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Episode
Kate Grandbois: Hello and welcome to SLP Nerd Cast. We are really excited for today's episode. Um, as many of our listeners know, Amy and I clinically have worked for years in the realm of a a c and know very little about med [00:02:00] SLP related topics. But this is one of the reasons why we love hosting the show because we get to bring content experts in to teach us all kinds of wonderful things.
And today we are. Looking forward to one of these experiences. We have the pleasure of welcoming Jackie Marchy to the show to discuss assessment in dementia care. Welcome, Jackie.
Jacquelyn Marchi: Great. Thank you so much for having me. I'm a big fan of the show, so I'm excited to be here.
Amy Wonkka: We are excited to have you on and thank you for spending this time with us this morning. Uh, you're here to discuss. Direction and dementia assessment considerations and hard conversations. But before we get started, could you tell us a little bit about yourself? Uh, maybe what drew you into this area of the field?
Jacquelyn Marchi: Yeah, absolutely. So I am a speech and language pathologist. Um, I. Actually got my start, um, in the outpatient setting. Um, I was at a rural community hospital, um, in rural Pennsylvania, um, where I was the only speech therapist who worked with adults for [00:03:00] many, many miles. And so what I found was I was often the first person noting signs of dementia in the patients that would come to me.
And more than that, I was. Often the person who had to lead some very difficult conversations with families and these patients of what was happening or what to expect. So I became a certified dementia practitioner. I learned more about how to better help these patients and their families. Um, and now I still like working with patients who have dementia.
Um, outside of my practice, I work as an acute care SLP. So I work with them in a little bit of a different way. Um, but I really continue to like to work with them and their families to help them navigate these difficult changes.
Kate Grandbois: You know, in, in, as a pediatric SLP, I'm very used to the idea of, you know, uh, kiddos coming into the clinic with a language delay and we're the first person to, uh, you [00:04:00] know, consider other larger medical issues that might be at play.
I had never considered that in the adult world, so thank you for sharing that perspective. Before we learn even more from you, uh, we do need to read through our learning objectives, so I will try to get through that as quickly as I can. After listening to this episode, participants will be able to self-report knowledge gains related to key elements that need to be considered when initially assessing a person with confirmed or suspected dementia.
Listeners will also be able to self-report knowledge gains related to strategies that promote memory. And finally, learners will be able to report knowledge gains related to the role of an SLP in collaboration with individuals with dementia. And their caretakers during initial evaluation and the creation of memory strategies.
Um, for anyone listening who would like to learn more about the financial and non-financial disclosures of today's episode, all of that information will be listed in our show notes as well as on the course landing page.
On our [00:05:00] website for anyone who is interested in earning ashe's, CEUs, or certificates of completion for listening to today's episode. The link to that will also be in the show notes and on the landing page for this course. Now that all of that is behind us, I am excited to. Hand pass the mic. Woo-hoo. Let's pass the mic.
Amy Wonkka: Uh, Jackie, let's start off, let's start off thinking about the SLPs role in collaboration. So what really is the place? I know in your past experience you were the only SLP also working with adults, which just on its own seems like a big responsibility. Um. Whether you're the sole practitioner or you're working in a larger, um, outpatient or medical setting, you know what, what is the SLPs role there when collaborating with the individuals who have dementia with their caretakers during that assessment process?
Jacquelyn Marchi: Yeah, so we are in a really unique and important position as [00:06:00] speech pathologists. So we don't diagnose dementia, um, but we're often the first person to really assess a patient's cognition and memory. And we look into the impact these changes have on the patient's life, um, and. I mean, we know this is such a growing field for speech pathologists.
I mean, worldwide, 47 million people live with dementia by the year 2050, uh, the number is expected to increase to 131 million. So yes, we provide speech, language and cognitive therapy, but we also help provide compensatory memory strategies for these individuals and their families.
And we can also help educate other medical professionals as to how they could cherry these conversations, um, and really help the individuals with dementia. Uh, to feel like they are still playing a part in these conversations. Um, so we diagnose memory to diagnose memory impairment. Um, [00:07:00] it requires evaluating patient for cognitive decline and looking into the impairment on their daily activities.
