WEBVTT
00:00:39.626 --> 00:00:44.878
Hello, and welcome to the Vlogging Pod. Today, we're continuing our Dementia
00:00:44.878 --> 00:00:49.663
Awareness Series with Dementia Educator and Advocate, Kathi Miracle.
00:00:50.104 --> 00:00:53.428
Kathy, now, for those who may be joining us for the very first time,
00:00:53.428 --> 00:00:58.118
could you take a moment to introduce yourself and tell our listeners a little
00:00:58.118 --> 00:01:02.828
bit about your background and your passion for helping individuals and families
00:01:03.177 --> 00:01:05.057
navigate the dementia journey?
00:01:05.435 --> 00:01:08.508
Well, thank you for having me again. I love being on your show.
00:01:08.508 --> 00:01:12.128
Happy to introduce myself. I am a native of Colorado.
00:01:13.508 --> 00:01:19.588
My office is out of Denver, Colorado. I have worked, specialized work in senior
00:01:19.588 --> 00:01:23.262
living, focusing on dementia almost my entire career.
00:01:23.948 --> 00:01:26.898
I usually say there's not much I haven't seen, although then something else
00:01:26.898 --> 00:01:29.068
new pops up and I'm like, oh, okay, I guess there is.
00:01:29.548 --> 00:01:34.108
And so it's always an interesting and challenging journey for professionals.
00:01:34.108 --> 00:01:37.773
So I know it's an interesting and challenging journey for families.
00:01:38.688 --> 00:01:42.338
I will tell people you either love working in dementia care or you hate it.
00:01:42.338 --> 00:01:45.608
And the only in between are the families who have to travel that journey because
00:01:45.608 --> 00:01:46.980
they simply have no choice.
00:01:47.728 --> 00:01:53.668
So I founded Silver Tsunami a couple of years ago to really better educate families
00:01:53.668 --> 00:01:58.189
to travel this journey easier with better knowledge and with great resources.
00:02:00.238 --> 00:02:03.764
Awesome. I picked the wrong moment to suck down some water.
00:02:05.864 --> 00:02:10.804
No, no, you're fine. I paused my mic and thought, this is an opportunity to
00:02:10.804 --> 00:02:12.394
drink some water. Little did I know.
00:02:15.324 --> 00:02:21.484
No, no, you're fine. What I was going to say before I was spitting that water right back out was
00:02:23.744 --> 00:02:29.484
one of the most difficult parts of caring for someone living with dementia is
00:02:29.484 --> 00:02:32.439
understanding changes in their behavior.
00:02:32.860 --> 00:02:38.414
What may seem confusing or even frustrating to family members is often the result
00:02:38.414 --> 00:02:40.830
of changes taking place within their brain.
00:02:41.614 --> 00:02:47.114
Today, I'd like to take the time to spend some time talking about those behaviors
00:02:47.114 --> 00:02:52.609
and why they happen, how families can better understand and possibly respond to them.
00:02:53.386 --> 00:02:57.463
So this is probably one of the topics I get asked to speak on the most,
00:02:57.463 --> 00:03:01.397
whether I'm at conferences or training professionals or talking to families.
00:03:02.333 --> 00:03:07.343
So the very first thing I talk about is that, you know, define the word behavior.
00:03:07.343 --> 00:03:12.629
So when we actually define the word behavior, what that means is that that's
00:03:12.734 --> 00:03:16.350
how somebody acts or conducts oneself, especially toward others.
00:03:17.313 --> 00:03:19.363
It is the way, you know, an animal
00:03:19.363 --> 00:03:22.591
or a person acts in a response to a particular situation or stimulus.
00:03:22.950 --> 00:03:26.840
And it's also the way in which a natural phenomenon or machine works or functions.
00:03:27.171 --> 00:03:32.348
Somehow, the word behavior has been negatively linked to people with dementia,
00:03:32.713 --> 00:03:35.883
toddlers, and sometimes educated individuals.
00:03:36.593 --> 00:03:41.943
And so, you know, I always, when I do training, I like to really refer to it
00:03:41.943 --> 00:03:43.499
more as an emotional expression.
00:03:43.899 --> 00:03:46.686
But through this, because I know we're using the word behavior,
00:03:47.333 --> 00:03:48.553
I'll refer to it as behavior.
00:03:48.553 --> 00:03:56.903
But really, what I tell people, too, is 80% of the behaviors people see is actually
00:03:56.903 --> 00:04:01.013
triggered, is actually because of the person interacting or their environment.
00:04:01.285 --> 00:04:04.995
Only 20% of behaviors actually come from a dementia diagnosis.
00:04:05.442 --> 00:04:13.183
And so if we learn to change how we are approaching someone or change the environment,
00:04:13.183 --> 00:04:16.454
we actually can minimize behaviors significantly.
00:04:16.727 --> 00:04:19.792
When I was in senior living and I ran memory care buildings,
00:04:20.105 --> 00:04:22.603
you could walk through my building just about at any time of day,
00:04:22.603 --> 00:04:25.823
especially, I loved when tours would come in at sundowning hours,
00:04:26.148 --> 00:04:27.493
because you wouldn't see
00:04:27.913 --> 00:04:32.469
my residents having behaviors, because my staff was trained on what to do.
00:04:32.840 --> 00:04:37.983
So when we look at that 80% of, you know, what triggers a behavior.
00:04:38.893 --> 00:04:41.153
Those four things are communication.
00:04:42.046 --> 00:04:46.424
Approach, medical need, and environment. So the easy one to start with is an environment.
00:04:47.506 --> 00:04:50.906
You know, I've had people say, oh, you know, George is having,
00:04:50.906 --> 00:04:53.146
you know, he's really agitated.
00:04:53.442 --> 00:04:57.966
And I would go down and the TV's going, the radio's going, somebody,
00:04:57.966 --> 00:05:01.196
a family's having a lot of people. And I'm like, whoa, look at the environment.
00:05:01.196 --> 00:05:04.408
George is in. How about we move into a calmer environment?
00:05:05.946 --> 00:05:10.006
And it's also why I never can understand why someone will do a cognitive assessment
00:05:10.006 --> 00:05:13.766
on an individual in an emergency room. I'm like, oh, overstimulated,
00:05:13.766 --> 00:05:16.846
so much going on. They're in pain. They're in crisis. That's when you're going
00:05:16.846 --> 00:05:18.711
to choose to do a cognitive assessment? Okay.
00:05:19.065 --> 00:05:23.066
I don't think the score is valid, but all right. So environments really do matter.
00:05:23.066 --> 00:05:27.906
Even somebody, so I actually had somebody say that if somebody's in a very quiet
00:05:27.906 --> 00:05:32.979
environment, like there's no stimulation at all, you go completely to the other end of the spectrum.
00:05:33.321 --> 00:05:37.166
You know, can that cause a problem? And so one of my colleagues and I decided
00:05:37.166 --> 00:05:40.666
to sort to test it out. And there was a day we decided, okay,
00:05:40.666 --> 00:05:42.876
for eight hours, we're not going to do anything. We're just going to sit on
00:05:42.876 --> 00:05:44.275
the couch. And for busy people,
00:05:44.902 --> 00:05:46.984
oh my God, I would take that day. And that's what I was like,
00:05:46.984 --> 00:05:51.644
I'll take that day. But we said, you can't play on your phone. You can't watch TV.
00:05:52.064 --> 00:05:56.204
You can't listen to the radio. You can't read a book. You're just sitting there.
00:05:56.605 --> 00:06:00.484
And for the first, I don't know, hour, hour and a half, it was kind of pleasant.
00:06:00.484 --> 00:06:02.183
I just watched a squirrel play outside.
00:06:02.538 --> 00:06:06.574
But then all of a sudden, I was like starting to count the dots in the ceiling.
00:06:06.574 --> 00:06:11.834
I was starting to try and by the end of the eight hours and my family came home,
00:06:11.834 --> 00:06:15.541
my husband's like, you were a bit testy and cranky. You know, you really were.
00:06:15.819 --> 00:06:20.594
So for individuals who, you know, they live alone and a family member shows
00:06:20.594 --> 00:06:23.900
up to bring them food or help clean their house and they snap at them,
00:06:24.306 --> 00:06:27.631
it could possibly be that they're in an understimulating environment.
00:06:27.858 --> 00:06:30.864
So you want to try to find that balance between an overstimulating environment
00:06:30.864 --> 00:06:34.470
and an understimulating environment so that you can keep the person balanced.
00:06:35.204 --> 00:06:40.681
Another thing is medical need. You know, I have, I've seen people who are in
00:06:41.006 --> 00:06:45.264
pain and because of that pain, they become very agitated.
00:06:45.264 --> 00:06:48.664
And I have, I had a daughter one time. She's like, oh, my mom's not in pain.
00:06:48.664 --> 00:06:50.544
I said, oh, I think she is.
00:06:51.020 --> 00:06:56.018
And she's like, and I said, well, so families will say, they'll ask these yes or no questions.
00:06:56.285 --> 00:07:00.302
And the most common word we hear from the time we're born till the time we die is the word no.
00:07:00.580 --> 00:07:04.214
So we're conditioned, you know, to like, I'm a car dealership.
00:07:04.214 --> 00:07:07.034
You know, I walk up to you, you're looking for a car. Before I open my mouth,
00:07:07.034 --> 00:07:08.336
you're ready to say, no, I'm just looking.
00:07:08.533 --> 00:07:13.113
I haven't even said anything, right? And so we're conditioned as individuals to say no.
