Working with the Aging Population

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Working with the Aging Population

• Julie Ana Skone, MSEd.
• Ron E. Bessent, MSW
• Dept. of Criminal Justice Services
• [phone]

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The Graying of America

• Our population is aging due to many factors
  primarily
• Longer life expectancy
• Better healthcare
• Baby Boomers account for 80 million people in our
  society baby boomers reaching late 50s one
  million are expected to live to be at least 100
  years old.

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The Year 2050

• Over 70 million people will be over the age of
  65 10 of those will have Alzheimers disease.
• Close to 20 million over the age of 85 half of
  those will have Alzheimers disease. An estimated
  14 million Americans will have Alzheimers
  disease if a cure is not found.
• Alzheimers disease will be the leading cause of
  death among adults.

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Dementia. . . what is it?
Definition without mind set of symptoms
resulting from a disease process or a condition
affecting the brain. progressive loss of
intellect, cognitive abilities gradual loss
of thinking, reasoning, remembering
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• Dementia what are the symptoms?
• Progressive Memory Loss
• Difficulty Remembering
• Difficulty Thinking Logically
• Difficulty With Communication
• Difficulty Planning Ahead
• Confusion
• Poor Judgment Poor Decision Making Skills
• Disinhibition

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Some Diseases That Cause Dementia
are Alzheimers disease Multi-infarcts
(multiple strokes) Parkinsons
disease Huntingtons disease AIDS- (dementia
complex) Chronic alcoholism- (Korsakoffs
syndrome) Downs Syndrome-(older individuals)
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Some physical conditions may cause or mimic
dementia. Some forms of dementia can be reversed
if the underlying cause is treatable.
Nutritional Deficiencies Vitamin B
Deficiency Thyroid Disease Depression Drug
Interactions Head Injuries Brain Tumors
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What is Alzheimers Disease?

• Alzheimers disease is an irreversible,
  progressive brain disorder that affects memory,
  behavior, personality and muscle control.
• Alzheimers disease destroys brain cells and
  causes abnormal structural changes in the brain.
• Alzheimers disease initially affects short-term
  memory eventually the person with AD loses the
  capacity to function on their own and become
  completely dependent on other people for their
  everyday care.

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Alzheimers Disease

• Alzheimers disease generally affects people over
  the age of 65, but people in their 40s and 50s
  can also have Alzheimers disease.
• Currently Alzheimers disease is the 4th leading
  cause of death among adults.
• 10 of people over the age of 65 have Alzheimers
  disease.
• 49 of people age 85 and over have Alzheimers
  disease.
• In Virginia, an estimated 101,000 individuals
  have Alzheimers disease.
•  

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Symptoms of Alzheimers Disease

• Progressive memory loss
• Difficulty remembering familiar things
• Difficulty performing familiar tasks
• Problems finding the right words
• Misplacing things
• Confusion
• Poor judgment and poor decision making skills
• Changes in personality mood swings
• Loss of initiative

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Alzheimers and Corrections Preparing for the
Future

• Prisons are attempting to adapt to the many new
  challenges they face daily in providing for the
  ever increasing and varying inmate populations
  needs.
• As correctional staff, dealing with the
  behavioral problems of inmates suffering from
  Alzheimers Disease can be one of the most
  interesting and frustrating of these challenges.

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A Prison Environment Is Considered Safe and Well
Structured But Is It This Way for Everyone?
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• Prisons generally operate in a very structured or
  regimented manner in order to maintain control
  and order.

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People With Alzheimers Are Very Sensitive to the
Environment They Live in and Less Able to Handle
Changes and Uncertainty.

• The ideal environment for a person with
  Alzheimers provides clear, calm, comforting
  structure.

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• Alzheimers disease often causes a person to
  exhibit unusual and unpredictable behaviors.
• This can easily lead to frustration and tension
  in the person with Alzheimers as well as the
  person responsible for them.

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Examples of Challenging Behaviors That May Be
Exhibited by an Inmate With Alzheimers Might Be

• Agitation, anger, depression, aggression
• Combativeness
• Psychosis

• Wandering
• Sleeplessness
• Sundowning
• Unpredictable situations

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A Person Is Not Acting This Way on Purpose.
Symptoms Could Be Due To

• Physical discomfort caused by an illness or
  medications.
• Over-stimulation from or overactive environment
• Inability to recognize familiar places, faces, or
  things
• Difficulty completing simple tasks or activities.
• Inability to communicate effectively.

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Agitation, Anger, Depression

• Agitated behavior can be disruptive.
• It interferes with the inmates ability to carry
  on with activities of daily living.
• An anxious person may not be able to put their
  feelings into words but instead manifest physical
  symptoms such as a racing heart, nausea, etc.
• Agitation may increase the risk of harm to the
  affected individual and to others.

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Agitation Takes Many Forms

• Irritability, frustration, excessive anger
• Blow-ups disproportionate to the cause
• Constant demands for attention reassurance
• Repetitive questions or demands
• Stubborn refusal to do things or go places
• Constant pacing, searching, rummaging
• Yelling, screaming, cursing, threats
• Hitting, biting, kicking

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Depression Is a Form of Agitation and Can Be
Characterized By

• Extreme tearfulness
• Hand-wringing
• An excessive need for reassurance
• Other signs of extreme unhappiness

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Aggression Is a Form of Agitation. It Includes

• Verbal accusations and insults
• Aimless screaming
• Refusal to cooperate with simple requests
• Physical assaults
• Self-injury such as head banging or biting oneself

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Combativeness Can Be Caused By

• Physical factors
• Is the person tired because of inadequate rest or
  sleep?
• Are medications causing side effects?
• Is the person unable to let you know he or she is
  experiencing pain?
• Environmental factors
• Is the person over stimulated by loud noises, an
  overactive environment, or physical clutter?
• Does the person feel lost or abandoned?

