A podcast that listens, hears, and offers wisdom & hope from caregivers who have lived the experience.

A Supportive Podcast for those Dealing with a loved one with Memory Loss

The Busy Caregivers Guide to Advanced Alzheimer’s

The Busy Caregivers Guide to Advanced Alzheimers

00:00:02 – 00:05:05

Welcome to fading memories, a podcast with advice, wisdom, and hope from caregivers who have lived the experience and survived to tell the tale. Think of us as your caregiver, best friend. Now you can join important Alzheimer’s disease research from home in minutes with picnic health. Go to picnic, health, dot com slash memories to sign up and get $25. What does picnic health? Well, picnic health collects and digitizes all of your medical records into one online account. Then, you can consent to share anonymized data from your records with medical researchers. By examining this real world data from medical records, researchers can find answers that can’t be found in clinical trials. There is important information in each person’s unique healthcare journey, so share your story. If you care for someone with Alzheimer’s, you can sign up on their behalf and manage their medical records in a picnic health account. Learn more at picnic, health, dot com slash memories, and get $25 when you sign up. Find the link in our show notes and on our website. Caring for someone with advanced Alzheimer’s disease is definitely a challenge. It can make you feel like you’re on a hamster wheel, running in circles, trying the same things over and over with no effect on your loved one. You may find it challenging to connect with your loved one and to understand what those living with Alzheimer’s disease are going through. The busy caregivers guide to advanced Alzheimer’s disease gives you a model designed to help you understand cope with and handle some of the most challenging behaviors associated with this disease. In this episode, doctor Jennifer stetler and I discuss her dementia connection model and how to use it in your caregiving. The following episode discusses specific challenges you may encounter and ways to tackle them in the most positive way possible. With me today is doctor Jennifer stelter. She has written the book the busy caregiver’s guide to advanced Alzheimer’s disease and not only are we going to talk today, we’re also going to have another episode next week. So thank you for joining me. Can you give us your background give us tell us about you first and then we’ll go into the book and all your great advice. Absolutely, absolutely. So thank you for having me. So I’m a clinical psychologist by trade. I have a very eclectic, I guess, background if you would call it that. Being a clinical psychologist, I think I started off in the what you would expect as a normal path of a psychologist going to graduate school and conducting clinical work. I have actually some research research background as well. I worked at a number of universities and different types of mental health centers and hospitals and things like that across the country. And where I really started to work with individuals who are aging was in my post doctoral fellowship. It was actually in I was conducting a research project between northwestern university here in the state of Illinois. And the Heinz VA, the veterans affair center. And so I actually was working with seniors on how to live healthfully and how to really try to extend their life. And so that was a really rewarding experience. And I absolutely fell in love with the aging population at that time. And so when I graduated from my postdoc, my first, I guess, real job right outside of that was in senior living. I actually joined a major long-term care company here in the state of Illinois there in the Midwest and also Wisconsin. And it actually was hired to run one of their behavioral health programs within one of their nursing facilities. And so although I went into mental health, my role quickly changed. I actually worked my way up into operations once I became licensed and I started to work with not only of course the behavioral health directors of the company, but also memory care directors. I was at working with our social workers. I was working with their activity professionals, right? And doing a whole list of other things. And so when I started to work in memory care, really that was somewhat new for me. And I’m going to be honest, you know, going through graduate school, of course, we have some studies in dementia. However, it’s not a sole focus. And so not being a sole focus, it was something where I really had to learn everything about dementia on my own. And so I knowing that this was really a continued, I would say epidemic. Within our industry, as well as within the world, I said, I really want to learn more.

