Services for Adults & Elders with Cognitive Impairment

New Leaves Clinic psychologists have years of experience working not only with children, but also adult and elderly clients suffering from cognitive impairment. Dementia is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as multiple cognitive deficits that include memory impairment and at least one of the following cognitive disturbances:

• Aphasia (i.e., changes in the ability to use language meaningfully)
• Apraxia (i.e., impaired ability for willful movement despite intact physical ability)
• Agnosia (i.e., failure to recognize or identify objects despite intact sensory function)
• Disturbance in Executive Functioning (i.e., inability to plan, organize, or understand abstract concepts)

Dementia should not be confused with becoming absent-minded with old age. All of us can expect to experience some minor losses in our ability to think and remember as we get older. For example, misplacing your car keys on your 80th birthday may be a normal part of aging. However, forgetting your wife’s name is probably suggestive of a more serious problem.

Dementia can be due to structural brain injury (e.g., car accident, tumors or subarachnoid hemorrhage), stroke (i.e., vascular disease), life choices (e.g., alcohol or illegal drugs) or degenerative brain diseases (e.g., Alzheimer’s and Huntington’s disease). Each type of dementia has specific traits and patterns of manifestation. However, all of them rob independence and self-esteem from once vibrant and active people. As forgetfulness sets in, persons with dementia can become frustrated, emotionally volatile, and experience disturbing changes in personality. As the disease progresses, sufferers can become incontinent, and even lose the ability to feed themselves. These diseases also affect families and caregivers as loved ones are forever changed, or simply “fade away.”

United States census projections warn that as the Baby Boom generation ages, the number of Americans over age 65 will be greater than ever before. As this happens, cases of dementia are expected to rise, bringing greater urgency to properly addressing the needs of these patients and their families. Fortunately, because of the courageous work of outspoken advocates like Nancy Reagan, the problem of dementia is now a part of public consciousness.

There are things we can do for those suffering from dementia. Drug therapies have been increasingly effective in slowing the course of degenerative processes as well as alleviating symptoms (e.g., cholinesterase inhibitors, anti-psychotics and anti-depressants). Mental health interventions are equally important since demented individuals continue to have active emotional lives with needs for quality interpersonal interaction (e.g., Validation and Reminiscence Therapies). In addition, as regulatory boards levy new expectations for mental health services in nursing facilities, psychologists are increasingly called upon to provide behavioral and environmental recommendations (e.g., to change problem behaviors such as resistance to nursing care).

At New Leaves Clinic, our goals are to provide your family with:

• Accurate assessment and diagnosis
• A firm understanding of the diagnosis/problem (i.e., disease processes, and how this diagnosis may impact your elder or disabled loved-one’s future)
• Information about cognitive disorders and treatment strategies
• A plan to address the problem that works within your family and lifestyle
• Support while teaching you to implement the treatment plan
• Assistance in working with other professionals to support your elder or disabled loved-one (e.g., nursing home staff and medical doctors)

Areas of Clinical Practice with Cognitively Impaired Adults and Elders

Listed below are areas of difficulty in which New Leaves Clinic psychologists are competent to provide assessment, diagnosis, treatment, management and consultation. This list is comprised of disorders recorded in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and additional services we provide that are not listed in the DSM (Italics). Please note that a diagnosis is not required for you to seek assistance.

• Dementia, Amnestic, and Other Cognitive Disorders
• Individual Psychotherapy/Nursing Home Visits
• Consultation with Caregivers/Family Support
• Assisted Living/Nursing Home Placement Consultation
• Death and Dying Issues
• Dementia Screening/PASAAR

Individual Psychotherapy / Nursing Home Visits

While concrete interventions can be implemented to help someone with an increasing memory problem (e.g., dry-erase boards, electronic memory aides), psychotherapy may be beneficial in improving quality of life, as well as decreasing behavioral problems. Reminiscence and Validation therapies that seek to re-integrate the client with a sense of their meaningful past are finding increasing validity in geropsychology research. Even with patients who have lost the ability to speak, supportive therapies where eye-contact and compassionate presence are emphasized can be helpful when applied consistently and with a clinical focus. Reading to someone, for example, is known to stimulate important cortical areas in children as well as adults.

Generally speaking, nursing home staff does a great job providing basic health care to residents. Unfortunately, meaningful in-depth social interactions that most of us take for granted are few and far between due to the staff’s overwhelming work load. From our experience, the number one complaint made by nursing home residents is:

“Nobody ever comes to visit.”

