ATrain Education Florida ADRD Specialized Alzheimer’s Adult Day Care: Level One, 4 units FL: ADRD for Specialized Alzheimer’s Adult Daycare, Level One Author: Lauren Robertson, BA, MPT Contact hours: 4 Price: $29 Expiration date: September 29, 2023 Florida DOEA Approval: Approved by the FL Department of Elder Affairs, Curriculum Approval #SAADC 9603. Approved through September 29, 2023. Certified Trainer: The author is certified as an ADRD trainer by the Florida Department of Elder Affairs and is available via e-mail at [email protected] or by phone Monday- Friday from 9 a.m. to 5 p.m. (Pacific Time) at 707 459 1315. This training is for those of you who have direct contact with clients in specialized Alzheimer’s adult daycare centers. It is designed to increase your awareness and understanding of Alzheimer’s disease and related dementias. Course Objectives When you finish this course, you will be able to: • Give 3 examples of normal changes in thinking that occur as we age. • Describe 3 characteristics associated with dementia. • Relate 3 ways in which dementia can affects general conversations. • Relate the 3 components that should be part of individual and group activities for clients with dementia. • Describe 3 ways in which stress can affect a caregiver’s quality of life. • Describe 3 issues family caregivers face as their loved one transitions from mild to moderate to severe dementia. • Identify 3 common behavioral and psychological symptoms of dementia. • Describe how mild, moderate, and severe dementia affects a person’s ability to complete basic activities of daily living. • Identify 3 philosophical concepts that are important in the design of a therapeutic environment for those with dementia. • Identify common ethical conflicts that may arise when caring for clients with dementia. Page 1 of 94 ATrain Education Florida ADRD Specialized Alzheimer’s Adult Day Care: Level One, 4 units Instructions for Mail Order Once you’ve finished studying the course material: 1. Record your test answers on the answer sheet. 2. Complete the course evaluation. 3. Complete your registration and payment*. Mail the completed forms with your payment to: ATrain Education, Inc 5171 Ridgewood Rd Willits, CA 95490 *Check or money order payable to ATrain Education, Inc (or enter your credit card information on the registration form). When we receive your order, we will grade your test, process your payment, and email a copy of your certificate to the email address you provide. If you would like a fancy copy of your certificate (suitable for framing), please add $8.50 to your payment. Questions? Call 707 459-1315 (Pacific Time) or email ([email protected]). Page 2 of 94 ATrain Education Florida ADRD Specialized Alzheimer’s Adult Day Care: Level One, 4 units 1. Understanding Alzheimer’s Disease and Related Disorders Although dementia has probably been around since humans first appeared on earth, it is only as we live longer that we have begun to see its widespread occurrence in older adults. The most common type of dementia is Alzheimer’s disease, but there are other types and causes of dementia. In fact, new research is suggesting that “pure” pathologies may be rare and most people likely have a mix of more than one type of dementia. Worldwide more than 50 million people live with dementia and because people are living longer this number is expected to triple by 2050 (ADI, 2019). In Florida, there are more than 500,000 residents currently living with Alzheimer’s disease and by 2025, this number is expected to increase by more than 200,000. For those of you working in adult daycare, it is very likely you will have contact with clients experiencing cognitive changes. Many will also have chronic conditions and recent hospitalizations. A major goal of adult daycare is to reduce the risk of hospitalizations and readmissions and manage chronic conditions among their participants (Caffrey and Lendon, 2019). Before getting into how the brain works and how it is affected by dementia, let’s learn a little about adult daycare. Adult Daycare There are approximately 4,600 adult day service centers in the United States serving nearly 286,000 people (Caffrey and Lenden, 2019). Adult day service centers provide non- residential coordinated services in a community setting for less than a day. There are three types: 1. Social, 2. Medical/health, and 3. Specialized (providing programs for people with dementia) (Siegler et al., 2015) Adult daycare is a program of therapeutic social and health services as well as activities for adults who have functional impairments. Services are provided in a protective, non-institutional environment. Participants may utilize a variety of services offered during any part of a day, but for less than a 24-hour period. The social model is designed for individuals who need supervision and activities but not extensive personal care and medical monitoring. The medical model provides more extensive personal care, medical monitoring, and rehabilitative services in