After the Webinar: Understanding Alzheimer’s and Dementia for First Responders. Q&A with the Presenters

Webinar Presenters Nancy Swigert and Amber Burgess Cox answered a number of your questions after their presentation,  Understanding Alzheimer’s and Dementia for First Responders. Here are just a few of their responses.

 

Audience Question: Several people have asked if there are specific tests to diagnose someone with Alzheimer’s. Is it a specific test? Is it a process of elimination? What exactly does it take to get somebody diagnosed with Alzheimer’s?

Nancy Swigert: Good question. And you know, we used to say, oh, you don’t know if it’s Alzheimer’s until after death with an autopsy. But that is not true. There are some fairly simple cognitive tests that your primary care physician or other professionals like psychologists, can administer that will show… there’s one called Mini Mental State. If you have a family member who’s elderly, even if you don’t suspect they have dementia, their  physician should be doing a cognitive screen at each visit so that they can watch for changes. So, the first step is to talk to the person’s primary care physician. Ask if they’ve done a cognitive screening. Make sure you go in with a list of concerns of things that you’ve observed that you can share with the primary care physician. You might be referred to a specialist like a neurologist who specializes in dementia. There certainly are some instrumental tests that can give more information like MRIs. But frankly, mostly it’s going to be a report of what’s happening with the person. As well as some of these fairly easy tests to give. Some of those different types of dementia that I talked about, vascular, etc. might lead to other things like MRI or CAT scans, but almost always the primary care physician can start the process rolling.

 

Audience Question: Are there any costs associated with that helpline? 

Nancy Swigert: Oh, no, none at all. That’s absolutely no cost at all to any of the services provided by the Alzheimer’s Association., There are also a lot of webinars that are recorded, and some of those are great for us as professionals, but also as family members, etc., to watch, and any of those services from the Alzheimer’s Association. There’s no charge.

 

Audience Question: Is there a correlation between head and brain traumas like TBI and an increase in the potential to develop Alzheimer’s later in life? 

Nancy Swigert:  Yes, there’s a simple, quick answer. Yes, there is. Well, just think of any of the sports figures you’ve seen boxers, etc., who developed dementia as an example. So yes, more times you knock the head around then there is an increase in the risk of dementia.

Host: So, I’m thinking about our victim advocates out there who work with domestic violence victims and those victims who have been diagnosed with TBI, strangulation, etc. That may be a concern for them in later life?

Nancy Swigert:  It may indeed.

Host: Very good to know. Thank you so much for sharing that.

 

Audience Question:  What de-escalation skills could be helpful for someone with Alzheimer’s who may be in crisis? So, you’re an officer, you’ve reported to a scene. Are there specific additional things that officers or anybody else could keep in mind as they’re working with somebody who has Alzheimer’s who’s in crisis?

Nancy Swigert:  A couple of things. First is, to look around, what are the distractions? And how can we get this person to a place where we can communicate with them in a more quiet environment? I’m not going to necessarily suggest the back of the squad car because that might be really intimidating. But you know, can we draw them away from the situation a bit? Even if communication is really impaired, the person responds to touch. So, a gentle touch on the shoulder. Taking the person’s hand, holding their hand, and just waiting a minute for them to calm down. And then also remember you can try and distract the person. And it could be something like, “Oh, you know what my sister has the same shoes. Are those comfortable?” So, getting their mind off of whatever is happening at that moment helps de-escalate the situation as well. And remember that your appearance as somebody in law enforcement may make them even more anxious and nervous. So again, taking off your hat, sitting down if you can, or getting on eye level, talking calmly, trying a distraction, trying a gentle hand hold. And you’ll know if you’re reaching for the person is more upsetting. But touch can be very calming.

 

Audience Question: How do we balance the understanding that the person’s reality may not be wholly accurate? But yet take what they’re saying seriously enough, such as if they’re saying they’re being abused, or if they’re saying they’re being stolen from?  Nancy, maybe you can talk at it from the Alzheimer’s perspective, and then Amber, if you can chime in with your own advice from the investigative or law enforcement perspective, that’d be great. 

Nancy Swigert:  Okay, so let me start that off Amber. And first, of course, is to treat this person with respect. They may be giving a true and accurate report. Or they may be confused, but respect their information, because in their reality that purse is nowhere around, and they’re sure it’s been stolen, for example. Or my car keys are gone. So, the first thing is, let’s treat that like it’s a real report. So, can you describe the purse to me? Where did you last see it? What do you think was in it that might be valuable? So, we are now taking what looks like an actual report. And then we say to the person, Let me get a little more information. So maybe nobody else is there at the house. So, you know, is there somebody we can call? Is there a neighbor or a family member that we can call? And then try to get some corroborating information or information that shows this is this is not accurate, but again treating this person with respect is in their mind, in their reality that’s what’s really happened. Somebody’s taken their purse or tried to break in when they were installing an air conditioner, etc. That’s really what they’re believing. So, Amber how about from your perspective?