So we look into memory. Language attention, spatial orientation, executive function, and we'll also wanna ask questions about mood and determine where breakdowns may occur and where we can help. And we do all of this with corroboration from a close friend or family member. 'cause they're the first people to really notice a change in, uh, their loved one's memory.
So they're the people that exist right next to the patient in their everyday life. Um, they can see the difficulty that's present now, that wasn't before and they might not be sure what it means or what it will eventually lead to, but they just know they're concerned. So we can provide education and counseling to these patients and their families.
Um, so. Moving on to the evaluation itself. Um, our evaluation will [00:08:00] start with a referral, of course. Um, but I think it's important to dig into a little bit behind the nuance of the referral. Um, this could be easy or tricky, depending. Um. On the situation before the patient comes in, what I really wanna know is, was it the patient who requested this?
Are they concerned? Is it the doctor by themselves? Are they concerned? Was it a family member? And the patient thinks they're fine and they really don't wanna come in at all. Um, depending on like the EMRs and the systems of whatever community you're in, it might be easier to find this information out than others.
Um. I find it's really important to know this, especially when it comes to counseling. If I have a patient who does not wanna be there with me and they don't want my help. I wanna know how the family is feeling. Do they also think the patient is fine? Um, and it's the doctor who recommended this, and I need to get in touch with the doctor to make sure we're on the same page.
[00:09:00] Um, 'cause in my experience, sometimes it's the patient themselves who sets up the appointment. It could be the family member that does it. Sometimes it's the PCPs office that sets it up and the patient just kind of comes in. They're like, I don't know why I'm here. I was just told to come in. Um, sometimes we can come in a lot later and the patient has already seen a neuropsychologist.
They've already received a dementia diagnosis. Their families are very involved and they're just coming to us for some me memory strategies. So regardless, family and caretakers are a really great source of information. They can tell us a lot about the amount of difficulty and level of independence a patient has.
So we wanna include them in every step of the way, especially when it comes to planning the memory strategies. We're going to recommend,
Kate Grandbois: I have a reflection that you're talking about the counseling piece and. That was exactly what my question was going to be because I know that what I do know about dementia is that, you know, there [00:10:00] are many, many layers and ripple effects of this I can't help but think about myself in a position of power or in a position, in a therapeutic position, navigating some of the nuance here. I wonder if you, how do you handle situations where maybe the physician made the referral, the patient?
Feels like they don't understand why they're here and neither does the family, if there are components of grief and denial related to what's happening in terms of symptoms and memory.
Jacquelyn Marchi: Yeah, so I'm planning to touch a little bit more on the counseling aspect later, but I'm happy to answer a bit of that now.
Um, so in the case where I have a patient who's unsure of what's happening, the family's not really sure and the doctor is concerned, most of the time what happens in that case is when the patient comes into me, there's a very apparent deficit. Okay? Because if they're coming into the doctor [00:11:00] and it's apparent enough that within the 10 or 15 minutes they're in the doctor's office, doctor is probably noticing a lot of things that other people might not. So the family might even kind of brush it off and think like, oh, that's just how she is.
She just might not remember things. Or she's getting old, like that's how older people are. Um, if you think about it, there's a lot of complex things that happen when you go to the doctor. So like you have to fill out forms in the waiting room. Go to the back, sit in a room and know that you have to wait there.
Some people get confused and they might go out like, why am I here? Um, and in that brief 10 or 15 minutes where the patient is one-on-one with the doctor, the doctor's probably picking up on some signs of memory and cognitive impairment. So in those cases, when I do have a patient in front of me, whether they're alone or there's a family member, I usually say, you know.
Your doctor was concerned enough to send you here to me, and we're [00:12:00] gonna dig into that a little bit more. Okay. So, and then that's when I ask my questions, which I'll get to a bit here about the questions I ask, um, and really kind of split the hairs. Um, but I really try to be very thorough in the evaluation, and then I lay out all the information of what I'm seeing.
Then hopefully that becomes, uh, more apparent to the patient and the family. Sometimes the pa the family might see it, but they don't want to accept it, or they don't, might subconsciously not even realize what's really going on.
