Person-Centered Approach to Alzheimer’s Part 2 - Encore

We’re revisiting this episode because its insights remain as powerful and relevant today as when it first aired.

This episode of Truth, Lies & Alzheimer’s features part two of host Lisa Skinner’s discussion of person-centered approaches to care.

Lisa discusses reminiscence therapy, an innovative caregiving approach that involves discussing memories and past experiences with a person by utilizing prompts such as photographs or music to evoke memories and stimulate conversation.

Reminiscence therapy can help a person with dementia reconnect with their lives and even help provide closure for past impactful events. Lisa tells the story of a creative memory care director who used reminiscence therapy to diffuse a patient’s anxiety by recreating his bedroom in the dementia unit to look like his office from when he practiced law.

About the Host:

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.

Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.

So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.

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Episode Transcript

Lisa Skinner (00:00):
Hello everybody. Thanks for tuning in to another

(00:04):
episode of the truth, lies andAlzheimer's show. I am your
host, Lisa Skinner, and I'd liketo shout out a very warm welcome
to all of you who have joined usagain today for a new episode. I
really appreciate you beinghere. I hope everybody has had a

(00:25):
great week, and I've got somereally valuable information for
you again today. So if youremember, if you were tuning in
to last week's episode, Iintroduced to you the concept of
a person centered approach tocare, and basically what that

(00:48):
means is it's a care design thatfocuses on each individual
person versus focusing on thedisease. Because, as I've
mentioned before, everybody whodevelops Alzheimer's disease, or

(01:09):
one of the other brain diseasesthat causes dementia will
experience the processdifferently, and that is why, as
you will come to see it is soimportant to focus on each
individual person. So I am goingto talk about on this week's

(01:33):
show, reminiscence therapy. Whatis reminiscence therapy? Well,
through reminiscence therapy,using photographs, personal
possessions with emotionalconnections and much loved
songs, these can help triggermemories, memorable thoughts of

(01:56):
the past for individuals livingwith dementia, for those folks,
personal identity diminishes asmemory reasoning and attention
continue to slip away, even asyour loved ones become less
aware of their surroundings andcurrent events, reminiscence

(02:16):
therapy enables them to hold onto long term cherished memories.
If you remember me explaining toyou, especially with Alzheimer's
disease, the short term memoryis what is damaged first in the

(02:37):
brain and that short term memoryswitch. Think of it like having
a switch that flips on and flipsoff. Sometimes the short term
memory is on and the personsuffering from Alzheimer's
disease is thinking perfectlyrationally and is very lucid.
When that short term memoryswitch flips off, they go back

(03:01):
into a different period of timein their life, so their personal
identity diminishes. And otheraspects of reminiscence therapy
can include simple activitieslike conversation sensory

(03:23):
stimulation to help a loved onebecome aware of these memories
that they once fondly held butare tucked away in that long
term memory bank. The ultimategoal of reminiscence therapy is
to help a person with dementiareconnect them to their lives,

(03:44):
as well as help provide closureand the processing of certain
life events, because people withdementia often feel
disconnected, reminiscencetherapy will help them feel
valued, connected and heard, aswell as help them become more
engaged, and then they are morelikely to open up. Another thing

(04:11):
I described to you that commonlyhappens with people who suffer
from dementia is they withdraw.So reminiscence therapy clearly
helps open them up and becomeengaged with you. Now,
reminiscing is not the same asasking someone to remember
something from their past.Asking a person with dementia,

(04:36):
do you remember such and suchcan be a stressful experience
for them, especially if theyfeel pressured or put on the
spot. However, if you're lookingthrough old photographs, this
may trigger a sudden and fondmemory for them, and when a
pleasant memory makes its way tothe forefront of your loved

(04:59):
ones. Mind, and they share itwith you, it feels really good
to them, and you know what? Thatfeeling lasts much longer than
the memory that they just had,and what a great way to bring
joy into the life of a personliving with dementia. Now,

(05:21):
memories can be associated withdifferent parts of the brain, so
it's always helpful to offeractivities that stimulate the
different senses. Here are somesuggested reminiscence topics
and activities that you can trywith the person you're caring
for or with your loved one whenyou're visiting, talk about

(05:43):
child, their childhood andholidays from their earlier
life. The more you know aboutthat, the more questions you can
ask them or stories you can askthem to tell you you can ask
them favorite playground gamesor board games to improve

(06:03):
memory. Now we want to tap intoall five senses so we can talk
about foods and differentsmells, their likes and
dislikes. You know, smell isactually a really great way to
access memories. You can usescent cards or jars using spices

(06:25):
or essential oils to remind aperson with dementia of their
favorite foods and places, forexample, also making a meal that
your loved one has loved throughthe years, like a special dish
from a past holiday celebrationcould help them recall the
memories associated with thatdish. For me, I that makes me

(06:50):
think about candied yams that mygrandmother used to make for
Thanksgiving and Christmasholidays with the yams and the
marshmallows that were roastingon the top. And I, to this day,
can smell that dish coming outof the oven, and it just brings