00:05:06 – 00:10:14

And so I took it upon myself over really a ten year period to study everything I could study. I went to conferences, I met worked, I met with individuals who were authors who had created models on their own, very familiar with following some of the major gurus like Cameron camp and David trexel and to be snow and Vicky to clerk from the validation institute, right? All those just awesome gurus who had so much to spread and learn about how to teach about the about dementia care. And so for me, it was really taking what I learned and applying it into the setting where I was working. And so I was overseeing about 17 memory care programs and that served quite a number of staff, of course, and thousands of residents. And so at that time, what I was doing was taking what I’ve learned and applying it directly with the patients as well as training and educating the staff on how to best interact and connect with those individuals who have dementia. And so that’s really my kind of journey in my career, honestly. And so there’s been other things that I’ve been involved in creator my own business as well as you can see here on neuro essence, I have a business partner who’s a biologist, her name is Jessica Ryan. And at neuro essence, what sets us apart is we, of course, specialize in dementia care. Doing traditional training and education, we develop programs for senior living spaces and private practices, organizations, but we also work individually with families in their homes to develop these programs for those they’re caring for. What dementia. And then we do consultative efforts. But what really sets us apart is we focus on non pharmacological interventions. So what we can do with our hands and our heart to connect with individuals who have dimensions. So we use a lot of the practices that are in my book. To develop these programs and to implement them. So that way everyone can use them. And so that’s what we do at neural essence. So that’s really my journey. So I have a hodgepodge of other things too, but I’ve always loved to myself be a forever student to become educated and then spread that love to other people. And my business partner has the same passion, but we do know that continued learning is good for our brains. Our aging. So I went from being a professional portrait photographer to be a podcaster and so I learned a lot of stuff and I think that was good for me. So anyway, it’s been it’s been a fun journey. But I will make sure that your neuro essence is also linked in the show notes because that sounds also interesting and I’ve talked to a lot of caregivers who do like the essential oils which you do talk about in your book, how to use them when to use them. And that kind of stuff. So it’s I personally am a non pharmacy, I try to do everything naturally if I can. Obviously, that’s not always possible, but my dad was on what I always called a pharmacological soup of so many different drugs. They had no idea what any of them were doing with each other. It was impossible. Over two dozen. That’s terrible. Wow. And every time he’d have interactions because of, you know, a new drug, they would give him, you know, it’s like, oh, I’m experiencing these symptoms. And they give him another one. It’s like, how about we dial back some of this? Because one is probably causing the other. Exactly. And that’s what I even in our field. There’s just an overuse of pharmacy in the domestic care field. And it’s just very unfortunate because there’s a lot that can be done from a non pharmacological perspective that it just takes the time to learn it, implement it and be able to see it success. My experience with my mom’s memory care residents, they were fantastic, but they could have used more training. They could have definitely used more staff so that each person would have more time to devote to whatever needs residents had. It wasn’t like they were neglected or there wasn’t enough staff to take care of what needed to be taken care of. There just wasn’t enough staff to, you know, of course your mother into the shower, or, you know, they had residents that needed to had gotten to the stage of the disease that they needed to be fed and obviously takes time and you can’t help somebody else when you’re feeding, you know, so and so and they need to change the fee structure for those. The whole financial way of that industry needs to change, but I don’t know how because that’s not my thing. So while I’m pretty sure it will change as the population’s aging because there won’t be an option not to change, but I will be 55 after this episode comes well before this episode comes out.

00:10:14 – 00:15:07

So I’m not sure it’s going to change fast enough for me, but I’m doing everything I can to keep my brain strong so maybe I can just move to assisted living so other people can take care of stuff like cooking and cleaning and maintenance of the facility and the home, et cetera. And I can just do whatever the hell I want. That’s my plan. Well, the last chapter of my book is on brain health and it gives you some easy strategies to implement that can help you to keep your brain strong. So there you go. So it’s even another reason to read the book. So which is gonna be linked in the show notes too, so you guys all know I always do that. So your book talks about the dementia connection model. Why don’t you explain that? Because I will probably butcher if I try. Absolutely. So let me talk a little about how the model came to be. And then I’ll get into the framework. So essentially, as you’ve learned my background was not specifically in dementia care, everything I learned was on my own. And so when I would learn different types of strategies or approaches, you know, I would bring it back and we would talk about it as a team and we would implement them at the company that I was working for. Had wonderful memory care directors that were just humor me every step of the way, which is great. I think for myself, it was really when my we’ll be back up here. You know, just listening to staff. Staff were struggling with really understanding the disease. They were struggling with the progression. You hear a lot of these typical statements and dementia care. Like, you need to live in their world. It’s a very typical statement, right? But nobody asks why? They just say, okay, live in their world. Okay, I can do that. Or yeah, show me how to do that. But no one says, well, why do I need to do that? Or let’s just say a person with dementia becomes aggressive, you know? People will say, oh, that’s part of the disease process. Well, no one says, well, why does that happen? So for me, when I developed a framework, I wanted to answer those questions. Why really easily? No matter if you’re a family member who is working with someone caring for someone with dementia or if you’re a staff member in a facility, I wanted to answer that why very easily. So that was one piece that went into the model that I thought was very important. But the other piece was or the second piece was when I was actually during this process, I was actually having children myself. And when my children were born, they’re now 5 and 7. When I was writing the book, I think that they were two and four or something like that. But everything came alive for me, I was at home caring for my children. And then I would go into the facilities and I would see the same types of behavioral expressions. I would see the same types of struggles within my patients who had dementia. And of course, the same frustrations as a parent I was having. Staff were having with the people we were treating. So I thought to myself, there’s a connection here. There’s a connection here and I need to figure it out. And so the third piece of it, being a clinical psychologist, I said, you know what? Humans are all like, no matter what is going on with our brain, whether it’s disease or not. We’re all like, we all have most of us have all the same parts. And so with that said, there’s got to be something that around the cognitive behavioral approach, which I’m very familiar with of course. In this perspective. So that’s kind of the backdrop behind it. I’m going to go into detail here. So the dimension connection model is essentially a framework of three pillars. The first pillar is a retrogene, the theory of retrogene. Now I didn’t develop that. That was developed by doctor Bayer reisberg many years ago. So I followed his research and it was a really just beautiful understanding of what was going on. It was answering the why, for me, and I thought to myself, it’s understanding the why for me, it’s got to help other people understand as well. Now with the theory is essentially he says that this is again in three years of research that as the disease progresses, the individuals actually go in reverse with all of their skills and everything. So we’re not just talking their ability to take care of themselves. We’re talking about communication. We’re talking about emotional expression, behavioral expression. We’re talking about maturity. We’re talking about various ways of coping. These are all going in reverse to infancy. And he had pinpoint a very specifically that individuals from moderate to late stage are really anywhere in their developmental age of 7 to about four weeks old. Now, he’s not saying and neither is my model, saying treat individuals with dementia like children because that is absolutely not the way to go about this at all.

