Dementia among seniors: an elite team for complex cases
At the sound of a waltz, Gertrude Holzmann, 77, performs a few dance steps in the arms of attendee experienced beneficiaries Arturo Sosa. The song finished, the lady of German origin sits quietly, a smile in her face. Upon arrival at the Montreal Geriatric University Institute in the summer of 2018, nobody would have thought that M me Holzmann could one day be so fulfilling.
Suffering from an onset of dementia, she was refractory to care and could give the nursing teams a hard time. But thanks to the support of a SWAT team specializing in behavioral and psychological symptoms of dementia (BPSD), M me Holzmann was smiling.
Created a year ago at the University Institute of Geriatrics of Montreal (IUGM), the team of SCPD has acquired expertise for which demand is exploding. “The population is getting older in Quebec and 125,000 Quebecers have Alzheimer’s disease. The demand is there, “says Christine Fournier, Administrative Manager of the SCPD team at CIUSSS in South-Central Montreal.
Composed of six nurses, two psychologists, a psychoeducator, an occupational therapist and three geriatric psychiatrists, the team assists the staff of residential and long-term care centers (CHSLDs), intermediary resources and home-based care. Helping to better care for elderly patients with dementia who have complex symptoms such as anxiety, depression, hallucinations, delusions or apathy.
The goal of the SCPD team is to treat these patients with the least possible use of medication. “There are two myths with these patients. The first is that there is nothing to do. The second is that the only thing to do is to give antipsychotics. This is not true. There are many other things you can do, “says Dr. Marie-Andree Bruneau, Geriatric Psychiatrist and Co-Manager of the BPSD Team.
In addition to supporting workers in its territory, the BPSD team also offers telephone consultations, online training, mentoring and field support throughout Quebec.
The record of each patient must be carefully evaluated to find out what action is most likely to appease him. Because a senior who is simply hungry or thirsty can become aggressive or agitated.
“We check the medication. We also learn about the life story of patients. And that’s super important. ”
– Dr. Marie-Andree Bruneau
A patient who survived a drowning in his youth could resist when bathing, illustrates Caroline Ménard, psychologist and clinical coordinator of the team SCPD.
This one adds that several simple gestures can sometimes be beneficial. “In schools, we teach beneficiary attendants to start washing residents by the face. But for someone with dementia, it can be too aggressive. It’s better to start with your hands, for example, “she says.
Several solutions have been tested by the SCPD team. To occupy some residents who often shouted while wandering, relatives were asked to prepare a projection of commented photos. Lasting 15 minutes, these projections appease residents, who can watch them a few times at the end of the day. Other residents who were restless in the evening and refused to go to sleep became very cooperative when they were given a voice recording of their spouse whispering to bed.
During La Presse’s visit to the Geriatrics Institute, music therapist Joanie Ayotte played the guitar while singing to a handful of residents. Patients for the most part who wandered before, agitated, and that we managed to calm thanks to various tactics, including music.
Sitting on a sofa, two ladies were singing softly on the air of Partons, the sea is beautiful. At the back of the room, a resident caressed a cat automaton while sometimes pushing the note.
“Music helps to reduce anxiety. For others, it stimulates. Everyone comes for what he needs. ”
D re Bruneau explained that Quebec is the province with the highest rate of prescription of antipsychotics in Canada. “It’s often prescribed in the absence of other approaches,” she says.
Every week, the SCPD team meets and discusses cases. Together, its members decide who should intervene. Sometimes the occupational therapist will suggest testing some tools, such as weighted blankets or automaton animals. Sometimes the nutritionist comes in.
“We need professionals to intervene with this clientele. […] The cases we see are more and more complex. Interprofessional collaboration is essential, “says D re Doris Clerc, geriatric psychiatrist and member of the BPSD team.
Early studies of the work of the SCPD team show that its actions allow a 35% decrease in symptoms, an improvement in the clinical condition of patients and an increase in the satisfaction of families and caregivers.
When it is pointed out that the lack of staff in CHSLDs is sometimes glaring and that the staff do not always have the time to learn about each patient’s life history or to think at length about the best approaches to adopt, Ms. Ménard replies “Yes, the question of lack of time often comes up. But managing aggression also takes a lot of time. The family is suffering. Sometimes taking time saves time. “” Of course we are dependent on the resources allocated […]. But there’s still something to do, “says D re Bruneau.
The team SCPD also has the mission to help caregivers, who can sometimes be exasperated, including the repetitive questions or public disinhibition of a loved one with dementia. Training capsules have been created and are available on the web.