Minutes of ESCOTA General Meetings

Minutes from the Thursday, November 11, 2010 General Membership Meeting

Date of Meeting: Thursday, November 11, 2010
Presentation: All Behavior Has Meaning: Managing Challenging Behaviors in People with Dementia
Speaker: Matt Kudish, LMSW

Reeva Mager called the meeting to order at 3:30pm and welcomed the group. The meeting was hosted by the Alzheimer’s Association.

Announcements:

Carol Kamine Brown, President of COHME, announced a part-time job opening for a social worker doing case management and marketing. Call her at 212-514-7147 for more information.

Susan Baida, co-founder of ECareDiary.com, introduced her website, which offers free tools and information and a search engine of care providers across the country.

Andy Margolin introduced himself as a financial planner and attorney who is available for seminars and presentations on elder care.

Daine Schottenstein, President of Elite Homecare Services, announced that she has started a blog and hosts periodic breakfast meetings with a speaker on elder care topics.

Reeva Mager, Chair of ESCOTA, requested that announcements members would like to have posted on the ESCOTA website between meetings should be emailed to Jae Gruenke, Co-Secretary, at .(JavaScript must be enabled to view this email address).

Check our website http://www.escota.info for updates.

Presentation:

All Behavior Has Meaning: Managing Challenging Behaviors in People with Dementia



Matt Kudish, LMSW is Vice President and Director of Education, Outreach and Caregiver Services at the Alzheimer’s Association, NYC Chapter. Prior to joining the Association in 2007, Matt was the Director of Knickerbocker Village NORC at Hamilton-Madison House and Director of Caregiver Services at Park Slope Geriatric Day Center. He received his MSW from Columbia University.

Matt began his presentation by defining Alzheimer’s disease as “a progressive, degenerative disease of the brain that causes impaired memory, thinking, and behavior” and is always fatal. More than 5.3 million Americans currently have Alzheimer’s, 5% of whom live in New York City, and it is on the rise. By 2050 11-16 million Americans will have Alzheimer’s and 1 in 5 New Yorkers will either have or be caring for someone who has the disease.

The damage Alzheimer’s inflicts on the brain occurs two ways: by interfering with the connections between neurons and by strangling neurons from within. It always starts in the hippocampus and spreads outward, and the characteristics of each individual’s illness are determined by the path it travels through that person’s brain. This accounts for how much the effects vary from person to person: “If you’ve met one person with Alzheimer’s disease, you’ve met one person with Alzheimer’s disease.”

Since the physical effects of the disease are invisible inside the head, particularly the brain shrinkage, people tend to relate to those with it as if they are still the same as before. Kudish quoted a trainer with the Alzheimer’s Association saying if the head shrank as much as the brain does, we would never have that expectation.

People with Alzheimer’s present many challenging behaviors, including screaming, paranoia, incontinence, wandering, repetitive behaviors, biting, and loss of impulse control and initiative. He encouraged us to think of these and other behaviors as communication rather than as symptoms of the disease. He pointed out that changes in speech are a hallmark of the disease and that difficult behaviors are often efforts to communicate unmet needs, since the person can’t communicate them verbally. If these needs can be discerned and addressed when the person is in the early stages of agitation then there is no reason for them to become more aggressive or for the situation to progress to a catastrophic level.

Kudish listed communication pitfalls to avoid: rapid questioning, complicated statements that rely on logic, offering too much detail, multiple-part commands, and testing (e.g. to see if the person remembers something said earlier). Common triggers for difficult behavior include: forcing something on someone who is unable to communicate their discomfort, fear resulting from feelings of intrusion into one’s personal space, misunderstanding or misperceiving a threat that is not there, an inability to describe in words what is needed.

Kudish presented a model of good dementia care focused on maintaining personhood. This includes the exercise of choice, the use of abilities, the expression of feelings, and living in the context of relationship. Problems should be addressed by understanding the social and emotional history of the person and also examining the ways our interactions with the person are making their situation worse.

This means planning a person’s activities and understanding their needs with an understanding of how they spent their life, what kind of work they did, and so forth.

It also means thoroughly addressing all sources of communication problems: hearing and vision impairment, distractions in the environment, barriers to communication such as slang, accents, and complex language, and the effects of time of day on the quality of communication.

Kudish recommends “positive physical approach,” which means to come from the front so the person isn’t surprised and frightened, go slow so there is time for the person to process what’s being said, step to the side out of range of any danger, and get low (especially when the person being addressed is seated) so as not to be in a dominant and/or threatening position. Smiling, making eye contact, addressing the person by name, remaining unhurried in voice and manner, and paying attention to tone all facilitate communication.

Kudish recommends stating things in positive rather than negative terms, keeping statements short and clear, and offering limited choices. “Kind and gentle touch and speech go a long way in offering reassurance and comfort,” he says.

In conclusion he reminded us that the person with Alzheimer’s can’t change, only we can change, and to try not to take difficult behaviors personally. He also offered a short summary of the services the NYC Chapter of the Alzheimer’s Association offers:

• 24-hour Helpline: 800-272-3900
• Care Consultation
• Support Groups
• Education & Training
• Early Stage Services
• MedicAlert+Safe Return

The meeting was adjourned at 5:00pm.

Next Meeting:

Date: January 13, 2011, 3:00 pm
Location: Stanley M. Isaacs Neighborhood House, Inc.
Presentation: Lisa Furst, LMSW
Speaker: Lisa Furst, LMSW

Respectfully submitted by Jae Gruenke, Co-Secretary

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