00:15:08 – 00:20:01

What it is it’s just an understanding that maybe you are working with someone who has a chronological age of 75. But the developmental age could be someone who’s 5 years old, who’s three who’s one years old, right? So it’s us being able to say, let me put myself in the shoes of that person. What I expect. This is all expectation, but I expect a one year old to act like an adult. What I expect a 5 year old, and so on, right? So we, as caregivers, can lower expectation of that person to really align with them. So there’s a lot that goes into that component, right? Of them getting younger, right, getting younger in some respect. The lovely thing I talk about in the book is the greatest thing is that you will get to know that person as they are 25 years old, then as they are 13, then they are 5, because their personality goes back in reverse as well. So it’s awesome that you get to see all those aspects of them. But what’s really going on, right? So this idea of can you need to live in the world of that person really means that their world is very similar. To a young child. That’s what that means. And so a lot of people that was never explained to them. So how does a young child learn? How does a young child act? How does a young child communicate? And so on and so forth, right? And really, much of it before the age of 5 is through their senses. And so I joke and I say, you know, when a baby is born, right? And they start to communicate a little bit. And we, of course, we usually try to teach them mama and Dada, right? They’re only learning that because of what they’re hearing and what they’re seeing. They don’t pick up a book at 6 months old and be like, okay, there’s my mother, and now I know that mama. Right? They don’t do that. So they only have learned that through their senses. So the assumption is, is that as someone with dementia is progressing, they’re going to rely on their senses to start to navigate their world now. That’s what they’re going to be able to connect to the world. And so when we talk about living in their world, it’s saying, I need to work with them by experiencing what their experiencing through their senses. What are they seeing and hearing and tasting and touching and smelling at all times? Because you think about it, right? Think about something as simple as our voice, right? So when an infant can hear their mom’s voice, right? Usually they’re have a big smile on their face. They get their calm because they know mom is in the room, right? Because they’re research shows that the baby can even hear mom’s voice through the womb, right? So that’s and a sensory stimulation of the auditory system. They’re hearing mom’s voice and they’re calm and or they’re happy. It’s positive feelings, right? So the assumption is, is that we can do the same with people with dementia, right? Because we can connect with them by influencing their senses. Using positive stimuli. So that’s the first pillar. And that’s the cognitive piece when we talk about cognitive behavioral therapy, right? Or cognitive behavioral approach. Is that this is the way they’re thinking now. This is the way they’re living their world. The second pillar is called habilitation. This is the how. How do you apply this model? And so this is really the behavioral approach that we’re going to use. And so when I talked about that, all humans are basically the same. Is that we love positive reinforcement. I mean, you can’t argue with that, right? Nope. And so part of I talk about the three R’s. I actually learned the three R’s through dementia guru named Josh fritas. He actually wrote the book the dimension concept. And he talks about routine, remind reward or the three words. So we apply that to my model, routine is we have to apply the dimension connection model consistently. And we know that people with dementia thrive on consistency and structure. The reminder, the sensory cues we’re going to use, because we’re going to get to the approach side here in a second. That’s the third pillar. We’re going to use sensory cues. And the third is the reward. The reward is that the person you’re caring for wins. And guess what? You as the caregiver win too. You win because you get to see the beautiful smile on their face. You get to see how calm they are. You get to see how much they really are enjoying themselves. And we love that as caregivers.

00:20:01 – 00:25:01

So everybody wins. I always talk about the win win in my book. So using the three R’s in the process of habilitation. That’s the second pillar. Maybe I fail to mention that. And so habilitation is basically how to reinforce skills, which is the behavioral therapy component, right? And that’s using the three R’s. Okay. Now the third pillar, which is basically sensory based knowledge is that we know then people with dementia, who are getting younger, they’re going to take in information through their senses and process it. Now the goal here is to use sensory stimuli that are positive for them. And so when they are when they’re feeling positive or we’re using positive stimuli. That will influence positive emotions. Why is that? So I’m going to get a little clinical here. So what happens is when we experience this for all humans, when we experience stimuli through our senses, whether it’s good, whether it’s bad, right? What happens is directly or indirectly influences our limbic system, right? And in our limbic system, houses a little being called the amygdala. And the amygdala is what, amongst other things that it does, it generates our emotions. So what happens is, when I say directly or indirectly, it’s because the olfactory system, what we smell directly influences the amygdala. Research has shown that. Indirectly is what we see and when we taste and what we touch and what we smell. Did I say that? What smell is the direct? So all other senses indirectly influence the limbic system. So essentially what we’re trying to do is we’re kind of playing on the benefit of what the brain does with this model by, of course, using positive stimuli to influence positive emotions. And so we’ve all seen it, right? So we’re all kind of doing this already. It’s just putting names to it. So essentially think of music. Music has been studied extensively with people with dementia. Not only does it help to influence positive moves, but there’s been some cognitive benefits as well. So when you think about it, if you just think about you and I, you can probably name songs that you play that make you feel motivated and happy and excited. And then there are songs that you can play that will of course without a doubt make you feel sad, depressed or angry or irritable, right? Well, the same thing applies for people with dementia. Find out what their preferences are. What kind of music do they like? You know, what kind of foods do they like? What kind of smells do they enjoy? What kind of visual aids do they like, you know, in terms of pictures or things that bring them joy, right? And you’re going to use those things on a regular basis to be able to influence those positive emotions. And I’m going to go back to another saying that you probably have heard, right? That if it doesn’t matter your name, it doesn’t matter what you do. It’s how that person would dementia feels with you. So this dementia connection model makes that come alive. It’s saying that if you can influence them to have positive emotions, they’re gonna feel all these good emotions around you all the time. Therefore, they’re gonna connect to you. And that’s why it’s called the dementia connection model. I have a quick, I have a quick story that demonstrates that. I always like to take my mom to the park to watch kids. Generally, or we’d go to the library or wherever. And she’d be out of the sunlight. It was just a very positive experience. Once we got to the park, we were sitting on the bench, it was positive. Getting there was a little challenging. And that’s what I did a lot. I would take her out of the residence and try to give her and it was challenging because you know she couldn’t watch her visual processing was really shot. And her attention span was so it was very difficult to do, but watching kids was her pleasure, and that was easy enough to handle, and that’s what we did. So we did that all the time. We’d go to the park or wherever. This one particular days, this was September 2019. So she was in the last year of her life, my husband and I had come home from a conference. If anybody has flown through or out of Denver, you know that they are constantly delayed because of wacky weather. So we didn’t get home until one or so in the morning and I am like a complete sunshine daylight person. Sun is up, I’m awake, sun is down, I’m gone. You know, it’s like the solar charge of a Californian. This is the way it is. And so I knew I was tired and I’ve learned from negative experiences with mom that if I was tired or stressed, even if I didn’t think I was showing it, she sensed it a 110%.

