GENTLECARE

Focuses on the Needs of People with Dementia

One day when I arrived at the nursing home to visit my mother I found she was extremely upset. A staff member hurried to explain that Mother, who had Alzheimer's disease, had been walking down the corridor. She came up behind a man in a wheelchair. And doing what was the most natural thing in the world, she pushed the chair and gave him a ride. The man did not want to be pushed. He hit my mother.

Due to incidents like this, eventually the nursing home decided to set up a special area for persons with dementia. Mother and about twenty other residents moved to the dementia care area. It had Dutch doors separating the area from the rest of the building. There was a designated eating space within the area. The nursing home build a high fence in back that gave the residents of the special area a safe place to walk outside. While this happened a number of years ago, it was a beginning in the recognition that persons with dementing illnesses need a different type of care from the medical model that nursing homes have been using.

Dementia area staff met the needs of some people very well. For example, a man and woman who both had dementia became good friends. A separate table was set up for the two of them to eat together. They chatted happily over meals - looking like they were in some outdoor cafe rather than sitting at a small table pressed against a nursing home wall. Other people on the unit also found companionship. One woman whose room was outside of the dementia care area visited daily with a friend in the special care area. The two women would walk together up and down the corridors.

On the other hand, there were still many things that staff did not understand about persons with dementia. They did not fully comprehend how profoundly dementia affects judgment. For instance, once I saw the cleaning supply room open and a resident in the room examining the plastic jugs with cleaning products in them - a potentially dangerous situation. Despite everyone's best efforts the nursing home was not an easy place for persons with dementia to live out their lives.

I was distressed to discover that Mother, who had been getting up to go to the toilet at home, was tied in her bed at the nursing home. Staff's reasoning was that she might get up and not find her way to the bathroom. "She might pee on the floor and then she, or her roommate, might slip and fall," staff said. To prevent this potential string of events they decided it was safer to tie her in bed. Mother could not object, and she was not the kind to strike out. She had always been a "Please" and "Thank you" person; she remained that way, but I discovered she had started to grind her teeth. I could see her clenched jaws and when I sat close I could hear the grinding sound. While she was still able to eat treats I would bring grapes. She enjoyed the grapes - and for a bit she stopped grinding her teeth - but you could see that the stress was still there.

Mother is no longer alive. The nursing home moved to a new facility; staff has been working hard to educate themselves about what really is "special" about a "special care unit." Dedicated caregivers, both family members and professionals, are relieved to see new ways to care are emerging.

One new approach, GENTLECARE, developed by Moyra Jones, focuses on the needs of each individual. GENTLECARE stresses the importance of maintaining the person's skills. Care plans focus on activities of daily living, that is, each person's ability to feed, dress, and take care of his/her personal needs. Staff-centered by-the-clock routines give way to personal routines. Staff helps people dress themselves, rather than taking over and dressing them. GENTLECARE gives the person affected by a dementing illness the opportunity to remain as "in-charge" as possible.

The GENTLECARE system strives to compensate for the deficits that persons with dementia experience due to progressive brain damage. GENTLECARE supports their existing levels of function in a way that supports, rather than challenges, them. GENTLECARE educates caregivers about providing the physical space, the programs and the kind of care that best compensates for the losses and enhances the remaining abilities of persons with dementia.

While GENTLECARE techniques will not take away dementia, it makes living with dementia a little easier, both for the person with the dementing illness and for their caregivers. I am not sure if GENTLECARE would have changed the number of days mother was in the nursing home, but I am sure her days would have been less stressful and happier.

Josselyn B Winslow

Community Service Coordinator

Alzheimer Society Of Washington

OACMHA Board Member

The Link between Depression and Nutrition

Anyone who has even felt a rush of pleasure after biting into a delicious chocolate knows that what you eat and how you feel are connected.  However, this link may reflect more than the simple enjoyment of the pleasures of dessert.  There is an association between proper nutrition and depression.  And, as we age, the importance of eating well becomes more and more significant.

 Depression

As people age, a number of factors can contribute to depression.  Older adults may experience an increase in physical and mental ailments, a decrease in mobility, and they may lose their spouse or other contemporaries.  These losses can leave older adults living alone and feeling isolated.  These conditions may often lead to a “reactive” type of depression, in which an individual’s down mood can be due to grief over loss of loved ones, loss of physical ability and health, and loss of a former sense of self, brought on by retirement or role changes. This has the potential to develop into a clinical depression, especially when combined with other risk factors such as family history of depression or an imbalance of brain chemicals.

 Nutrition       

The same conditions that contribute to depression can also contribute to poor nutrition.  As physical abilities such as chewing, sense of taste, and hand-eye coordination decline, so does a person’s ability and desire to prepare and eat healthy meals.  The decline of mental abilities such as concentration and memory may deter older adults from eating regularly or following a recipe.  A decrease in mobility can prevent older adults from maneuvering around the kitchen and making trips to the grocery store.  With the loss of a spouse or companion, older adults can find themselves living alone and not wanting to “just cook for one”.  Finally, as a result of retirement or the loss of a spouse, household income can be drastically reduced, leaving an older individual with little money to buy healthy food.