They just think like, oh, my older mother is just a little confused. I mean, she's getting old. That's how things are. They might not realize, oh no, there is something happening and it is going to continue to decline. We need some strategies to keep her as independent as possible for as long as possible. I hope that answers your question.
That was kind of a long roundabout.
Kate Grandbois: It does, no, it does answer my question and I, I really appreciate that you're [00:13:00] unpacking the complexity of family systems and how that's really being, um, like I mentioned a ripple effect earlier, but you know, these kinds of diagnoses, they are impacting more than one person as I is, I guess the point I was getting at and appreciating that you were kind of unpacking some of those complexities.
Amy Wonkka: The counseling piece must be such an absolutely huge component of your assessment. Uh, but you mentioned earlier, you know, you're looking at all of these different pieces. You're looking at your patient's executive functioning, you're looking at their language functioning.
Can you talk to us just a little bit more about what. Those questions are, and what all of those pieces of information you are trying to pull out in those initial interactions with the client, with the caregivers, so that you do have that really nice detailed picture that you were talking about.
Jacquelyn Marchi: Yeah, absolutely.
So we have the referral. Um, let's say we have the patient there with us. Hopefully they brought another person with them. We'll talk a little bit more about that later. Um, [00:14:00] and we do have to do a formal assessment. Um, you can do it at any point when they're there for the session. Um, I like to do it a little bit earlier and when I, like, whenever I do it, I like to start with what I consider some gentle pre-counseling, counseling.
It's not uncommon for families and or the patients to get emotional at during the session at any point, but especially if they're put on the spot and given what they consider to be a test. So I'm very honest with them and I don't use the word test and I'll say something like, look, we have to do a formal assessment.
I'm going to ask you to do a lot of tasks and answer some questions, and I don't want you to feel upset or discouraged if it's hard because it can be hard. And what I'm doing there is I'm preemptively acknowledging how I think they might feel. I'm not waiting for them to get worked up. Um, when they can't or if they can't do what I'm asking of them, [00:15:00] I'm setting them up to know that parts of this might be easy.
Parts of this might be challenging, and that's okay. And then I continue to say, this is just a tool. It doesn't tell me about you as a person or how you're functioning in everyday life. And those are the things I care more about. So I'm taking pressure off of them and off of the assessment. So while we have to do a formal assessment, it's also important to do other informal tasks.
So depending on. Just how my gut feels, kind of where they're at and where they are in the conversation. I, I'll ask them to sort playing cards by suit or by color, or I'll give them a cookbook, ask them to find a specific recipe. Or I might give them a calendar with a lot of things written on it and ask them to find specific things and tell me, um, okay, well, what's happening on this state?
Um, can you find when this is happening? So [00:16:00] as we're doing all of these things, I'm watching and taking note of how much support they need from me. Can they follow my initial instruction? Do they need a model? And then they're, okay. How much do they need me to step in in order to be successful? Or do they rely on me completely to do it?
After we do the formal and informal assessments, um, I want to consider the patient's home environment, their personal relationships, their daily routines and interests, and their level of independence.
So let's start a little bit with their home environment. So I don't wanna grill them with questions, so it feels like they're being interrogated. I want it to be very much the flow of a conversation. I'll say, tell me about the ground level of your house.
I wanna get an idea of what you see when you walk in through the front door. And the reason I'm doing this is because. I really wanna know the floor plan. I wanna know how [00:17:00] many floors there are, how big the house is, how much land could be attached to the house. And that's not because I'm being nosy. I want to get an idea of what rooms the patient could be in the most and how much they need to move throughout the day.
So sometimes with dementia, individuals may hide things or they might move things and forget where they're placed. Throughout this conversation, I'm also thinking about safety. If they come in and they clearly have balance issues and they're telling me they live in a two story home, they do laundry downstairs and then take it upstairs.
I'm going to ask a bit more about that and also mention that to the doctor. I also wanna gauge how much responsibility they have in the home. So bigger homes, uh, might require more maintenance. They might be, might be more physically demanding. So like I mentioned, if they have to carry laundry, um, you know, is there a [00:18:00] swimming pool that needs cared for?