00:07:13.438 --> 00:07:16.184
And so when we start saying, are you in pain? No. Are you hungry? No.
00:07:16.544 --> 00:07:19.724
Are you thirsty? No. And we're really, we're asking these yes and no questions.
00:07:19.724 --> 00:07:23.324
And when it comes to medical need, that's really, really, really dangerous.
00:07:23.731 --> 00:07:27.874
And somebody may be taking an over-counter medication and what they need is
00:07:27.874 --> 00:07:31.234
a scheduled one. or they're on a 200 milligram scheduled pain med,
00:07:31.234 --> 00:07:35.269
but what they really need is a 400 one or an infection arises.
00:07:35.513 --> 00:07:40.134
And people get asked very quickly with like a urinary tract infection or when
00:07:40.134 --> 00:07:42.496
COVID existed or pneumonia.
00:07:43.158 --> 00:07:45.991
They get very agitated very quickly, and they get very confused.
00:07:46.234 --> 00:07:50.008
So medical needs can actually trigger behaviors.
00:07:50.607 --> 00:07:53.798
How somebody approaches a person with dementia. I tell people,
00:07:54.187 --> 00:07:59.877
never, ever, ever, ever approach somebody from behind. Because their line of
00:07:59.877 --> 00:08:04.294
vision is really about 45 degrees to the right of them and 45 degrees to the left.
00:08:04.613 --> 00:08:08.433
And if you're approaching from behind, they don't know you're approaching. And they don't know.
00:08:08.665 --> 00:08:13.831
And you tap them on the shoulder, they could turn around and pop you one. because they didn't.
00:08:14.867 --> 00:08:18.452
I also tell people, I'll tell people, put your hands in fists and put it up by your eyes.
00:08:18.795 --> 00:08:21.847
And I'll walk directly in front of the person and I'll say, tell me when you
00:08:21.847 --> 00:08:26.427
can see me. And I'm like in their personal space, almost nose to nose before they can see me.
00:08:26.798 --> 00:08:30.119
And what that really sort of represents is glaucoma or cataracts,
00:08:30.392 --> 00:08:33.767
you know, that person's vision is starting to diminish and they're not going
00:08:33.767 --> 00:08:35.527
to see somebody approach from the front.
00:08:35.527 --> 00:08:39.617
And people, a lot of times, especially professionals, they walk so fast that
00:08:39.617 --> 00:08:42.937
they approach the person too fast and the person's brain does not have the time
00:08:42.937 --> 00:08:45.461
to process what's happening. So they become startled.
00:08:46.547 --> 00:08:51.347
Approaching them slowly from a 45 degree angle with your hand outstretched.
00:08:51.827 --> 00:08:55.837
Because if you, for somebody like you or I, you know, when someone you don't
00:08:55.837 --> 00:08:59.637
know gets in your personal space, we usually back up. If they do it again,
00:08:59.637 --> 00:09:03.207
we sort of back up. If they do it again, you kind of put your hand out kind of like, I need you.
00:09:04.007 --> 00:09:04.455
Yeah.
00:09:04.583 --> 00:09:08.310
Right. And so our personal space is three feet.
00:09:08.536 --> 00:09:11.597
For the person with dementia, their personal space is six feet.
00:09:11.597 --> 00:09:14.977
It's their three feet and your three feet. And if you get into their personal
00:09:14.977 --> 00:09:17.865
space, they don't back up, they just start defending it.
00:09:18.161 --> 00:09:21.497
And that's where I see a lot of resident to resident altercations that happen
00:09:21.497 --> 00:09:25.347
in professional communities is because, you know, the little lady is trying
00:09:25.347 --> 00:09:28.657
to fix the handkerchief in the man's shirt pocket and gets too close and he
00:09:28.657 --> 00:09:32.132
hits her or he pushes her because he does, he's defending a space.
00:09:32.463 --> 00:09:35.029
And so then it becomes really problematic. Um,
00:09:35.488 --> 00:09:39.767
So approach, doing it slowly. I always keep my hand outstretched.
00:09:39.817 --> 00:09:44.037
And when I'm saying, hi, I'm Kathy, and the person usually will outstretch their
00:09:44.037 --> 00:09:47.713
hand, and I can pump their hand a couple of times, which gets their attention,
00:09:48.032 --> 00:09:50.964
because the palm of your hand is the second most sensitive part of your body.
00:09:51.254 --> 00:09:54.467
And then they're looking at me, and then I have their attention to get closer
00:09:54.467 --> 00:09:57.088
to them, or I have their permission to get closer because they'll smile,
00:09:57.326 --> 00:10:00.337
or you'll see a look on their face. Or you see this look of confusion on their
00:10:00.337 --> 00:10:03.077
face, and you know not to keep getting closer. You're going to get hit,
00:10:03.077 --> 00:10:04.037
or something could happen.
00:10:04.396 --> 00:10:07.804
And so you want to keep your distance if you don't see the right look on their face.
00:10:08.557 --> 00:10:13.626
And then communication is the other piece. I see people who communicate too much and too fast.
00:10:13.940 --> 00:10:19.437
And when that happens, the person doesn't have the ability to process everything
00:10:19.437 --> 00:10:22.129
that was just thrown at them. So the simpler, the better.
00:10:22.857 --> 00:10:26.448
Don't give somebody a lot of choices. Two choices is great. But you want,
00:10:27.117 --> 00:10:30.117
I tell people, you want to slow down your speech. You're going to feel like
00:10:30.117 --> 00:10:32.201
you're walking through mud when you talk.
00:10:32.549 --> 00:10:35.017
You want to slow it down so they can understand you.
00:10:35.637 --> 00:10:40.357
I also say, as men age, this is where God has a sense of humor.
00:10:40.357 --> 00:10:45.808
As men age, the decibel range they lose their hearing is the same decibel range as women's voices.
00:10:46.139 --> 00:10:50.717
So for female forgivers, you want to lower your voice and talk a little slower.
00:10:50.717 --> 00:10:54.852
You might, it feels funny in the beginning, but when you get practice at it,
00:10:55.131 --> 00:10:58.147
the person can hear that. They can't, I tell people all the time,
00:10:58.147 --> 00:11:01.783
quit screaming and yelling. They can't hear that. They just can't.
00:11:02.027 --> 00:11:04.378
Just lower your voice and talk a little slower.
00:11:04.668 --> 00:11:10.166
And when people do those four things correctly, they can minimize behavior significantly
00:11:10.386 --> 00:11:12.087
while they're caring for the person with dementia.
00:11:12.773 --> 00:11:16.796
Yeah, that's very interesting. Now, you talked about the feet,
00:11:16.796 --> 00:11:21.885
which I would take that as like one of the triggers because you're invading personal space.
00:11:22.314 --> 00:11:27.956
So what are some of the most common triggers that can lead to agitation,
00:11:27.956 --> 00:11:33.309
anxiety, anger, or possibly confusion in dementia patients?
00:11:33.547 --> 00:11:36.676
I think if I were to pick two, I would say approach and communication.
00:11:36.676 --> 00:11:41.846
Those are the two top ones I see constantly happening because people don't,
00:11:41.846 --> 00:11:43.775
they approach the person too fast.
00:11:44.193 --> 00:11:46.672
They approach the person from the wrong direction.
00:11:47.576 --> 00:11:50.506
I've even seen people like, you know, they're trying to help somebody get their
00:11:50.506 --> 00:11:53.616
shoes and socks and their, you know, their, their undergarments and their pants
00:11:53.616 --> 00:11:57.806
on and they position themselves directly in front of the person with dementia.
00:11:58.131 --> 00:12:00.816
And if you startle them, like sometimes when you're trying to put somebody's
00:12:00.816 --> 00:12:02.897
socks on, you know, their toes can get stuck.
00:12:03.292 --> 00:12:07.628
And if that hurts, because the person's trying to do it in a quick manner,
00:12:07.924 --> 00:12:11.546
if that hurts, they're going to, again, they're going to defend themselves.
00:12:11.546 --> 00:12:14.696
And the first thing they do is they reach out and smack the person or push the
00:12:14.696 --> 00:12:16.236
shirt or push their hair.
00:12:16.555 --> 00:12:20.026
And you've positioned yourself directly in front of them to be kicked in the
00:12:20.026 --> 00:12:22.956
wrong place or to be, you're an open target.
00:12:22.956 --> 00:12:27.216
So I always say, keep yourself to the side, always a 45 degree angle,
00:12:27.216 --> 00:12:30.476
because they have a harder time. They're not going to kick to the side.
00:12:30.476 --> 00:12:32.693
That's not natural. They're just going to kick directly in front of them.
00:12:33.070 --> 00:12:37.616
So the approach is really, really important. I actually watched a lady who was
00:12:37.616 --> 00:12:41.356
delivering medications to a woman with dementia and she, one,
00:12:41.356 --> 00:12:44.698
wasn't carrying the medications correctly. She just had this cup in the palm of her hand.
00:12:45.098 --> 00:12:49.656
And when she approached from behind, the woman turned around and hit her and
00:12:49.656 --> 00:12:55.336
pills went flying everywhere oh my oh my but she's it's kind of like if you
00:12:55.336 --> 00:12:59.251
came home and someone came out from behind a door and went boo.
00:13:01.904 --> 00:13:04.684
And your second reaction usually is to take a swing at somebody,
00:13:04.794 --> 00:13:05.938
right? Like, don't do that.