00:25:02 – 00:30:13

So I show up on this particular day. It actually happened to be my wedding anniversary, and I brought my wedding album, which she put together because my dad he was a photographer as well. His associate did our wedding. So she was very integral in choosing the pictures and putting the book together and everything. But I knew she wouldn’t remember any of the people and it was just it was just something to do because I was afraid trying to take her out that they would result in a negative experience. And neither one of us wanted that. So I show up and she sees me and she most of my listeners know, but you don’t. My mom thought I was her best friend, which was fine. So she sees me and she goes, oh, hi, where are we going today? I was like, excuse me? Like, you don’t remember our relationship. You don’t remember what you did 5 minutes ago. If I go to the bathroom, you won’t remember I’m here, but you remember that we go out all the time. That’s just blew my mind. I’m like, literally, like, the puffs of dust came out my ears. I was shocked. I was just, and then I felt guilty because I was like, oh, crap, now we’re not going anywhere today. Yeah. It was so sweet in your face with the emotions she has felt over and over and over again. We made me feel good that she felt that way that I felt guilty we weren’t going out, but I did bring a chocolate spice bread that I made, which is really super good. And so that cured that problem, so there you go with 6s all things. So my listeners are probably heard that story a lot, but it does reinforce what you’re talking about is how you make them feel is important and you may not realize 90% of the time I didn’t know if my mom even registers what we were doing. I know she had zero idea of how much effort it was. So that was very rewarding that she she says, oh, hi, where are we going today? I was like, oh my gosh. You know? So I felt very her dying was a little bit sudden. Sort of, but it was a blessing ’cause I have no idea what I would have done with her during the pandemic. There was no kids in parks, parks were closed. It was just like, last year would have been super, super ugly. So I’m very glad I didn’t have to try to figure out how to take somebody that I spent a lot of time dragging to the park. And try to figure out what to do with them when that wasn’t an option. So I was lucky that way. So you guys know, I’m not a coffee drinker, but man, do I need my tea? Unfortunately, too much tea and I get a real sour stomach. Thankfully, I found something that helps. It’s a drink that makes you way more productive and helps keep you focused on what you need to get done. It’s called magic mind, and it’s light on caffeine, which is real benefit for me. It’s created with all natural ingredients, which is important for any of us interested in brain health. So what’s in magic mind? It’s got adaptogens that help decrease stress totally needed. Neotropics that boost blood flow and cognition and matcha that keeps you focused. The macho will help you crush your to do list while drinking less coffee or tea. I’d never tried matcha before, and I’m really glad that I found it with magic mind. If you’re a tech geek, then you’ll know that the creator of magic mine, James Bashar, he drank so much coffee, gave himself a heart issue. Looking to find a better alternative, James combined all these ingredients that help him stay productive and dominate the business world. Then he sweetened it up for the rest of us, which, you know, I like. The taste is better than I expected. You can take it all in one shot or in sips with your morning meal. That’s what I prefer. I’ve been using it to stay on task with our move and my podcast, which is seriously no easy feat. It’s helping me and I’m sure it’ll help you with all your caregiving responsibilities. Learn more or order your own at WWW dot magic mind dot CO slash fade memories. Be sure to use the code fading memories 20 for a 20% discount. That’s magic mind dot CO slash fading memories. You can find the link in our show notes and on our website. How does this dementia connection model? How do we how do we go forth with this? Now we can we’ve heard why we should and why is always a question I ask, so I was super excited that that’s how you started this talk today is explaining why do we do this because I always like to know why. So now how do we do it? Yeah. So essentially, when you look at the second point, which is the key here is that you can use a dementia connection model and you’ll get an immediate response because again, if you were to play music, let’s say that mom likes, right? And that she really enjoys. It’s going to influence her to feel all those feel good feelings, right? But the key here is, is that first R, which is consistency or what we call routine, right? So essentially, are consistently playing that music.

