Speech and Language Pathology

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Dementia
fouxdefafa wrote in speechpathology
What do you do with dementia? 

I had my first session (in a SNF) with a sweet lady with Alzheimer's today.  She had some goals written for safety awareness and communicating functional items...but her memory is so bad and I don't see much in the way of new learning, we mostly spent the time looking through a memory book a relative had made her.  Reminiscence therapy...glad there's a term for that.  Cuz it really just felt like being a nice person and spending time with a confused, frightened old lady who was painfully aware of losing her mind.  

Tips?  What is your general approach with Alzheimer's in a sub-acute setting? 

I would be interested in hearing what other slps say. i have undergrad in gerontology and lot of work experience w/elderly but not as slp..

Could you give us some more on your perspective from a general gerontology standpoint? What is the focus of care for dementia patients in assisted living situations? (I'm pretty sure I know the basic answers but maybe you have some cool insights?)

is this person's goal to go home? otherwise, i'd probably do nothing. if she were going home i *might* do a "functional maintenance program" with the family/caregiver education. but if she really cant learn, in the context of a progressive, incurable disease, i'd probably do nothing. IMO, there is often an ethical dilemma when it comes to tx patients with advanced dementia......

Yeah, I think it is to go home (SLP was consulted but her admit dx was something else, more acute). I agree with you, which is why I was surprised to see this on my caseload.

Would it be possible to do some short term treatment to see if she has gains. Then you could let her go if no gains were measured?

horseteeth, i was going to say as well surely it's not ethical to treat patients w/advanced dementia. who gains from it? for sure families may need to be taught some things like the nature of the disease, progression etc but not the advanced dementia patient.. i have a particular fondness for alzheimer's patients based upon my experiences working in an assisted living facility and other places..

Dr. Michelle Bourgeois is a faculty member at my undergraduate institution, and her research and work with dementia patients is AMAZING.

She has a tumblr set up that is somewhat regularly updated at michellebourgeois.com. She advocates the use of memory books, similar to the reminiscence therapy you mentioned, it seems, as well as using flash cards and modified games and activities related to activities/ interests that the client held before the onset of her dementia.

Dr. Bourgeois's book, Memory Books and Other Graphic Cuing Systems and research may be helpful to you in working with dementia cases. After all, at this point, your job is to make life minimally confusing and optimize communication/ understand within your scope of practice and the client's level of ability.

you're very welcome. i hope it helps!

also, i hadn't realized that i wasn't logged in! oops!

To the original poster - boy I could go on for ages as to my experiences and thoughts on care of the elderly. In a nutshell the company I worked for (major corp) it seemed they only cared for the physical aspects of the elderly not the mental aspect. Not enough was done to engage with them even though my friend was a wonderful activities director. You could only do so much. The assisted living director just stayed in her office. I would go visit with residents, you find yourself singing songs w/soldier from World War II who couldn't remember what he did 5 mins ago but could tell you with great clarity his wartime experiences. So for me based on the experiences I had not enough was done for their mental stimulation at all. Sorry I'll get off my lecture post now..

Edited at 2012-05-05 06:02 pm (UTC)

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