Guest Blog: Interdepartmental Communication in Long-term Care

By Sarah Murray

While completing my Bachelor of Social Work from Wilfrid Laurier University, I had the opportunity to do my placement at the Sheridan Centre for Elder Research and a long-term care home. While I was at placement, I observed different types of communication between staff and residents. Doing so made me aware of how important effective communication is when working in these settings; this communication is verbal, non-verbal and written. Some barriers to communication in long-term care settings are lack of time to communicate, language barriers, disabilities and cognitive impairments. Communication in long-term care homes is essential to create a positive work environment for the staff and residents.

The nature of long-term care makes it hard for effective communication to take place; most workers are swarmed with work and have to manage a large caseload of residents. The residents of these homes all have their own unique individual needs that need to be addressed; there is no one solution when working with individuals who have cognitive impairments. Benefits of effective communication in the work place include; employee satisfaction, greater staff efficiency, and result in a positive team environment for both the staff and the residents of the home. There are also risks associated with poor communication; these include staff burnout, low staff morale, negative work environment and unmet needs of residents. When the resident’s needs are unmet it can create another wave of communication breakdown, due to responsive behaviors associated with unmet needs in dementia patients. These events can also intensify staff burnout and make the work environment less desirable.

Tips for communication for residents with Dementia (from the Alzheimer Society of Ontario):

  • Introduce yourself, instead of assuming the patient remembers you.
  • Be calm, friendly and communicate at their pace. (Sometimes vocalizing words is difficult for dementia patients, give them the time to pronounce the word)
  • Give instructions once at a time rather then all at once, and wait for a response
  • Maintain engaging open body language (crossed arms may indicate you are angry or annoyed)
  • If the resident repeats themselves, do not tell them so; instead act like it is the first time your hearing it
  • Never say “Don’t you remember” or correct their ideas
  • Do not change the tone of your voice when speaking to individuals with dementia and avoid baby talk

In 2010, 35.6 million people worldwide were living with dementia, a number that is expected to double in 20 years. (Statistics Canada, 2016) Hospitals and long-term care homes and community organizations will have their hands full to provide care to this aging demographic. The first skill needed to positively deal with this demand is communication, if this is done correctly many older adults and their families will benefit, as well as staff employed to work with this population.

When communication is perfect on every level, it creates an environment of trust and respect that allows people to maintain a sense of dignity and pride.
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Sarah Murray completed her placement at the Centre for Elder Research while achieving her Bachelor of Social Work from Wilfrid Laurier University.

Wong, S. Gilmour, H. Ramage-Morin, P. (2016) Alzheimer’s disease and other dementias in Canada. Statistics Canada.
http://www.statcan.gc.ca/pub/82-003-x/2016005/article/14613-eng.htm

Technology and Aging: Technology to Support Older Adults Living with Dementia and Their Caregivers

_C4A3960The term dementia is often misunderstood. Dementia is not a disease but rather a term used to describe a progressive decline of cognitive abilities. It is a symptom of diseases like Alzheimer’s. Although dementia mainly affects older adults, is not a normal part of aging.

According to the World Health Organization “The number of people living with dementia worldwide is currently estimated at 47.5 million and is projected to increase to 75.6 million by 2030. The number of cases of dementia are estimated to more than triple by 2050”.

New technology has the capacity to improve the quality of life for those who are living with dementia. Listed below are examples of how technology is addressing some of the issues related to dementia and creating supportive solutions.

Wandering
Wandering is a serious safety concern for individuals living with dementia. The young grandson of a gentleman with dementia created a clever solution to his grandfather’s wandering out of bed at night. Using sensors that can be placed in a sock or attached to a foot, caregivers can be alerted via smartphone when a loved one with dementia steps out of bed.

Memory Challenges
Using a computer, tablet or smartphone, the Book of You is a multimedia app that allows users to create a “digital life storybook”. Creating and sharing the storybook with family and professional caregivers provides prompts for reminiscence. According to the UK Alzheimer Society “techniques like this are popular because they draw on early memories, which people with dementia tend to retain best. There is evidence that life story and reminiscence work, particularly when done one-on-one, can improve mood, wellbeing and some mental abilities such as memory”.

Cognitive Changes
According to the Alzheimer’s Foundation of America “when used appropriately, music can shift mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function, and coordinate motor movements”. SingFit PRIME is an app that “incorporates singing, movement, trivia and reminiscence for a fully engaging mind/body workout”. The app was designed specifically to be used with older adults living with dementia in group settings. The app compensates for loss of memory by providing the words to a song before they need to be sung.

