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Personal care and CBT notes for VaD patient

Discussion in 'I care for a person with dementia' started by mojo1943, Aug 17, 2015.

  1. mojo1943

    mojo1943 Registered User

    Dec 19, 2013
    722
    North Devon
    I hope the following very long post will be of use to carers involved with Vad patients...mo43;)

    Diet and Care Plan and CBT by mo43 aka mojo1943
    http://forum.alzheimers.org.uk/show...ia-VaD-recently-diagnosed-no-treatment-no-way
    Intro
    The purpose of this doc is to itemise the actions taken by mo43 to ensure mrs mo43 is in good shape mentally and physically for as long as possible, at present personal care and domestic cleaning are 2 hours per week at £16 / hour.
    NB good body hydration is essential ok when urine is light straw and fibre correct when stools float. Carafe of water and glasses must always be available as must a 7 day large pill dispenser – about £7 as is a pestle and mortar to pulverise AZ vitamin and other supplementary tablets mr & mrs mo43 essentially share this diet and lifestyle very closely and body weights are recorded weekly. This diet does maintain weight - balanced by the present exercise profile created by a house and garden adjust food quantity to raise / lower weight.
    Diet
    Breakfast
    Cups(s) of tea poured into cups with a teaspoon tsp of honey and about 1gm of ground cinnamon powder – milk to taste NB made from skimmed powdered milk to take advantage of lo its fat and added calcium.
    Slice of toast 5 seed sliced wholemeal bread Warburton’s covered with home made hummus – 24 hr soaked dry chick peas say cupful add to taste ¼ tsp cayenne pepper olive oil garlic from tube sea salt tsp juice from 2 squeezed lemons and a handful of fresh mint and or basil. Whizz to a smooth puree and keep in the fridge ? lasts 5 days
    Top the hummus with say tuna and sweet corn mayo from asda or 3 cheese mayo Morrison’s etc add say 5 small plum tomatoes - mo43 has one large tom.
    Serve ½ a banana to each mo43 = breakfast complete after all due pills swallowed.
    Lunch
    Soup based on Heinz Tomato with Basil plus any useful extras eg diced Swede carrots peas sliced peppers tomatoes sliced ham added sea salt water (Aldershot ale army speak) boiled before any serving in a large ss saucepan stirred well. Served into soup bowls with squirt of balsamic glaze added to taste, ½ a toasted garlic and coriander pita bread with butter to taste.
    On an oval plate do a sliced avocado (Cheapest £1 for 4) with small shrimps & some sea salt covered in seafood sauce and squeezed lemon.
    Home made say roasted turkey thigh cubes in a casserole with red sauce plus a bed of rice plus balsamic glaze to taste garnish with cooked frozen peas – same with tinned tuna but white sauce – use prepared main meals to augment with fresh / frozen veg..
    Take pills as required with glass of water
    Afternoon tea – time to suit bed time say 45 mins before
    Crucial meal – last before sleep – cups of tea as per breakfast plus a pudding in an oval dish place crushed supplementary pills say 5cc tsp cover with say ½ Fybogel sachet add desert spoon of Greek yoghurt with honey, plus crushed oats then mix with a slice of cake add some custard add in season fresh blueberries, raspberries, melon at each end add clotted cream to taste and more custard- use fresh fruit when in season or frozen when not, ½ of a banana to complete a nourishing meal..
    This is the stealth delivery system for crushed tablets NB side cutter pliers are useful / essential to pre crush tablets.
    Hot Drink – mocawockachocka = a 1/3 mix of drinking chocolate cocoa and coffee mixed with honey and ground cinnamon – milk to taste with hot water into a large mug. Mojo43 16/08/2015

    Diet and Care Plan and CBT by mo43 aka mojo1943
    http://forum.alzheimers.org.uk/show...ia-VaD-recently-diagnosed-no-treatment-no-way

    Cognitive Behaviour Therapy CBT

    Intro
    Before reading these notes please study and remember

    Compassionate Communication with the Memory Impaired
    The following piece was posted a while ago on ALZ forum Talking Point and made a big impression on me. It is something I have referred to time after time and tried hard to follow.
    We have many new members who may not have seen it before. Yesterday I posted it on another Thread but thought it might be helpful if it had a Thread of it`s own.
    It`s a tall order but an excellent guideline.