00:13:06.304 --> 00:13:09.094
Well, that's what you're doing with the person with dementia is you're startling
00:13:09.094 --> 00:13:14.517
them. So their natural human instinct is to kind of, they get startled and then they're going to react.
00:13:14.813 --> 00:13:18.928
And so approach is a big one that I tell people, be very, very careful.
00:13:19.864 --> 00:13:23.304
Approach from the front. Approach 45 degrees. Approach very slowly.
00:13:24.104 --> 00:13:29.482
Keep your hand outstretched. Do not approach from behind. Be careful if you're coming up from behind.
00:13:29.708 --> 00:13:33.944
You actually want to go around them. Go around them until they can see you,
00:13:34.264 --> 00:13:37.516
and then you can kind of say their name. But if you say their name from behind,
00:13:37.824 --> 00:13:39.472
it's going to cause some challenges.
00:13:39.844 --> 00:13:43.604
Communication is the other one. I see people all the time. Hey,
00:13:43.604 --> 00:13:44.586
George, how are you doing?
00:13:44.970 --> 00:13:48.122
Okay, all he heard was, hey, George. He never heard anything else.
00:13:48.487 --> 00:13:51.194
And then the caregiver gets frustrated because George isn't responding,
00:13:51.194 --> 00:13:53.445
and they're talking faster or they're talking meaner.
00:13:53.729 --> 00:13:56.884
And the person with dementia will pick up on body language, facial expressions,
00:13:56.884 --> 00:13:59.314
and tone of voice before they pick up on anything else.
00:13:59.778 --> 00:14:03.464
And so it starts to create panic, and they start to get agitated,
00:14:03.464 --> 00:14:05.571
and now it's just this tug-of-war going back and forth.
00:14:07.626 --> 00:14:14.314
Now, we often hear about behaviors such as wandering, repetitive questions,
00:14:14.314 --> 00:14:18.924
suspicion, or even accusations toward family members.
00:14:19.304 --> 00:14:24.154
What do you believe causes these behaviors, and how should possibly the caregivers
00:14:24.154 --> 00:14:26.050
respond when they happen to occur?
00:14:27.484 --> 00:14:27.850
So, yes.
00:14:28.702 --> 00:14:32.410
Let's take wandering, first of all, because I have people who talk to me about,
00:14:32.410 --> 00:14:36.850
you know, George wandered away from the house. And so there's a difference between
00:14:36.850 --> 00:14:40.335
purposeful wandering, non-purposeful wandering, and exit seeking.
00:14:40.649 --> 00:14:44.660
So purposeful wandering happens usually in the home and the person's going around
00:14:44.660 --> 00:14:48.070
and touching things that they're familiar with. And that's actually a self-soothing
00:14:48.070 --> 00:14:50.117
activity. And you don't want to mess with that.
00:14:50.390 --> 00:14:53.420
There's also then you have the non-purpose for wandering. Those happen more
00:14:53.420 --> 00:14:54.993
in communities than in homes.
00:14:55.730 --> 00:14:59.170
But you see this jig-jaggedy sort of behavior. They're pacing.
00:14:59.610 --> 00:15:03.000
Their breathing gets different. Their face gets red. That's something that they're
00:15:03.000 --> 00:15:05.755
getting agitated and you need to jump on and be able to redirect.
00:15:06.069 --> 00:15:08.840
Exit-seeking means they're actually trying to get out. They're trying to get
00:15:08.840 --> 00:15:12.122
out a window. They're trying to get out a door. They're pounding on something.
00:15:12.401 --> 00:15:15.520
There's a reason what they're trying to get away from, you know.
00:15:15.520 --> 00:15:19.843
And so I always, you know, what I used to tell my staff is I'm like.
00:15:21.057 --> 00:15:24.657
If Betty is trying, where do you think she's going to go? She's 80 with a walker.
00:15:24.657 --> 00:15:27.424
Like, do you not think you can out walk her or out run her? You know?
00:15:27.680 --> 00:15:30.762
So if she's trying to get out this door, what is she trying to get to the other side to see?
00:15:31.163 --> 00:15:34.927
So I used to take, I used to take residence all the time and I'd walk them outside.
00:15:34.927 --> 00:15:37.947
I'm like, well, what are we looking for? We're looking for your car.
00:15:37.947 --> 00:15:41.457
Well, what color is your car? Blue? Okay. Well, I don't see a blue car here.
00:15:41.457 --> 00:15:44.877
So maybe we should go back in and make some phone calls. Okay.
00:15:44.877 --> 00:15:47.509
Well, by the time they get it back inside, they don't know when I'm going to make some phone calls.
00:15:47.771 --> 00:15:52.247
People try so hard to, as soon as you say no to the person with dementia,
00:15:52.247 --> 00:15:54.429
you've now created an argument and good luck winning it.
00:15:54.905 --> 00:15:59.917
And so it's kind of like, what is happening? The challenge becomes when people
00:16:00.257 --> 00:16:05.947
are, you took my money, you took my wallet, because they take it and they hide
00:16:05.947 --> 00:16:08.051
it so that you haven't cleaned it.
00:16:08.283 --> 00:16:11.997
Well, now it's not on top of the dress or where it's been 50 years of my life.
00:16:11.997 --> 00:16:14.117
So some, the explanation is you must've taken it.
00:16:14.686 --> 00:16:19.077
So I try really hard at the end of the day, like if someone is going to,
00:16:19.077 --> 00:16:23.423
you're helping them get ready for bed, can you help them put that in the right spot?
00:16:23.672 --> 00:16:27.777
Does that work 100% of the time? No, nothing works 100% of the time when it
00:16:27.797 --> 00:16:29.170
comes to the dementia journey.
00:16:29.506 --> 00:16:33.401
And so the more consistent routines we can create for people, the better.
00:16:34.197 --> 00:16:37.871
There's people who will say, you're not my husband, you know, because
00:16:38.144 --> 00:16:42.997
as we age, they no longer maybe understand the person in front of them is a
00:16:42.997 --> 00:16:46.707
spouse they've been married to for 50 or 60 years because what they remember
00:16:46.707 --> 00:16:49.837
in their head is when I was younger.
00:16:49.837 --> 00:16:54.227
And that's certainly not the person. Or I've seen people who believe that their
00:16:54.227 --> 00:16:57.867
oldest son is their husband or their brother because they look so much like
00:16:57.867 --> 00:16:59.379
that individual because of genetics.
00:16:59.779 --> 00:17:03.210
And those are really tough things to kind of work their way around.
00:17:03.518 --> 00:17:05.915
Most often in times, families become.
00:17:08.030 --> 00:17:12.120
It's disturbing for a family. It's distraught. And they focus on their feelings
00:17:12.120 --> 00:17:15.486
and their emotions. And not that those aren't important. They absolutely are.
00:17:15.748 --> 00:17:19.672
But in that moment, you have to find a way to redirect the person with dementia first.
00:17:19.968 --> 00:17:24.450
And unfortunately, as a caregiver, we often put, we have to put how we're feeling
00:17:24.450 --> 00:17:28.440
and how we react in the situation on the back burner because the person with
00:17:28.440 --> 00:17:32.112
dementia has brain damage. They don't, you can't negotiate with them.
00:17:32.373 --> 00:17:36.490
You cannot try to convince them of otherwise. And when you try to do those things,
00:17:36.490 --> 00:17:37.940
you're just going to enter into an argument.
00:17:38.271 --> 00:17:42.250
And again, you won't win. So in those moments, I really try to find someone
00:17:42.250 --> 00:17:46.340
to talk about the topic or to talk about something that, you know,
00:17:46.340 --> 00:17:49.805
is you're not creating this argument. You're not creating this tug of war.
00:17:50.450 --> 00:17:54.606
And someone saying, I can't find my wallet, instead of saying,
00:17:54.838 --> 00:17:58.188
well, you must have hidden it. Well, no, I didn't. Yes, you did. No, I didn't.
00:17:58.472 --> 00:18:02.230
It's, oh, well, tell me about the wallet. You know, What color is it? Okay.
00:18:02.950 --> 00:18:08.101
How big is it? And what do you believe is inside of it? You're talking about the topic.
00:18:08.479 --> 00:18:13.703
Okay. And where do you think you normally, you put it right here on the dresser and it's not here? Hmm.
00:18:13.988 --> 00:18:17.215
I have no idea what could have happened, but I will help you look for it.
00:18:17.877 --> 00:18:20.193
You know, we can talk about the topic.
00:18:21.850 --> 00:18:25.280
And what I will tell listeners is I've been doing this for over 30 years and
00:18:25.280 --> 00:18:29.272
I certainly didn't sound like this 25 years ago or 28 years ago.
00:18:29.574 --> 00:18:34.590
So this takes a lot of practice to be able to not react because we're human.
00:18:34.590 --> 00:18:37.695
The very first thing we want to do is we want to defend ourselves and we react.
00:18:38.310 --> 00:18:41.290
And so it takes a lot of practice to just take a step back and take a big,
00:18:41.290 --> 00:18:42.850
deep breath and to say, OK,
00:18:43.370 --> 00:18:47.790
what what questions can I think of that's talking about the topic with this
00:18:47.790 --> 00:18:52.060
individual to start to try to redirect them to either get their mind off of
00:18:52.060 --> 00:18:56.794
what's going on right now or to be able to find a solution to what they're upset or agitated about.
00:18:58.042 --> 00:19:00.904
Right. I can understand that. Um,
00:19:03.768 --> 00:19:09.663
Sorry, I'm looking at my camera, my husband's home. Let's see. So.
