Dementia Care Archives - Pedal for Alzheimer's

Social Prescription in Dementia Care

When we think about how far research has come in dementia care, the unfortunate reality is that there is still no known medicine for it, as well as no cure. We truly think our industry is close. Therefore, the medical model doesn’t work in dementia care. However, we can’t say that there isn’t any treatment available, because we have social prescription. Social prescription is about getting to know the whole person living with dementia, from their preferences in life, roles they’ve been in, understanding what makes them happy and calm, who surrounds them in their life, and their strengths and weaknesses; essentially it’s the essence of who they are. Around 70-75% of a person’s overall health are their social determinants, not their physical or medical health. And several modalities in dementia care have proven positive outcomes by using aspects of social prescription, like the Best Friends™ Approach, Montessori Method, and Validation Therapy. The newest empirically-validated approach upholding social prescription is the Dementia Connection Model©.

The Dementia Connection Model is a cognitive-behavioral framework that takes into account how the person living with dementia is progressing through their disease, focusing on what we know works well with advancing dementia – sensory stimulation. When a person with dementia is stimulated using their senses, that information is processed either directly or indirectly in the limbic system of their brain that houses the amygdala (feelings) and hippocampus (memories). Therefore, positive stimuli should be used to promote positive feelings and memories, this then promotes positive behavioral expressions. And when the caregiver is the one providing these positive experiences, the person with dementia will either connect or re-connect with them because they like how they feel with that person.

The key to this connection is to consistently (i.e., structured, daily) provide these positive experiences in order to reinforce the connection and skills to maintain their highest level of independence for as long as possible (also called habilitation). This is the key to social prescription, utilizing a “prescription” of social determinants when providing good quality care. Within the Dementia Connection Model, the caregiver trials which sensory stimuli are effective, like types of music for auditory stimulation, essential oils for olfactory stimulation, and so on. Then, they determine the frequency and when this will be implemented based on what would be the most beneficial for the person they are caring for. Yes, caregivers should feel free to “prescribe” these interventions to their loved ones or seek assistance with a knowledgeable provider to do so; physicians shouldn’t have to take responsibility for this, although they should be a supporter and contributor.

Within the Dementia Connection Model, comes an approach to care called The Perfect Day™. Each part of the day (i.e., morning, mid-day, afternoon/evening), set sensory stimuli should be used to encourage positive behavioral expressions and minimize sundowning behaviors. These various sensory stimuli include auditory stimulation with music, olfactory stimulation with aromatherapy, tactile stimulation with exercise, pets, dolls, and more, and so on. Let’s dive into the aromatherapy part of The Perfect Day.

Aromatherapy is a relatively safe, all-natural use of essential oils to support one’s health. Although research has shown that a person’s sense of smell may decrease as Alzheimer’s disease progresses, the nose is still an entryway for the sensory stimuli of essential oils because the nasal cavity and nerve cells in the nasal lining are the closest entry to the limbic system. This connection between the sense of smell and the limbic system accounts for the influence of essential oils on mood and memory. Using essential oils can aid in efforts to restore the body back to its natural balance. For example, if you’re feeling sad, they may help you feel content; if you are feeling anxious, they may help you relax. Essential oils can be diffused in the air, placed on stoned jewelry, or applied to pulse points around the neck and wrist areas, like perfume or cologne. Within 20 seconds of inhaling, an essential oil will start to work. And by 30 minutes they have surfaced the whole body. Many clinical trials support the effectiveness of essential oils, including lavender and cedar for reducing anxiety and peppermint for mental stimulation. Essential oils may also be used as part of efforts to stimulate the appetite, help with sleep, increase energy, improve attention and concentration, and much more.