Is there a garden? Is there a yard where the grass needs cut? Um, I also wanna know where is there mail delivered? Are there pets that need to be cared for? Is there a fireplace that needs to be maintained? So. There's really, you wanna get really specific when asking about their home. 'cause these things matter, especially when we're considering a patient's safety home.
And so I also wanna know who lives with them, who is doing the cooking. If someone is doing that for them and is doing laundry for them, I wanna know why. Is it because they mentally can't handle the task or is it because they physically can't do it? Or is it a combination? Um, or is that just how they divide the chores in their home?
And so then that brings us to personal relationships. We wanna consider the people they're speaking with the most frequently throughout the week. So. [00:19:00] Are there people in the home? Are there friendly neighbors? Are there friends they talk to pretty often? Uh, where does the family live, if not at home? Are they close by?
Sometimes kids and grandchildren can live outta state, but they're still pretty present in a loved one's life or maybe family dynamics are complicated and they don't have much contact at all, and this person has to rely more so on their friends for help. I also would like to ask, do they work or volunteer?
I'm interested to know what cognitive demands they might have in other environments and if they're meeting those demands. I also wanna know how much support they have and how social they are. I once had a patient who told me that it was a very caring coworker who pointed out her cognitive changes first.
So I think sometimes we, as speech therapists, we, when we think about the support system a patient [00:20:00] might have, we immediately think family and friends. I want us to get a little bit broader with that. Not for every patient, but sometimes there is a patient who is still working or who is still very active in their church.
Let's think about those people as well, because as we know, social connections are so important. 'cause I can't tell you how often I had patients come in who have isolated themselves from their friends. Whether it's because they notice a change in themselves and they just feel embarrassed, or they get overwhelmed being in a group and they can't keep up with conversation.
Uh, I really believe that friends want to help. I mean, they just don't know how, and the patient stops answering phone calls. Then the friends stop following up and that's not the friend's fault. Okay? But we wanna encourage our patients to keep following up, keep calling friends, keep allowing visitors, uh, be around [00:21:00] people anytime they're invited to.
So by this point in the evaluation, I have an idea of what their house is like. I know who might be in the house with them. Who might be prominent people in their life. Uh, and now I wanna get an idea of their daily routines and interests. I wanna know about them as a person. So I like to start by asking, walk through a day in your life.
Start with when you wake up in the morning and end when you go to. This also gives me some really good informal data on language and memory. Are they remembering the central question? Okay. How specific is their language? Are they using a lot of circumlocution kind of talking in circles, not getting too specific?
Are they struggling to respond? And if so, I'll get more specific. I'll ask yes and no questions. I'll give two or three multiple choices. I might ask, what do you do after lunch? What do you do in the [00:22:00] morning? Um, could be as specific, depending on where I think they might be at this point. Um, I might say like, do you need help getting dressed?
Uh, I wanna make sure I ask a lot of questions about what they like to do. So I'll ask, how do you spend your free time? And depending on their capabilities, maybe they like to take a bike ride every day, or maybe they just like to eat cereal, watch TV, and read the paper, and that's totally okay. Um, but I'm going to keep asking a lot of questions to get to know their interests.
Do you like music, gardening, walking, cooking? What did you do for work if you used to work? Those things might not necessarily be so important to our evaluation, but it's going to be very important information when it comes to our therapy and treatment SE sessions later. Um, or planning memory strategies to try to keep them independent in these hobbies and interests that they have.
'cause the overall goal, of [00:23:00] course, is to help these people be as independent as possible for as long as possible, and participate in the things that give them joy. Um. So depending on where they're at in their journey with dementia or suspected dementia, we want to be able to anticipate any possible issues that could come up and preemptively provide solutions.
So if they're still cooking for themselves and I am concerned about them using the stove top, maybe microwaveable meals could be an option. Or meals that could be served cold and kept in the fridge easy to prepare. Finger foods might be a good option. If they're forgetting appointments or plans to see friends, maybe we need to use calendars and alarms.
Do they remember to lock the doors at night and to turn out the lights? If not, maybe we could use Post-its or a list. We can come up with those strategies if we need to, and I'll touch on those a little bit later. We also wanna ask about personal [00:24:00] finances. Uh, so I'll directly ask, do you take care of your own bills or does someone help you?