00:30:13 – 00:35:01

You want to associate that with something that you’re trying to do with her. So I’ll give you an example. Let’s talk about bathing. We know bathing as a challenge, right? And now one thing I want to say before I get into how to use this with bathing is, let’s think about what do children like when they are bathed. The idea here are the goal, let’s say, is to be clean. We want to get our loved one clean, right? Now, children when they’re obviously infants when they’re born. We usually give them some kind of sponge bath. Then they transition into a regular bath. Eventually they transition in a shower. But my daughter is 5, and she’s still prefers baths. Sometimes she’ll take a shower, you know? My son is 7, and he is now pretty much fully independent. I want to take my shower on my own kind of a thing, right? And so that’s really going to be the progression of their likes and dislikes as well. You know, as they are progressing to the disease, they’re going to be okay with showers for a bit. Then they’re going to want baths. Then they’re going to it’s going to be better for sponge baths, right? So we have to accept through the theory retro genesis that this is what’s going to occur. So that’s the first component of let’s understand why this is happening. Why does mom not want to get in the shower anymore? Why is she fighting with me? Those kinds of things, right? Let’s just try to switch up the technique. Let’s try a bath. And let’s see if she enjoys that better. So that’s the first pillar, right? So then we talk about the third pillar which is these sensory stimulation or sensory based knowledge. And we say, what can we do during bathing that will make this a very positive experience? Well, we can do lots of things from a sensory perspective. We can play music, let’s say. Let’s play, let’s say she loves Barbra Streisand. I just have some problems by her streisand. Let’s play Barbara streisand in the bathroom where we’re at. From a tactile perspective, let’s give her something to hold on to. Maybe a luffa or maybe she can hold the shampoo bottle, help her feel purposeful in that fashion, right? And also why tactile simulation is so powerful is because Emily is it her ability to feel purposeful that she’s doing something. But there’s also a process in our brain that’s occurring simultaneously called neuroplasticity. And essentially, she’s creating new neural pathways, but what’s the really wonderful thing about this? What Jess can I always talk about a side benefits of neuroplasticity is that it helps to reduce anxiety and fear. And increases the tension of focus. Like that’s the best recipe when you’re doing any ADL with someone dementia, right? So tactile stimulation is rape, right? You could be diffusing lavender essential oil in the bathroom. And lavender has been shown through research to be very calming. So they’re just going to examples of ways that you can use sensory stimulation of a way to create an experience that will make her feel relaxed, happy, content, all those feel good feelings, right? So when you do that one time, right through when we talk about habilitation, we’re reinforcing skills. You’re going to make that immediate response. You know, she will feel calmer and et cetera. Now, if you associate these three exact things, every single time you bathe her. So you’ve got the essential oil going, the aromatherapy. You’ve your plain Barbara streisand, and she’s holding on to that sponge bath or that the sponge or the shampoo, let’s say, about over about a four to 6 week period, she will really associate that with those feel good feelings almost automatically. So you can play Barbra Streisand and she will already want to go into the bath. She will want to enjoy that bath. She will want to. All of those things, right? And that allows you as the caregiver to feel much more calm, you’re feeling successful because you are able to bathe her in the way that you feel like you need to, right? And then there’s a connection there. You’re enjoying your time with her. She’s enjoying her time with you. And it makes the bathing process so much easier. And rewarding, right? And so that’s just an example of how the dementia connection model can work with bathing. I’ll tell you this. This is a great story. And this is actually in my book. I had done a very brief mock study where in one of our facilities that I was working at around the dining process in this sense of sensory stimulation.

