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[Music]

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and some new faces. So this evening we
are incorporating a dementia live

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simulation. So basically what we're
going to do is kind of divide the group

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into half and half of you are going to
hang out with me for the first session

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and we're going to really dig into and
talk about understanding common

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behaviors when it comes to dementia and
how we can best respond to those

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behaviors. while the other half of you
go with my friend Judy who's in the

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back. She is with Hospice of Southwest
Ohio and she's going to be leading you

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on um a dementia live simulation. And
this is meant to be an experience that

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helps to give you um a direct experience
and empathy to understand what it's like

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to have your your processing and your
senses um altered by dementia. So, it's

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going to give you a really direct way to
kind of understand what someone might be

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going through. So, when you head back
with Judy, she's going to give you the

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opportunity if you kind of want to
observe and you don't want to tell us in

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front of the whole room, but maybe you
just kind of want to sit back and watch

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and not participate, that's okay, too.
Um, but for now, we are going to divide

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up um half and half. So, I'm going to
ask that this part of the room go ahead

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and join Judy in the back and we're
going to take you out into the hallway

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and close the doors and she's going to
get you ready for that simulation.

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» Thank you. You'll come back in about 25
minutes and you get to hang out with me.

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» You're welcome to leave your belongings
here. Whatever is more comfortable for

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you. Um, I'll make sure Chris keeps an
eye on it.

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Perfect.
>> Chris, you need to call Amberly if you

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have a problem. Which side of the
Amberly do you call the ad?

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» You're going to follow me back here.

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We are going to need two hands for this

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area.
>> Close the door so she can talk and we

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can talk as well.

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» Wait for this door to close so that you
don't hear any any secrets.

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» It's best to go into that simulation.
You're kind of not knowing exactly what

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you expect. Creates a really cool
experience for you. Okay. So, They're

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getting ready to close those doors. And
I'm just going to do a quick recap on

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what we've talked about in our previous
three sessions. Okay. So, tonight we're

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going to be talking about behaviors.
>> I think when we met first in gosh, when

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was that March? We talked about healthy
living. We talked about a lot of those

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lifestyle um choices and decisions we
can make to help reduce our risk of

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developing dementia. Then when we met
again, we talked about the warning

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signs. As I age, what do I look out for
in myself or my neighbor, my loved one?

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you know, what are common signs of
dementia and then what are those typical

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age related changes that just happen as
we get older. You know, our brains slow

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down as we age, just like our bodies do.
And then we talked about communication.

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So, what you're going to hear tonight is
probably a little bit of familiar

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information from what we covered when we
talked about communication. They kind of

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communication and behaviors really go
hand in hand. So before we talked about

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things like joining someone in their
reality, someone with dementia, you

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should join them in their reality
because they cannot join you in yours.

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You know, they do not have the logic the
way that a a healthy, you know, normal

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brain does to kind of follow any kind of
clues and cues to ground them in the

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here and now. So we want to kind of join
them where they are. We want to avoid

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arguing or quizzing or testing someone
that will likely lead to probably not a

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great interaction. And I know I don't
like to be told like you're wrong,

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right? No one loves that. So it might
make someone kind of shut down. Same

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goes with someone with dementia. So we
might see that lead to some behaviors

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that are related to that communication,
right? We want to be really careful with

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not just our verbal communication, our
tone of voice, our facial expressions,

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um our body language. So I think when I
stood up your laps, I was standing up

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here and I was just telling you how
excited I am to be here, right? and I

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was being sarcastic, crossing my arms,
and so all the words coming out of my

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mouth sound like I'm saying, "I'm
excited to be here." But communication

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comes in a lot of different forms,
right? So someone as they progress in

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the later stages of dementia, middle to
late stages, they're losing their

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ability to communicate their needs with
with verbal communication. So part of

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the way they're going to be
communicating is through their

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behaviors. So, we might at times find so
and so was always sweet as pie and I