A published review from 2019 provides an excellent summary of studies supporting the therapeutic use of essential oils in people with Alzheimer’s disease specifically. In The Perfect Day method, the prescription recommended to help curb negative behavioral expressions and sundowning includes using peppermint and a citrus scent in the morning. This helps increase mental clarity while improving mood – great for a morning time regimen; citrus additionally increases appetite. At meal times, citrus scents should be used to encourage eating and keep the ‘mood of the room’ elevated. Then, about 30 minutes prior to sundowning and through the afternoon and evening, lavender should be used to promote a sense of calm and encourage sleep. If the person can still smell and they don’t care for the scents being used, then simply try another essential oil that has the same benefits, truly fitting this prescription to the person’s preferences. Now, when this prescription is used daily, there is an immediate effect on promoting positive feelings and behaviors, however, after about four weeks, the person may associate these senses with understanding what time of day it is and what they should be doing, decreasing confusion, loneliness and fear.

It’s important to keep in mind that any substance with a fragrance, including essential oils, may cause an allergic reaction in individuals with sensitivities. Use caution and test a small amount of the oil when introducing it. You will want to consult with your loved one’s health care practitioner and be sure to mention any essential oils and other supplements that you may be using or want to use.

All-in-all, we need to start using social determinants to create prescriptions that we know work for those with dementia. Start this by trying The Perfect Day, using aromatherapy, within the Dementia Connection Model. At the Dementia Connection Institute, we are always striving to educate caregivers and professionals to fill their toolbox with lots of tools to be prepared when caring for those living with dementia. Within social prescription, creating prescriptions using these tools helps when providing care.

For more information on the Dementia Connection Model and much more, go to www.DementiaConnectionInstitute.org. To grab your own ‘The Perfect Day’ aromatherapy kit, go to www.NeuroEssenceOlfactoryToolboxes.com.

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WRITTEN BY:

Dr. Jennifer Stelter

Dr. Jennifer Stelter, also known as The Oil Doctor, Psy.D., is a Clinical Psychologist and Johns Hopkins Press author, who specializes in dementia care. She has 20 years experience in the healthcare field and over a dozen in the senior living industry. She is a Certified Dementia Practitioner and Certified Alzheimer’s Disease and Dementia Care Trainer through the National Council for Certified Dementia Practitioners.

Additionally, she is the CEO of NeuroEssence, LLC at the Dementia Connection Institute and the creator of the Dementia Connection Model(c). Also, she is the author of The Busy Caregiver’s Guide to Advanced Alzheimer Disease. At the Dementia Connection Institute, we provide training and education on dementia care to professionals and family caregivers with a heavy focus on ‘prescribing’ with non-pharmacological interventions and engagement and empowering care providers to do the same. The vision is that those living with dementia will be able to experience and navigate their new world freely because caregivers and professionals feel better educated, prepared, and empowered in how to provide quality dementia care. We are now open! Visit us at DementiaConnectionInstitute.org.

Jessica Ryan

Jessica Ryan is a university educated Biologist and Educator, a Certified Dementia Practitioner (CDP) through the National Council of Certified Dementia Practitioners (NCCDP), an AromaTouch® Technique Trainer certified by Dr. Hill, a top doTERRA Wellness Advocate, and a founder and co-creator of AromaTechniques an aromatherapy and hand massage technique specific to the “vintage” population. She is the CEO of The Oil Mama, LLC, and co-founder and co-owner of NeuroEssence, LLC. She has 25+ years of experience in education and the sciences from high school to university and professional level. Over the last 10 years she has committed to staying on the forefront of evidence- based essential oil uses and educating individuals and families on reducing toxic load and increasing cellular nourishment as the key to healthy mind and body at any age. She has pioneered a specialization in working with the “vintage” population, healthcare professionals, and caregivers to educate them on the usage of therapeutic essential oils for longevity and quality of life as it relates to the Alzheimer’s, Dementia, and brain health.

Jessica regularly leads workshops and offers valuable and continued support through her various resources and one-on-one consultations. She also offers additional services to healthcare and residential facilities as related to the “vintage” population including caregiver and continuing education, hospice tools, and customized community wellness plans.