The Link between Nutrition and Depression

So, how do poor nutrition and depression relate to each other, aside from having many of the same origins?  Studies show that older adults with poor eating habits are more vulnerable to depression. It has been shown that low levels of the nutrients folate, zinc, B-6 and B-12 can lead to an increased risk of depression. And conversely, those who are clinically depressed often do not maintain a nutritionally balanced diet, either by eating too much or too little.  Thus, poor nutrition can lead to depressive symptoms, and vice versa, resulting in a downward spiral of increasing depression and decreasing nutrition.

Proper nutrition and eating habits can help older adults to improve their general health and quality of life, and in turn ward off some of the physical and mental ailments associated with a higher risk of depression.

Improve your nutrition and well-being

Overcome some of your healthy eating “obstacles”

And don’t forget to bite into that delicious chocolate once in a while!

Noelle Downing

Director of Consumer Education

Positive Aging Resource Center (PARC)

Pathways to Emotional Wellness and Fulfillment

PARC was established in 2002 as part of an initiative of the Substance Abuse and Mental Health Administration (SAMHSA) to improve the quality of mental health care and service delivery for older adults, under cooperative agreement #SM55043.

Hikmah Gardiner Challenges Senate Special Committee on Aging

“Depression has been my unwanted companion for at least 60 odd years.  We know each other very well”.  With these words, OACMHA Vice President Hikmah Gardiner grabbed the attention of the members of the Senate Special Committee on Aging at their July 28 meeting.  As part of a panel of experts on older adults and depression, Ms. Gardiner gave a face to the staggering statistics around late life depression and its effects on the nation. 

In calling the hearing that looked at depression and suicide among the nation’s seniors, Senator John Breaux (D-LA) stated, “We are not giving enough attention to the mental health of older Americans, and more must be done to diagnose, treat and prevent mental health problems and senior depression.”  Senator Breaux also announced his July 25 introduction of the Positive Aging Act (S. 1456) as a companion bill to Rep. Patrick Kennedy’s (D-RI) House bill (HR2241). If enacted, this legislation would address the mental health needs of older adults by promoting models of care that integrate mental health services and medical care within primary care settings and improve access to mental health services in community-based settings.

Focus Groups Chart Course for Mental Health Principles of Care for Older Adults

During late summer and early fall, OACMHA conducted focus groups around the establishment of Mental Health Principles of Care for Older Adults.  In Topeka, KS, Philadelphia, PA and Seattle, WA, older consumers, family members, caregivers, providers, administrators, advocates and state agency representatives came together to provide input on the draft Principles of Care previously established by the OACMHA Board of Directors.

 A final report of the findings of the focus groups will be published by the end of the year and will include recommendations to move forward to a National Consensus Conference to be held in the fall of 2004.  If you are interested in receiving a copy of the final report, contact the OACMHA office and one will be provided.

The National Consensus Conference will bring together stakeholders from across the country representing all the major organizations and agencies that represent older adult mental health consumers.  Watch for further information regarding this important event.

Coping with Mood Changes Later in Life

DBSA, the Depression and Bipolar Support Alliance has published a pamphlet on depression in older adults.  The brochure includes causes and symptoms of depression, treatment options, and coping with side effects of medications, ways to talk to health care providers about depression, faith and spirituality and how they help, symptoms of suicidal thoughts and how to help relatives or friends with depression or bipolar disorder.

Copies of the brochure may be obtained by contacting the OACMHA office (oacmha@aol.com or 202-467-5730x140) or the DBSA office (312-642-0049).  Mildred M. Reynolds, Ed.D., M.S.W., a member of both OACMHA and DBSA made the brochure possible through a generous gift.

Medicare Parity for 50% Co-Payment Requirement Not Included

It does not appear that major reform for Medicare will happen in 2003.  This includes ending the disparity that exists with current restrictions in the program that apply only to treatment for mental illness. These restrictions include the current 50% co-payment requirement for outpatient mental illness treatment and the 190-day lifetime limit on inpatient psychiatric treatment. Representative Ted Strickland (D-OH) and Senators Olympia Snowe (R-ME) and John Kerry (D-MA) offered separate amendments calling for a phase-in of parity for the 50% outpatient co-pay over a 6-year period.

This proposal was estimated by the Congressional Budget Office (CBO) to cost as much as $5.9 billion over the 6 years and as such the amendments would have been forced to include an offsetting cut within Medicare to "pay for" the proposal, due to the overall cost restriction of $400 billion.   As a result, these amendments were withdrawn without being voted on.

OACMHA will continue to work with members of Congress to end these disparities.