Developing Personally Relevant Goals for People with Moderate to Severe Dementia

Abstract

Many speech-language pathologists work in the skilled nursing facility setting and have a growing number of patients with moderate to severe dementia on their caseloads. Traditional rehabilitation interventions are often not appropriate for people with dementia due to the severity of their cognitive impairment and the progressive nature of dementia. Whereas a rehabilitation approach focuses on deficits (so they can be improved), a habilitation approach focuses on what strengths remain and who the patient is as a person. Through a habilitation approach, the goal is not to improve the patient's skills; the goal is to improve the environment (and the people in it), so the person with dementia can function at their highest possible level. This case study is a thorough example of how the habilitation approach can be used to provide intervention for a person with moderate to severe dementia. The case study will explain indication for treatment, assessment, goal selection, and research to support the treatment plan.

Keywords

Evidence-based practice (EBP) - dementia - habilitation - hearing impairment - caregiver education - skilled nursing - long-term care - speech-language pathology

• References

• 1 Alzheimer's Association. 2014 Alzheimer's disease facts and figures. 2014. Available at: http://www.alz.org/downloads/Facts_Figures_2014.pdf . Accessed March 8, 2015
• 2 Coste JK. Learning to Speak Alzheimer's: The New Approach to Living Positively with Alzheimer's Disease. New York, NY: Houghton Mifflin Company; 2003
• 3 Raia P. Habilitation therapy: a new starscape. In: Volicer L, Bloom-Charette L, , eds. Enhancing the Quality of Life in Advanced Dementia. Philadelphia, PA: Brunner/Mazel; 2013: 21-34
• 4 Nasreddine Z. (2015). Montreal Cognitive Assessment [Measurement Instrument]. Available at: www.mocatest.org . Accessed February 1, 2015
• 5 Bruce C, Brush JA, Sanford JA, Calkins MP. Development and evaluation of the environment and communication assessment toolkit with speech-language pathologists. Semin Speech Lang 2013; 34 (1) 42-51
• 6 Brodaty H, Draper B, Low LF. Nursing home staff attitudes towards residents with dementia: strain and satisfaction with work. J Adv Nurs 2003; 44 (6) 583-590
• 7 Testad I, Ballard C, Brønnick K, Aarsland D. The effect of staff training on agitation and use of restraint in nursing home residents with dementia: a single-blind, randomized controlled trial. J Clin Psychiatry 2010; 71 (1) 80-86
• 8 Burgio LD, Allen-burge R, Roth DL , et al. Come talk with me: improving communication between nursing assistants and nursing home residents during care routines. Gerontologist 2001; 41 (4) 449-460
• 9 Sloane PD, Hoeffer B, Mitchell CM , et al. Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. J Am Geriatr Soc 2004; 52 (11) 1795-1804
• 10 Dalton DS, Cruickshanks KJ, Klein BE, Klein R, Wiley TL, Nondahl DM. The impact of hearing loss on quality of life in older adults. Gerontologist 2003; 43 (5) 661-668
• 11 Arlinger S. Negative consequences of uncorrected hearing loss—a review. Int J Audiol 2003; 42 (Suppl. 02) S17-S20
• 12 Allen NH, Burns A, Newton V , et al. The effects of improving hearing in dementia. Age Ageing 2003; 32 (2) 189-193
• 13 Wilson R, Rochon E, Mihailidis A, Leonard C. Examining success of communication strategies used by formal caregivers assisting individuals with Alzheimer's disease during an activity of daily living. J Speech Lang Hear Res 2012; 55 (2) 328-341
• 14 Small JA, Perry J. Do you remember? How caregivers question their spouses who have Alzheimer's disease and the impact on communication. J Speech Lang Hear Res 2005; 48 (1) 125-136
• 15 Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry 2006; 14 (3) 191-210
• 16 Rossato-Bennett M. Alive Inside [documentary]. Projector Media BOND/360 City Drive Films, New York, NY; 2014
• 17 Sung HC, Chang AM. Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature. J Clin Nurs 2005; 14 (9) 1133-1140
• 18 Witzke J, Rhone RA, Backhaus D, Shaver NA. How sweet the sound: research evidence for the use of music in Alzheimer's dementia. J Gerontol Nurs 2008; 34 (10) 45-52
• 19 Cooke M, Moyle W, Shum D, Harrison S, Murfield J. A randomized controlled trial exploring the effect of music on quality of life and depression in older people with dementia. J Health Psychol 2010; 15 (5) 765-776
• 20 Kristjanson LJ, Toye C, Dawson S. New dimensions in palliative care: a palliative approach to neurodegenerative diseases and final illness in older people. Med J Aust 2003; 179 (6, Suppl): S41-S43
• 21 Friedel DM, Ozick LA. Rethinking the role of tube feeding in patients with advanced dementia. N Engl J Med 2000; 342 (23) 1756
• 22 Cardinal Blue. Pic Collage. Computer Software. Apple iTunes Store. Version 5.12.18. Cardinal Blue Software, LLC, Mountain View, CA; 2014