Transcript Older Adult Mental Health Update 2007

Working with Memory
Problems
Presented by
Dr Nigel George
Clinical Psychologist
Growing Older
“Growing old… what is the opposite of
‘growing’? I ask myself. Withering perhaps? It
is, I assume, quite easy to wither into old age,
and hard to grow into it” (Mary Sarton).
Why has the person got memory
problems?
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Any physical health issues:
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Infections
Bloods
Falls
Concussion
CT scan
Depression
Anxiety
Mild Cognitive Impairment
Dementia
Quick revision of memory
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How memory made?
Absorbing (encoding)
 Storing
 Recalling
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Process of making memories
Working memory
 STM
 LTM – autobiographical, procedural, faces, words
etc
 Different areas of the brain involved and difficulties
can occur in one or many areas
 Most common difficulty with emerging Alzheimer
dementia is ‘absorbing’ new verbal information
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MCI
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Mild Cognitive Impairment (MCI) – what is it?
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Still can function, neuro psych have only memory problems
or other subtle changes; MMSE not specific enough to pick it
up
How many convert to dementia?
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6-25% of people presenting with MCI will convert to
Dementia each following year
Approximately 10% remain stable in fact some become
normal again over time
Diagnosis of increased risk rather than of degeneration
Working with Memory Problems
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Treatments:
Physical - body
 Medication
 Social – the carer
 Environmental
 Psychological
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Holistic is best!
Journey of Increasing Memory
Issues
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MCI
Clearer Forgetfulness
Early Dementia
Mild
Moderate
Severe
‘Treatments in each area build on not move on’
Strategies for Working with
Memory Problems
1. Absent minded –
normally more of an
attention problem
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Improve concentration:
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Make sure awake!!
Focus attention and avoid
distractions
Don’t divide attention – do
one thing at a time
Short activities
Frequent breaks
Give information in slow,
absorbable form
Absent minded - continued
Hydrated
 Blood sugar
 Time of the day
 Physical activity – good for lowering risk of a
developing vascular dementia in particular
 Pain? – very distracting
 Other meds and side effects e.g. Valium
 Cognitive stimulation
 Maintenance of social network
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2. Early memory problem – forgetfulness – aware of
issues – still motivate self to do these tasks
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External aides to memory:
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Note books
Memory station
Dictaphone
Calendar
Clocks at right time
Diary
Associate new information with older information
Conscious of use of mnemonic
Repeat information – verbal
Chunk information – telephone numbers
Organise information – post it notes
Bleepers for medication
Begin to use more visual cues and prompts
3. Memory problem (Dementia)
– can’t remember verbal
information just given –
repeated asking, a little
disorientated at times
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Reality orientation:
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Verbal prompts and cues
External cues – signs in
rooms, clocks, calendars, etc
Structure/routine
Medication (dementia)
4. Moderate memory problems:
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Can’t remember much of what is said to them.
Begin to not remember faces.
Disorientated – place and time of day.
Might be getting some other problem behaviours emerging –
disinhibited/agitation etc.
Reality orientation/validation:
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More obvious cues (signs) and reminders around home
Begin validation techniques
Start to rely more on autobio memory – reminiscence therapy
Rely more on visual memory – use photos as prompts to life
Use of routine
Carer starts to more clearly become ‘the environment’
5. Severe memory problems – appears confused a
lot of the time, can’t remember significant
people, places, where they are etc. Maybe some
behavioural problems – aggressive, disinhibited
etc
 Person centred care:
Environment more important
 ABC charts
 Comforters, manipulators, distracters
 Life books
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Dementia with severe behavioural
and psychological symptoms (BPSD)
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BPSD behaviours might
include:
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Wandering
Yelling
Disorientated
Disinhibited
Personality changes
Sun downing
Apathy
Dementia
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Dementia – multiple cognitive (thinking) deficits –
memory, language, frontal (organization, planning,
inhibiting)
Types:
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Alzheimer's
Vascular
Frontal temporal and others
Treatments:
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Environmental (nursing/psychological/activity)
Medication
Approaches to dementia care
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Reliance on care environment most important ‘rementing’ – environmentally driven behaviours
Behaviour modification – ABC – knowing the person’s
history
Reality Orientation - 24hr/individual
Reminiscence - life review/reminiscence
Validation therapy
Stimulation - OT/exercise/Music/Dogs/Snoezelen
Working with care givers - family therapy/elder
abuse/nurses
How understand?
THE CARER
1. Care practices
2. Attitudes of carers
3. Relationships
How understand?
THE ENVIRONMENT
1. Architecture
2. Interior decoration
3. Layout
How understand?
BIOLOGY
1. Dementia
2. Sensory Changes
3. Physical Changes
4. Ill Health Pain
How understand?
THE PERSON
1. Life History
2. Attributes
3. Beliefs and Expectations
4. Habits and Needs
How understand?
THE ENVIRONMENT
1. Architecture
2. Interior decoration
3. Layout
THE CARER
1. Care practices
2. Attitudes of carers
3. Relationships
THE BEHAVIOUR
Behaviour
(ie. mood, thought,
speech and action)
BIOLOGY
1. Dementia
2. Sensory Changes
3. Physical Changes
4. Ill Health Pain
THE PERSON
1. Life History
2. Attributes
3. Beliefs
4. Habits