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just saw her get so aggressive or I
heard words come out of her mouth that

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she never said before. You know, some uh
spicier flavorful language. Right? So,

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we're seeing these behaviors as a form
of communication when someone is trying

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to tell you, "I'm uncomfortable. I'm
frustrated. I'm confused." And they

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can't tell you with their words. So just
like we talked about with communication,

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we really want to focus on keeping
someone safe and happy. So we can employ

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different strategies just like we talked
about last time about, you know, kind of

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uh following them and meeting them where
they are in their world, focusing on the

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feelings over the facts and making sure
that we are creating a soothing calming

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environment and making them feel seen
and heard with whatever emotion they're

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feeling. and then we can kind of move
along maybe tell a therapeutic fib of

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and go along with where they are and
then we can move on to an activity that

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they enjoy. So let's get into today. So
what we're going to cover in the next

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20ish minutes is really talking about
some of those common triggers that we

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see often times for behaviors that are
associated with dementia. So, we're

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going to talk about the process of how
no matter what type of common, you know,

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dementia related behavior we see, we can
use a process for kind of assessing,

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evaluating, and identifying some of
those challenging behaviors. And then

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again, just like we did with
communication, talk about those

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strategies that we can use to address
those behaviors. So, I think we talked

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last time about putting on our detective
hat and kind of using what we're seeing

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in our environment, what they might be
trying to tell us with, you know, all

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these different forms of communication
to address what might what might be

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happening. So, we'll continue and expand
on that this evening. So, behavioral

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changes can have a lot of different
types of triggers, right? So, even in a

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a healthy normal brain, this is the
case, right? if we're um in pain or

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we're uncomfortable, maybe we're
overstimulated, someone with dementia,

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and this is something that you're going
to experience this evening in terms of

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processing. Um there is some gear that
that'll help you understand what it

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might feel like to process many things
at a time in your mind. Um so over

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stimulation can be a piece. If let's say
someone with dementia comes into a room

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with 20 people all talking at once, they
have a hard time following a

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conversation with one person. So, that's
going to be way too much for them to

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follow and they're going to feel
overstimulated.

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Or maybe they're bored. You know,
sitting in front of the TV watching

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Jeopardy is not going to be a fun
activity for anyone if that's all

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they're doing. And that's including
someone with dementia. So, having

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dementia does not mean that we don't
need to be continuously stimulated. We

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want to make sure that they have
engaging activities that they can

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participate into in a safe way. Any
person wants to have some some meaning

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and purpose in their life, right? Even
if they have dementia. So that might

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mean, you know, if they always did all
the laundry, they always took care of

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the household, maybe that means they're
they're helping fold towels, right?

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Let's do something that can give them a
meaningful activity. Even if they're not

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going to do it the way you want it done,
even if you're going to have to refold

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those towels later, right? We want to
give them something that's going to help

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stimulate them and find that balance.
We can also um be fearful or frustrated.

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So, attempting to communicate and not
feeling like someone is receiving or

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understanding or being in an environment
that can be disorienting or or confusing

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for you can lead to some of that fear.
Unfamiliar surroundings, it gets more

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challenging for an individual with
dementia to leave the house. You know,

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that's mo more than likely going to be
the final kind of comfort zone that they

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have. So when you take them out of that
familiar space where they have um some

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understanding of where things are and
they have a little bit of routine, it's

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going to be much harder for them to kind
of regulate and process what's going on

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around them. And then complicated tasks
that can be really disorienting and

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cause some behaviors as well. So when I
say complicated tasks, I don't mean

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changing the oil in your car. I don't,
you know, I guess maybe I could do that.

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Um maybe. Um, we're talking about things
that are like brushing your teeth. You

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know, if you were to have an alien come
down from space and you had to explain

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the process of brushing your teeth, it's
a really complicated step-by-step

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process, too. You could write down all
the directions for brushing your teeth

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and it would probably be a few pages.
So, it's not as intuitive as it seems.