Connecting to Those Who Have Dementia. It’s Simple.

Caregivers of those with dementia experience a wide range of emotions during their caregiving journey, including a sense of loss that they can no longer connect to that person, like they could before. Or, for those who are new to caregiving for that individual, they just can’t feel successful in aligning with them. With many frustrating interactions, they find themselves saying things like “This isn’t who my mom is” or “I just can’t seem to do anything right for her” or “Why does this keep happening?”, leaving the caregiver feeling hopeless.

What would make that individual with dementia happy again, to feel safe and secure, and calm? Although this can seem impossible to imagine, it can be quite simple. For their own sanity and peace, the caregiver needs to lower their expectations of the person they are caring for. There is a level of acceptance needed that the person they are caring for does not have all the skill-abilities as a fully-functioning adult, yet the developmental level of a young adolescent, according to Dr. Barry Reisberg’s research and his theory of retrogenesis. Therefore, their chronological age does not match their developmental age. As the disease progresses, the person’s skill abilities go in the reverse order in which they learned them (i.e., their skills are reversing towards infancy), including mobility, communication and language, coping, independent activities of daily living (IADL’s) (like managing money, prescriptions, etc.), and then ADL’s (like dressing, grooming, etc.). This also includes how the person learns and navigates their world – adapting to a new world they now live in – as it mimics very similarly to the world a young child lives in between ages 7 years old to 4 weeks old, indicated by Dr. Reisberg. In this new world, the person with dementia is using their senses to understand what is happening around them, and these stimuli influence the person’s mood and memories all the time, very similarly to an adolescent’s experience before the first 5 years of life. This does not mean we treat those with dementia like children, but better yet we put ourselves in that person’s shoes to understand clearer what they are capable of. This leads to acceptance.

When a person with dementia is stimulated using their senses, that information is processed either directly or indirectly in the limbic system of their brain that houses the amygdala (feelings) and hippocampus (memories). Therefore, positive stimuli should be used to promote positive feelings and memories (i.e., sensory stimulation). And when the caregiver is the one providing these positive experiences, the person with dementia will either connect or re-connect with them because they like how they feel with that person. The key to this connection is to consistently (i.e., structured, daily) provide these positive experiences in order to reinforce the connection and skills to maintain their highest level of independence for as long as possible (also called habilitation).

This framework I described above is called the Dementia Connection Model©, utilizing Dr. Reisberg’s theory of retrogenesis (the WHO & WHY), the act of habilitation (reinforcing skills consistently, over and over) (the HOW & WHEN), and intervening using sensory stimulation (the WHAT). With over 10 years of research and hands-on work with individuals with dementia, caregivers and staff, I created this model to provide an avenue of acceptance and a better understanding of the progression, as well as to put tangible tools in caregivers’ hands, so that there is a strong, harmonious connection between the person with dementia and their care partner.

Multi-sensory based tools have been clinically proven to enhance the life of those living with dementia. Tools include preferred music (auditory stimulation), aromatherapy (olfactory stimulation), pet and infant-doll therapy (tactile stimulation amongst others), using colors to one’s advantage (visual stimulation), and many more.

When the caregiver is better educated and prepared, this sets them up to feel confident and competent. In turn, they provide better quality care and engagement. Then, the person with dementia benefits because they can freely be themselves as they are now, without judgements, controls, and expectations. Their world is and should be filled with ‘sunshine and roses’; it’s that simple.

For more information, stay informed about the newly opened Dementia Connection Institute by NeuroEssence, LLC. And read more about the Dementia Connection Model© in my newly released workbook-style guide called The Busy Caregiver’s Guide to Advanced Alzheimer Disease, published by Johns Hopkins Press, available at Amazon, Barnes and Noble and Johns Hopkins Press Bookstore.

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WRITTEN BY:

Dr. Jennifer Stelter

Jessica Ryan