00:35:03 – 00:40:00

And so what we had done is we had a consistent way every single day of how we did each single meal. Breakfast lunch and dinner with our residents and dementia. So there are a couple of things. We played specific music at breakfast versus lunch versus dinner. We diffused different oils depending on time of day. So in the morning, we would diffuse different kinds of citruses in the afternoon we did citruses. And then afternoon we did citrus and lavender, right? Because citrus sounds actually increases appetite, which is wonderful, right? We need that for people who are struggling with their appetite as the disease progresses. So we did that and then we also had a specific way that we would set up the dining table. So that way it looked like a dining room. And there was no other confusion as what it was to be used for. Because sometimes a nursing care, dining rooms can be used as activity rooms and vice versa. And so we made sure that the room was set up for 90, right? And so it was interesting is we did this, of course, we got immediate responses of patients eating right away. One thing I failed to mention is we actually use different plate wear too. We use bold plate wear. So we used red and yellow. Because research has shown that red plate wear actually increases appetite. And yellow sustains attention. And you think about this. We think about the theory of retro genesis and when we talk about what stimulates children when they’re younger is children don’t like to eat off of plates that are white or cream. That’s not fun. When you go to any buy buy baby store, when you go to the feeding section, everything is bold colors. Bright red, bright yellow, bright orange, right? Because it keeps them excited about eating. So, again, we apply that same concept to people with dementia. And so it actually studies have been shown that it has increased appetite for individuals with dementia, actually by 25% more consumption was found in one research study. So we tried it as well. And we found the same effects. But the interesting part with the theory of habilitation is we wanted to see if this will sustain over time. So every single day for about a month, we did this consistent approach. With the plate wear and the essential oils and so on, right? And it was funny because we have normally in senior living, you have staff that escort the residents to the dimer when it’s time to eat. Well, after just a few weeks, when we would put our aromatherapy on and we would play that music, we had residents wheeling themselves to the dining room. Because they learned, it’s time to eat. All of this is associated with it’s time to eat. And when they got to the dining room, they were visually reinforced because they had to see the dining set up. They saw the bold plate wear. So they knew, yep, it’s time to eat. So we had patients becoming more independent by wheeling themselves to the dining space without meeting staff assistance. So there’s a reward there. Residents were more independent. Staff had less work to do. They could just observe and supervise and guide, right? So talk about that study in the book and it just wasn’t absolute wonderful experience to see the model really come alive in this mock study that we did. It makes sense. I have a question on the bathing. Because everything that you said, I’ve heard and I tried to implement with my mom except for taking baths. Now, she wasn’t a bath person, and then the home that she and my dad had for 47 years, they had a 3D the bathroom because of dry rot and all that, you know, typical stuff of homes as they age. And so she took out the bathtub for a couple reasons one was that typical kid type bathtub wasn’t great for adults anyway, but it also, you know, because you have to step up and over. It does become a possible hazard and we all know that bathrooms are like the most dangerous room in the house. So she didn’t have a bath should basically a slightly step into the shower. It wasn’t flush with the floor. I forget what those are called the no threshold showers, I believe. And the same thing was in her care home, she was you could have wield a wheelchair. They were designed for, I don’t want to say disability, but I guess that’s kind of what they’re for. You know, definitely designed for safety. And I’ve also read and had confirmed from a gal that is living with FTD that sometimes the water hitting the skin from the shower feels like needles. They actually redid their shower in their house, and she really enjoyed it the first time. The second time she got very disoriented and the water hitting her. It was just that too much. So in the care homes, they don’t have bathtubs.

00:40:02 – 00:45:00

I guess. How do we reintroduce a bath bath to an adult who hasn’t taken a bath bath for a dozen years? Absolutely. I would say that a lot of senior living spaces are moving more towards having bath options. As a kind of spa feel. And so as more senior living organizations are partnering with dementia gurus, right? And really understanding what works for them, some of that is kind of being reimplemented. But I would say start with a sponge bath. And so very similarly, we would give a sponge bath to an infant. You would take out one arm and you would clean with the sponge, then you would dry and put the arm back and so on and so forth, right? Introducing that kind of sense of having the warmth of the water around the body. Rather than just pouring on the head. And to your point, two things with that, you know, yes, it feels like needles. That’s one aspect, especially if they’re dealing with a lot of different kinds of pain. Like neuropathy and things like that. But the other thing, too, is let’s take that theory retro genesis again, right? When you stick a young child under a shower, it scares them to the bejesus because they don’t know what that is, right? And they scream and they cry, right? And so again, when the person with dementia is reversing back when that comes out and hits them, they get really scared. And so the fear increases. And then they act out, right? And we talk about these behavioral expressions of yelling out and maybe some aggression, right? Or they want to leave. They want to run. Well, that’s what we do when we’re scared. Fight or flight. Right? And so because they’re going back to a younger state, their instincts are going to be more their coping skills, which I talk about in the book. Rather than them being able rationalize what’s going on and think how to problem solve their way out. They can’t do that anymore. As a disease progresses, just like young children can. Young children just fight or flight. And so it could be because of pain, but it could be that fear based on just something hitting them in the face and they don’t know what it is. And they weren’t expecting it, right? Because part of this is they don’t know how to expect anymore. They don’t know what’s coming next. Because the ability to problem solve or what we call anticipate is all House in the frontal lobe and the frontal lobe unfortunately is decompensating over time. So their ability to it’s not going to be there anymore. So they don’t know, I get into a shower. I turn on the knob and that water is going to come out. They don’t know that anymore. They just think I’m here and all of a sudden there it is, right? Very scary for them. And then they act out. And then, of course, the category is confused. Why are the yelling? Why are they hitting? Why are they trying to get out of the bath? I don’t understand. And it’s because we just scared them to the bejesus. We didn’t mean to. We didn’t know that if that’s just we just didn’t know. So that’s a lot of the challenges that occur when we’re caring for people with dementia. That’s pretty much what happened with my mom. She got extremely aggressive in the last year. She, the more helps she needed, the more she resisted, which I’m sure if we talk longer, you can probably analyze why that happened. So we don’t have to do that next week. But what happened with her? She walked with no aids, had no problem. You know, with any of that, but it took two caregivers to shower her, despite my guidance and coaching on how to maybe get her to cooperate better. I think this is where more time would be beneficial that way they’re not rushed that they gotta bathe, you know, ten residents or I mean I know they had like they shifted her once to afternoons and it got really bad. I’m like, no, no, no, this is a morning shower woman. And they switched her back to mornings and it got better, but in the last year of her life, she literally scratched caregivers till they bled. It was embarrassing. But she jerked away from them. This is my interpretation. They said she reached for her clothes after a shower had slipped. You don’t slip. Just by reaching. I know my mom. She jerked away from them in super irritation. And then slipped and broke her leg, and that was the end of that. So the other thing I thought of after I’ve talked to hundreds of people. Is that shower that they had for them and many of us do this in our homes? They’re like white subway tiles, a big design thing right now. That’s shower was white, floor, walls, ceiling, I think, was white or cream. It wasn’t colored. So it must have kind of felt it was the opposite of all the bold colors you’re talking about with the plates and the dishware.

