Episode Transcript:
David: Hello everyone and welcome to our next episode of life conversations. I'm David Chandler and I'm joined by my cohost Christina chart ran, and we are very excited today to share about a little bit about Alzheimer's and we're gonna be recognizing World Alzheimer's Day on September 21st. And so for today, I am personally excited to learn from Christina. She is our Senior Helpers Expert on all things dementia. And as we were preparing for this episode, she is just such a wealth of knowledge on this topic. And she has a lot to share, so... Today we're gonna actually be doing like a little interview style where I'm gonna be asking Christina some questions about how to support our loved ones with that have this diagnosis. And Christina, you ready? We're gonna get ready. We're gonna dive in.
Christina: Yeah, I'm ready. I'm excited. Yeah, so we're talking about people with Alzheimer's and dementia and their living environment. And so we're going to talk about some different aspects around that to things that you can make changes and improvements in the home.
David: Absolutely. So our first question, Christina, is, do you change the environment, the home environment, based on what stage of dementia someone is in?
Christina: Well, the answer to that is yes, you do. And it's very interesting. So I'm gonna talk about kind of some different stages and some things that you wanna think about with you have a loved one with Alzheimer's or dementia. So the first thing is that if you have somebody in early stage dementia, you actually do not wanna change the environment at all. You want things to stay in its same place. You want, and what happens is, is because there's, memory loss and their short-term memory loss, but there's also that muscle memory that I like to talk about and those are things you kind of keep for a long time and that's kind of where the muscle memory comes in and What you're doing is you want to keep things in your routine in the same place. They're going to have a better day So if you have wherever you put coffee, you're going to put coffee back in that same spot wherever you put your dishes You're going to put that back at the same time toothpaste where are you going to put your pillows where you're going to put the pills that you need to take where you're going to put? The remote control to the TV because every time you move some of those is going to be really difficult for them to find them.
As the stage let's think about dementia as it progresses So as dementia progresses our frontal temporal lobe is going to be affected as well So I like to talk about just make it easy impulse control So thinking about when we think about impulse control, there's a couple things you want to think about. It's when you do something that you normally wouldn't do if you had full functionality. And so I like to think of things that are in the home that would be, could provide danger. So one of the things would be, for example, a step stool. I wouldn't want to have a step stool around because I wouldn't want them to use it to climb up to try to grab and to get something. I'm also going to think about things and let's just think about the kitchen environment.
I'm going to think about making sure that they understand hot and cold. And when you're not so sure anymore, you may want to control the temperature of hot. As time goes on, you may want to think about changing the stove, because if they're turning the stove off and not turning it on, or turning it on but not turning it off, that could be dangerous right there.
When you think of surface environment, so let's just think of the bathroom. I'm just giving you some quick different types of things to think about. When you have a lot of surface, let's just say all the same, let's say it's white, and you've got a lot of things that are white. So let's say like a washcloth and soap and toothpaste. And let's just say in the toothbrush, they're all white. Well, you want to, as dementia changes, your vision changes, and so you want to have contrast there.
So what I like to think about is less on the counter and just putting the thing that you want them to do with contrast. And contrast doesn't mean having to change the top of your sink. It actually could mean taking a washcloth that's the color blue and putting the white toothpaste as well as if you had a white toothbrush on top of it so they can see the contrast between the two. But less is more. That's when I find putting less things out for things that you want them to do.
Another thing that's interesting that comes up, and we talk about this in our life profile training, David, is things that look like something else. So for example, in the kitchen, let's just say you have a cleaning product, maybe like Draino, and that it's in a bright yellow or bright orange container, right? Which would look similar to something you would keep in your refrigerator, which would be like orange juice.
David: Orange juice.
Christina: Right, a juice product, right? And so what we're trying to do is, we don't want them to get confused between something that could be poisonous and hurtful to them. So what you also may wanna think about is eliminating things that could be miscontrued for something else. That's another piece to think about. Also as the disease progresses, so let's just say we're in kind of the mid to late stage dementia.
And what I actually do like to have is a lot of things that they can hold and carry. Because what you find in that stage are people want to manipulate and hold things. So maybe I would have containers of things such as, how about yarn balls, right? Yarn balls that you can pick a bunch of yarn balls up or towels that you could grab and you can carry and you can move things from one to the other. I would want to create an environment that has things for them to hold and carry too.