00:19:10.405 --> 00:19:14.009
When we talk about dementia and becoming upset or emotionally upset,
00:19:14.009 --> 00:19:18.449
what are some of the techniques, again, that caregivers might be able to use
00:19:18.449 --> 00:19:19.931
to handle the situations?
00:19:20.256 --> 00:19:28.329
Well, usually what my staff was trained to do is I bought a lot of unscented lotion in my community.
00:19:29.409 --> 00:19:32.749
Lavender, using an essential oil that has lavender in it.
00:19:33.410 --> 00:19:38.838
There's a lot of great oils out there, different companies. Just make sure you're buying 100% oil.
00:19:39.769 --> 00:19:42.769
If you go into a store, you see oils that are all the same price that are not
00:19:42.769 --> 00:19:46.479
100%. I mean, like rose oil should be more expensive than lavender oil.
00:19:46.479 --> 00:19:49.078
Lavender oil, it was one of the cheapest oils you can get.
00:19:49.479 --> 00:19:54.319
But lavender oil, and I would put it in unscented lotion because I would sit
00:19:54.319 --> 00:19:56.849
down with somebody and if they're agitated about something, I go,
00:19:56.849 --> 00:19:59.759
well, can we sit and talk? Sometimes they'll let you, sometimes they won't.
00:20:00.078 --> 00:20:03.509
But with people, if I say, oh, you know, oh my goodness, we have some ice cream
00:20:03.509 --> 00:20:05.186
right here. Can we just sit and talk?
00:20:05.929 --> 00:20:10.339
And then I can take lavender lotion and I'm rubbing the palm of their hands.
00:20:10.660 --> 00:20:13.749
I've been able to de-escalate people very quickly because, again,
00:20:14.109 --> 00:20:17.243
the palm of the hand is the second most sensitive part of the body.
00:20:17.504 --> 00:20:19.041
The first is anything around the mouth.
00:20:19.413 --> 00:20:22.819
But if you're sitting there kind of massaging the palm of their hand with lavender
00:20:22.819 --> 00:20:27.719
oil or lavender lotion, and I really truly get unscented lotion with essential
00:20:27.719 --> 00:20:32.529
oil. I don't go out and get lavender lotion. You don't have the amount of lavender
00:20:32.529 --> 00:20:33.606
scent in it that you need.
00:20:34.012 --> 00:20:37.699
So that's why I use those two combinations. But just sitting there and just
00:20:37.699 --> 00:20:41.663
massaging the palm of their hand with the lavender that they're inhaling,
00:20:41.866 --> 00:20:45.465
that actually can keep somebody, you know, it starts to calm them down. That's one thing.
00:20:46.309 --> 00:20:49.939
The other thing that it can be really, really helpful for people is that from
00:20:49.939 --> 00:20:55.329
the time somebody's born until the time we die, when we feel any kind of emotion,
00:20:55.329 --> 00:20:58.609
when we're angry, frustrated, agitated, overwhelmed, depressed,
00:20:58.920 --> 00:21:00.699
the brain actually releases a chemical.
00:21:00.699 --> 00:21:03.883
And what that chemical craves is something salty, sweet, or fatty.
00:21:04.297 --> 00:21:07.886
So I've been in trainings and conferences, and I can pick out several people
00:21:07.886 --> 00:21:12.011
and say, tell me what your comfort food is, and it will land in one of those three categories.
00:21:12.331 --> 00:21:16.126
So as we, you know, when we get frustrated or we get agitated,
00:21:16.126 --> 00:21:21.686
we turn to chips and fries and pizza and beer and wine and chocolate and ice
00:21:21.686 --> 00:21:24.256
cream, and it will fit into one of those three categories.
00:21:24.256 --> 00:21:28.076
And once the body is consuming one of those things that's salty,
00:21:28.076 --> 00:21:32.126
fatty, or sweet, all of a sudden that chemical starts to calm down in the brain,
00:21:32.323 --> 00:21:34.105
and the person can start to calm down too.
00:21:34.401 --> 00:21:37.376
So I used to go through a lot of vanilla ice cream, too, because we get vanilla
00:21:37.376 --> 00:21:41.106
ice cream and put caramel on it or strawberry topping or chocolate syrup.
00:21:42.105 --> 00:21:46.116
So that, you know, as soon as somebody sees that, and that was really important
00:21:46.116 --> 00:21:50.069
to me as part of their admission paperwork is what is their three top comfort foods.
00:21:50.429 --> 00:21:54.096
And most people know that. And so I would make sure that we knew what the three
00:21:54.096 --> 00:21:58.376
top comfort foods were and we would be able to give it to that person and they,
00:21:58.376 --> 00:21:59.766
oh, that's something I like.
00:21:59.766 --> 00:22:02.186
And as soon as they start consuming it, kind of on their own,
00:22:02.186 --> 00:22:04.906
they start to calm down. And then if you can combine that with the lavender
00:22:04.906 --> 00:22:08.126
lotion, there's ways to be able to, you know, soft music.
00:22:08.726 --> 00:22:11.766
If they have a favorite, you know, blanket or stuffed animal.
00:22:11.766 --> 00:22:16.045
I mean, everybody's just slightly different in what's going to calm them down.
00:22:16.766 --> 00:22:20.846
What I will say is don't say, please calm down. But nobody in the history of
00:22:20.846 --> 00:22:23.696
the world, when hearing those words, can calm down. You know,
00:22:23.696 --> 00:22:24.996
so don't say those words.
00:22:25.706 --> 00:22:30.563
So we want to use the techniques that are individualized or customized to that person.
00:22:31.393 --> 00:22:31.794
Right.
00:22:32.398 --> 00:22:37.224
So, Kathy, as we finish our conversation for today, what would you think would
00:22:37.224 --> 00:22:42.674
be the most, like, our listeners to remember about the behavioral changes that
00:22:42.674 --> 00:22:44.716
often accompany dementia?
00:22:45.424 --> 00:22:50.024
Well, the very first thing that my teams and when I work with families that
00:22:50.024 --> 00:22:56.116
I really impress upon them is that you're interacting with an individual who has brain damage.
00:22:57.074 --> 00:23:01.274
There's nothing other way to describe this because as the brain goes through
00:23:01.274 --> 00:23:05.154
the dementia journey, whatever type of dementia that is, the brain is shrinking
00:23:05.154 --> 00:23:08.544
and the brain is having more difficulty sending messages from point A to point B
00:23:08.834 --> 00:23:13.258
or difficulty processing the information or recalling it. So.
00:23:13.966 --> 00:23:18.407
How would you interact with a person you know is six months out of a car accident?
00:23:18.517 --> 00:23:23.086
You're not going to expect them to interact with you as normally as you would
00:23:23.208 --> 00:23:26.215
before they had the car accident. Because we have this somewhat understanding
00:23:26.215 --> 00:23:29.825
that we know a car accident created this traumatic brain injury for you.
00:23:30.174 --> 00:23:33.575
And somehow people don't seem to get that a traumatic brain injury is brain
00:23:33.575 --> 00:23:35.607
damage just like dementia is brain damage.
00:23:35.926 --> 00:23:38.562
So you have to enter into their world.
00:23:38.922 --> 00:23:42.828
You have to approach and interact the person with patience, creativity,
00:23:43.136 --> 00:23:47.655
being a detective, providing space, and most of all, having a sense of humor.
00:23:48.155 --> 00:23:51.339
I used to say all the time, check your ego and pride at the door,
00:23:51.518 --> 00:23:54.071
because if you don't, it's going to get bruised and damaged pretty quickly.
00:23:54.408 --> 00:23:57.785
And so you have to always look at things from their perspective.
00:23:57.785 --> 00:24:01.175
And there are many times we say, I know this is not the person.
00:24:01.175 --> 00:24:05.467
I know it's the brain damage. And so I need to give them some grace and I need to take a step back.
00:24:05.716 --> 00:24:09.735
And it's okay to say, I need a break. I need to walk away from this.
00:24:09.735 --> 00:24:14.445
I mean, families who do with this 24 hours, 24-7, I don't know how they do it
00:24:14.445 --> 00:24:17.695
because in a community, we have different shifts. We tap out.
00:24:17.695 --> 00:24:20.995
And when somebody's getting frustrated, somebody else steps in to then deal
00:24:20.995 --> 00:24:22.626
with, you know, whatever's going on.
00:24:22.882 --> 00:24:26.905
But families, they need to realize and understand it's okay to step away from
00:24:26.905 --> 00:24:27.897
the situation, take a break.
00:24:28.182 --> 00:24:31.985
Hence the reason I really encourage getting a support system in place early
00:24:31.985 --> 00:24:35.435
on, even if it's meaning that somebody's coming in to give that caregiver the
00:24:35.435 --> 00:24:37.510
rest that they need because at some point they're going to burn out.
00:24:37.673 --> 00:24:42.264
They will say and do something that is not something they can ever take back.
00:24:42.433 --> 00:24:46.682
So I tell families all the time, please know and understand any type of dementia
00:24:46.926 --> 00:24:50.605
is brain damage. And that you're dealing with a person who the brain is not
00:24:50.605 --> 00:24:55.143
functioning the way it did prior to having that diagnosis. Right.
00:24:55.666 --> 00:24:58.127
I want to thank you again, Kathy, for joining us tonight.
00:24:58.795 --> 00:25:01.500
Thank you so much for having me. Always a pleasure to be on your show.
00:25:02.028 --> 00:25:08.553
Awesome. I want to thank our listeners for joining us. Until next time, bye-bye for now.