Amber Burgess Cox: So, from the law enforcement perspective, it’s always taken it seriously until proven, otherwise. Trust, but verify. One thing, because my mom is starting to have the early signs, and she has Parkinson’s. The one thing that I have learned just from sitting in on Nancy’s class is you have to be patient. It’s also – if anybody’s worked with cognitive behavioral therapy, it’s one of those things you have to disprove them with the facts, but not in a demeaning way. So, you treat them with respect, like an adult, peer to peer. Show them, “Oh, here I found your checkbook. It’s not stolen. Let’s come up with a plan so you’ll know where it is,” or “Let’s find somebody you can trust that won’t steal your money.” Use the Golden Rule. How would you want your mom to be treated? How would you want your grandma to be treated? Just keep using those community policing skills, using those skills, even though you might have been to that house a hundred times – keep that patience because the individual does believe whatever they’re telling you has happened. So, go with it, but maintain your officer safety, of course. Keep your distance if you have to – if things are escalating. But know that you can prove them wrong, but help them at the same time and correct the problem.

 

Audience Question: Do you or other experts consider what we eat to be part of the risk factors in developing dementia or Alzheimer’s? 

Nancy Swigert:  Yes, and I tell you there’s my favorite course that I teach for Alzheimer’s is called Healthy Living for the Brain and Body. And there are many things you can do to reduce your risk and diet is right at the top of the list. Actually, it’s second, I’ll tell you what’s first in a minute. It’s second on the list, and I can’t recommend a specific diet. But I will tell you the two that are often mentioned in the research are the DASH diet and the Mediterranean diet. And if you look at those diets, both of them are very low in red meat. I’m a Vegan, so for me, none. But very low in red meat, very many, many vegetables and fruits, whole grains. So just look at the Mediterranean diet or the DASH diet and that can have a huge impact. Remember, way back, I said, there were risk genes and deterministic genes. I heard a lecture once by a physician who was talking about this concept of risk. He said, “You can have a genetic risk, but the environment pulls the trigger,” and I love that because if I have a risk, now I don’t feel so helpless. So that’s huge. The number one thing is physical exercise. Remember that what’s good for your heart is good for your brain. Every time your heart pumps, 25% of the blood goes to your brain. So, if you’re doing things that are good for your cardiovascular system, you are doing things that are good for your brain. So, if you are only going to do two things (and there are ten things we teach in that Healthy Living course), if you’re only going to do two to reduce your risk: (1.) Get physical exercise, and again, you know, it’s not that you run a marathon. It could be a nice brisk walk for about 30 min a day. Doesn’t have to be all at once. It’ll be 10 min at lunch and 20 after dinner. (2.) And change what you’re eating.

 

Audience Question: Are there any questions or trigger words that can be used when speaking with an elderly member of the community on the phone or 911 to help advise responding resources that the person may potentially have Alzheimer’s or dementia? 

Nancy Swigert: Well, that’s a tough one. I’m going to ask Amber to jump in on that one, too. I guess you’re taking the call. And it just doesn’t sound right. Okay, so something just doesn’t sound right. And maybe asking also. “Is there anyone else there that we could talk to?” Amber? How about you? That’s a tough one from my perspective.

Amber Burgess Cox: That is a good question. I would say “Hey, are you by yourself?” It may not be necessarily what they’re saying but how they’re saying it. Are they agitated? Does their behavior seem to follow what they’re calling about? You know, if they’re real agitated and saying a piece of mail didn’t come or got taken from the mailbox. The reaction to what they’re calling about isn’t connecting because I think it’s more about when it’s over the phone – the tone and the emotion. So maybe, use those minimal encouragers that we learn about, “Go on…” “You don’t say,” “Tell me more…” and the more you can get them talking and Nancy will back me up with this, your active listening with someone with dementia or Alzheimer’s, the calmer and not necessarily softer you’re speaking, but the slower and simpler you can be is going to get you the most feedback from them. So that would probably be rather than specific words, I would say, utilize your active listening skills. Use your minimal encouragers and be, I don’t want to say bare bones, but very basic like Nancy mentioned earlier in your questioning. You know, in law enforcement, we always train to ask open-ended questions. If you’re dealing with somebody who has Alzheimer’s or dementia, that is not the time to ask questions where you want a 15-minute reply back. “Is your car black or white?” “Are you alone? Yes or no?” With these individuals, you want to use more close-ended questions to help them dial in on what the issue is, or what they need from you.

 

Click Here to Watch a Recording of Understanding Alzheimer’s and Dementia for First Responders

 

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