10/29/2018. There s an App for That. Video from Nebraska website. Iowa.

Transcription

1 Video from Nebraska website Mary Kelly, LLC 120 Iowa Mary Kelly, LLC 121 There s an App for That Mary Kelly, LLC 122 1

2 Teepa Snow Toothbrushing Mary Kelly, LLC 123 People with dementia cannot change their thinking, WE have to change ours. Mary Kelly, LLC 124 It s About Them Respect Older adults with dementia may forget aspects of their lives, but they never forget that they are adults. R. Jablonski Mary Kelly, LLC 125 2

3 It s About Them Non verbals Choices Maximize hearing Do not force participation Mary Kelly, LLC 126 Mouth care an intimate and potentially invasive procedure seen as a threatening action by a stranger. Mary Kelly, LLC 127 Threat Reduction Strategies Rita A. Jablonski, Jane Chalmers and many others Mary Kelly, LLC 128 3

4 Overall Approach Approach from the side and be at or below eye level Mary Kelly, LLC 129 Establishing Rapport First engage in affirming social conversation and build relationships. Mary Kelly, LLC 130 Judicious Touch Gentle and non threatening contact avoiding a restraining action Mary Kelly, LLC 131 4

5 Priming A process by which implicit memories are accessed pertaining to specific, repetitive tasks Mary Kelly, LLC 132 Cueing Verbal, respectful and polite onestep requests are used. Mary Kelly, LLC 133 Gestures and Pantomime Help communicate and cue the steps associated toothbrushing Mary Kelly, LLC 134 5

6 Avoid Elderspeak Speech pattern similar to baby talk, use of collective plural pronouns and infantilizing endearments Mary Kelly, LLC 135 Encouraging Self Care Having individuals with dementia perform own brushing Mary Kelly, LLC 136 Chaining Initiation of toothbrushing by care provider with the older adults will complete Mary Kelly, LLC 137 6

7 Bridging Older adults start to resist care provider places a related object, usually an extra toothbrush, in their hand. Mary Kelly, LLC 138 Distraction An attempt to change gears Mary Kelly, LLC 139 Hand Over Hand Care provider places his/her hands over older adult s hand and guides him/her with toothbrushing. Mary Kelly, LLC 140 7

8 Mirror Mirror See what you are doing and imitate. Caregiver s hand reaching around from the back to create illusion that the individual with dementia is providing own care. Mary Kelly, LLC 141 Rescuing Replacement of one care provider by another Mary Kelly, LLC training content2.s3.amazonaws.com/data/208/ee458fd6 efaa e d 0e63451df8f4/story_html5.html Mary Kelly, LLC 143 8

9 Considerations for Frail and Challenging Oral care and oral health deteriorate Fewer dental visits Low motivation to continue oral care Stop caring about tooth loss Fewer are entering nursing facilities Mary Kelly, LLC 144 It s about them Dental office Best appointment time Walk at their pace Talk to/ Look at patient Explain each procedure Mary Kelly, LLC 145 It s about them As patients age, monitor factors that negatively affect oral health Mary Kelly, LLC 146 9

10 It s about them Radiographs Precaution with ultrasonic Give 2 choices of prophy paste Written and verbal patient education More frequent recare appointments Mary Kelly, LLC 147 Dentate residents in nursing facilities increased from 54% to 70% in the past 20 years. NIDCR 2002 Mary Kelly, LLC 148 It s about them Nursing or assisted living facility Ask permission to enter the room Introduce yourself Call them by name Mary Kelly, LLC

11 Explain why you are there Tell them what you are going to do Reassure with words and touch Mary Kelly, LLC 150 Home* Care Recommendations Toothbrush Power brush Interdental cleaner Toothpaste Mouthwash *Residential location Mary Kelly, LLC 151 It s about them Suggestion: Have DDS work with patient s physician Mary Kelly, LLC

12 Suggestions Not remembered being married Ask family or care facility about the person Post it note! Manufacturer s apps Lessen opportunity to say NO Don t interrupt bingo or nap Mary Kelly, LLC 153 Case presentation Explained why I was there Cued with toothbrush Mary Kelly, LLC 154 Step by Step Oral Care Instruct me to brush Mary Kelly, LLC

13 Mary Kelly, LLC 156 Trial and Error Document your successes Laugh! Mary Kelly, LLC 157 Case Study Sally resided in memory care and wandered in common area after lunch which was toothbrushing time. She would rarely stay seated for me. One visit Sally was in her private room. I knocked and asked Sally if I could come in. She consented and I found the room very calming. I asked Sally to sit in her recliner. Next, I stated that I was going to help brush her teeth. I had total compliance. What should I do? Post study DDS visit success Mary Kelly, LLC

14 Case Study June an 82 y/o female on hygiene schedule. Receptionist giggled that pt called 3x the day before to confirm her dental appointment for herself and her husband. During appt. June concern about her husband s oral health. Asked about repeatedly confirming her dental appointment June accepted that she is worried about herself & dementia. June had meticulous oral hygiene in the past although this visit presented with mild gingivitis and light plaque. Jane has multiple units of crown & bridge. What can you do? Mary Kelly, LLC 159 Case Study Female aged 72 Dementia in assisted living Dysphagia Polypharmacy Xerostomia Family concerns: multiple visits and transportation What can you do? Mary Kelly, LLC 160 Case Study Confirm your 71 year old male with upper and lower implantsupported dentures who is now in a nursing facility. What can you do? Dementia is severe enough that family members do not want to bring him in for his preventive appointment any longer. Mary Kelly, LLC

15 Know Better You Do Better Mary Kelly, LLC 162 Thank You! Mary Kelly, LLC 163 Mary Kelly, LLC

16 Mary Kelly, LLC 165 Mary Kelly, LLC 166 Mary Kelly, LLC

17 Mary Kelly, LLC 168 Question: Clinical evidence to support Waterpik/floss claim Mary Kelly, LLC 169 Precooperative waiting for insurance Mary Kelly, LLC

18 Mary Kelly, LLC 171 Mary Kelly, LLC 172 Sandra is a dedicated dental hygienist who demonstrates the commitment to bringing the best dental care to her patients through personal professional development and supporting others in the dental community. Mary Kelly, LLC