Because if not,they're going to be carrying all your other stuff around the place, but your socks, things like that to change. So, you know, there's so many things that I can talk about with the environment, with changing the environment. Um, but I think the big things that I always think about is one at first, keeping it the same, but later down the road, think about safety, right? Because safety is a really important thing. So things that we can change to keep that person safer. Safer. And then the third thing when I think about the environment is having things in the environment that are appealing and things to do, right? Things that they enjoy doing, things that they can find themselves, right? And that are safe for them.
David: Absolutely. One of the, one of the things you mentioned earlier that I hadn't thought about was really like with the water temperature, keeping that for seniors if they previously like really kept that water temperature up high, then going and adjusting that water heater so that way they're not going to scald themselves. So that was something that I took away from our conversation that was new for me that I hadn't really thought about before. So really great pointers.
Christina: Yeah. Having new items too. Like if, because as memory, when you lose memory, you're losing your newest memories first to your last memories many times, especially people with dementia. And so having a newer item in there, let's just say, you know, some type of fancy coffee pot that's only been in that house for six months, they're really not gonna understand how to use it. So what we find is really having things that they've had there for a long period of time, they're gonna better understanding of how to use it.
David: Yeah, those are great tips. How about any suggestions around sundowning? I know that this is something that I experienced often being in memory care, even sometimes in assisted living, that a lot of our residents had symptoms or experiences around sundowning. Do you have any tips for us around that? And what is sundowning?
Christina: I do. It's a phenomenon. It honestly is. And with brain change. And for many times, as what happens is when the sun begins to fade and it starts turning to night, what you find is a lot of behaviors that people have such as wandering, getting agitated, getting scared about something, nervous. And so what we're trying to do is alleviate some of that and why that happens. So there's a couple things I want you to think about. The first thing I like to talk about is think about maybe some of the reasons why somebody might get agitated during that time of the day. As the sun is fading, and if we've got a window, a glass window, is that there is a point towards when the day is, sun is fading, is you can actually see your reflection in.
You can actually see your reflection in the window. And why I bring that up is because if you are in mid-stage dementia or even mid to late stage, you don't realize that that's your reflection. You can actually think that somebody is looking into your home environment, and that could make you very frightened. So part of sundowning sometimes is it's just what they're beginning to see, visually what's changing.
So one of the things that I like to think about is I like to catch it before the sun goes down. So the way I would do that is that I would close the blinds and brighten the environment prior to the sun going down. So one of the things I find is really helpful is to keep a very bright area, always an area in your house. So I know people have a habit of turning lights off, turning lights off.
And I actually wouldn't turn lights off. I would have lights up bright. I would change your bulbs to a much higher bulb than you normally would ever do to provide that bright light. And sometimes instead of light going down this direction, think about light going up this direction. And what it does is when light's going down like this, it creates shadows. And what we want to do is shadows can be confusing. And light going up this direction isn't going to create as many shadows. It's going to make the light nice and bright, and that might provide some of that opportunity to reduce some of that agitation and things that people are feeling. I also like to provide a meaningful activity to do during that time of day, something that's engaging, something that they enjoy doing. And not something new, it's typically something that they've been used to doing before, so they can have that connection and try to get past some of that time when the sun is changing.
David: Wow. Several of those, like the light pointing up, I had never thought of that before. So very good, very good.
Christina: Yeah, light is really, really important. I think we forget about that, how important light is. One other thing to think about sometimes is that if it's dark and you are moving from, let's just say, a carpeted floor that has very light carpet to a wood floor that has, let's say, dark wood, and your lighting is dark, in mid-stage to late-stage dementia, that light to dark, that's gonna look like a hole. It's gonna look, not look like, not understanding that you're moving to a surface that's just a darker surface. It actually looks like you're taking a step into something that you can drop into. And so that also can be very confusing for people. So it kind of goes back to that, my importance of making your space as bright and light as possible and watching when the sun changes is to change that environment and keep it all bright. And that can help that time of day.
David: Wow. All right. And then our last question for today is around the importance of visual cues. I know you've mentioned several of them, but are there any other visual cues that you can think of that would help us in caring for our loved ones?
