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OIB Services for Individuals with Dementia

The topic for this live discussion is: OIB Services for Individuals with Dementia. Dementia describes a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities. We invite you to share your success stories, tips, strategies, and concerns for working with older individuals with vision loss and signs of dementia.

Audrey Demmitt R.N., B.S.N. is with us today from Georgia. She has written and presented on Dementia and Vision Impairment and has worked with older adults as a nurse, an adjustment counselor, and support group leader.

Feel free to add a new comment or to reply directly to a previous comment. All discussion will take place on this page, but you may need to refresh your browser every few minutes to make sure you see the latest comments. This is a text-only forum, so no audio equipment is needed. These posts will remain on the site, to serve as a reference for those who may have similar questions in the future. If you would like to submit a question anonymously, you may email DBedsaul@colled.msstate.edu.

Comments

Priscilla Rogers's picture

What types of visual deficits cause mistakes in perception for individuals with Alzheimer's dementia and how do these affect vision rehab?
Audrey Demmitt's picture

Great question!-deficits can vary greatly...from blurriness in acuity, lack of depth perception, field loss, loss of color discrimination and contrast, problems sensing motion and then there are others that are neuro in nature and more about the interpretation of information. So the rehab approach is the same as for anyone with these deficits...use all the methods you already know! The differences may come more in ways to communicate with the consumer and setting realistic goals in the face of constant decline.
Audrey Demmitt's picture

Keep in mind that Alzheimer's dementia causes its own visual problems and they may be on top of other eye conditions the consumer has-AMD, cataracts, glaucoma, etc. Fall prevention is key in these consumers, so is lighting, contrast, simplifying the environment, removing shiny surfaces and shadows which can provoke anxiety in the consumer. It will be very individual and will require assessing what stage they are in as well.
Mark Armstrong's picture

Anxiety is so relevant to the rehabilitation process. Seniors can be resistant based on their fears of being identified as different from their peers and/or from their lack of knowledge. Seniors with combined vision and hearing loss have been known to take up to 7 years to acknowledge the loss.
Kenalea Johnson's picture

I agree with you on both of your posts, Audrey. I see the same issues. Kenalea Johnson
Matthew Haynes's picture

I have found that some persons with dementia often cannot describe their residual vision accurately. For example, based on the consumer description you think they can see very little, but when a magnifier evaluation is done, find that they need a much lower strength than expected. This can also be said in other areas of independent living, and as their mental decline increases it becomes more difficult, even if their vision is basically the same.
Bill Tomlin's picture

Great point Matt
Kendra Farrow's picture

I have sometimes found consumers are not able to read, even with magnification that should be close to correct. Do you think more than usual difficulty with using magnification/reading could be a symptom of dementia?
Audrey Demmitt's picture

Not in and of itself...it would have to be found in the midst of a combination of symptoms like memory loss, trouble carrying out the steps of a task, problem solving skills declining etc. In isolation, I would think first about hand coordination (do they have arthritis?) or hearing impairment and they don't hear the instructions properly...
Matthew Haynes's picture

From what I gather difficulty reading is something that occurs more in the later stages. But this could be compounded for those with vision loss. One suggestion I found was having them read books or magazines from the past that they enjoyed.
Mark Armstrong's picture

Great point Matt, I like to play Western TV Theme Songs as a game. Many seniors who have memory loss and/or dementia most often do very well naming the TV show. It is a type of recall which I found sometimes helps to connect with the person with whom I am working.
Kenalea Johnson's picture

Kendra I look at the symptoms of dementia as slowly happening as the brain becomes more dysfunctional in specific areas. As I work with a population of persons without literacy or expressive communication it is often based on movement changes and ocular movements and responses to requests. I think the most important part of evaluating is sensory overload. So I work in short periods (no longer than 15 minutes) in quiet low light environments and communicate with the person. Often there are several of these periods before I can really see what areas of communication, movement, social skills, and vision/hearing to find a picture of the person. The diagnosis is easy to find as our residents' health record is easily accessible. But, determining how the individual is impacted and what type of brain dysfunction is happening takes longer.
Audrey Demmitt's picture

Yes-so taking the time to make some "functional" assessments can serve you well. Even though dementia has predictable symptomology and follows a predictable course, it does not look the same in each consumer. Symptoms are determined by which area of the brain are damaged and that will be different from consumer to consumer. Keep in mind there are different kinds of dementia too. Alzheimer's accounts for 60-80% of cases. The next most common type is Vascular which can present with many different symptoms.
Audrey Demmitt's picture

Some of this may have to do with the consumer "faking it" or masking their problems due to anxiety and embarrassment. They will also have more problems using words and speech as cognitive symptoms come in to play. Vision can stay the same-that is the part that the eye does, while the brain has more trouble interpreting the information. This may result in bizarre responses or reports of hallucinations.
Mark Armstrong's picture

Perhaps in the more recent cases of vision loss, the person doesn't quite know how to isolate central vision when describing their vision. Other factors may be affecting their description such as contrast, lighting, glare...
Kenalea Johnson's picture

I work with aging profoundly intellectual and multiple disabled (PIMD) persons who have lived most of their lives in institutions. Few have any expressive language and if so their conceptual knowledge is limited. I do have success in evaluating their brain based visual impairments and have success in providing intervention for those problems. I find that the dementia is very similar to brain based visual impairments as it is also brain based. So I am able to research probable areas of the brain that are not working so well and work to teach skills and bring more cognition into their lives. Kenalea Johnson
Joanne L Stamp's picture

On visual deficits - as well as color blindness issues, I think it is important to investigate effects of color and color perception that the individual is possibly experiencing. I know that black and red may cause specific reactions or create visual perceptions for an individual. If we are supplying tools in the visual impairment tool box such as increasing contrast, then it would help to know how color may be affecting them.
Bill Tomlin's picture