    Compassionate Communication with the Memory Impaired
    by Liz Ayres
    A Volunteer of the Alzheimer's Association and Former Caregiver

    DON'T
    Don’t reason.
    Don’t argue.
    Don’t confront.
    Don’t remind them they forget.
    Don’t question recent memory.
    Don’t take it personally.

    DO
    Give short, one sentence explanations.
    Allow plenty of time for comprehension, then triple it.
    Repeat instructions or sentences exactly the same way.
    Eliminate 'but' from your vocabulary; substitute 'nevertheless.'
    Avoid insistence. Try again later
    Agree with them or distract them to a different subject or activity
    Accept blame when something’s wrong (even if it’s fantasy).
    Leave the room, if necessary, to avoid confrontations.
    Respond to feelings rather than words
    Be patient and cheerful and reassuring. Do go with the flow.
    Practice 100% forgiveness. Memory loss progresses daily.
    My appeal to you: Please. elevate your level of generosity and graciousness.

    Remember
    You can’t control memory loss, only your reaction to it. Compassionate communication will significantly heighten quality of life.
    They are not crazy or lazy. They say normal things, and do normal things, for a memory impaired, dementia individual. If they were deliberately trying to exasperate you, they would have a different diagnosis. Forgive them ... always. For example: they don’t hide things; they protect them in safe places... And then forget. Don’t take ‘stealing’ accusations personally.



    Their disability is memory loss. Asking them to remember is like asking a blind person to read. (“Did you take your pills?” “What did you do today?”) Don’t ask and don’t test memory! A loss of this magnitude reduces the capacity to reason. Expecting them to be reasonable or to accept your conclusion is unrealistic. (“You need a shower.” “Day care will be fun.” “You can’t live alone.”) Don’t try to reason or convince them. Give a one sentence explanation or search for creative solutions. Memory loss produces unpredictable emotions, thought, and behaviour, which you can alleviate by resolving all issues peacefully. Don’t argue, correct, contradict, confront, blame, or insist.

    Reminders are rarely kind. They tell the patient how disabled they are – over and over again. Reminders of the recent past imply, “I remember, I’m okay; you don’t, you’re not. ”Ouch! Refer to the present or the future. (If they’re hungry, don’t inform them they ate an hour ago, offer a snack or set a time to eat soon.) They may ask the same question repeatedly, believing each time is the first. Graciously respond as if it’s the first time. Some days may seem normal, but they are not. They live in a different reality. Reminders won’t bring them into yours. Note: For vascular dementia, giving clues may help their recall. If it doesn’t work, be kind ... don’t remind.

    Ethical dilemmas may occur. If, for instance, the patient thinks a dead spouse is alive, and truthful reminders will create sadness, what should you do? To avoid distress, try these ways of kindness: 1) distract to another topic, or 2) start a fun activity, or 3) reminisce about their spouse, “I was just thinking about ______. How did you two meet?” You might even try, “He’s gone for a while. Let’s take our walk now.”

    Open-ended questions (“Where shall we go?” “What do you want to eat/wear/do?”) are surprisingly complex and create anxiety. Give them a simple choice between two items or direct their choice, “You look great in the red blouse.”
    They are scared all the time. Each patient reacts differently to fear. They may become passive, uncooperative, hostile, angry, agitated, verbally abusive, or physically combative. They may even do them all at different times, or alternate between them. Anxiety may compel them to shadow you (follow everywhere). Anxiety compels them to resist changes in routine, even pleasant ones. Your goal is to reduce anxiety whenever possible. Also, they can’t remember your reassurances. Keep saying them.
    Examples

    Don’t reason
    Patient What doctor’s appointment? There’s nothing wrong with me.”
    Don’t (reason) “You’ve been seeing the doctor every three months for the last two years. It’s written on the calendar and I told you about it yesterday and this morning.”
    DO (short explanation) “It’s just a regular check-up.”
    (accept blame) “I’m sorry if I forgot to tell you.”