Christina: Yeah, that's a really, I'm very passionate about this one. And let me explain why. So when we're caring for somebody, we are either visual, we're typically touching and talking to them. Touching, talking, sometimes talking, touching, visual, but touching and talking when we're caring for somebody. So we're telling them and we're helping them out with something. And what we find with people with dementia is that what you wanna do is you wanna actually focus on more visual cues, and put them in the order of visual, verbal, and then touch. Because what we found is, is that because of the loss of language and receptive language as well, so hearing what you're saying and not understanding everything, is that they're not getting all the points and things that you're going to do. So if you said, I'm going to help you get up, right? They may not be understanding all of that. So part of what we have to do is think about using more visual cues. So let me give you a couple of examples.
So if we were gonna ask somebody what they would like a snack, hey, would you like goldfish or would you like pretzels? And sometimes we get the answer, I don't want anything. Well, all right, do you want goldfish or pretzels? I said snack time, goldfish or pretzels? I don't want anything. And the reason they don't want anything is because they don't understand what you're asking them for. But if you went out with a bag of goldfish and you showed them a bag of pretzels and you said, mm, which one would you like? They're gonna be able to tell you because that's what a visual cue, how strong a visual cue is.
It's because you're showing them what you want them to do. I also find using visual cues in some of what we call our ADL tasks. So let's just say we're helping somebody in the shower. If we show them that we want you to wash your arms, if you show them yourself, and then they will go ahead and do it as well. Brushing your teeth, you show first, brushing your hair. I also find it really helpful in eating.
Sometimes eating can be very overwhelming for someone with dementia, especially when there's a lot on the plate. And what I really encourage people to do is put less on a plate, but also to sit next to them, hold that fork as well, holding their own plate. You show what you're eating and they're eating as well, right? What you find is if you're doing something, because they don't want to feel stupid, and especially in mid-stage dementia when they're not understanding, the last thing they want to do is feel dumb and stupid and not understand what you're trying to tell them.
And so what we wanna do is we wanna provide more of those visual cues. Another time that can be pretty dangerous if the visual cue is when we've done things like, let's just say, take the car away. So we say, you know what, mom? You're not able to drive anymore. But in the house, we still have car keys hanging up and we still have a car in the garage or on the driveway.
We're not, remember short term memory, we're not gonna remember that we were told that we're not supposed to be driving anymore. But we see a visual cue, I see my car, and I see my car keys, and so I'm going. And so that's why you get a lot of arguments, you know? And so what we wanna do is take, if there's something we don't want them to do, we need to take that visual cue out of sight. It can't be there because that muscle memory is gonna come back. It's something they've done before for a long time in their life. They've been drivers for years. They're not gonna remember that they're told not to do it. So the more visual cues that we put in, I'm a big fan of setting up the table, getting ready for dinner, have it visually there versus telling them all the things that you want them to do. If you want them to put their coat on, you put your coat on first and then they'll put on their coat right afterwards. So, that's kind of the importance of really using those visual cues.
David: Wow, these are so many great tips that I had never even thought of before. So thank you for sharing these.
Christina: Oh, these are really fun. And I hope to come back another time and we can talk about some other things as well. It's about setting up an environment for people with dementia. I feel like these are a lot of good topics and things that they can, easy things, right David? Really easy things you can make changes.
David: Oh yeah, absolutely. So looking forward to revisiting this and as our listeners can tell, Christina is really the expert in all things, Alzheimer's and dementia and just such a wealth of knowledge to be able to share as we're looking to provide the best care and support for our loved ones.
Christina: Yeah, and we do have, we can direct people to our website. So if people wanna learn more about the Senior Helpers Alzheimer's and Dementia Care Program, there's more information there. And then we also have a wheel that they can request and you go, what's a wheel? But the wheel actually talks about the different stages of dementia and it talks about the characteristics and also talks about some of these techniques and strategies that I talked about today.
David: Awesome. Well, we hope you all will join us for our next episode of Life Conversations, and we look forward to seeing you next time.
Thank you for listening to Episode 5 of 'LIFE Conversations with Senior Helpers.' We hope this episode, dedicated to World Alzheimer's Day 2023, has enriched your understanding of Alzheimer's and dementia care. The strategies discussed by David and Christina offer practical steps to enhance the lives of those with dementia, ensuring their safety and comfort. Continue to follow our series for more insightful discussions and expert advice on senior care.