The Window of Opportunity and Dementia

 

If you have worked in long-term care long enough, you have heard of the term "window of opportunity." The term is used when a resident responds cognitively or physically above their baseline in brief periods of orientation, motivation, or physical ability. The periods that arise from these cognitive reserve units are challenging to reproduce, measure, and build upon as these enhanced moments or "windows of opportunity" are often fleeting. According to Kraal et al. (2021), predictors of functional status may involve a sense of mastery or self-efficacy in one's abilities, and depression and apathy decrease functional levels or "windows of opportunities. Interdisciplinary teams see the importance of treating comorbidity with depression in the elderly and seek to address the need for mastery and self-efficacy by offering failure-free activities and by promoting the learning and relearning of daily living activities for the cognitively impaired.

–Dr. Stewart

Reference:

Kraal et al., (2021). Functional Reserve: The Residual Variance in Instrumental Activities of Daily Living not Explained by Brain Structure, Cognition, and Demographics. Neuropsychology, Vol. 35: No. 1, 19-3. The American Psychological Association.

Picture Yourself Stronger LLC Consulting

Favor the Familiar

 

Dr. Debra Stewart

Organization Psychologist and Consultant

In caring for persons living with dementia, it is recommended to favor the familiar regarding activities of daily living and leisure interests. "Favoring the familiar" has been shown to reduce confusion and agitation in persons living with early to mid-stage dementia. Favoring the familiar also supports our innate need for apophenia or patternicity, which is our brain trying to make sense of a seemingly meaningless and unrelated order of events. 

However, even in the cognitively intact person, there are false positives and negatives in predicting the meaning behind a pattern of events, leading to bias, stereotypes, or faulty decision-making. But within the thought process of someone struggling with confusion, delusion, delirium, and disorganized thoughts, the struggle to find the familiar and find recognizable patterns may be frustrating and produce unsafe or exhausting behaviors. For example, exit seeking or wandering residents seek the familiar too and assign meaning to a seemingly meaningless and unrelated order of events. In a continually changing environment, such as a facility in long-term care, the familiar might be lost. To reduce wandering and exit seeking behaviors, favor the familiar by keeping the walking paths and social areas decorated with easy-to-recognize environmental designs and imagery. ~ Dr. Debra Stewart 

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Self-efficacy, Self-worth, and Exercise

 

It can be difficult to motivate your residents to participate in your exercise classes. Self-efficacy concerning exercise adherence is a person's confidence in his or her ability to be consistent with an exercise program. Self-worth tests assumptions about the value of the exercise for the individual. If a person is confident and finds value in an exercise program, then the person will be intrinsically motivated to continue exercise. This means that self-talk and memory triggers should be about desired health outcomes and improved quality of life rather than just being about weight loss and body image. This will help the individual find the confidence and the value needed to be consistent with an exercise program over the life course.

 

COVID-19 and Resident Loneliness

In the past, residents in nursing homes were assigned to receive one-to-one visits if the resident was adjusting to nursing home placement, refused social interaction, or were at further risk of decline. The goal would be for residents to have a balanced day of social interaction and independent activity of their interest. According to Cacioppo, Capitanio, and Cacioppo (2014), to avoid loneliness, one-to-one visits conducted by families, volunteers, or staff members must be personal, and they must consist of a positive social relationship to be meaningful.

Research continues to inform us the there is a strong link to perceived loneliness and high morbidity and mortality rates. Interestingly, Cacioppo et al. (2014) stated that when the brain senses a loss of mutual assistance or security, it puts the brain into a self-preservation mode that involves survival-based behaviors. For residents living with dementia or other cognitive deficit, survival-based behaviors may emerge as wandering, hoarding, self-isolation, and hypervigilance with a perceived social threat. The research indicates that perceived loneliness is vital to understand and consider as we design meaningful one-to-one visits during the COVID-19 pandemic without the help of family and volunteers. -Dr. Stewart

 

Reference:

Cacioppo, S., Capitanio, J. P., & Cacioppo, J. T. (2014). Toward a neurology of loneliness. American Psychological Association

2014, Vol. 140, No. 6, 1464–1504 0033-2909/14/$12.00 http://dx.doi.org/10.1037/a003761