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It's just something that we got used to
because we do it all the time. But all

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of that information over time is is
deteriorating for someone with dementia.

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So even a simple task that we would
assume is simple like brushing our teeth

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can become complicated.
So when we're looking at understanding

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and addressing the behavior at hand, no
matter what the trigger was, here's kind

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of the line of thinking that you want to
employ. So we want to detect and

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connect. So you know, what are we
noticing in our environment? What are

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they maybe trying to tell us about, you
know, the environment or what might be

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irritating or agitating them? Am I
noticing that they're they're kind of

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tugging at maybe a sweater or are they
kind of itching at their neck? Maybe I'm

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going to check the thermostat, right?
How is the room stuffy? Can I open a

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window? Is there a fan I can turn on?
So, we're going to kind of try and our

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best to detect and connect with what's
going on. Address their physical needs

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first. So, I mentioned that safe and
happy, right? Safe is first. So, we want

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to make sure, are they in any kind of
danger? Are they in any kind of

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immediate physical pain that we need to
address? Do they need medical attention?

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Right? So, if that's not the case, then
we're going to move on and kind of

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assess their emotional needs. So, what
might they be trying to tell me by um

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you know, their agitation or their
irritability or maybe they're angrier

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than they normally would be in this
scenario? What else might be going on?

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Is it something where I'm trying to help
them put their shoes on, I'm noticing

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them wincing in pain? Maybe they have an
ingrown toenail that they can't tell me

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about. Right? So, try and use what
you're seeing in when I do this, I'm

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noticing this. And try and figure out
what might be going on behind the

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scenes. And then when you do notice that
trigger that causes that behavior, it's

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not the end of the world. It doesn't
mean you're a terrible person. Doesn't

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mean you're a bad caregiver. It might
just mean you learn some new

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information.
That might change over time. Sometimes

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someone might love Elvis and then they
get to the point where they get to a

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stage in this disease and they hate
Elvis. They despise the sound of Elvis.

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If you turn on Elvis, so help you. Like
they are going to throw a fit and they

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might throw some things. So, okay, we no
longer like Elvis. During my next visit,

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I am not going to turn on some Elvis,
right? So you can really use what might

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even feel like a hard situation and
figure out how you can adjust for next

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time.
Okay, I think I got a little ahead of

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myself for the sake of time. So this
just goes into a little bit more details

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on that detect and connect. Again, we're
joining them in their reality. We're

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trying our best to see the world through
their eyes. So in doing that before we

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intervene we're thinking about all the
who, why, where, how, what's taking

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place, what take place, what took place
before we saw this behavior and then

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kind of what's going on after. And then
make sure that, you know, we talk with

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communication about that approach. So we
want to make sure we are approaching

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calmly. Someone even in a state of, you
know, any kind of heightened emotion, if

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you're being calm, they're going to
start to over time match your tone. So,

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you want to be a calm, helpful person
and come back to those communication

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strategies we talked about. You want to
approach from the front. You want to

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make eye contact and you want to be at
eye level. So, I don't want to pick on

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anyone, but with all of you in a chair,
if I'm approaching you from the front,

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but I'm not making eye contact and I
don't have your direct line of sight, I

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want to be on your level. If I'm up
above someone with dementia, let's say I

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stand in front of your your TV show,
right? that person with je with uh with

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dementia might just see me as an
obstruction. They don't might not think,

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"Oh, this person's trying to talk with
me and I should look up and make eye

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contact." They might just say they're
blocking my show and move their head

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around you. So, you want to make sure
that you're on their eye level, that

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you're approaching calmly and slowly and
getting their attention so that you

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don't startle them um and then have a a
negative reaction when they're when

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they're afraid. right here.
>> So, addressing their physical needs,

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we're talking about those medical
issues. Maybe they're hungry or thirsty.