00:00:39.626 --> 00:00:44.878
Hello, and welcome to the Vlogging Pod. Today, we're continuing our Dementia
00:00:44.878 --> 00:00:49.663
Awareness Series with Dementia Educator and Advocate, Kathi Miracle.
00:00:50.104 --> 00:00:53.428
Kathy, now, for those who may be joining us for the very first time,
00:00:53.428 --> 00:00:58.118
could you take a moment to introduce yourself and tell our listeners a little
00:00:58.118 --> 00:01:02.828
bit about your background and your passion for helping individuals and families
00:01:03.177 --> 00:01:05.057
navigate the dementia journey?
00:01:05.435 --> 00:01:08.508
Well, thank you for having me again. I love being on your show.
00:01:08.508 --> 00:01:12.128
Happy to introduce myself. I am a native of Colorado.
00:01:13.508 --> 00:01:19.588
My office is out of Denver, Colorado. I have worked, specialized work in senior
00:01:19.588 --> 00:01:23.262
living, focusing on dementia almost my entire career.
00:01:23.948 --> 00:01:26.898
I usually say there's not much I haven't seen, although then something else
00:01:26.898 --> 00:01:29.068
new pops up and I'm like, oh, okay, I guess there is.
00:01:29.548 --> 00:01:34.108
And so it's always an interesting and challenging journey for professionals.
00:01:34.108 --> 00:01:37.773
So I know it's an interesting and challenging journey for families.
00:01:38.688 --> 00:01:42.338
I will tell people you either love working in dementia care or you hate it.
00:01:42.338 --> 00:01:45.608
And the only in between are the families who have to travel that journey because
00:01:45.608 --> 00:01:46.980
they simply have no choice.
00:01:47.728 --> 00:01:53.668
So I founded Silver Tsunami a couple of years ago to really better educate families
00:01:53.668 --> 00:01:58.189
to travel this journey easier with better knowledge and with great resources.
00:02:00.238 --> 00:02:03.764
Awesome. I picked the wrong moment to suck down some water.
00:02:05.864 --> 00:02:10.804
No, no, you're fine. I paused my mic and thought, this is an opportunity to
00:02:10.804 --> 00:02:12.394
drink some water. Little did I know.
00:02:15.324 --> 00:02:21.484
No, no, you're fine. What I was going to say before I was spitting that water right back out was
00:02:23.744 --> 00:02:29.484
one of the most difficult parts of caring for someone living with dementia is
00:02:29.484 --> 00:02:32.439
understanding changes in their behavior.
00:02:32.860 --> 00:02:38.414
What may seem confusing or even frustrating to family members is often the result
00:02:38.414 --> 00:02:40.830
of changes taking place within their brain.
00:02:41.614 --> 00:02:47.114
Today, I'd like to take the time to spend some time talking about those behaviors
00:02:47.114 --> 00:02:52.609
and why they happen, how families can better understand and possibly respond to them.
00:02:53.386 --> 00:02:57.463
So this is probably one of the topics I get asked to speak on the most,
00:02:57.463 --> 00:03:01.397
whether I'm at conferences or training professionals or talking to families.
00:03:02.333 --> 00:03:07.343
So the very first thing I talk about is that, you know, define the word behavior.
00:03:07.343 --> 00:03:12.629
So when we actually define the word behavior, what that means is that that's
00:03:12.734 --> 00:03:16.350
how somebody acts or conducts oneself, especially toward others.
00:03:17.313 --> 00:03:19.363
It is the way, you know, an animal
00:03:19.363 --> 00:03:22.591
or a person acts in a response to a particular situation or stimulus.
00:03:22.950 --> 00:03:26.840
And it's also the way in which a natural phenomenon or machine works or functions.
00:03:27.171 --> 00:03:32.348
Somehow, the word behavior has been negatively linked to people with dementia,
00:03:32.713 --> 00:03:35.883
toddlers, and sometimes educated individuals.
00:03:36.593 --> 00:03:41.943
And so, you know, I always, when I do training, I like to really refer to it
00:03:41.943 --> 00:03:43.499
more as an emotional expression.
00:03:43.899 --> 00:03:46.686
But through this, because I know we're using the word behavior,
00:03:47.333 --> 00:03:48.553
I'll refer to it as behavior.
00:03:48.553 --> 00:03:56.903
But really, what I tell people, too, is 80% of the behaviors people see is actually
00:03:56.903 --> 00:04:01.013
triggered, is actually because of the person interacting or their environment.
00:04:01.285 --> 00:04:04.995
Only 20% of behaviors actually come from a dementia diagnosis.
00:04:05.442 --> 00:04:13.183
And so if we learn to change how we are approaching someone or change the environment,
00:04:13.183 --> 00:04:16.454
we actually can minimize behaviors significantly.
00:04:16.727 --> 00:04:19.792
When I was in senior living and I ran memory care buildings,
00:04:20.105 --> 00:04:22.603
you could walk through my building just about at any time of day,
00:04:22.603 --> 00:04:25.823
especially, I loved when tours would come in at sundowning hours,
00:04:26.148 --> 00:04:27.493
because you wouldn't see
00:04:27.913 --> 00:04:32.469
my residents having behaviors, because my staff was trained on what to do.
00:04:32.840 --> 00:04:37.983
So when we look at that 80% of, you know, what triggers a behavior.
00:04:38.893 --> 00:04:41.153
Those four things are communication.
00:04:42.046 --> 00:04:46.424
Approach, medical need, and environment. So the easy one to start with is an environment.
00:04:47.506 --> 00:04:50.906
You know, I've had people say, oh, you know, George is having,
00:04:50.906 --> 00:04:53.146
you know, he's really agitated.
00:04:53.442 --> 00:04:57.966
And I would go down and the TV's going, the radio's going, somebody,
00:04:57.966 --> 00:05:01.196
a family's having a lot of people. And I'm like, whoa, look at the environment.
00:05:01.196 --> 00:05:04.408
George is in. How about we move into a calmer environment?
00:05:05.946 --> 00:05:10.006
And it's also why I never can understand why someone will do a cognitive assessment
00:05:10.006 --> 00:05:13.766
on an individual in an emergency room. I'm like, oh, overstimulated,
00:05:13.766 --> 00:05:16.846
so much going on. They're in pain. They're in crisis. That's when you're going
00:05:16.846 --> 00:05:18.711
to choose to do a cognitive assessment? Okay.
00:05:19.065 --> 00:05:23.066
I don't think the score is valid, but all right. So environments really do matter.
00:05:23.066 --> 00:05:27.906
Even somebody, so I actually had somebody say that if somebody's in a very quiet
00:05:27.906 --> 00:05:32.979
environment, like there's no stimulation at all, you go completely to the other end of the spectrum.
00:05:33.321 --> 00:05:37.166
You know, can that cause a problem? And so one of my colleagues and I decided
00:05:37.166 --> 00:05:40.666
to sort to test it out. And there was a day we decided, okay,
00:05:40.666 --> 00:05:42.876
for eight hours, we're not going to do anything. We're just going to sit on
00:05:42.876 --> 00:05:44.275
the couch. And for busy people,
00:05:44.902 --> 00:05:46.984
oh my God, I would take that day. And that's what I was like,
00:05:46.984 --> 00:05:51.644
I'll take that day. But we said, you can't play on your phone. You can't watch TV.
00:05:52.064 --> 00:05:56.204
You can't listen to the radio. You can't read a book. You're just sitting there.
00:05:56.605 --> 00:06:00.484
And for the first, I don't know, hour, hour and a half, it was kind of pleasant.
00:06:00.484 --> 00:06:02.183
I just watched a squirrel play outside.
00:06:02.538 --> 00:06:06.574
But then all of a sudden, I was like starting to count the dots in the ceiling.
00:06:06.574 --> 00:06:11.834
I was starting to try and by the end of the eight hours and my family came home,
00:06:11.834 --> 00:06:15.541
my husband's like, you were a bit testy and cranky. You know, you really were.
00:06:15.819 --> 00:06:20.594
So for individuals who, you know, they live alone and a family member shows
00:06:20.594 --> 00:06:23.900
up to bring them food or help clean their house and they snap at them,
00:06:24.306 --> 00:06:27.631
it could possibly be that they're in an understimulating environment.
00:06:27.858 --> 00:06:30.864
So you want to try to find that balance between an overstimulating environment
00:06:30.864 --> 00:06:34.470
and an understimulating environment so that you can keep the person balanced.
00:06:35.204 --> 00:06:40.681
Another thing is medical need. You know, I have, I've seen people who are in
00:06:41.006 --> 00:06:45.264
pain and because of that pain, they become very agitated.
00:06:45.264 --> 00:06:48.664
And I have, I had a daughter one time. She's like, oh, my mom's not in pain.
00:06:48.664 --> 00:06:50.544
I said, oh, I think she is.
00:06:51.020 --> 00:06:56.018
And she's like, and I said, well, so families will say, they'll ask these yes or no questions.
00:06:56.285 --> 00:07:00.302
And the most common word we hear from the time we're born till the time we die is the word no.
00:07:00.580 --> 00:07:04.214
So we're conditioned, you know, to like, I'm a car dealership.
00:07:04.214 --> 00:07:07.034
You know, I walk up to you, you're looking for a car. Before I open my mouth,
00:07:07.034 --> 00:07:08.336
you're ready to say, no, I'm just looking.
00:07:08.533 --> 00:07:13.113
I haven't even said anything, right? And so we're conditioned as individuals to say no.