00:45:01 – 00:50:07

Note to self don’t get rid of plates when we replace our plates because I don’t need to eat 25% more. You know, so I was thinking it’s like if there’s a brand new assisted living memory care community that’s about to open here in town. And I’m going to go over there and see if they have tubs because now I’m curious because you have the walk in tubs, which I still don’t understand how that works, but maybe someday I’ll figure that out. And you know, it’s like if they had colorful tiles on the wall or even the designers and people are going to go, but if it was multiple colors, which doesn’t sound at all attractive actually, but it might help. It was like, Mike, I’ve said before, my mom’s visual processing was just didn’t exist, really. And I wonder if that would have helped, but I know she also wasn’t accustomed to sitting and they would try to get her to sit. You know, for safety reasons and it’s just about the color, I actually do talk a lot about colors and how to address the environment with relation to that as well. Because colors plays plays a huge role in this. And a big piece of it is what are colors that are going to course stimulate more positive moods. And that because the visual stimulation. I mean, lime green, let’s think about that. Lime green is the longest color that we all can see. So with people with dementia, it’s actually a very safe color. They can navigate better when they see green, like bold green. And so and actually there was a study done where they looked at in lower aggression. And actually improve falls. So there is actually use this at the company that I worked for. We implemented all the CNAs and nurses or lime green scrubs. And it was a tremendous effect that it had on the behavioral expressions that individuals with dementia had. And so some organizations kind of picked up on that and started to do to do that. So color is big. I wanted to talk a little bit about what you had just said. It was regards to they tried to get mom to sit all the time. In the shower in the shower. Let’s play on the dimension connection model, right? When you try to force a two year old to sit. No, they don’t. They’re gonna become stiff as a board. Exactly. So why would we think that people with dementia are going to want to just sit too, right? And be forced to sit, right? Because they don’t know what you’re trying to do with them. And so especially those who like, let’s just say gently guide them down and hold them and say, sit, and they do this over and over. The person with dementia is getting frustrated. They don’t know why they need to sit, right? So they’re going to get more and more agitated, more and more frustrated. And to the point where they just have had enough. And so they get up and they usually fall because they’re so angry, or they want to S.W.A.T. or they want to kick, you know? So to avoid that, we’ve got to engage them in different ways that will be exciting for them to want to sit. If we think city is going to be more appropriate to help with reducing falls, right? So engage them with something. So for example, I talk a lot in the book about animatronic pets or different ways to engage through puzzles or you can even use infant doll therapy. Things that will stimulate them in positive ways using all kinds of senses that will they’ll say, yeah, I want to stay here and do this. Because again, when you can engage a two year old, you set them down, you have something in front of them for them to do. They’re going to want to stay. But if you give them nothing to do, they want to get up and run around. So at the same path going to happen with people with dementia too, from what we know from the theory of retrogene. That makes sense. And I think my mom would have benefited probably it would have been worth trying one of those like the reborn dolls, ones that look pretty realistic, although I don’t know should have needed one quite that. Realistic, those really do look like real babies. Because my mom was always a helper, a caregiver, she was a mom. She’s a grandma. She always wanted to help the other residents. I almost hurt myself, trying really hard not to laugh out loud when she leaned out her apartment door and said, you know, if you need anything, just let me know. I’m here to help and I thought, oh, right. You know? Like, okay, well, you’re a better shape than her because she’s got a walker and, you know, you can at least walk unaided, but when she said that it just struck me so hysterically funny and I thought if I laugh out loud, she’s gonna get mad at me. And it was just, I mean, the whole thing was like, it was almost surreal because the way she leaned out the doorway was kind of like it was like a throwback to the town I live in when she grew up here, it was like 1500 people.