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I know I am just generally speaking a
hangry person. So, I am constantly

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trying to say like, okay, I'm feeling a
little cranky. I'm feeling a little off.

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Have I had some water? Do I need a
snack? Same goes for here. Let's think

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about those, you know, immediate basic
needs. Um, lack of social interaction.

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Maybe it's too little or too much. And
then kind of look for some of those

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environmental triggers, too. You know,
maybe the sun's shining and it's too

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bright and it's it's distracting them
from the thing that you're trying to

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tell them. Or maybe the music is too
loud while they're trying to eat and

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they can't focus on both at once. Yeah.
>> I guess I'm having a problem with you.

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» Mhm. Tell me more.
>> You're saying is not good. It is

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absolutely

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» being an educator.
>> Yeah. All these students that I met,

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college students, young students, they
don't have clue. They don't have even

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the knowledge of if an old man want to
drink or it's cold or is hungry or want

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to It is a thing.
>> Yeah. Yeah. It's really hard. So,

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» it is a thing.
>> Yeah. And all these right now as a grown

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up to do for other people that have to
be

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as
>> all kids I know you look at the

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» Yeah. You know where the kid I feel like
the younger people probably you know I

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remember being 20 and being reckless and
thinking I was going to live forever. I

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ate whatever. I drank whatever. We'll
leave it at that, right? I'm not going

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to say anything else.
>> You're a little more reckless. you think

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you'll never be older, right? And so
this is something that we see is

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happening later in life. They don't need
to worry about it. When it affects them

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is when it's their their grandparents,
their family members, their loved ones.

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So this is an increasing problem that's
going to affect people. And I know when

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I was in my 20s, my grandpa was living
with Alzheimer's and I got really

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fearful. I didn't know how to interact
with him when I visited. and I didn't

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have any tools to know, okay, what do I
do if he says something or what what do

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I do if I show up and he doesn't know
who I am? I can still have a meaningful

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visit with him even if he doesn't know
my name. Who cares? But at 20, I did not

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know that. So, I think like we got to
increase that education for everybody

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» on the lower level, not
>> absolutely. Yeah, give them my number.

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If you meet any of those young folks,
I'm happy to talk to them. We go

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through. So, Judy, you'll meet Judy. We
um train all the students at Butler

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Techch up in Westchester in rotations
every fall. Before any of those kids

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graduate from that school, those young
people, they have all had some dementia

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education. So, we are working on it.
>> Even the caregivers will come to help

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you.
>> Yeah.

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» Yeah. And we do staff trainings, too. So
we are, you know, if you know of

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organizations or people that need
resources, give them my information

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because we are trying to bridge that gap
because we know what that's that's

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that's real. So thank you for bringing
that up.

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Okay, I'm going to move us forward to
thinking about those emotional needs. So

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we talked about focusing on the feelings
over the facts. I'm going to say that

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over and over again. Use what you know
about that person's um preferences. So

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this can help with different types of
interventions when they are in that

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heightened state. So if you know that
they love the smell of lavender, they

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were always an avid gardener, maybe
we're incorporating the scent of

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lavender into that room when we visit.
Is it in the form of, you know, some

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Freze fabric refresher or whatever, or
are we lighting some candles? How can we

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kind of help to set that tone? Um, maybe
they really love baking, you know, so

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can I get them out of this heightened
state and then kind of deflect and move

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our conversation to an activity that
they enjoy, you know, even who cares

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what the cookies look like? Maybe we're
just mushing some dough around, but how

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can we kind of move them to a more
soothing activity that they enjoy? Do

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they love walking in nature? Do they
love looking at the birds? Right? How

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can we incorporate some things we know
that they like to help bring them back

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to that that um less heightened state?
And then again, you're not going to get

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it right every single time. When I look
back at when I was 20 years old visiting

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my grandpa, I know I did it wrong. I
know I, you know, ask him if he

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remembered me, right? Um so you want to
make sure that you're going back to what

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you've talked about and what did I
notice? What didn't work? What did work?