00:07:13.438 --> 00:07:16.184
And so when we start saying, are you in pain? No. Are you hungry? No.
00:07:16.544 --> 00:07:19.724
Are you thirsty? No. And we're really, we're asking these yes and no questions.
00:07:19.724 --> 00:07:23.324
And when it comes to medical need, that's really, really, really dangerous.
00:07:23.731 --> 00:07:27.874
And somebody may be taking an over-counter medication and what they need is
00:07:27.874 --> 00:07:31.234
a scheduled one. or they're on a 200 milligram scheduled pain med,
00:07:31.234 --> 00:07:35.269
but what they really need is a 400 one or an infection arises.
00:07:35.513 --> 00:07:40.134
And people get asked very quickly with like a urinary tract infection or when
00:07:40.134 --> 00:07:42.496
COVID existed or pneumonia.
00:07:43.158 --> 00:07:45.991
They get very agitated very quickly, and they get very confused.
00:07:46.234 --> 00:07:50.008
So medical needs can actually trigger behaviors.
00:07:50.607 --> 00:07:53.798
How somebody approaches a person with dementia. I tell people,
00:07:54.187 --> 00:07:59.877
never, ever, ever, ever approach somebody from behind. Because their line of
00:07:59.877 --> 00:08:04.294
vision is really about 45 degrees to the right of them and 45 degrees to the left.
00:08:04.613 --> 00:08:08.433
And if you're approaching from behind, they don't know you're approaching. And they don't know.
00:08:08.665 --> 00:08:13.831
And you tap them on the shoulder, they could turn around and pop you one. because they didn't.
00:08:14.867 --> 00:08:18.452
I also tell people, I'll tell people, put your hands in fists and put it up by your eyes.
00:08:18.795 --> 00:08:21.847
And I'll walk directly in front of the person and I'll say, tell me when you
00:08:21.847 --> 00:08:26.427
can see me. And I'm like in their personal space, almost nose to nose before they can see me.
00:08:26.798 --> 00:08:30.119
And what that really sort of represents is glaucoma or cataracts,
00:08:30.392 --> 00:08:33.767
you know, that person's vision is starting to diminish and they're not going
00:08:33.767 --> 00:08:35.527
to see somebody approach from the front.
00:08:35.527 --> 00:08:39.617
And people, a lot of times, especially professionals, they walk so fast that
00:08:39.617 --> 00:08:42.937
they approach the person too fast and the person's brain does not have the time
00:08:42.937 --> 00:08:45.461
to process what's happening. So they become startled.
00:08:46.547 --> 00:08:51.347
Approaching them slowly from a 45 degree angle with your hand outstretched.
00:08:51.827 --> 00:08:55.837
Because if you, for somebody like you or I, you know, when someone you don't
00:08:55.837 --> 00:08:59.637
know gets in your personal space, we usually back up. If they do it again,
00:08:59.637 --> 00:09:03.207
we sort of back up. If they do it again, you kind of put your hand out kind of like, I need you.
00:09:04.007 --> 00:09:04.455
Yeah.
00:09:04.583 --> 00:09:08.310
Right. And so our personal space is three feet.
00:09:08.536 --> 00:09:11.597
For the person with dementia, their personal space is six feet.
00:09:11.597 --> 00:09:14.977
It's their three feet and your three feet. And if you get into their personal
00:09:14.977 --> 00:09:17.865
space, they don't back up, they just start defending it.
00:09:18.161 --> 00:09:21.497
And that's where I see a lot of resident to resident altercations that happen
00:09:21.497 --> 00:09:25.347
in professional communities is because, you know, the little lady is trying
00:09:25.347 --> 00:09:28.657
to fix the handkerchief in the man's shirt pocket and gets too close and he
00:09:28.657 --> 00:09:32.132
hits her or he pushes her because he does, he's defending a space.
00:09:32.463 --> 00:09:35.029
And so then it becomes really problematic. Um,
00:09:35.488 --> 00:09:39.767
So approach, doing it slowly. I always keep my hand outstretched.
00:09:39.817 --> 00:09:44.037
And when I'm saying, hi, I'm Kathy, and the person usually will outstretch their
00:09:44.037 --> 00:09:47.713
hand, and I can pump their hand a couple of times, which gets their attention,
00:09:48.032 --> 00:09:50.964
because the palm of your hand is the second most sensitive part of your body.
00:09:51.254 --> 00:09:54.467
And then they're looking at me, and then I have their attention to get closer
00:09:54.467 --> 00:09:57.088
to them, or I have their permission to get closer because they'll smile,
00:09:57.326 --> 00:10:00.337
or you'll see a look on their face. Or you see this look of confusion on their
00:10:00.337 --> 00:10:03.077
face, and you know not to keep getting closer. You're going to get hit,
00:10:03.077 --> 00:10:04.037
or something could happen.
00:10:04.396 --> 00:10:07.804
And so you want to keep your distance if you don't see the right look on their face.
00:10:08.557 --> 00:10:13.626
And then communication is the other piece. I see people who communicate too much and too fast.
00:10:13.940 --> 00:10:19.437
And when that happens, the person doesn't have the ability to process everything
00:10:19.437 --> 00:10:22.129
that was just thrown at them. So the simpler, the better.
00:10:22.857 --> 00:10:26.448
Don't give somebody a lot of choices. Two choices is great. But you want,
00:10:27.117 --> 00:10:30.117
I tell people, you want to slow down your speech. You're going to feel like
00:10:30.117 --> 00:10:32.201
you're walking through mud when you talk.
00:10:32.549 --> 00:10:35.017
You want to slow it down so they can understand you.
00:10:35.637 --> 00:10:40.357
I also say, as men age, this is where God has a sense of humor.
00:10:40.357 --> 00:10:45.808
As men age, the decibel range they lose their hearing is the same decibel range as women's voices.
00:10:46.139 --> 00:10:50.717
So for female forgivers, you want to lower your voice and talk a little slower.
00:10:50.717 --> 00:10:54.852
You might, it feels funny in the beginning, but when you get practice at it,
00:10:55.131 --> 00:10:58.147
the person can hear that. They can't, I tell people all the time,
00:10:58.147 --> 00:11:01.783
quit screaming and yelling. They can't hear that. They just can't.
00:11:02.027 --> 00:11:04.378
Just lower your voice and talk a little slower.
00:11:04.668 --> 00:11:10.166
And when people do those four things correctly, they can minimize behavior significantly
00:11:10.386 --> 00:11:12.087
while they're caring for the person with dementia.
00:11:12.773 --> 00:11:16.796
Yeah, that's very interesting. Now, you talked about the feet,
00:11:16.796 --> 00:11:21.885
which I would take that as like one of the triggers because you're invading personal space.
00:11:22.314 --> 00:11:27.956
So what are some of the most common triggers that can lead to agitation,
00:11:27.956 --> 00:11:33.309
anxiety, anger, or possibly confusion in dementia patients?
00:11:33.547 --> 00:11:36.676
I think if I were to pick two, I would say approach and communication.
00:11:36.676 --> 00:11:41.846
Those are the two top ones I see constantly happening because people don't,
00:11:41.846 --> 00:11:43.775
they approach the person too fast.
00:11:44.193 --> 00:11:46.672
They approach the person from the wrong direction.
00:11:47.576 --> 00:11:50.506
I've even seen people like, you know, they're trying to help somebody get their
00:11:50.506 --> 00:11:53.616
shoes and socks and their, you know, their, their undergarments and their pants
00:11:53.616 --> 00:11:57.806
on and they position themselves directly in front of the person with dementia.
00:11:58.131 --> 00:12:00.816
And if you startle them, like sometimes when you're trying to put somebody's
00:12:00.816 --> 00:12:02.897
socks on, you know, their toes can get stuck.
00:12:03.292 --> 00:12:07.628
And if that hurts, because the person's trying to do it in a quick manner,
00:12:07.924 --> 00:12:11.546
if that hurts, they're going to, again, they're going to defend themselves.
00:12:11.546 --> 00:12:14.696
And the first thing they do is they reach out and smack the person or push the
00:12:14.696 --> 00:12:16.236
shirt or push their hair.
00:12:16.555 --> 00:12:20.026
And you've positioned yourself directly in front of them to be kicked in the
00:12:20.026 --> 00:12:22.956
wrong place or to be, you're an open target.
00:12:22.956 --> 00:12:27.216
So I always say, keep yourself to the side, always a 45 degree angle,
00:12:27.216 --> 00:12:30.476
because they have a harder time. They're not going to kick to the side.
00:12:30.476 --> 00:12:32.693
That's not natural. They're just going to kick directly in front of them.
00:12:33.070 --> 00:12:37.616
So the approach is really, really important. I actually watched a lady who was
00:12:37.616 --> 00:12:41.356
delivering medications to a woman with dementia and she, one,
00:12:41.356 --> 00:12:44.698
wasn't carrying the medications correctly. She just had this cup in the palm of her hand.
00:12:45.098 --> 00:12:49.656
And when she approached from behind, the woman turned around and hit her and
00:12:49.656 --> 00:12:55.336
pills went flying everywhere oh my oh my but she's it's kind of like if you
00:12:55.336 --> 00:12:59.251
came home and someone came out from behind a door and went boo.
00:13:01.904 --> 00:13:04.684
And your second reaction usually is to take a swing at somebody,
00:13:04.794 --> 00:13:05.938
right? Like, don't do that.
