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Dementia expert gives tips to first responders

How to approach and calm someone who is agitated and possibly violent

By Barbara Peters Smith
Sarasota Herald Tribune (Florida)

SARASOTA, Fl. — National dementia expert Teepa Snow wants people in Southwest Florida to be more aware that they are surrounded by neighbors with some form of cognitive disorder — and many of them are driving on our roads.

About half of all people who are 85 and older have some form of dementia, she told an audience of emergency responders and health care providers Monday on the first day of a three-day caregiver conference at the Pines Education Institute in Sarasota.

In Sarasota, Manatee and Charlotte counties, that one segment of the dementia problem comes to about 24,000 people, almost 3 percent of the total population.

Monday's session, free to emergency responders, was to help law enforcement officers, paramedics and firefighters recognize and react to signs of dementia. The need can arise from a 911 call to a private home, she said, or in a routine traffic stop, since "40 percent of people with moderate-stage dementia are still driving motor vehicles, and not well."

Emergency responders, Snow said, "tend to deal with these people in a crisis situation, when they're at their worst. And they won't necessarily respond to a uniform in ways you would expect."

Snow said that because people with Alzheimer's disease or another form of dementia often look confused and disheveled, the first assumption an officer might make is that they are drunk. In the training session, she discussed how to recognize the difference, and to approach and calm someone who is agitated and possibly violent.

Inappropriate words and actions are common, she said. In later stages, dementia patients have little impulse control and they hunger for sensory stimulation. She demonstrated the problem by approaching members of her audience and hitting or shouting at them.

The normal human response is to try to control the situation by seizing a person's wrists. But Snow pointed out that this will create bruises on an older person -- sometimes leading to a suspicion of abuse by the caregiver or emergency responder.

"We have a lot of caregivers who are never taught anything, and are flying by the seat of their pants," she said. And as a person with dementia ages, emergency calls increase. Medical emergencies, she said, "get harder and harder to figure out" because the ill or injured patient has no way to describe symptoms.

Snow demonstrated her "supportive stance" technique: Approach the person and stop 6 feet away, at the border between public and personal space. Then offer to shake hands. Instead of dropping the handshake, she said, shift the grip so the fingers are on top of the hand, and then step to the person's side, out of the field of vision.

"In most cases," she told the law officers, "this lets you turn so that your weapon is away from the person's reach."

Many of Snow's techniques help get through a moment of confusion or even violence. But she acknowledged that many dementia patients need more help than current health care or legal systems can offer.

"We need to get our act together and talk about this," she said. "There are so many ways in which the system can fall apart. It's not really set up for people with dementia."

Longevity and the aging of baby boomers should combine to force better solutions, she predicted.

"People who survive multiple chronic illnesses are living longer," she said, but those illnesses, like heart disease or cancer, take a toll on the brain. "And if you're a full-time caregiver, your own risk goes higher from the stress."

One dilemma that needs to be addressed, she said, is the burden that dementia sufferers can place on hospital emergency rooms.

"This is a terminal illness, and that's something people don't think about," she said. "How many times do you go back to the ER? How many times do you give antibiotics for infections that keep coming back? We don't have answers, but we need to start asking these questions."

Copyright 2012 Sarasota Herald-Tribune Co.
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