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Psychosis Is Another Form of Challenging Behavior

• There are two types of psychosis
• Delusions
• Hallucinations

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Delusions

• The is when the person believes things that are
  not true.
• Common examples of delusions would be
• Believing that one is in danger from others and
  that others have stolen items or money.
• A spouse is unfaithful
• Unwelcome guests are in the house
• A relative or friend is an imposter and not who
  they claim to be.

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Hallucinations

• This is a false perception of objects or events
  involving the senses.
• The person my see, hear, smell, taste or feel
  something that is not there.
• If it doesnt cause a problem it might be best to
  ignore it.
• If it becomes continuous then look for a possible
  underlying physical cause.

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Sleeplessness and Sundowning

• As many as 20 of those suffering from
  Alzheimers disease will, at some point,
  experience periods of increased confusion,
  anxiety, agitation, and disorientation beginning
  at dusk and continuing throughout the night.

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Late-day confusion, or sundowning may be caused
by

• End-of-day exhaustion (mental physical)
• An upset in the internal clock causing a
  biological mix-up between night day
• Reduced lighting and increased shadows
• Disorientation due to the inability to separate
  dreams from reality when sleeping
• Less need for sleep, which is common among older
  adults

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General Tips for Responding to Challenging
Behaviors

• Stay calm and be understanding
• Be patient and flexible
• Dont argue or try to convince the person
• Acknowledge requests and respond to them.
• Try not to take behaviors personally
• Accept the behavior as a reality of the disease
  and try to work through it.

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Try Different Responses in the Future.

• Did your response help?
• Do you need to explore other potential causes and
  solutions? If so, what can you do differently?

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Identify and Examine the Behavior to Determine
the Cause.

• Often the trigger is some change in the persons
  environment.

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In the Jail Setting This Change in Environment
Could Be

• At the time of classification/ admission
• At the time of any housing change
• At the time of shift change when new staff are
  taking over a post
• Any transportation (i.e., Doctors appointment,
  court appearance)
• Change in cellmates

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• Repair, painting or other change in housing area.
• Change in daily routine or schedule.
• Change in health status (something the inmate may
  not be able to express)

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A Key Principle of Intervention Is Redirecting
the Affected Individuals Attention.

• Dont
• Argue or disagree
• Be confrontational
• Raise your voice
• Take offense
• Corner, crowd
• Try to reason

• Do
• Simplify the environment
• Simplify tasks and routines
• Allow adequate rest between stimulating events
• Use labels or clues to remind

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Dont Do

• Restrain,
• Shame, criticize
• Demand or try to force
• Condescend, ignore
• Explain, teach
• Rush
• Show alarm
• Make sudden movements

• Back off
• Use calm, positive statements
• Reassure
• Slow down
• Offer guided choices between two options
• Limit stimulation and offer simple exercises

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Monitor Personal Comfort by Checking For

• Pain
• Hunger
• Thirst
• Full bladder
• Fatigue
• Infections
• Skin irritation

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• Poor communication
• Are you asking too many questions or making too
  many statements at once?
• Are your instructions simple and easy to
  understand?
• Is the person picking up on your own stress and
  irritability?
• Are you being negative or critical?

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Talking with a person who has Alzheimers Disease

• Remember people with Alzheimers Disease often
  find it hard to remember the meaning of words
  that you are using or to think of the words they
  want to say.

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Tips to help you communicate more effectively

• You may feel angry but dont show it. This will
  only increase their agitation. If you are about
  to lose it try counting to ten. REMEMBER that
  this person has a disease and is not deliberately
  trying to make things difficult for you.
• Identify yourself by name and call the person by
  name. Dont ask, Do you know who I am?

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• Approach the person slowly from the front and
  give them time to get used to your presence.
  Maintain eye contact.
• Try to talk away from other distractions such as
  a loud TV or others trying to join the
  conversation.
• Speak slowly and distinctly. Use familiar words
  and short sentences.

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• Keep things positive. Offer positive choices
  like Lets go to lunch now.
• If the person seems frustrated and you dont know
  what he or she wants, try to ask simple questions
  that can be answered with yes or no or one-word
  answers.
• Use gestures, visual cues, and verbal prompts to
  help. For instance if it is lunchtime get out
  their coat and walk to the door and say Time for
  lunch.

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• Set up needed supplies in advance for tasks such
  as dressing, bathing, etc. Try to help the
  person feel in control of the task
• Have special signals for going to the bathroom.
  Place colored rugs or special colored signs at
  the door commode. Observe for visible clues
  like restlessness or facial expressions that may
  indicate the person needs to go to the bathroom.
• If conversation causes agitation drop the issue
  rather than try to clear it up.

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• Use memory aids such as calendars lists.
• Explore various solutions.
• Accept the behavior as a reality of the disease
  and try to work through it.
• Acknowledge requests and respond to them.
• Respond to the emotion and not the behavior.
• Offer corrections as a suggestion. Avoid
  explanations that sound like scolding. Try I
  thought that was a spoon.

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QUESTIONS?