00:13:06.304 --> 00:13:09.094
Well, that's what you're doing with the person with dementia is you're startling
00:13:09.094 --> 00:13:14.517
them. So their natural human instinct is to kind of, they get startled and then they're going to react.
00:13:14.813 --> 00:13:18.928
And so approach is a big one that I tell people, be very, very careful.
00:13:19.864 --> 00:13:23.304
Approach from the front. Approach 45 degrees. Approach very slowly.
00:13:24.104 --> 00:13:29.482
Keep your hand outstretched. Do not approach from behind. Be careful if you're coming up from behind.
00:13:29.708 --> 00:13:33.944
You actually want to go around them. Go around them until they can see you,
00:13:34.264 --> 00:13:37.516
and then you can kind of say their name. But if you say their name from behind,
00:13:37.824 --> 00:13:39.472
it's going to cause some challenges.
00:13:39.844 --> 00:13:43.604
Communication is the other one. I see people all the time. Hey,
00:13:43.604 --> 00:13:44.586
George, how are you doing?
00:13:44.970 --> 00:13:48.122
Okay, all he heard was, hey, George. He never heard anything else.
00:13:48.487 --> 00:13:51.194
And then the caregiver gets frustrated because George isn't responding,
00:13:51.194 --> 00:13:53.445
and they're talking faster or they're talking meaner.
00:13:53.729 --> 00:13:56.884
And the person with dementia will pick up on body language, facial expressions,
00:13:56.884 --> 00:13:59.314
and tone of voice before they pick up on anything else.
00:13:59.778 --> 00:14:03.464
And so it starts to create panic, and they start to get agitated,
00:14:03.464 --> 00:14:05.571
and now it's just this tug-of-war going back and forth.
00:14:07.626 --> 00:14:14.314
Now, we often hear about behaviors such as wandering, repetitive questions,
00:14:14.314 --> 00:14:18.924
suspicion, or even accusations toward family members.
00:14:19.304 --> 00:14:24.154
What do you believe causes these behaviors, and how should possibly the caregivers
00:14:24.154 --> 00:14:26.050
respond when they happen to occur?
00:14:27.484 --> 00:14:27.850
So, yes.
00:14:28.702 --> 00:14:32.410
Let's take wandering, first of all, because I have people who talk to me about,
00:14:32.410 --> 00:14:36.850
you know, George wandered away from the house. And so there's a difference between
00:14:36.850 --> 00:14:40.335
purposeful wandering, non-purposeful wandering, and exit seeking.
00:14:40.649 --> 00:14:44.660
So purposeful wandering happens usually in the home and the person's going around
00:14:44.660 --> 00:14:48.070
and touching things that they're familiar with. And that's actually a self-soothing
00:14:48.070 --> 00:14:50.117
activity. And you don't want to mess with that.
00:14:50.390 --> 00:14:53.420
There's also then you have the non-purpose for wandering. Those happen more
00:14:53.420 --> 00:14:54.993
in communities than in homes.
00:14:55.730 --> 00:14:59.170
But you see this jig-jaggedy sort of behavior. They're pacing.
00:14:59.610 --> 00:15:03.000
Their breathing gets different. Their face gets red. That's something that they're
00:15:03.000 --> 00:15:05.755
getting agitated and you need to jump on and be able to redirect.
00:15:06.069 --> 00:15:08.840
Exit-seeking means they're actually trying to get out. They're trying to get
00:15:08.840 --> 00:15:12.122
out a window. They're trying to get out a door. They're pounding on something.
00:15:12.401 --> 00:15:15.520
There's a reason what they're trying to get away from, you know.
00:15:15.520 --> 00:15:19.843
And so I always, you know, what I used to tell my staff is I'm like.
00:15:21.057 --> 00:15:24.657
If Betty is trying, where do you think she's going to go? She's 80 with a walker.
00:15:24.657 --> 00:15:27.424
Like, do you not think you can out walk her or out run her? You know?
00:15:27.680 --> 00:15:30.762
So if she's trying to get out this door, what is she trying to get to the other side to see?
00:15:31.163 --> 00:15:34.927
So I used to take, I used to take residence all the time and I'd walk them outside.
00:15:34.927 --> 00:15:37.947
I'm like, well, what are we looking for? We're looking for your car.
00:15:37.947 --> 00:15:41.457
Well, what color is your car? Blue? Okay. Well, I don't see a blue car here.
00:15:41.457 --> 00:15:44.877
So maybe we should go back in and make some phone calls. Okay.
00:15:44.877 --> 00:15:47.509
Well, by the time they get it back inside, they don't know when I'm going to make some phone calls.
00:15:47.771 --> 00:15:52.247
People try so hard to, as soon as you say no to the person with dementia,
00:15:52.247 --> 00:15:54.429
you've now created an argument and good luck winning it.
00:15:54.905 --> 00:15:59.917
And so it's kind of like, what is happening? The challenge becomes when people
00:16:00.257 --> 00:16:05.947
are, you took my money, you took my wallet, because they take it and they hide
00:16:05.947 --> 00:16:08.051
it so that you haven't cleaned it.
00:16:08.283 --> 00:16:11.997
Well, now it's not on top of the dress or where it's been 50 years of my life.
00:16:11.997 --> 00:16:14.117
So some, the explanation is you must've taken it.
00:16:14.686 --> 00:16:19.077
So I try really hard at the end of the day, like if someone is going to,
00:16:19.077 --> 00:16:23.423
you're helping them get ready for bed, can you help them put that in the right spot?
00:16:23.672 --> 00:16:27.777
Does that work 100% of the time? No, nothing works 100% of the time when it
00:16:27.797 --> 00:16:29.170
comes to the dementia journey.
00:16:29.506 --> 00:16:33.401
And so the more consistent routines we can create for people, the better.
00:16:34.197 --> 00:16:37.871
There's people who will say, you're not my husband, you know, because
00:16:38.144 --> 00:16:42.997
as we age, they no longer maybe understand the person in front of them is a
00:16:42.997 --> 00:16:46.707
spouse they've been married to for 50 or 60 years because what they remember
00:16:46.707 --> 00:16:49.837
in their head is when I was younger.
00:16:49.837 --> 00:16:54.227
And that's certainly not the person. Or I've seen people who believe that their
00:16:54.227 --> 00:16:57.867
oldest son is their husband or their brother because they look so much like
00:16:57.867 --> 00:16:59.379
that individual because of genetics.
00:16:59.779 --> 00:17:03.210
And those are really tough things to kind of work their way around.
00:17:03.518 --> 00:17:05.915
Most often in times, families become.
00:17:08.030 --> 00:17:12.120
It's disturbing for a family. It's distraught. And they focus on their feelings
00:17:12.120 --> 00:17:15.486
and their emotions. And not that those aren't important. They absolutely are.
00:17:15.748 --> 00:17:19.672
But in that moment, you have to find a way to redirect the person with dementia first.
00:17:19.968 --> 00:17:24.450
And unfortunately, as a caregiver, we often put, we have to put how we're feeling
00:17:24.450 --> 00:17:28.440
and how we react in the situation on the back burner because the person with
00:17:28.440 --> 00:17:32.112
dementia has brain damage. They don't, you can't negotiate with them.
00:17:32.373 --> 00:17:36.490
You cannot try to convince them of otherwise. And when you try to do those things,
00:17:36.490 --> 00:17:37.940
you're just going to enter into an argument.
00:17:38.271 --> 00:17:42.250
And again, you won't win. So in those moments, I really try to find someone
00:17:42.250 --> 00:17:46.340
to talk about the topic or to talk about something that, you know,
00:17:46.340 --> 00:17:49.805
is you're not creating this argument. You're not creating this tug of war.
00:17:50.450 --> 00:17:54.606
And someone saying, I can't find my wallet, instead of saying,
00:17:54.838 --> 00:17:58.188
well, you must have hidden it. Well, no, I didn't. Yes, you did. No, I didn't.
00:17:58.472 --> 00:18:02.230
It's, oh, well, tell me about the wallet. You know, What color is it? Okay.
00:18:02.950 --> 00:18:08.101
How big is it? And what do you believe is inside of it? You're talking about the topic.
00:18:08.479 --> 00:18:13.703
Okay. And where do you think you normally, you put it right here on the dresser and it's not here? Hmm.
00:18:13.988 --> 00:18:17.215
I have no idea what could have happened, but I will help you look for it.
00:18:17.877 --> 00:18:20.193
You know, we can talk about the topic.
00:18:21.850 --> 00:18:25.280
And what I will tell listeners is I've been doing this for over 30 years and
00:18:25.280 --> 00:18:29.272
I certainly didn't sound like this 25 years ago or 28 years ago.
00:18:29.574 --> 00:18:34.590
So this takes a lot of practice to be able to not react because we're human.
00:18:34.590 --> 00:18:37.695
The very first thing we want to do is we want to defend ourselves and we react.
00:18:38.310 --> 00:18:41.290
And so it takes a lot of practice to just take a step back and take a big,
00:18:41.290 --> 00:18:42.850
deep breath and to say, OK,
00:18:43.370 --> 00:18:47.790
what what questions can I think of that's talking about the topic with this
00:18:47.790 --> 00:18:52.060
individual to start to try to redirect them to either get their mind off of
00:18:52.060 --> 00:18:56.794
what's going on right now or to be able to find a solution to what they're upset or agitated about.
00:18:58.042 --> 00:19:00.904
Right. I can understand that. Um,
00:19:03.768 --> 00:19:09.663
Sorry, I'm looking at my camera, my husband's home. Let's see. So.