Are you behind on any bills? And by this point, we have a pretty good idea of the patient's level of independence. We know their living situation, how they handle finances, how they do their activities of daily living, and if it hasn't come up organically by this point, I want to ask about driving. On the top, this topic could be a whole other podcast in and of itself, it's a very sensitive subject.
It can be a big source of tension for families and especially for professionals. Um, and it's probably not something we're going to address in the initial evaluation, but it's something I want to mention and know about. So can be an ongoing conversation. So as we ask all these questions, um, the patient might not have the best self-awareness into their strengths and weaknesses, and that's why it's so important to keep a family member or a close friend.[00:25:00]
Another objective third party involved.
Amy Wonkka: I feel like driving must be one of the trickiest topics that you talk about.
And I, and I can see how that could be it's whole other podcast because it, there's so much independence connected with that. As you've been speaking, I think it's. Just over and over again. I'm thinking about the importance of counseling and how important that is and what a huge piece of your initial assessment. But your subsequent visits with the patient and with their care, their caregivers must really focus around that.
Um, whether that's. You know, thinking about accommodations, trying to plan for the future, and I didn't know if you wanted to talk to us just a little bit about what that might look like, maybe depending upon where your patient is on that progression with their dementia.
Jacquelyn Marchi: Yeah, so once we've gathered all this information, um, and we want to communicate our observations with compassion, of course, um, to the patient and their family, um.[00:26:00]
There is a time and a place for blunt honesty and this is not the time. And I think speech therapists, I think we're pretty good about being very caring with how we deliver, um, our observations. I think sometimes. Especially in like the medical side of things, it's easy to get caught up in the like, referral evaluation.
Here's my recommendation. Referral evaluation. Here's my recommendation. Um, we want the patient to trust us and continue to work with us, and the same with their families. And they're not going to do that if we seem flat and we make them seem hopeless. Okay. So we don't just wanna say, yeah, I see signs of dementia, and then we list them and then we've dropped this.
We've got this bomb on this family and they just kind of feel hopeless there. That's not to say it's wrong to list the signs. We do want to give our opinion, but we wanna be careful in the language we use. Um, we wanna use neutral language and balance our [00:27:00] professional observations with empathy. Um, I like to start by speaking in statements and then I ask a question.
So I'll say something like, I'm observing. It's hard for you to remember things right after they happen. Do you notice that or I notice you lose your train of thought during a task. Do you agree? So leaves it open-ended for them. Okay. And then the loved one or the family member, they can step in and also say if they're noticing that, um.
Up a bit. There are some questions I would want to ask them more specifically as well. I want to know a little bit more about like how much is the patient needing their help throughout the day? Have they noticed any emotional changes? Um, are there any changes to eating habits, to sleeping habits? I really wanna get a full circle picture by the time we're at the very end.
So once I've said all of those things. I do have a script [00:28:00] that I like to use. Um, and I'll say while I can't diagnose dementia, there was enough concern from your doctor or daughter, spouse of friend, whoever it was that suggested this, uh, to recommend an evaluation. And I am seeing signs of memory difficulty.
And while it's not possible to bring memory back, we can work together on some memory strategies that can help you Now. So some patients yes, are reluctant to acknowledge our observations and they will argue, and possibly their families will too. They'll have an excuse for why these cognitive and memory issues are happening.
And I mean, we're not going to change their mind in that moment. I mean, I'm not the first one to say this. Um, but we aren't the problem, we're the face of a problem. Okay? And so. We don't wanna keep arguing with them. That's going to add to the frustration. And [00:29:00] ultimately our goal is to help them. And it's not helping them.
If we're not comforting them in that moment, if we're just saying like, no, you need to face this. I'm right, you're wrong. They're never gonna come back again. And our hope is that they will come back and they will let us help them. So I would say in that situation, no matter the reason that's causing these issues.
I think we can work on some strategies to help throw away the reason. It doesn't matter the origin of what's causing the issue. Could be what you think, could be what I think, what I think maybe. But um, we can work on some strategies to help. So in that case, um. Let the referring provider know. Of course they'll get the reports and then I like to call them directly and at least tell someone in their office how uh, the patient took that information.