00:50:07 – 00:55:00

There was more cows than there were people. So I was getting this visualization of this farm town that was used to be really rural now it’s a typical suburb. And you know, kind of like the aunt B from Andy Griffith. Show my age now. Yeah, just leaning out the door. Let me know if you need it. But it’s just like, yeah, you can’t help them because you can hardly help yourself. So I should have known that about lime green though. Perhaps that’s what she always did was Lena help you know in the town that she grew up in like you’re explaining in all those kinds of things. Maybe she was in that moment for herself. So probably. It just hit me hysterically, and I was just like, excuse me, what? No. He’s like, I didn’t say anything. I didn’t try to correct her anything. I just knew not to laugh out loud. Because that would have been rude. She would not have appreciated that at all. But now, I don’t know why I forgot that lime green was the longest color we can see. It will be in a photography you would have thought I’d remember that, but most people don’t wear lime green and portraits, so you don’t they don’t. That’s interesting because when they renovated the community that she lived in, so it was all rusts and browns and golds and it looked very, very nice, but there was some serious things that were not practical. The care staff was like, I don’t know why they had to they used to have these almost hospital like reclining chairs and then they went to like typical living room furniture. Not practical. And the way they had it arranged, it wasn’t easy to get the wheelchairs reckless. You know, they made it pretty for those of us that were visiting our relatives. They didn’t really necessarily make it functional for the residents. It was fine for my mom because she walked just fine. But for a lot of people, they needed the loungers. They needed space and, you know, it was interesting, but they did use red plates. But they did also use the dining tables. They would push them together and do the activity. So there was a differentiation between activity, time, in this space, and mealtime in this space. So, you know, they get, they get pretty good marks on that one. I was just as you were talking about some of the things that help give them a little bit more independence. Everything we just talked about, I was like, thinking about what they did where my mom lived. And so they did pretty good considering I think everybody’s still learning about this disease. Absolutely. I mean, I think that, unfortunately, I think some owners and operators, they wanted to look nice as you said. They wanted to almost look like a hotel feeling, but the reality is, the more you can make it look like a home for persons with dementia, that’s going to make them feel more safe and secure. And not this unknown place. And so I think that some new owners and operators who are revamping their dementia programs, some things they’re getting right, but not everything. And so, you know, what they really do need to work with people who are experts in the field to guide them as to what’s going to work and what’s going to really promote the independence of the person rather than worrying about is this would look beautiful, right? So then they need to work with the sales team to translate or not translate but to give that information to people that are looking like when I went and looked and my listeners know this, my sister and I don’t agree on anything. And we had agreed on a plan for moms care after dad died. He was on hospice. And then, you know, because I didn’t want to make life easy. I jumped off that page, you know? And fortunately, the plan we had did not the person that we were going to involve was not interested. It was my mom’s sister. So she helped kick the plan to the curb, which saved my height a little bit. But I went looking for a nice community for mom. There was literally one down the hill from my house. I knew from having been there before that it was dark and it was just, it was no. Which would have been nice a mile down the hill from my house, but it just, it wasn’t right. And I went to this one and, you know, they showed me around and it was nice. You know, in the assisted living dining room, they had flowers and salt and pepper and silverware on the tables and you go into the memory care part of the community and the tables are naked, no tablecloths, no napkins, no of pretty little fake flowers or any of that. But I understood why that was. And when I took my sister there, she’s like, well, I wish it was pretty over here as it is on the other side and I’m like, well, none of that crap would stay on the tables anyway.

00:55:00 – 00:59:10

It will all disappear. I mean, I understood that, but I felt the same way. It was like, yeah, I wish it could be that way too. I understand why it’s not. And so having been there for three years, I’d seen other family members, I can see why they make them look like hotels and not like places that help them maintain some of their independence and their abilities as long as possible. So we need to communicate all of these all of the stuff that you’ve learned and other dementia guers have learned and we need to help educate everybody, which is kind of my mission and yours as well because you don’t want to walk in. You don’t want to pick a memory care residents based on how pretty it is. And how perky and young and energetic, the care staff is you want people with knowledge and understanding like everything that you went through to teach people stuff, so that’s another hill to climb. One training at a time, right? Yeah, for real. It’s like, oh my gosh. I’m like trying to. I’m trying to pave the way. So if I need memory care, you know, it’s gonna be all better than it has been, but jeez, it’s taken forever. So is this a good place to stop and we can pick up again next week? Or anything else we want to cover before we wrap it up? No, I think this is good and maybe next week we can get into how does the model work with behavioral expressions. So when people are feeling they have depression or maybe they’re experiencing some hallucinations or some anxiety, those kinds of things we can talk about how the model will work for all those behavioral expressions that we see. Well, there’s your clue to tune in again next week and I want to thank doctor Jennifer for today and we will be here again from her next week. Thank you so much. Appreciate it. Well, as you heard, next week is part two of the busy caregiver’s guide to advanced Alzheimer’s where we discuss specific ways to handle ADLs and other normal challenges. Also, be sure to be signed up on my email newsletter because I have a very exciting announcement for our my 200th episode that comes out the first Tuesday of January. You can find that at the bottom of the homepage on my website. Easily access all of your loved ones medical record and help support our show by going to picnic health dot com slash memories that’s picnic, PIC, and IC, health, TH dot com slash memories. We thank you for supporting the show. When I learned that despite eating is healthy as possible, we can still have undernourished brains. I was frustrated. I also live in a farming community, so I’m aware that our food isn’t grown as well as we need. Learning about neuro reserves relevant and how it’s formulated to fix this problem convinced me to give them a try. Now I know many of you are skeptical as was I. However, I know it’s working because of one simple change. My sweet tooth is gone. I didn’t expect that and it’s not something other users have commented on, but here’s some truth. My brain always wanted something sweet. Now fruit usually did the trick, but not always. One bad night’s sleep would fire up my sugar cravings so much they were almost impossible to ignore. You ever have your brain screaming for a donut? Well, for me, those days are gone. It’s been about 6 months since I started taking the supplement and I have no regrets. I believe in my results so much that I’m passing on my 15% discount to you. Try it for two or three months and see if you have a miraculous sweet tooth cure or maybe just better focus and clarity. It’s definitely worth a try. Their link is in the show notes.