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Dementia Agitation
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While memory impairment is often what comes to mind when one thinks of Dementia, agitation is what most often causes my phone to ring with a request for an evaluation.  Behavioral changes, paranoid delusions, hallucinations and long periods of screaming were described by the psychiatrist Alois Alzheimer, for whom Alzheimer’s Disease is named, in 1907 in his original case description of the disease nearly 100 years ago. ‘Agitation’ is a term that is most often used to describe a wide variety of behavioral symptoms seen in patients with dementia.  The medical term used to describe these symptoms is the Behavioral and Psychiatric Symptoms of Dementia, or BPSD for short.
 
It is estimated that BPSD affects up to 90% of all individuals with dementia over the course of their illness, and is independently associated with poor outcomes, including distress among patients and caregivers, long-term hospitalization, misuse of medication, and increased health care costs.
 
There are several categories of BPSD, these include: 
  • Disturbances of emotional experience such as mood lability, depression, anxiety, irritability/hostility, apathy, and crying spells.
  • Psychotic experiences including delusions, hallucinations, and paranoia.
  • Sleep Disturbances such as sleeping excessively, waking up frequently, sleepwalking and its related conditions.
  • Appetite Disturbance can manifest as low to non-existent appetite and weight loss, excessive appetite/demands for food, and ingestion of non-edible substances.
  • Disinhibited Behaviors include wandering (present in about 25% of patients with Alzheimer’s), yelling (seen is 25% of Nursing Home residents), excessive talking, inappropriate sexual behaviors, and hypermetamorphosis (the need to touch, and sometimes hoard, every object in sight).
  • Personality changes can manifest both as acting in atypical ways as well as experiencing a ‘distillation’ of the personality so that the person behaves as a caricature of themselves.
  • Uncooperative behaviors are most often related to personal care such as bathing, dressing, taking medications, and grooming activities.
  • Certain behaviors can be more commonly associated with different types of Dementia. For example, hallucinations can be a prominent feature of Lewy-Body Dementia, and Complex Sleep Related Behavioral Disorder is often associated with Parkinson’s Dementia, and changes in personality can be the first symptoms of Fronto-Temporal Dementia.
 While these behaviors are often manifestations of the underlying brain damage caused by dementia, they are sometimes related to co-occurring medical conditions which should be evaluated as part of an assessment of BPSD. These include things such as urinary tract infections, vitamin deficiencies, thyroid abnormalities, diabetes, kidney and liver function, and pain syndromes.
 
Assessment of BPSD begins with a thorough evaluation consisting of gathering information from multiple sources to learn not only about the onset and evolution of the BPAD and underlying dementia, but also a detailed assessment of medical conditions, all medications being taken by the individual, as well as an assessment of the possible contributors/triggers of the BPSD from the living environment.
 
Improvement of BPSD is often achieved through a combination of adjustments in medication, treatment of any underlying medical conditions, and modification of the individual’s environment/caregiver approach.  Because there are so many different types of agitation and because each patient’s background, life story, medical issues, and temperament are unique, an individualized approach that takes all of these variables into account is most likely to be successful.

A Huge THANK YOU to our Caregivers & Staff
a special note from Brian Rodgers

Over the course of five days in January during the epic Winter Storm Jonas, our nurses and nursing assistants were simply amazing. While most of our neighbors stayed home, CCN caregivers, like first responders during an emergency, made incredible efforts to be with their clients and complete crucial visits throughout the storm and subsequent cleanup.

It is also important to acknowledge our coordinators and office staffers for their fantastic foresight, communication and coordination before, during and after the epic snowstorm.

In fact, during and after the storm, I personally received multiple notes from clients’ and family members expressing their gratitude and appreciation of our amazing caregivers and office staffs’ efforts during the weather emergency.

So it is only fitting to once more applaud their efforts and allow me to say “job well done!” to all.
Travel isn’t for the young. You don’t need to be in your 20s to discover the world. As we age, learning new things and exploring new places can actually help our brains stay vital.
Unfortunately, there’s a stigma surrounding traveling with seniors. continue reading...
Winter can be a bit of a downer. Snow, ice, unsafe driving conditions, bitter cold—all of these factors can make winter seem depressing. But winter blues are more than just a passing notion; each year some people get SAD, or Seasonal Affective Disorder. continue reading...

The Memory Cafe

We know that one of the hardest aspects when dealing with memory loss is feeling like you’re losing a support system or social group. That's why we support IONA offering the Memory Café. The Memory Café is held every fifth Friday and provides a safe and supportive environment for individuals with memory loss, caregivers, family members, and friends to get together and enjoy some food and companionship. The goal is for guests to have a fun and stress-free evening out! 

he first Café was in January. The next one is April 29th. RSVP by calling Sharon O'Connor at 202-895-9469 or emailing registration@iona.org
We provide the best care available to clients and families with varying needs. Our team of nurses, nursing assistants, and care providers offers the following services:Care Assessment
  • ADL (Activities of daily living)
  • Elder Care
  • Post-Operative Care
  • Short & Sweet
  • Medication Management
  • “Daughter Down the Street/Son Stopping By” Companion Service
Any question, any time, no matter where you are in your journey, one of our experienced care coordinators is available to listen and provide answers.

We’re available 24/7
1-866-687-7307

The Cottage at Curry Manor
Refined Residential Living
for Seniors


Please call us 301-652-4344
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Service Area

Capital City Nurses serves the greater Washington, Northern Virginia, Baltimore and Annapolis areas including the Eastern Shore of Maryland, and Delaware. We work with your schedule and come to you, wherever you are.

For more information, or to schedule a caregiver, call the Capital City
Nurses toll-free hotline at: 1-866-687-7307
 


Coastal Home Care Services (Eastern & Western shores)
1323 Mt. Herman Rd.,
Suite 5B
Salisbury, MD 21804

1-866-687-7307

Coastal Home Care now has its own monthly newsletter! Click here to read it
 



Office in Delaware
20771 Professional Park Boulevard
Georgetown, Delaware, 19947

302-752-1800
 


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Severna Park, MD 21146

410-344-7495
 



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Alexandria, VA 22314 


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