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Johns Hopkins Bayview News - Actions Speak Louder

Summer 2014

Actions Speak Louder

By: Jessica McQuay
Date: June 2, 2014

Engaging patients with dementia through activities they love

Female care provider shaking hands with elderly female patient
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Agitation. Irritability. Anxiety. Refusal of care and medications. Verbal or physical aggression. These frustrating, sometimes frightening, symptoms are a complex, yet common, part of dementia. “Behavioral disturbances” can escalate due to any number of factors—including decreas­ing cognitive function (memory, thinking and judgment), medications, pain, delirium or the environment of care—leaving families and care­givers desperately looking for ways to help their loved ones. Johns Hopkins Bayview’s Medical- Behavioral Unit can help dementia patients and their caregivers better manage these symptoms and bring balance back to the home.

Moving Beyond the Deficits

Staff on the 28-bed inpatient unit recently participated in the trial of a new care model for patients with dementia, based on successful re­search by Laura N. Gitlin, Ph.D., director of the Johns Hopkins Center for Innovative Care in Ag­ing, and her occupational therapy team. The trial focused on identifying capabilities and interests of people with dementia who were admitted to the hospital with behavioral symptoms, as a favorable alternative to simply prescribing medication. The idea was to heavily engage these areas in which the person with dementia was still highly func­tional to improve their mood, behavior and sense of self-worth. “With the diagnosis of dementia, standard tests emphasize deficits,” explains Dr. Gitlin. “But, they don’t really help families with how to effectively support the person with dementia at home. Families of people with dementia need to know what the person can do.”

During the trial, each patient was assessed upon admission, using a variety of task-oriented tests to measure their cognitive, physical and neuro-psychological abilities. These include a “leather lacing” test, a timed physical functioning test and other basic tasks (asking the patient to state their name, shake hands and make eye contact). The patient and their family/caregivers also were extensively interviewed to get an idea of the patient’s likes and dislikes.

The occupational therapy team then created activities combining the patient’s strengths with their interests and background.

Bringing Back Quality of Life

Occupational therapists, who design the activities tailored to best engage the patient, then train the recreational therapists and nursing staff on the unit to use these activities throughout the patient’s stay. Before discharge, the care team teaches families how to use and adapt the activities at home. The average patient spends two to three weeks on the Medical-Behavioral Unit before being discharged to their home or care facility.

“A lot of times, family members just don’t know how to deal with someone suffering from dementia, especially when they have increased behavioral disturbances,” says Tristen Kvedar, OTR/L, an occupational therapist on the unit. “We can offer them something structured that the patient enjoys, and that the family can now enjoy doing with them. It improves quality of life for both the patient and the family. ”

Kvedar recalls one case in particular: a man who arrived highly irritable, refusing to be touched and displaying generally disorganized behavior. “We found out he was a former member of a barbershop quartet. I began playing barbershop music whenever we spent time together, and he quickly became organized, happy and often sang along.” These seemingly small changes can have big impacts and help patients remain in the home with their family members following discharge.

Maintaining an Identity

“In our preliminary research, we found that a commonly unaddressed need was to include people with dementia in meaningful activities,” explains Dr. Gitlin. “It may seem simple, but the implications are huge. Medications may remain important in treating symptoms associated with dementia, but the activity-based approach also is a way to preserve the patient’s dignity and sense of self.”

To find out more about the Medical-Behavioral Unit, visit or call 410-550-7642.

Memory & Alzheimer’s Treatment Clinic

Using the latest diagnostics and the most recent advances in the treatment of dementia and Alzheimer’s disease, the Johns Hopkins Memory & Alzheimer’s Treatment Clinic can provide patients and families with a thorough assessment, accurate diagnosis and collaborative treatment in an outpatient setting.

For more information or to make an appointment, visit or call 410-550-6337.

Defining Dementia

Dementia is a loss of brain function associated with a number of diseases (namely Alzheimer’s disease). It affects a person’s memory, thinking, judgment, language and behavior. In most cases, dementia is irreversible. Early signs of dementia may include:

  • Difficulty with tasks that used to come easily, such as spelling, balancing a checkbook or playing simple, familiar games
  • Getting lost on familiar routes
  • Language problems, such as trouble with the names of familiar objects
  • Frequently misplacing items
  • Personality changes and loss of social skills

As dementia progresses, these problems worsen. The person may begin forgetting details about current events or their own life. Dramatic changes in mood and behavior may be seen as well. In the advanced stages of dementia, skilled medical care is recommended.