Thanks for the responses and help. I must admit that despite the help, I see little, if any, potential for improvement with this person. I know those of you working with this population may scoff at me saying that, but I'm beginning to think that working with advanced dementia is for the OT specialist rather than the generalist.
Ron -- Ron Carson MHS, OT ----- Original Message ----- From: susanne <[email protected]> Sent: Sunday, December 14, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Help with Treatment Plan??? s> ---- Original Message ---- s> From: "Ron Carson" <[email protected]> s> To: <[email protected]> s> Sent: Saturday, December 13, 2008 2:05 AM s> Subject: [OTlist] Help with Treatment Plan??? >> Evaled a new patient who was just transferred to an >> Alzheimer's ALF. s> Is she diagnosed with Alzheimer's? Fronto/temporal lobe dementia s> might need to be ruled out. (Much different approach, and most often different setting needed.) s> My work experience is mostly with the FT clients, and those with s> Alzheimer's who have the most "difficult" behavior, thus often ending up in same placements. s> Being in a new placement - this is a time where I've seen a lot of s> struggling. At least when staff or other residents interfere - do s> this, don't do that. Two things: s> 1: Build connection, exchange smiles, kind words and gestures, s> cooperate. If she starts moving furniture, help her! If dangerous s> moves, distract. Silently offer involvement in whatever household s> tasks are happening - even a minute of shared folding of clothes is often worth a lot. s> 2: Find out what works - there may come a time where she's willing s> to go to bed - if that is fully dressed, so be it. It may take s> weeks to get to a somewhat acceptable hygienic standard - this is s> normal. But staff might need to be educated about this, or they s> might appear all physically combative and non-cooperative to the patient:-) s> The patient spoke primarily in Spanish >> but also in some English. s> The language first learned will be the last to go. If at all s> possible, find her a contact person that can relate to her in s> Spanish - at least during this transition. Songs and tunes from her s> childhood/youth - sing or hum them while e.g. walking her to the s> bathroom - keep up the detective work til you find the right one. s> She was very non-cooperative >> and was physically combative with ALF staff and myself. >> >> The staff says she is dependent for all ADL's except >> eating and that she ambulates with CGA - Min A. >> >> What can I do with this patient? s> Make contact, observe, make some guesses to start the detective s> work, educate staff. Listen to staff and let them know they hold s> valuable information. And, what Chris said. s> Usually, in Denmark, a "dementia coordinator" (which might be an s> OT, or not) would do this kind of visiting consultancy. While an OT s> might simply be part of the nursing staff - I was. Without special s> background I'd hesitate to do consultancy about behavior issues. s> warmly s> susanne, denmark s> -- s> Options? s> www.otnow.com/mailman/options/otlist_otnow.com s> Archive? s> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