Responsive Behaviours
The Murray Alzheimer Research and Education Program describes Responsive Behaviours (RB) as a “term originating from, and preferred by, persons with dementia that represents how their actions, words and gestures are a response, often intentional, to something important to them. Persons may use words, gestures, or actions to express something important about their personal, social, or physical environment”. Some examples of RB’s are aggression, agitation, and cursing. In an effort to better understand the reasons for an individual’s RB, an app was designed for use in long term care homes to record and categorize the details of specific incidents of RB in dementia clients. Using this app allows care workers to detect patterns of RB and therefore reveal what is triggering the behavior. This gives care workers an opportunity to provide person-centred care plans that work towards alleviating the triggers and creating a better quality of life for the client living with dementia.

Follow this link to see an informative video on the progression and biology of Alzheimer’s disease on the brain.

Arts and Aging: The Arts as a Way to Improve the Quality of Life for Individual’s Living With Dementia

An article entitled How Art Therapy Helps People with Dementia and Alzheimer’s explains that “Art therapy can be a useful and fulfilling activity to help those who suffer from Alzheimer’s disease. It can increase the quality of life for those suffering and become a way of expression, even after other types of communication start to fail.”

Worldwide, there are agencies and projects advocating the arts as a way to improve the quality of life for older adults with dementia. Listed below are inspiring examples of projects that provide people living with dementia access to the arts and the associated benefits of engaging in arts-based activities.

music-for-memoryMusic and Memory is an American non-profit organization that brings personalized music into the lives of older adults through digital music technology. The Alzheimer Society of Toronto and Jazz.FM91 partnered to implement a local Music for Memory iPod Project. The project was created “in response to overwhelming evidence showing the beneficial effects of music and stimulation on people living with dementia”.

The Society for the Arts in Dementia Care located in Vernon B.C. (with affiliates in Australia) offers resources in the form of workshops, conferences, and videos. Their website offers inspiring examples of artwork created by individuals with dementia.

h-artzThe American Foundation Artist’s for Alzheimer’s (ARTZ) enhances the cultural and creative life of people living with Alzheimer’s disease. “ARTZ draws on the support and collaboration of artists and cultural institutions, both nationally and internationally, as a collective resource, to share, educate and inspire.”

indexThe international documentary I Remember When I Paint highlights the “positive impact of art and other creative therapies on people with Alzheimer’s and how these approaches can change the way we look at the disease”.

An Artist with Alzheimer’s Drew Self Portraits for Five Years and the result is very moving. According to the artist’s widow “In these pictures we see with heart-breaking intensity William’s efforts to explain his altered self, his fears and his sadness”.

To see the transformative power of music and dance on older adults living with dementia check out this video.

Older Adults and Dementia

Dementia is not an illness or disease in itself, but is a broad term which is used to describe a range of signs and symptoms that occur when the brain is affected by certain diseases and conditions such as Alzheimer’s disease and vascular dementia.”

January is Alzheimer Awareness Month. According to the Government of Canada, 6-15% of Canadians age 65 and older are living with some form of dementia. These numbers are expected to double by 2031.

The most common forms of dementia are:

  1. Alzheimer disease
  2. Vascular dementia
  3. Lewy Body dementia
  4. Frontotemporal dementia
  5. Early onset dementia

Diagnosis:

A family doctor is the first step to a diagnosis. A team of health care professionals such as psychologists, psychiatrists, neurologists, geriatricians, nurses, social workers and/or occupational therapists may be called upon to make a final diagnosis. Since several conditions can be the cause of dementia it is important to remember that symptoms can vary.

Support and Resources:

Many agencies and organizations offer programs and services for individuals with dementia. Listed below is a sample of resources:

  1. Alzheimer Society of Canada is the umbrella organization of local agencies that provide services, education and resources for individuals with dementia and their care partners. For community-specific information look for the society with the name of your region in it. For example, Alzheimer Society of Peel (region).
  2. The Alzheimer’s Association is the American equivalent of the Alzheimer Society.
  3. The Alzheimer Society UK offers a wealth of information and research about dementia and caregiving.
  4. The Canadian Women’s Brain Health Initiative shares research and information related to women and dementia. According to the site, 70% of individuals newly diagnosed with Alzheimer disease will be women.
  5. Baycrest has introduced a Rethinking Brain Health and Aging information portal that talks about preserving memories and changes in memory.
  6. BrainXchange is the Alzheimer Knowledge Exchange (AKE) and the Canadian Dementia Resource and Knowledge Exchange (CDRAKE) combined to form a new network.

Early diagnosis helps individuals plan and become better informed for the challenges that lie ahead. If you are concerned about memory loss or other symptoms of dementia contact your health care provider.