At New Leaves Clinic, a licensed clinical geropsychologist is available to visit with your elder or loved one. If you are the legal guardian, we can keep you abreast of emotional and physical developments in a weekly report that will be sent directly to your home. If your parent is having adjustment difficulties, or has a history of metal illness, we can also provide psychotherapy in the nursing home.

Consultations with Caregivers / Family Support

If you’ve just received news that a close family member has dementia, you need information! This is especially true for families trying to care for a loved one at home. Lack of understanding can lead to blaming, guilt, and unnecessary problems within the family. You may have many unanswered questions:

“What does mom’s shouting mean?”

“Why is grandmother suddenly so rude?”

“Why does dad tell the same story over and over again?”

Let New Leaves Clinic answer all of your questions, while offering useful ideas for improving your loved-one’s safety as well as your peace of mind.

Assisted Living/Nursing Home Placement Consultation

One of the most difficult decisions a person can make is whether or not to place a beloved parent or loved one into a nursing home. Contrary to popular belief, America’s elderly are not being “shelved away” by their ungrateful children. Rather, from our years of experience in this field, we’ve found that nursing facilities provide an appropriate level of care to people who can no longer look after themselves. Yet despite this fact, families labor over placement decisions, often suffering a great deal of unnecessary guilt and stress.

Below are some examples of how New Leaves Clinic can help you make these important decisions:

“My dad isn’t impaired enough to be in a nursing home, but he can’t drive and never leaves his trailer. What can I do?”

We can coordinate services and recreational activities for you. Having worked in this area for years, we’ve compiled a database of contacts and services that might be available to your family. Options may include respite for caregivers, and day treatment with bus transportation to senior organizations. In many cases, the only way to find out is to ask.

 “My wife is beginning to worry me. Does she need more care than I can offer?”

As the spouse of a person with dementia, you may be the first to notice subtle changes in their thinking or behavior. Often, families note worrisome behaviors such as resistance to care, poor medications compliance, combative or disinhibited behaviors, sexual inappropriateness, wandering, failure to thrive or other unsafe behaviors (e.g., leaving the stove on).

First, it is important to consult with your family member’s primary care provider (PCP) to assess for any medical changes.

Second, we suggest that you call New Leaves Clinic to ask how we can assist your family in working through these changes in your loved one’s life. Many caregivers express relief at knowing the concerns they have are real and founded in neuropsychological fact. To this end, we offer emotional and cognitive screening of your loved ones abilities and limitations, with a full report that is yours to keep.

 “My mom has always been so independent. How do I go about telling her it’s time to move to a nursing home?”

Convincing a parent that the time has come for them to move can be a daunting task. We can help you to deliver the news at a scheduled meeting with you and your loved one. Let us offer our experience, support, and sensitivity to your family during this difficult moment. Also, many people who move into nursing homes from independent living experience serious adjustment difficulties (e.g., homesickness) that can last for months. New Leaves psychologists can ease that transition by providing weekly visits with your loved one until their new residence feels more like home.

 “Before his stroke I could help my dad with bathing. He’s still too clever for a nursing home. What happens now?”

A nursing home is not always the most appropriate placement. Everyone, including your loved one, values their freedom and independence. That’s why it is important that you find the least restrictive level of care that meets your loved one’s needs. Your parent may be eligible for Medicare reimbursed in-home visits, licensed home health care, foster care, assisted living, or full nursing home placement. Let a New Leaves Clinic geropsychologist do the research for you, and we will schedule a conference where your options will be explained to you and your loved one in detail so you can make an informed decision together.

“Are some nursing homes better than others? How do we go about choosing one?”

Yes, some are better than others. While all nursing homes are required to meet minimum standards set by the Health Care Licensure and Certification Section (Oregon Health Department), we have found a wide variance in the age of the buildings, aesthetics, cleanliness, quality of activities, and staffing.

New Leaves Clinic can help you make this difficult decision by matching your needs (e.g., location, nature of disability, etc.) with our unbiased data on qualified nursing facilities in your area. This information will be provided to you in a report format, along with related marketing information, so your family can make the most informed choice.

“This is all too much for me. I don’t even understand the steps I need to take to make this decision. What should I do next?”

Give us a call. It is easy to become overwhelmed, but you can take some comfort in knowing that others have been through this process before you. Let New Leaves Clinic help you and your family navigate through this natural and important stage of life.