(07:14):
back the fondest memories forme. So like everybody else,
people relate past memories andfond memories with different
smells of food. I know chocolatechip cookies are definitely one
for the books, so whatever youknow was maybe a favorite food

(07:35):
or drink, like mulled cider isalways popular during the
holidays, you could test outthat and see if it stimulates
some fond memories for yourloved ones. Some other ideas are
pets and animals. We call pettherapy. You can either use

(07:58):
stuffed animals or you can usereal animals. People often have
pets in their younger years andlove petting dogs and cats. You
can talk about their family,their friends and other
relationships, like tell meabout your wedding day and see

(08:18):
if they remember that day, andstart telling you the story.
Don't push them if they don'tremember though their school
days old photographs and familyalbums, pictures or keepsakes
that bring back memories areanother excellent way to
reminisce. Photos of families,friends and important events are

(08:40):
all wonderful choices as well asphotos of things that will
remind your loved one of theirfavorite hobbies. Music is
powerful. You can put together aplaylist of favorite songs they
enjoyed when they were younger,maybe in their teenage years or
in their adult years, you canshow them album covers and say,

(09:06):
Oh, tell me this story.
Just remember, try to refrainfrom saying, Do you remember
this? Ask them in an open endedway, tell me the story about
this music for people withdementia, helps people relate to
emotions and past experiences.You can listen to your loved

(09:29):
one's favorite songs with them.You can have sing along or play
music on simple instruments likeringing bells, tambourines or
even tapping on a drum.Activities involving touch, like
painting pottery, craft, doingthings like frosting cupcakes or

(09:52):
cookies, is really special.Bring in some already made
cupcakes, have your loved onefry. Sit, and then y'all get to
eat the cupcakes or the cookies,and it is a memorable
experience. You know, touch canremind someone of the past,
including activities likedrawing, painting, pottery,

(10:16):
knitting and sewing, and even ifyour loved one now finds it
difficult to do the entire taskbecause maybe they're in the
later stages of their dementia,still doing things like having
them touch the paint brushes,swirling watercolors together

(10:38):
and playing with fabrics candefinitely evoke strong
emotions. Some other topics youcan talk about, especially with
men, would be sports cars, popculture, especially from their
younger years, beauty products,looking through magazines. And

(10:59):
then you can also create memoryboxes together. And what are
memory boxes? Memory boxescontain personal objects from
the person's past and can beused in several ways, like
triggering positive memories,helping family members and

(11:19):
friends stay connected to theirlife through conversation
prompts that can provide insightinto a person's life story.
That's what that idea is allabout, providing prompts that
will trigger insight andreconnect them to their lives.
The idea is that these crops maytrigger a memory or a sense of

(11:44):
identity, and that person thencan share their thoughts and
feelings as they arise again.Open ended questions work best
as they are more likely tocreate discussion. Now let me
tell you a real life,situational story from my book

(12:06):
whose lies and Alzheimer's itssecret faces that illustrates
this very concept ofreminiscence therapy. This story
is a true story from my days ofworking with in elder care, and
I call this story the bedroomlitigator Tom had only been in

(12:28):
the memory care section of theassisted living facility for a
short time prior to that, he hadbeen living with his daughter
after his Alzheimer's diagnosis.However, he had declined to the
point where he needed full timecare every day since he was
placed there, Tom was constantlyirritated and anxious and was

(12:53):
desperately looking forsomething. What's wrong Tom, one
of the caregivers, asked him,one day, I can't find my dang
office. He replied in a panickyvoice, Oh, honey, you don't have
an office anymore. Just go backto the dining room with your
friends. Tom, clearly agitated,snapped back at her and said,

(13:18):
Shut up. You don't know whatyou're talking about. Tom, you
see, was obsessed with gettingto work every weekday morning.
Since he moved into that memorycare unit, the staff tried
everything they could think ofto redirect his attention to
something else, but nothingworked. He was dogged and

(13:41):
determined, just as he had beenduring his career as one of
Washington DC top litigationattorneys, he was convinced that
he was needed at his office.Well, the facility's Memory Care
director, her name was Louise.Had recently attended a

(14:02):
conference on a new approach totreating neurotic behaviors
associated with brain diseasecalled reminiscence therapy,
which is the recreation of apatient's personal environment
as a scene or object that theywould recognize from their past.
So with the help of Tom'sfamily, Louise recreated a

(14:26):
section of Tom's bedroom in thedementia unit to look like his
office did from when hepracticed law years earlier.
Well, the experiment worked likea charm. Every day after
breakfast, Tom would say, Okay,guys, I've got to get to work

(14:46):
now. And he'd disappear into hisoffice until the evening. Of
course, the staff checked on himregularly and were pleased to
see him working diligently athis desk. His family members
also visited. Visited himregularly and were relieved to
see him happy and no longeragitated. The reminiscence

(15:08):
therapy completely changed hisbehavior. For those afflicted
with brain disease, the mentaland physical resources they
relied on before has now robbedthem of the ability to make the
new transition. Reminiscencetherapy definitely helps
alleviate the uncertainty ofshedding the skin of their

(15:32):
former selves and provides asmoother transition into the
next and often final stage oftheir lives. Now the story I
just read to you called thebedroom litigator is a great
example of common behaviors thatcan be triggered when a person's

(15:55):
short term memory is sodiminished that they become
disoriented to time and placeand believe they are living in a
different past period of theirlife, just like Tom did now. His
disease also led to personalitychanges such as irritability,

(16:17):
anxiety and obsession with anidea that wasn't real, as well
as becoming easily angered andaggressive, the caregiver
solution diffused Tom'sbehaviors and allowed him to
reengage with his surroundingsin a calm and positive way.