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What should I avoid doing next time?
What did I notice? And how can I The

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room is always stuffy. That room where I
visit him is always stuffy. I'm gonna

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arrive 10 minutes earlier and I'm going
to see if we can open some windows. Or

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maybe I'm going to bring one of those
little clip-on fans that can sit on the

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side of the table that can blow and
circulate some air or bring him a really

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cold drink that he loves. Right? So, how
can we make this better next time? What

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went well? What didn't? And how can I
make those adjustments?

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I think it's a bit too late.
>> You think it'll be too late?

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» Yeah. So, I know growing up at seven
grand

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and
>> we didn't need to ask.

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» Mhm.
>> It was there.

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» Yeah. Yeah.
>> Automatically it was there. We didn't

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have to be talking to that. I'm sure
sometime we

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» Yeah.
>> But it was there and we were aware of

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it.
>> Sure.

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I think having those generations
together can make a huge difference. So

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I hope we kind of swing back in that
direction, right?

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» Yeah. Yeah.
>> Okay. So when we think about we're going

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to kind of move so through some specific
behaviors very quickly for the last few

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minutes just so you can get an idea of
what these look like. We're talking

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about anxiety or agitation. These are
some of our common behaviors. So when

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we're talking about this, we're looking
at someone who's u maybe experiencing

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restlessness or pacing, distress, and
over reliance on caregivers. Um so this

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can kind of come in the form, if you're
familiar with sundowning, maybe someone

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who um people do get pretty restless and
start to pace at specific times of day.

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We want to think again, use what we know
about this person. What do they used to

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do at 5:00 p.m. every day? Maybe they're
at the window waiting for so- and so to

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get home from work, right? or waiting
for the kids to get off the bus. So, use

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what you know about the individual and
their life and their history to kind of

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um have a little bit more understanding
of where they are and what might be

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going on that could be causing that
anxiety or or causing that pacing. They

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might just be kind of stuck in a
different time and place.

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» Confusion or suspicion, not recognizing
familiar people, places, or things. This

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can show up in the form of accusing
others of theft, infidelity, and other

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scenarios. So, we often see that, you
know, we might lose track of things that

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we've donated, right? Um, I gave that
tea set away six months ago, but now I'm

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looking for that tea set and what
happened to that tea set, right? So,

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this can get kind of common. And again,
we're not looking to argue or logic our

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way through a conversation with someone
who's in this state of confusion or

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suspicion. We want to make sure that
they're we're hearing them out. You're

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right. I can't believe that T set's
gone. That's really, really frustrating.

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I'm going to help you look for it. Why
don't we I'm going to spend the next

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time I'm going to go down in the
basement. Why don't you make yourself a

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cup of tea? I'm going to go down in the
basement and look around for that tea

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set. Just let them feel validated that
they're going to move along. You're

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going to move into a different activity
and they're going to stop fixating on

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that tea set, right? We just got to kind
of move them out of that state and make

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sure that we're not shove, you know, you
gave that tea set away. What if you

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don't even remember giving it away?
that's probably going to make them feel

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that they're not being heard, right? And
they might be kind of offended that you

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don't believe them and that you're not
siding with them, right? So, we want to

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make sure that we're we're kind of going
along with what they're feeling.

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Aggression, aggressive behavior. This
can look like physical aggression or

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verbal aggression. So, it can appear out
of what feels like no reason whatsoever.

