Integrating Care: Alzheimer’s Disease

By Pat Jakubiec, OT

We can better understand individuals, support their success and quality of life, reduce the burden of care, and uncover the joy that can be experienced in care-giving in all stages of life.

Currently, there are over 35 million individuals with Alzheimer’s disease or a related dementia worldwide. This number has increased by 10 million in the last 5 years. There are over 5 million with the disease in the United States. There is no available cure. Adaptation through care-giving and environmental approaches is critical for the care of these individuals. Improving function, preventing secondary consequences and promoting their well-being can have a huge impact on society, both economically and socially.

The Allen Cognitive Network is an international group of professionals that pursue clinical teaching, service delivery and research activities related to psychosocial, physical and geriatric rehabilitation. Their mission is to promote and advocate for the value and understanding of Allen’s Cognitive Disability Model through education and networking opportunities that empower health care professionals to promote their best abilities to function for individuals with cognitive disabilities.

The Network recently hosted its 8th international cognitive symposium this year in Philadelphia with a theme of “Linking Evidence with Practice.” The Keynote speaker featured was Dr. Laura N Gitlin, PhD. Dr. Gitlin is a professor in the Department of Occupational Therapy, School of Health Professions, and the founding director of the Jefferson Center for Applied Research on Aging and Health at Thomas Jefferson University in Philadelphia. She is recognized nationally and internationally for her innovative research and publications on dementia care.

Dr. Gitlin uses the Cognitive Disability Model in her research and spoke of dementia as being a significant challenge to society, as it is 100% incurable. She feels we need better ways of diagnosing the disease and that culturally appropriate tools are underestimated. There is fragmentation in service delivery, and the direct and indirect costs associated with memory disorders are skyrocketing. Medications can be overused, and there is a growing body of evidence that supports non-pharmacological approaches. Some of the common challenges associated with dementia include:

  • Refusing care
  • Repeating questions
  • Toileting issues
  • Unmanaged pain
  • Verbal aggressiveness
  • Inappropriate behaviors
  • Agitation
  • Functional decline
  • Disengagement
  • Depression

Dr. Gitlin supports a collaborative care model and treatment that:

  • Maintains or improves quality of life
  • Maintains or increases function and engagement in activities
  • Supports medical management
  • Supports families
  • Customizes programs to address identified needs

After the international symposium, Delaune Pollard from Australia, author of several clinical books used for training in this program, and Pat Jakubiec, Ensign therapy resource, presented a two-course program at Grand Valley State University in Grand Rapids, Michigan. Also present were Joan Riches from Alberta, Canada, and Jo-Anne Gislesen from New Zealand, both past presidents of the Allen Cognitive Network (ACN), and Carol Luhmen, president-elect of the ACN.

As a therapy resource for Ensign, I am pleased to be able to bring forth an integrative approach and training program. Ensign has a culture that supports the standards and provides direction and leadership in this area. The program uses an evidence-based framework, both for application and training. It includes the use of standardized assessments, completion of a skilled personal profile, development of individualized programs that are integrated with all staff and family members, and environmental structuring. Teams are educated together to provide continuity of care and unified growth.

Last year we piloted this program in four facilities, all with positive experiences. Holladay Health Care in Utah, Julia Temple in Colorado, Vista Knoll Specialized Care in Southern California and Cloverdale in Northern California. One building has reported a significant reduction in falls, and others have reported better management of challenging behaviors, more focused activity programs, and better ways to educate the families.

We are currently looking at progressing some of the pilot sites and tracking outcomes. Julia Temple in Colorado is currently involved in a phase 2 intensive program. The building has strong core practice structures that will support an innovative program. They have a neighborhood structure, regular nurse aide assignments and a team that embraces caring and a continuous improvement process. They are managing challenging behaviors better, individuals are more engaged in their surroundings, the environment is calmer and some families have started to take note. They have implemented an innovative music program, using speakers under the direction of Audrey Lyons, a skilled music therapist. Later next year, we hope to implement a formal family program. This program will be available to all facilities and Home Health programs affiliated with Ensign as it develops within the organization.

Learning about the Integrated Cognitive Training has given me a totally different perspective on how to care for patients. I have been in skilled nursing for over 10 years and have typically done things in the same way, whichever has worked in the past. They say don’t change what isn’t broken. However, I have observed an increase in the number of cognitively impaired patients coming to our industry for rehabilitation; most of which we have given up in the past. No form of experience has given me the solution to bring out the best in these patients. We have accepted that we can only do so much for them; so you just have to try, with not much expectation. Learning about this system has given me a totally different perspective on how to do things. I now have the tools to truly work with different levels of cognitively impaired patients. Putting this theory into practice is just like a game, but with a very positive, promising outcome. I understand it will take time and everybody’s involvement, but this has given me the confidence to deal with staff and families, to ask their participation in totally supporting this program. I am a visionary. I would like to see Vista Knoll improve our program, not only for dementia patients, but to truly be called a Specialized Care Program, as our name suggests, and be well known for rehabilitation for the cognitively impaired.” Marivic Uychiat RN BSN , Director of Nursing , Vista Knoll Specialized Care

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