to rest/sleep at night. The caloric intake needs of the patient must be balanced with their energy
output to maintain their optimal physical condition.
Indoors can be the safest type of pacing behavior for the patient. They could be walking in cyclical
patterns through the house/facility, or following a caregiver around as they perform their daily activities of
living. Setting up safety barriers and having alert staff tend to be a care routine in a facility; in the home, a
sole caregiver will need to be innovative, watchful, and obtain respite from 24/7 duties.
Safety outdoors can be challenging for all types of patient movements until all aspects of escape are
addressed. In south Florida, the outdoors contains many wonderful benefits and therapeutic values for the
patient and caregiver alike: stimulation, diversity, sunshine, fresh air, trees, pets, even quiet. Many facilities
have secure enclosed patio areas that these patients can enjoy; wander guard devices on the patient that
alarm if they are near an exit; and, areas of the building that are locked & require a code to enter. Making a
typical home nearly escape-proof is possible, but is a complicated, time-consuming and usually expensive task
for a caregiver who is already trying to cope with the other impacts of the disease on their family life.
Safety issues become even more complicated for nocturnal movement by the patient, and are very
challenging to address adequately. In a facility, care is taken to assure this patient does not awaken/bother
others who are trying to sleep. However, pacing the hallways is usually a quiet & solitary activity for these
patients – and staff should be on duty 24/7 to adequately supervise the patient.
Sundowning, however, presents behaviors of agitation & irritability that some medications may assist
to relieve in the patient. Dementia trained healthcare practioner’s can be of vital assistance in prescribing for
and monitoring such drugs. In the home setting, this nocturnal activity is especially disheartening to family
caregivers who are torn between their own vital need for rest/sleep, and the terrifying thought of the patient
being unsupervised at night.
Patients who display the behaviors of pacing, sundowning and exit-seeking are the primary reason that
family caregivers seek placement in long-term care facilities as they cannot effectively cope with these issues
for very long before the very real symptoms of physical fatigue, exhaustion and stress develop and impair their
caregiving and their own health.
12
SUCCESSFUL STRATEGIES
Never leave the patient unsupervised. This includes: at home, the doctor’s office, restaurant, grocery store,
house driveway, in a car, a facility without wander-guard systems, etc.
Identification - Make sure the patient has identification on them at all times. Laundry labels in clothing and
shoes; shoe tags; ID bracelet; electronic monitoring device; GPS type monitoring device; implanted electronic
chips; Safe Return jewelry; money belt with identification instead of money; flash drive bracelet and so on.
Distraction – Use conversation, food, favorite juice or a change in activity to redirect them.
Toileting – Always try this strategy. Many dementia disorder patients are not aware of their body’s signals to
‘go’. Most of them will respond if you take them to the right place & assist. If it has been 1-2 hours since they
were last toileted (or ate/drank something) – try it!
Medication Check – If a new drug (or changed dose) has been recently implemented, this could be a trigger
for the brain to exhibit a behavior. Consider all medications: over-the-counter, herbal, illegal and
supplements.
Intake – Is the patient hungry or thirsty? Offer favorites, not just anything available.
Environmental triggers – Reduce stimuli like loud music, the TV, vocal dog or children that might spark an
unwanted behavior.
Camouflage – Doors & windows that look like something else (bookshelf or wall) can be very effective
deterrents.
Locks – Simple slide bolts in high or low locations (many dementia disorder patients do not seem able to
recognize or reach these-check your patient first). Dutch door with locking handles. Key operated slide bolts.
Soft Alarms - Bells on clothing or doors; simple motion sensors; beaded doorway curtains.
Signs – Simple words or pictures/drawings can be effective in the early stage to identify particular items or
locations of things; perhaps to warn the patient away with a ‘STOP’ sign.
Walk with the Patient – The exercise could benefit both of you & allow memories to connect.
Safety Plan – Keep current photo and notations of height, weight, eye & hair color available. Tell neighbors &
friends of the patient’s diagnosis & behaviors; make sure they have your telephone number. Have essential
names & phone numbers of healthcare providers, friends & family.
Remove Cues – Essential errand/work items such as coats, hat, shoes, keys, purse, wallet and glasses that the
person will not go out without picking up. Don’t put them on the table by the door! Substitute a set of keys
that won’t operate anything.
Dementia Specific Respite – An adult day facility can provide appropriate stimulation, therapeutic activities,
nourishment and socialization for the patient – and relief time for the caregiver. Arranging for a week of
dementia-specific facility care for the patient could allow the caregiver to attend a significant family event or
have minor surgery or catch up on rest or……..!
Adapted from: The Complete Guide to Alzheimer’s Proofing Your Home by Mark L. Warner, Purdue
Publications
Providing good care for the dementia disorder patient does not mean that the caregiver must perform
each task themselves. It is vital to remember that other’s can often perform the tasks and allow the caregiver
to be able to have the time & energy to interact with the patient without the stress of believing they must be
responsible for and do everything themselves.
We provide a safety net around our patients and caregivers every day. ™