00:19:10.405 --> 00:19:14.009
When we talk about dementia and becoming upset or emotionally upset,
00:19:14.009 --> 00:19:18.449
what are some of the techniques, again, that caregivers might be able to use
00:19:18.449 --> 00:19:19.931
to handle the situations?
00:19:20.256 --> 00:19:28.329
Well, usually what my staff was trained to do is I bought a lot of unscented lotion in my community.
00:19:29.409 --> 00:19:32.749
Lavender, using an essential oil that has lavender in it.
00:19:33.410 --> 00:19:38.838
There's a lot of great oils out there, different companies. Just make sure you're buying 100% oil.
00:19:39.769 --> 00:19:42.769
If you go into a store, you see oils that are all the same price that are not
00:19:42.769 --> 00:19:46.479
100%. I mean, like rose oil should be more expensive than lavender oil.
00:19:46.479 --> 00:19:49.078
Lavender oil, it was one of the cheapest oils you can get.
00:19:49.479 --> 00:19:54.319
But lavender oil, and I would put it in unscented lotion because I would sit
00:19:54.319 --> 00:19:56.849
down with somebody and if they're agitated about something, I go,
00:19:56.849 --> 00:19:59.759
well, can we sit and talk? Sometimes they'll let you, sometimes they won't.
00:20:00.078 --> 00:20:03.509
But with people, if I say, oh, you know, oh my goodness, we have some ice cream
00:20:03.509 --> 00:20:05.186
right here. Can we just sit and talk?
00:20:05.929 --> 00:20:10.339
And then I can take lavender lotion and I'm rubbing the palm of their hands.
00:20:10.660 --> 00:20:13.749
I've been able to de-escalate people very quickly because, again,
00:20:14.109 --> 00:20:17.243
the palm of the hand is the second most sensitive part of the body.
00:20:17.504 --> 00:20:19.041
The first is anything around the mouth.
00:20:19.413 --> 00:20:22.819
But if you're sitting there kind of massaging the palm of their hand with lavender
00:20:22.819 --> 00:20:27.719
oil or lavender lotion, and I really truly get unscented lotion with essential
00:20:27.719 --> 00:20:32.529
oil. I don't go out and get lavender lotion. You don't have the amount of lavender
00:20:32.529 --> 00:20:33.606
scent in it that you need.
00:20:34.012 --> 00:20:37.699
So that's why I use those two combinations. But just sitting there and just
00:20:37.699 --> 00:20:41.663
massaging the palm of their hand with the lavender that they're inhaling,
00:20:41.866 --> 00:20:45.465
that actually can keep somebody, you know, it starts to calm them down. That's one thing.
00:20:46.309 --> 00:20:49.939
The other thing that it can be really, really helpful for people is that from
00:20:49.939 --> 00:20:55.329
the time somebody's born until the time we die, when we feel any kind of emotion,
00:20:55.329 --> 00:20:58.609
when we're angry, frustrated, agitated, overwhelmed, depressed,
00:20:58.920 --> 00:21:00.699
the brain actually releases a chemical.
00:21:00.699 --> 00:21:03.883
And what that chemical craves is something salty, sweet, or fatty.
00:21:04.297 --> 00:21:07.886
So I've been in trainings and conferences, and I can pick out several people
00:21:07.886 --> 00:21:12.011
and say, tell me what your comfort food is, and it will land in one of those three categories.
00:21:12.331 --> 00:21:16.126
So as we, you know, when we get frustrated or we get agitated,
00:21:16.126 --> 00:21:21.686
we turn to chips and fries and pizza and beer and wine and chocolate and ice
00:21:21.686 --> 00:21:24.256
cream, and it will fit into one of those three categories.
00:21:24.256 --> 00:21:28.076
And once the body is consuming one of those things that's salty,
00:21:28.076 --> 00:21:32.126
fatty, or sweet, all of a sudden that chemical starts to calm down in the brain,
00:21:32.323 --> 00:21:34.105
and the person can start to calm down too.
00:21:34.401 --> 00:21:37.376
So I used to go through a lot of vanilla ice cream, too, because we get vanilla
00:21:37.376 --> 00:21:41.106
ice cream and put caramel on it or strawberry topping or chocolate syrup.
00:21:42.105 --> 00:21:46.116
So that, you know, as soon as somebody sees that, and that was really important
00:21:46.116 --> 00:21:50.069
to me as part of their admission paperwork is what is their three top comfort foods.
00:21:50.429 --> 00:21:54.096
And most people know that. And so I would make sure that we knew what the three
00:21:54.096 --> 00:21:58.376
top comfort foods were and we would be able to give it to that person and they,
00:21:58.376 --> 00:21:59.766
oh, that's something I like.
00:21:59.766 --> 00:22:02.186
And as soon as they start consuming it, kind of on their own,
00:22:02.186 --> 00:22:04.906
they start to calm down. And then if you can combine that with the lavender
00:22:04.906 --> 00:22:08.126
lotion, there's ways to be able to, you know, soft music.
00:22:08.726 --> 00:22:11.766
If they have a favorite, you know, blanket or stuffed animal.
00:22:11.766 --> 00:22:16.045
I mean, everybody's just slightly different in what's going to calm them down.
00:22:16.766 --> 00:22:20.846
What I will say is don't say, please calm down. But nobody in the history of
00:22:20.846 --> 00:22:23.696
the world, when hearing those words, can calm down. You know,
00:22:23.696 --> 00:22:24.996
so don't say those words.
00:22:25.706 --> 00:22:30.563
So we want to use the techniques that are individualized or customized to that person.
00:22:31.393 --> 00:22:31.794
Right.
00:22:32.398 --> 00:22:37.224
So, Kathy, as we finish our conversation for today, what would you think would
00:22:37.224 --> 00:22:42.674
be the most, like, our listeners to remember about the behavioral changes that
00:22:42.674 --> 00:22:44.716
often accompany dementia?
00:22:45.424 --> 00:22:50.024
Well, the very first thing that my teams and when I work with families that
00:22:50.024 --> 00:22:56.116
I really impress upon them is that you're interacting with an individual who has brain damage.
00:22:57.074 --> 00:23:01.274
There's nothing other way to describe this because as the brain goes through
00:23:01.274 --> 00:23:05.154
the dementia journey, whatever type of dementia that is, the brain is shrinking
00:23:05.154 --> 00:23:08.544
and the brain is having more difficulty sending messages from point A to point B
00:23:08.834 --> 00:23:13.258
or difficulty processing the information or recalling it. So.
00:23:13.966 --> 00:23:18.407
How would you interact with a person you know is six months out of a car accident?
00:23:18.517 --> 00:23:23.086
You're not going to expect them to interact with you as normally as you would
00:23:23.208 --> 00:23:26.215
before they had the car accident. Because we have this somewhat understanding
00:23:26.215 --> 00:23:29.825
that we know a car accident created this traumatic brain injury for you.
00:23:30.174 --> 00:23:33.575
And somehow people don't seem to get that a traumatic brain injury is brain
00:23:33.575 --> 00:23:35.607
damage just like dementia is brain damage.
00:23:35.926 --> 00:23:38.562
So you have to enter into their world.
00:23:38.922 --> 00:23:42.828
You have to approach and interact the person with patience, creativity,
00:23:43.136 --> 00:23:47.655
being a detective, providing space, and most of all, having a sense of humor.
00:23:48.155 --> 00:23:51.339
I used to say all the time, check your ego and pride at the door,
00:23:51.518 --> 00:23:54.071
because if you don't, it's going to get bruised and damaged pretty quickly.
00:23:54.408 --> 00:23:57.785
And so you have to always look at things from their perspective.
00:23:57.785 --> 00:24:01.175
And there are many times we say, I know this is not the person.
00:24:01.175 --> 00:24:05.467
I know it's the brain damage. And so I need to give them some grace and I need to take a step back.
00:24:05.716 --> 00:24:09.735
And it's okay to say, I need a break. I need to walk away from this.
00:24:09.735 --> 00:24:14.445
I mean, families who do with this 24 hours, 24-7, I don't know how they do it
00:24:14.445 --> 00:24:17.695
because in a community, we have different shifts. We tap out.
00:24:17.695 --> 00:24:20.995
And when somebody's getting frustrated, somebody else steps in to then deal
00:24:20.995 --> 00:24:22.626
with, you know, whatever's going on.
00:24:22.882 --> 00:24:26.905
But families, they need to realize and understand it's okay to step away from
00:24:26.905 --> 00:24:27.897
the situation, take a break.
00:24:28.182 --> 00:24:31.985
Hence the reason I really encourage getting a support system in place early
00:24:31.985 --> 00:24:35.435
on, even if it's meaning that somebody's coming in to give that caregiver the
00:24:35.435 --> 00:24:37.510
rest that they need because at some point they're going to burn out.
00:24:37.673 --> 00:24:42.264
They will say and do something that is not something they can ever take back.
00:24:42.433 --> 00:24:46.682
So I tell families all the time, please know and understand any type of dementia
00:24:46.926 --> 00:24:50.605
is brain damage. And that you're dealing with a person who the brain is not
00:24:50.605 --> 00:24:55.143
functioning the way it did prior to having that diagnosis. Right.
00:24:55.666 --> 00:24:58.127
I want to thank you again, Kathy, for joining us tonight.
00:24:58.795 --> 00:25:01.500
Thank you so much for having me. Always a pleasure to be on your show.
00:25:02.028 --> 00:25:08.553
Awesome. I want to thank our listeners for joining us. Until next time, bye-bye for now.