(16:38):
Tom's short term memory wasalmost completely erased at this
stage of his disease. There wasabsolutely nothing anyone could
have done to convince him thathe was now living in a dementia
care facility and that he nolonger had a career as an

(16:59):
attorney or an office to go toevery day he believed that he
did and trying to change hisreality would have been futile
for his caregivers, and it wouldhave continued to exacerbate The
situation
with an overall prevalence ofabout 30% agitation is the third

(17:24):
most common neuro psychiatricsymptom in dementia, after
apathy and depression. Confusionis one of the leading causes of
anger and aggression inAlzheimer's and dementia
sufferers, as we heard in thestory the bedroom litigator.
Confusion can be triggered bylost trains of thought, mixed up

(17:49):
memories, or a sudden change inthe environment, such as a
change from one caregiver toanother, believe it or not, as
we heard in Tom's story,treatments like reminiscence
therapy help patients cope withthe loss of their core cells.
For Alzheimer's patients likeTom the best thing we can do is

(18:12):
to keep them safe, keep themengaged and keep them
comfortable in the last years oftheir lives. You see, it's our
memories that keep us pluggedinto the work and play of our
lives, what we do and how we doit. It also allows us to
understand how we fit into thesocial fabric, because it's our

(18:36):
memories that store the keyhabits, beliefs and values that
makes each one of us unique andvital. Now, unfortunately,
dementia profoundly affects aperson's ability to keep their
world in order, and thereforeimpacts the way they live in
that world and how they getalong with other people in it,

(19:00):
most people become confused whensituations go beyond the limits
of their thinking ability, andas this disease progresses, the
mind's ability to avoidconfusion declines because they
lose the normal filters andprotections that they once had

(19:21):
when their brains were healthy.Success in Tom's story was about
finding a creative way to joinhis reality. You remember I
talked about that on last week'sepisode, and your loved one may
have a different preoccupationthan Tom had, but the lesson

(19:41):
here is that with a littleinsight into what's driving the
preoccupation and a littlecreative troubleshooting, you
too, can find a way to put yourloved one at ease. For most
people living with Alzheimer'sdisease, their recent. Memories
are the first to fade away bysharing memories from the past

(20:05):
through reminiscence therapy,people with dementia can feel
more positive and less stressedor agitated through basic
activities and a littleprompting, including asking
simple questions, looking atphotos, singing, playing songs,

(20:26):
talking about a family anecdote,your loved one may be able to
recall memories from theirchildhood and beyond.
Reminiscing about these memoriescan definitely help people with
dementia feel more confident andeven a lot happier. So engaging

(20:47):
with them in a conversationsurrounding these memories can
also help relieve boredom, aswell as feelings of loneliness,
depression and despair. Researchhas shown that reminiscence
therapy can actually help withdepression by focusing on the
positive and rewarding aspectsof their past and support

(21:11):
uplifting thoughts. Now I justwant to mention one caveat to
reminiscence therapy. You neverknow which memories might
surface when reminiscing aboutthe past, if an unhappy memory
emerges through the conversationor through the prompts and cues

(21:33):
that we have been talking about,just remember to respond with
kindness and understanding toensure that your loved one
remains safe, calm and at easeif something negative does come
up, use your judgment as towhether it's best to listen and
offer support or to gently steerthem Towards a happier memory.

(22:00):
So I think we are just about outof time for today's episode. So
I'm going to introduce to youwhat life skill stations are on
next week's episode, and I havea true life situational story to
share with you at that time thatreflects on a life skill

(22:26):
situation, story. One last note,I can't emphasize enough how
much it means to me for y'all toknow that this show is about you
and how my experiences,expertise and strategies will
hopefully be able to help youand your loved one have an

(22:48):
easier time while strugglingthrough this disease. I know how
difficult it is for everybody,therefore, I would love it if
you would send me your commentsand suggestions on what topics
you'd like me to cover on thisweekly show, you can send them
to my email at dementiawhisperer [e-mail] Also, if

(23:16):
you're listening to this onYouTube, or if you Got here
through our social media page,please leave your comments or
questions, and I promise I'll domy best to address them. I will
certainly look forward toreceiving your thoughts and
ideas. And in the meantime, Iwant to say, take care of you.

(23:37):
Talk to you all next week, bye,bye. You.