13
www.alzcare.org
CHALLENGING BEHAVIORS AND

HELPFUL APPROACHES
There are GENERAL GUIDELINES for working with patients who have dementia symptoms. These strategies are
not strictly specific for each of the behaviors with which they are listed. If one strategy does not work, try
something else until the patient is calmer and the unwanted behavior has stopped or been changed for the better.
Behavior/Response Definition Strategy
1. Exit Seeking/Wandering/Pacing Exit Seeking – continually distraction

trying to leave care safe area to pace
area/facility/building monitor fatigue
Pacing - movement with or NEVER leave patient unattended
without a purpose or goal identification on patient
disguise & lock exits
remove travel cues
locator device on patient
2. Rummaging/Pillaging/Hoarding searching, looking at, name on personal items
touching, holding, moving use “straightening up” as an activity
items from one place to replace one item with another
another set special areas or boxes for
retaining multiple items with rummaging/hoarding
or without purpose remove excess items periodically
do not question or argue
3. Anxiety/Agitation disturbed, troubled state of avoid frequent changes, crowds, or loud
fear, anger, in response to noises
stimulation; demonstrated by avoid anything that can be
inappropriate verbal, vocal, or overwhelming
physical activity remove person from the stressful
situation
speak quietly and validate
4. Catastrophic Reaction exaggerated or over-reaction anticipate stressors
to an incident; demonstrated use positive statements
by sudden mood change, distraction/diversion
uncontrolled crying, agitation, failure-free activities
restlessness, anger, with or respond to the emotion, not action
without violence use planned exercise to reduce stress
5. Combativeness/Aggression physical striking out (hitting, respond, distract (use singing) to avoid
pinching, biting, etc) due to further aggression
fear, anger, misinterpretations, move and speak slowly, remind them
or challenges who you are; do not threaten
develop a pre-planned system of
response
14
avoid restraints if possible
6. Sundowning increased behaviors (pacing, simplify approaches and environment

confusion, restlessness, encourage fluids until 7 pm
yelling, etc.) that occur mid-to schedule soothing bedtime ritual
late afternoon and evening; plan evening calm-down activity
possibly due to physical and provide security and protection
emotional exhaustion or evaluate medications, lighting
dehydration
7. Screaming, yelling, calling expressions of fear, or losing distract, divert (use music, sing)
control provide repetitive task (mating socks)
use touch, if appropriate
8. Repeated movements using hands or fingers to take distract, divert attention
apart or pull at things or engage in singing
hitting or wiping surfaces, or provide an object to hold (ball, stuffed
chewing, clapping, etc. animal, etc.)
box of varied tactile objects
9. Layering or removing clothes dressing/undressing of gently assist them to put on a robe or
clothes in inappropriate clothes
layers, places or times if in public, do not argue; distract &
cover significant body parts
substitute appropriate for inappropriate
clothing
10. Sexually explicit behavior inappropriate language, remain calm; don’t overreact, argue, or
public exposure, offensive scold
and/or misunderstood ignore language and behavior, distract
gestures or divert
assist to a private space
11. Demanding or accusing wants everything done use caring, calm voice
immediately or done for assist to find missing items
him/her; can’t remember use food or tasks to distract
where possessions are
12. Hallucinations & Delusions hallucinations: sensory check hearing, vision, hearing aids,
experiences (hearing, seeing, glasses
tasting, smelling, feeling) not modify environment to eliminate causes
experienced by anyone else; if harmless, let go and distract with
delusions: persistent tasks
incorrect beliefs (“You’re not remember that it is real to them
my daughter) don’t take it personally
13. Withdrawal & apathy sadness or depression to avoid problem situations
surroundings and people encourage positive situations
reassure them that you are there to help
do not force participation
gentle touch – if appropriate

15

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State of Florida Department of Elder Affairs

Statewide Education Webinar

Normal Brain Anatomy

Neurons are the

Normal human neurons transmit

Slight decline in the ability to retrieve information.

Normal Aging Dementia

NOT a diagnosis, NOT a disease, NOT due to normal aging

Could be caused by a treatable condition

Top 10 Signs Of Dementia

Common Treatable Causes of

Common Non-reversible Causes of

Common Non-reversible Causes of

Brain tissue experiences lack of blood due to

Resource: African-Americans and Alzheimer’s Disease—The Silent Epidemic, Alzheimer’s Association

Lewy Body Disease

Lewy Body Disease

Neuron cells contain microtubules acting as the

Amyloid Protein projects through cell membrane into

Microscopic amyloid protein

Alzheimer’s Brain Changes

The Four A’s Of Alzheimer’s

• Inability to use • Inability to perform

Current Assessment Techniques

Medical History Electrocardiogram

P.E.T. Scan Shows Brain Functioning

P.E.T. CURRENT RESEARCH

Due to scientific research, it is believed

The patient’s declining cognitive abilities, personality

The majority of AD diagnoses

Increase in Infections Unable to stand

How People Communicate

It’s not WHAT you say,

93% of ANY communication is NOT VERBAL !!!

Early Stage ADRD Patient

The degeneration of the brain and its

ADRD Wandering, Pacing, Sundowning or

ADRD Wandering, Pacing Or Exit-seeking

ADRD Wandering, Pacing Or Exit-seeking

The degeneration of the brain and its

Unsafe wandering is wandering that is disruptive to other residents or places the

• agitation, anxiety, boredom, or stress;

Elopement is not an issue exclusively related to dementia residents. Cognitively intact

Common elements of high-performing and effective health care organizations are:

• The delivery of patient-focused care;

Leadership: Resident Elopement/Unsafe Wandering

The aforementioned elements drive an organization’s prevention of and response to an

Leadership: Policies and Procedures/Staff Education & Training

Leadership: Assessment/Care Planning

Leadership: Quality Improvement

The following factors need to be considered as part of the assessment:

Any effective care plan -- whether a problem-oriented type or a resident-centered plan

Anxiety and Agitation

Combativeness and Aggression

Reference: NIMH, National Institute of Mental Health.gov

Reference: NIMH, National Institute of Mental Health.gov

….physical or verbal behavior intended to

Being surprised Medications

ADRD very different from Mental Illness

ADRD Mental Illness

Common ADRD Hallucination

Resources: Healthline.com – Connect to Better Health

Common ADRD Triggers