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What brought this on? Um or it can come
following a trigger. Um, it kind of

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depends on the person, but again, we
want to kind of use what were some of

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those triggers that we may have seen or
sometimes it can appear as, you know,

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the paid caregiver that came in the room
to help give them a bath looks like

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someone they went to high school with
that they hate, right? That it can be

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just as simple as that. So, how can we
work to diffuse that situation? How can

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we maybe step out and let that person
take a breath and come back in and try

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again? So, um, again, we want to kind of
try and identify what we might be seeing

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and why.
So, often times aggression specifically

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is not dangerous. Um, but it can be
really scary and a little stressful. Um,

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occasionally the person can be a danger
to themselves or another person. We

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might need to take some safety measures.
It depends on the person. We want to

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make sure that before we're deciding a
more aggressive um intervention here

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that we're talking with their doctor or
um you know calling your safety officer,

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calling 911 and getting some help,
calling our helpline and getting some

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help. With repetition, we're talking
about someone saying something over and

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over again, repeating words, maybe
asking the same question over and over

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again, right? We talked about that with
communication. So, this is something

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that we see often. You can honestly use
it as an opportunity to try again. If

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you feel like you didn't, you know,
respond properly last time, well,

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they're probably going to come back in
10 minutes and and say the same story.

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So, there's always that opportunity to
kind of figure out how you want to, you

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know, improv. You're kind of you might
be having a little bit of a one-sided

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conversation, but again, we just want to
make sure that they feel heard. And then

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what I really want to note with
wandering because I think with a lot of

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these behaviors, we see them most often
in the middle to later stages of the

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disease, further along in the
progression.

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Wandering can happen in the earlier
stages as well. And this can be really

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scary because if we think about someone
getting lost, they can be behind the

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wheel of a car. They can be on foot out
in the heat or on a really busy road.

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And they might think that, oh, I'm a
little turned around and I think I'm

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just going to go this way. and then they
get more disoriented and more

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disoriented and they're kind of digging
the hole deeper. So this I wanted to

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note that this can happen at any stage
in the disease um without any kind of

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00:23:46,000 --> 00:23:51,280
warning. So it might not be that you're
noticing someone, you know, walk out of

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the house in the middle of the night
who's in those more advanced stages.

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This could be someone who is in those
early stages, maybe just showing some of

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those early warning signs we talked
about. But we do know that 60% of people

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with dementia will wander at some point.
So, this is something we want to be

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aware of and and kind of be kind of
planning what what will we do? What kind

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of safety measures can we employ um to
combat wandering um when or how that

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happens?
>> So, I think Judy is probably wrapping

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up, right? Okay. I talked so much. I
cannot believe I did that in that amount

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00:24:23,840 --> 00:24:32,559
of time. I know that was really quick.
Does anyone have any questions before we

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kind of rotate out?

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If you're an old person
>> and then someone did take something

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away,
>> I'm sure they still

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» don't believe you because they
>> they think you don't know what you're

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talking about.
>> Yeah. I mean, I think that might be just

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kind of a different a different scenario
entirely, right?

354
00:24:52,720 --> 00:24:58,400
» Yeah. We want to make sure that, you
know, Mason was talking before about how

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people with dementia can be especially
susceptible. So, we want to make sure

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00:25:00,159 --> 00:25:05,919
we're we're on the lookout for them. How
can we, you know, if they do have

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precious belongings that we we do worry,
we want to make sure they feel reassured

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00:25:07,279 --> 00:25:12,640
that they're safe. Okay. How can we make
sure that those items are secure? You

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00:25:11,120 --> 00:25:16,480
know, we can we can kind of mitigate
that a little bit.

360
00:25:14,000 --> 00:25:22,080
» I say anybody that's ever been around a
person with dementia, everything you've

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said here tonight is exactly.
>> Yeah. Well, thank you for pointing that

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out. Yeah.
>> Every step by step.

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» Yeah. And you know what's what's really
hard is that it can look so different in

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in so many people. You know, those
behaviors can look different. Um so

365
00:25:37,120 --> 00:25:44,080
there's no perfect road map. So having
some examples and talking about it more

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00:25:41,919 --> 00:25:49,960
openly will give people a little bit
more guidance on on what you can do. So

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thank you for saying that.

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[Music]