Introduction

There are recommended practices for working with persons who have dementia. They may be different than those used with persons without dementia and there may be some overlap between the sets of practices. In this module, you'll take a look at those practices for effective dementia care.

The CNA's Role

The CNA has a very important role in the assessment process with regards to people with dementia. He or she is able to assist with the completion of a person’s assessment through the collection of data such as the vital signs of the care recipient as well as through observation and reporting.

CNAs work very closely with their recipients on a daily basis, and that gives them the opportunity to observe obvious changes in a person’s physical condition and the not-so-obvious changes in their emotional state. CNAs also provide nurses with information regarding the changes in the recipient’s condition using several different methods. One method that’s used regularly is called 'Interact, Stop, and Watch'.

Recommended Practices for Effective Dementia Care

Assessments should acknowledge that the care recipient functioning might vary across different caregiver shifts. For example, some people may become confused, disoriented or more active as evening approaches or during caregiver changes.

Thorough assessment includes obtaining verbal information directly from recipients and from family when possible.

• Example 1: Caregivers can ask recipients about their reactions to care routines, and caregivers can provide feedback on successful techniques to the entire support network.
• Example 2: Family members can help develop a 'life story' of the person, offering detailed background information about their life experiences, personal preferences, and daily routines.

The Alzheimer’s Association Campaign for Quality Care recommend assessments be conducted as follows:

Holistic Assessments

A holistic assessment of the care recipient’s abilities and background is necessary to provide care and assistance that’s tailored to their needs.

A holistic assessment includes understanding the recipient’s following concerns:

• Cognitive health
• Physical health
• Physical functioning
• Behavioral status
• Sensory capabilities
• Decision-making capacity
• Communication abilities
• Personal background
• Cultural preferences
• Spiritual needs and preferences

If obtaining information from a recipient or family is difficult, caregivers can still learn about the recipient through other sources, such as medical records, and by observing the person’s reaction to particular approaches to care.

A person with dementia may communicate preferences indirectly through behaviors.

• Example 1: A person who repeatedly refuses a certain food may simply not like that particular food.
• Example 2: Someone who consistently resists entering the shower room may need another method of keeping clean.

Formal Assessments

Regular formal assessment, as required by federal or state regulation, is key to appropriate care management. Equally important is ongoing monitoring and assessment, particularly upon return from the hospital or upon a significant change in their conditions.

If assessment identifies problems requiring consultation with health or other types of professionals, making the appropriate referrals can help mitigate these problems.

• Example: Professionals such as physical or occupational therapists can help people with dementia regain physical health and improve their performance of daily activities.

Obtaining the most current advance directive information (e.g., durable health care, power of attorney or living will) as well as information about a care recipient’s preferences regarding palliative care and funeral arrangements, helps ensure that the person’s wishes will be honored.

INTERACT

Interact is an early warning tool that the CNA may use to notify the nurse of any changes in a person’s condition.

When using this tool, the CNA will have observed something out of the ordinary going on that’s of concern. Then, the CNA completes the Interact Stop & Watch form and gives it to the charge nurse. The charge nurse follows up on the concern and provides the required care to the person, and informs the physician and family. Before the end of the shift, the charge nurse shares the information in a huddle with the CNA. Allowing for consistent assignments for the care providers will allow the CNA to become very familiar with the care recipients, and providers will be able to more quickly identify that the condition of the recipient has changed.

The Interact Tool and Instructions are located in the participants manual at the conclusion of this module.

Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes

When assessing a person with dementia, the nurse must understand some areas of the assessment require special attention. These areas have been outlined in the Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes and have been reproduced here for easy reference.

Food and Fluid Consumption

Inadequate consumption or inappropriate food and fluid choices can contribute directly to a decline in a person’s health and well-being. Caregivers should do the following:

• Provide good screening and preventive systems for nutritional care.
• Ensure proper nutrition and hydration, given the person’s preferences and life circumstances.
• Promote mealtimes as pleasant and enjoyable activities where caregivers have an opportunity to observe and interact with recipients.

Pain Management

Pain is under-recognized and under-treated among people with dementia primarily because they can have difficulty communicating. Poorly managed pain can result in behavioral symptoms and lead to unnecessary use of psychotropic medications. When pain is identified, caregivers should do the following:

• Ease the distress associated with pain and help recipients enjoy an improved quality of life.
• Treat pain as the “fifth vital sign” by routinely assessing and treating it in a formal, systematic way, as one would treat blood pressure, pulse, respiration, and temperature.
• Tailor pain management techniques to each individual’s needs, circumstances, conditions, and risks.

Social Engagement

Engagement in meaningful activities is one of the critical elements of good dementia care. Activities help people maintain their functional abilities and can enhance the quality of life. In order to ensure that a person maintains his or her functional abilities, the caregivers should do the following:

• Offer many opportunities each day for providing a context with personal meaning, a sense of community, choices, and fun.
• Design interactions to do with--not to or for--the care recipient.
• Respect their preferences, even if they prefer solitude.