addition to structured and stimulating activities. O’Keefe et al., 2014 In Florida, there are approximately 351 adult daycare centers that provide therapeutic programs, social services, health services, and activities for adults in a non-institutional setting (AHCA, 2020). About one-third of adult daycare clients have Alzheimer’s disease or a related disorder (Harris-Kojetin et al., 2016). Page 3 of 94 ATrain Education Florida ADRD Specialized Alzheimer’s Adult Day Care: Level One, 4 units In Florida, there are approximately 15 specialized adult daycare centers, which are specifically designated to treat clients with Alzheimer’s Disease and other types of dementia. The specialized centers enroll a higher percentage of clients with dementia than do regular adult day centers and require specialized dementia training for their staff. A specialty license is also required to provide services as a Specialized Alzheimer's Services Adult Daycare Center (O’Keefe, 2014). In general, adult daycare clients are younger and more racially and ethnically diverse than users of other long-term care services. More than one-third of adult daycare clients are non- white, about 17% are non-Hispanic black, and about 20% are Hispanic (Harris-Kojetin et al., 2016). Most (about 2/3) of adult daycare participants attend at least 3 days/week (Siegler et al., 2015) and most clients use transport services provided by the centers. This course is for those of you who have direct contact with clients in a specialized adult daycare center. It discusses Alzheimer’s disease and other common types of dementia from the perspective of both workers and clients. It includes information on how dementia affects the brain and how Alzheimer’s disease differs from other types of dementia. It describes behaviors you will see in people with mild, moderate, and severe dementia and discusses communication issues at different stages of dementia. The course includes with activities you can do with your daycare clients and provides information on how to assist with their activities of daily living. We also include information about family issues, caregiver stress, and share some innovative ideas about “therapeutic environments.” We conclude with a discussion of ethical issues you may encounter. 2. How the Brain Works The brain is a communications center consisting of billions of neurons, or nerve cells. It is the most complex organ in the body. This three-pound mass of gray and white matter is at the center of all human activity—you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities. The brain regulates your body’s basic functions; it enables you to interpret and respond to everything you experience and shapes your thoughts, emotions, and behavior (NIDA, 2018). Networks of neurons pass messages back and forth among different structures within the brain, the spinal cord, and the nerves in the rest of the body (the peripheral nervous system). These nerve networks coordinate and regulate everything we feel, think, and do (NIDA, 2018). Dementia interrupts the efficient function of these networks, affecting every aspect of a person’s life. Page 4 of 94 ATrain Education Florida ADRD Specialized Alzheimer’s Adult Day Care: Level One, 4 units Alzheimer’s disease and other types of dementia damage the brain. The most significant and obvious damage occurs in the critically important part of the brain called the cerebrum. The cerebrum fills up most of our skull and is divided into four lobes: 1. Frontal lobes: reasoning, judgement, motor control, planning, decision-making 2. Temporal lobes: memory and emotion, hearing, language 3. Parietal lobes: sensation, touch, temperature, pressure, pain 4. Occipital lobes: visual processing, depth, distance, location of objects The Human Brain The four lobes of the cerebrum, plus the cerebellum and the brainstem. Alzheimer’s disease starts in the hippocampus, located in the temporal lobe. ©Zygote Media Group, Inc. Used with permission. The cerebrum allows us to think, form memories, communicate, make decisions, plan for the future, and act morally and ethically. It also controls our emotions, helps us make decisions, and helps us tell right from wrong. The cerebrum also controls our movements, vision, and hearing. When dementia strikes, brain cells in the cerebrum begin to shrink and die. As the damage progresses, brain cells are no longer able to communicate with one another as well as they did in the past. Not surprisingly, as more and more brain cells are damaged, connections are lost, pathways are disrupted, and eventually people with dementia lose many brain functions. Because the right and left sides of each lobe differ in function, the location of the deterioration is important to understand. For example, damage in the left frontal and temporal lobes can affect the so-called language centers, causing difficulties with speech and language comprehension, while damage to the right hemisphere can cause problems with spatial perception and identifying objects by touch.