Great Point Joanne, thank you for your comment!
Audrey Demmitt's picture

I imagine this would be quite individual, and perhaps doing some assessment to see if there are emotions or negative reactions to certain colors that may be related to what they represent, or eliciting certain memories. I am sure that busy patterns cause confusion and colors in the blues and purples are difficult to discriminate for them.
Priscilla Rogers's picture

Can you offer any tips to minimize Visuoperceptual Mistakes that may be caused by Alzheimer’s Dementia?
Audrey Demmitt's picture

Use color and contrast at mealtimes, remove clutter around the house, improve lighting, eliminate shiny surfaces, label things in large print-for instance if they have trouble remembering where the bathroom is, put a large sign on the door. May need to simplify ADL's and use tools to help with them. Use memory aids like alarms, and organizational aids like labeling techniques for medication management...these types of things.
Priscilla Rogers's picture

Can you suggest any additional resources to find out more about this topic?
Audrey Demmitt's picture

Yes - there are several articles on this topic on www.VisionAware.org. Just use the search bar with key words. Also, the alz.org site has good information.
Mark Armstrong's picture

This is particularly important to seniors who are hard of hearing and blind or have low vision. Visual, Auditory, and Tactile Alerts can be useful as a stand alone alerts or in combination with one another, depending on the progression of the combined vision and hearing loss and the environment in which the alert is being used.
Kenalea Johnson's picture

good information on the Alzheimers.org.uk about Visuoperceptual difficulties in people with dementia
Sandy Neyhart's picture

Would you offer some practical tips that would assist direct line staff in delivering skills of blindness techniques to someone who is experiencing dementia. These are likely to be skills or goals in ADLs that were identified by the individual. Retaining skills and practicing the techniques that are taught by the staff may be the challenge.
Audrey Demmitt's picture

Indeed this will be the challenge! they will NOT retain skills no matter what. And the goals are to keep them as independent, safe, calm as possible for as long as possible but they WILL decline and lose ADL's eventually. Teach them in as simplified way as possible, target what they need, teach skills in real life context, and enlist the reinforcement of the lessons by family, caregivers, staff etc.
Audrey Demmitt's picture

There will come a point where there is very little carry-over from lessons taught. At that point, it may be best to direct the teaching to the family and caregivers -give them strategies that can help them and that they can keep using between lessons while caring for the consumer.
Kendra Farrow's picture

It seems like itinerant services for individuals with a diagnosis of dementia should focus on simplifying the task visually, using high contrast visual cues, and not spend time on attempting instruction of new skills. Is that correct? I don't want to have low expectations of a consumer's potential, but under these circumstances it seems that this is realistic.
Audrey Demmitt's picture

I would still teach new skills...even if the consumer will only use it for a few months and then lose it. How to brush their teeth, bathe safely, etc. are skills that preserve their dignity and independence for as long as possible...it can seem futile but I think it is important.
Matthew Haynes's picture

I agree with Audrey's point that eventually direct service staff can focus more on helping caregivers provide accommodations than seeing the consumer learn skills. This leads to a better quality of life for the consumer and the caregiver.
Kenalea Johnson's picture

Quiet environment, short periods of instruction, short period of self regulation time (will allow the information to be sent to long term memory) and positive reinforcement. I use the BCP type of goals for the instruction of skills and they go like this: 5 second attention to task with supervision and encouragement, next step is 10 seconds attention to task with supervision and encouragement, next step is to have 5 second attention to task without supervision, etc. I find that skills are more quickly learned with 100% success and diminishing supports.
Sophie Kershaw's picture

If a consumer tells me they have been diagnosed with dementia, what should I ask to better understand? How can I make their plan of service realistic?
Audrey Demmitt's picture

Ask them what stage they are in, and what is the prognosis from their doctor. What other health conditions or eye conditions they have to consider. Explore what they WANT in the future and help them plan for that. In early stages, a consumer may have quite a bit of insight and knowledge about what is going to happen. If not, bring that information to them, help them learn about their disease in accessible ways.
Sophie Kershaw's picture

This is a great reminder to open a dialogue and keep the lines of communication moving with consumers.
Priscilla Rogers's picture

Can you talk a little about this syndrome? How does it relate to this topic?
Audrey Demmitt's picture

CBS is a type of visual hallucination that happens with people who are losing vision. People can see simple patterns or complex images of people or objects. This type of visual phenomenon is NOT related to mental illness or damage in the brain. The hallucinations that can happen in late stages of dementia are due to brain damage, sometimes related to medications that are given, etc. Certain types of dementia are known to cause hallucinations, like Dementia with Lewy Bodies.
Audrey Demmitt's picture

Consumers with dementia could have both experiences and both types of hallucinations can be frightening so they will need some reassurance, support and information. The hallucinations of dementia will be worse and maybe more interruptive and should be reported to the doctor.
Kendra Farrow's picture

My aunt had Lewy Bodies dementia. Before she was diagnosed, she was describing things she was seeing, children, animals, flowers, etc. My first thought was Charles Bonnet syndrome, but she had no vision condition. It was a good reminder to me that I should be cautious about automatically jumping to one conclusion. It is important to get more details and an official diagnosis.
Mark Armstrong's picture

Yes, I was thinking about this too. My question is whether or not there is difficulty diagnosing someone with CBS hallucinations as opposed to dementia since CBS comes from the break down of vision?
Kenalea Johnson's picture

Has anyone worked with person with Posterior Cortical Atrophy Dementia?
Audrey Demmitt's picture

This is a more rare type of dementia and onset is earlier- age 50-60. It affects the visual center of the brain-so first symptoms are usually visual problems, not always memory issues. Here is a website that offers more information and support for professionals: www.raredementiasupport.org/pca/.