    Don’t argue
    Patient “I didn’t write this check for $500. Someone at the bank is forging my signature.”
    Don’t (argue) “What? Don’t be silly! The bank wouldn’t be forging your signature.”
    DO (respond to feelings) “That’s a scary thought.”
    (reassure) “I’ll make sure they don’t do that.”
    (distract) “Would you help me fold the towels?”


    Don’t confront
    Patient “Nobody’s going to make decisions for me. You can go now ... and don’t come back!”
    Don’t (confront) I’m not going anywhere and you can’t remember enough to make your own decisions.”
    DO (accept blame or respond to feelings) “I’m sorry this is a tough time.”
    (reassure) “I love you and we’re going to get through this together.”
    (distract) “You know what? Don has a new job. He’s really excited about it.

    Don’t remind them they forget
    Patient: “Joe hasn’t called for a long time. I hope he’s okay.”
    Don’t (remind) “Joe called yesterday and you talked to him for 15 minutes.”
    DO (reassure) “You really like talking to Joe, don’t you?”
    (distract) “Let’s call him when we get back from our walk.”

    Don’t question recent memory
    Patient “Hello, Mary. I see you’ve brought a friend with you.”
    Don’t (question memory) “Hi, Mom. You remember Eric, don’t you? What did you do today?”
    DO (short explanation) “Hi, Mom. You look wonderful! This is Eric. We work together.”

    Don’t take it personally!
    Patient “Who are you? Where’s my husband?”
    Don’t (take it personally) “What do you mean – who’s your husband? I am!”
    DO (go with the flow, reassure) “He’ll be here for dinner.”
    (distract) “How about some milk and cookies?” .. Would you like chocolate chip or oatmeal?

    Do repeat exactly
    Patient "I'm going to the store for a newspaper."
    Don’t (repeat differently) "Please put you shoes on."
    "You'll need to put your shoes on."
    DO (repeat exactly) "Please put your shoes on."
    "Please put your shoes on."

    Do eliminate "but", substitute "nevertheless"
    Patient "I'm not eating this. I hate chicken."
    Don’t (say "but") "I know chicken's not your favorite food, but it's what we're having for dinner."
    DO (say "nevertheless") "I know chicken's not your favorite food, (smile) nevertheless I'd appreciate it if you'd eat a little bit."

    Used with permission from Ellen Warner at Ageless Design

    Should be learnt by heart & mind by every and any carer concerned with dementia patients mo43 1/1/2015

    Posted on http://forum.alzheimers.org.uk/show...ia-VaD-recently-diagnosed-no-treatment-no-way
    By mo43 aka mojo1943




    CBT Cognitive Behaviour Therapy

    CBT means whatever you - the teacher want it to be…for me it’s the challenge to repair / restore what long mid term memories and by repetitive actions help short term memory with simple tasks.

    Use anything and everything to aid CBT eg television programs – yes especially Simpsons episodes that are family centred = most…
    DVD box sets of old favourite programs are a must – play and discus as they proceed.

    Help in the kitchen preparing meals and washing up are essential memory kick starts.

    Use the Montessori teaching principles – follow all leads where ever and as far they go.

    Standard Teaching principles – progress from the known to the unknown or forgotten…?

    You provide the New Learning Material NLM

    Do the lesson to include NLM

    Repeat and revise the NLM as lessons progress

    Use the NLM to proceed smoothly to the next NLM…called a syllabus in the teaching trade….

    Remember to repair a damaged hard disk drive HDD the bad sectors are isolated = go round them to solve problems….

    Always remember as a Teacher - (your) Attitudes are Caught not Taught…
     

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