©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients End-of-Life Care for Alzheimer’s Clients: Preserving Dignity and Providing Comfort ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients Objectives Understand special challenges faced in caring for AD clients at end of life Understand when hospice care might be an option for end of life AD clients Participate in effective strategies for communicating with end-stage AD clients Participate effectively in care strategies for clients at end of life ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Challenges for Alzheimer’s End-of-Life Care End-stage Alzheimer’s difficult for caregivers and family Clients lose ability to: Recognize loved ones Control bowels or bladder Communicate verbally Make medical-care decisions Important to prepare advanced directive ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Challenges for Alzheimer’s End-of-Life Care (cont.) AD client cannot express needs effectively Noticing changes in behaviors critical in determining need for intervention for pain ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients When to Choose Hospice A special program for those terminally ill Provides a holistic approach to care Generally utilized for those with less than six months to live ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients Criteria for Hospice No ability to communicate Cannot walk without assistance AND one or more of the following: Aspiration pneumonia Upper urinary tract infection Sepsis or other overwhelming infections Worsening bedsores Weight loss > 10% over past 6 months ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients Hospice Care Covered by: Medicare Medicaid Care provided wherever client resides Private Homes Assisted Living Independent Living Nursing Home Many private insurances ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients Hospice Care (cont.) Furnishes social worker and spiritual counselor Volunteer program helps both client and family Continues up to a year after a client dies ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Risk Factors of AD Clients Living Less than Six Months Problems with day-to-day activities Being a man Unstable medical condition Poor eating ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Risk Factors of AD Clients Living Less than Six Months (cont.) Bowel incontinence Advanced age Being confined to bed or sleeping most of the day ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Communicating with Clients with End-Stage AD Touch Hold hand Brush hair Give gentle massage Smell Perfume Flower Food ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Communicating with Clients with End-Stage AD (cont.) Sight Videos Bird cage Hearing Read to client Soft music ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Providing Care for End-of-Life Clients Best way to care for client who cannot give feedback Trust instincts Seek advice and support ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Providing Care for End-of-Life Clients (cont.) Symptoms client may experience: Pain Difficulty breathing Lack of interest in eating or drinking Pressure sores ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients Pain Control Be sensitive to client—increased agitation or confusion may mean client is in pain Consult medical personnel Assess causes Discuss possible treatments Be client’s advocate ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients Pain Control (cont.) Alternative pain control options: Guided mental imagery Hypnosis Relaxation Counseling for stress and anxiety Spiritual support ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Providing Comfort Care Most important way to help AD client at end of life: provide comfort care Put lotion on skin, moisturize lips Keep client clean Make sure client is positioned comfortably ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients Difficulty Breathing Normal for client to become congested and have trouble breathing Consult medical staff May help to: Turn client’s head to side to let moisture drain from mouth Dab mouth with moist cloth Avoid giving food or fluids ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Lack of Interest in Eating or Drinking Normal at end-of-life When close to dying, food and/or drink not necessary for comfort Body can no longer process nutrients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Lack of Interest in Eating or Drinking (cont.) To treat dry mouth Swab inside of mouth with water-soaked cotton swabs Spoon a few tiny ice chips into mouth Apply lip salve Dab mouth with glycerin swabs Brush client’s teeth ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients Pressure Sores Form of skin breakdown Can become infected and painful To prevent pressure sores Turn clients in bed every 2 hours Help clients move and reposition arms and legs Use inflated air-suspension bed ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

Relating to Clients and Family and End-of-Life Clients and families benefit from close human contact Assume dying person can hear you Speak in a quiet, normal tone, and say what you can to support and comfort the person ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients Please Complete Test and Evaluation. Thank You. ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients

©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©CareTrack Resources, Inc, 2008. All Rights Reserved. May Not Be Used or Reproduced Without Permission. Contact 1-888-424-7003 for Assistance. ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients ©2008 CareTrack Resources: End-of-Life Care for Alzheimer’s Clients