There will likely be some feelings, some tears and emotions that will come up through the [00:30:00] evaluation and in subsequent sessions. Um, so. At this point, it's really important to emphasize strengths. These people have had a lot of information thrown at them. They're scared and they need a win. Nothing is too small.
Okay? Do they pour their own glass of milk in the morning? Do they still get themselves dressed? Do they use a phone? Do they care for their pets? Do they get their own mail? Do they recognize their friends? Okay. Okay. Were they able to answer the phone when someone calls? Are they brushing their own teeth?
Nothing is too small. Are they responding appropriately in conversation? Okay. Focus on those things. 'cause if we just say, here's everything you're missing. Yeah. I have some strategies to help. Okay. Yeah, we can help, but what? What can they do? Okay. And I think we as speech pathologists do a pretty good job of that anyway.
But I just like to really emphasize that at the end. So that moves us right into the memory [00:31:00] strategies. So all therapists are a little bit different. Um, once we finish the interview and the assessments, I like to do a brief overview of the strategies that I think would work best for the patient. And then in following sessions is when we get really specific and tailor them to the patient and their home environment.
So first I wanna touch on memory books. And these are one of my favorites to make. They're exactly what it sounds like. They're very creative and flexible. Um, it's, you can have different things for different ones. So you can have a book of memories, just a page or two of personal happy memory written out.
It could be, um, work accomplishments, vacations, childhood memories, something from their wedding day. Um, I did this with a patient and then she and her husband went home and found a picture to go with each memory. You could just have personal book. Okay. It's just. Personal information, home address, important phone numbers, birthdays, [00:32:00] doctors, daily schedules, medications, a family tree.
You could have a page of their hobbies and interests, kind of like an About me. You could have a page of what they would order at their favorite restaurants. That way when they go to their restaurant, they're not overwhelmed with a menu. They have exactly what they would want right there on a page. Okay.
You can also do a mini wallet version of this, um, small enough to fit in their pocket. You just keep the pages together with a little silver ring. Um, when you can put their personal information, any allergies, important medications, do write that they have a memory impairment, um, and that if they need help, uh, contact this person.
Next I wanna touch on, uh, labeling photos and wearing name tags. So what I've had happen with some patients is they have photos up around their homes and they forget the names of the people in the photos. Now, I wanna stress this doesn't necessarily mean they are [00:33:00] forgetting these people all together.
Okay? Sometimes the brain just needs an extra push to connect the name to the face, so. Take some masking tape, the sticky part of a Post-it or painter's tape, write their name on it and stick it next to their face. Um, as for name tags, um, at holidays, cookouts, anywhere there where there's gonna be a big group of people, have everyone wear a name tag.
We really wanna avoid situations where someone's gonna go up to the person with a memory impairment and be like, what's my name? Do you remember me? It's too much stress, it's unnecessary. Just have people wear name tags. It makes things a lot easier. Um, the next one I wanna touch on is signs. So using signs around the house so you can use words, um, or pictures.
Single simple words to label each room. So that would be like bathroom, bedroom, garage, basement. Um, they're also great for labeling [00:34:00] drawers, cupboards, and closets to show what's inside. You could put a picture of shirts on a drawer, underwear, socks, um, on a closet. You could have winter coats, shoes just to help the individual who has a memory impairment or dementia still stay independent in their home and find things a little more easily.
So I wanna touch on lists. Um, this would be good for someone who's still fairly independent in just helping them with their everyday functioning. Um, I like to have daily, weekly, and monthly to-do lists, keep them invisible spots. So on a mirror, on a cabinet, on a door. And when you think of something
and I tell them, when you think of something you need to do later, immediately write it down. Don't rely on your own brain to remind you of it. That way, the tactile feedback of writing it down and seeing what you're writing, that visual feedback, you're more likely to remember it. Plus you have it written on a note, and you'll probably see it again at some point [00:35:00] a little bit later to remind you.
Next to touch on Post-Its, which probably my favorite thing ever created. They are so functional for everything. Um, they can be used for reminders. I mean, you can put it on your bathroom mirror and say, take your medicine, brush your teeth. You can have it downstairs. They clean the litter box, check the mail.
Um, easy, simple directions you can leave in plain sight. And another thing I like to use this for is if a patient is forgetting to put their seatbelt on in a car, just put it on the dash and have it say, put on seatbelt. Done. Uh, keeping with routines is another really important strategy and regardless of where the person is at, um, with their level of dementia, I tell all families this,
keep a predictable schedule because it can help provide a sense of familiarity, security, and control. Um, if something that's not planned comes up or something comes out of nowhere, it can really cause [00:36:00] anxiety, confusion, and sometimes a person can get really agitated. So trying to keep things, um, as routine, uh, and as expected and normal as possible.
Um, few last ones before we wrap up. Planners and calendars, I like to recommend using a paper planner, uh, because it keeps the individual writing, although some, uh, patients and their families might be a little more tech savvy and prefer an electronic calendar. Um, but I like to get one that has like the two pages that shows a whole month.
And then in the following pages, there are little entries for each day. So that way we can use the whole month to kind of write out our appointments and then we can use the individual date entries as little journal entries. And that can be the homework I give them week to week. I want you to go and write what you did every day and then we'll reflect on it.
Um. Alarms. I love helping [00:37:00] patients set alarms. Um, especially with smartphones, you can set them for every day. You can set them weekly reminders to take medications, um, reminders to call grandkids, things like that. Reminders to take the dog out, reminder to let their dog back in. Um. So depending on where the individual is at, I'll suggest any combination of these strategies.
Um, and of course, the patient and the caretaker will be very involved in choosing them as well, letting me know what they feel, what would help the most, and what might be the most challenging to implement.
Kate Grandbois: This has all been incredibly helpful and interesting, and one of the things that I really appreciate about the perspectives that you've brought today is again, this impact of family systems. Putting the patient first in considering what they're bringing to the table, what their family unit is bringing to the table, and altering our communication style and strategies to make sure that that.
That those components [00:38:00] and those complexities are held at the forefront. So thank you so much for bringing that perspective into the talk today. In our last few minutes. For anybody who's listening who is maybe, um, doing this for the first time or thinking about how to integrate some of these strategies or evaluative perspectives in their clinical work, what recommendations do you have or what final words of wisdom, uh, can you share with us?
Jacquelyn Marchi: I think I would say don't be afraid of what you don't know, because there have been times where I was asked a question with a patient and it's okay to say, you know, I'm not sure. Let me look into that and I will let you know next week when you come back or let me do some digging on that and I will come up with a solution or I'll come up with a plan.
Um. I think sometimes we think we have to know everything on the spot. Um, but we of course, are clinicians who are always learning, [00:39:00] always practicing. And when you meet one person with dementia and their family, you've met one person with dementia in their family. So everything's a little bit different. Um.
And cut yourself some slack. Sometimes you can do absolutely everything right, and someone just really might not be there to accept it and might not want help. So, um, I would say those things.
Kate Grandbois: That's wonderful. Thank you so much. We've really appreciated all of this content. Uh, just a few quick thank yous to wrap up today's episode.
So first and foremost, thank you to our audience, anybody who is listening, who would like to write in. Or find us on social media. Please like and share. Leave us a comment in your podcast player. We love hearing from all of you. We also wanna thank our production team, Dr. Anna Paula Mui, who makes our ashes EU possible.
Tegan a Hearn, our production manager who keeps this project alive. Darren Lopez, our production assistant who prepares all of our course material and web [00:40:00] production. Tracy Callahan and Dr. Mary Beth Schmidt, who facilitate our peer review process and elevate the quality of our material. The advisory board who interacts with our material and, uh, also supports our peer review process.
And last but not least, Jackie, thank you so much for being here today. This was truly a wonderful experience and we hope you will join us again someday.
Jacquelyn Marchi: Thank you so, so much for having me and, uh, giving me this platform to speak about something that I really enjoy doing. Um, I've had a great time and I would love to come back another time.
So thank you so, so much.
Thank you.
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Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.
Please check in with your governing bodies or you can go to our website, [00:41:00] www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at [email protected]
thank you so much for joining us and we hope to welcome you back here again soon.
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