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Section 5
Care Management Program for Caregivers

Question 5 | Test | Table of Contents

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In the last section, we discussed excess disability.  Key factors regarding excess disability concerning dementia related cases are understanding excess disability and how to avoid excess disability through identifying problems and finding the right approaches.

In addition to discussing treating the aging client with dementia, we will also discuss treating the caregiver.

In this section, we will discuss care for the caregiver.  Two important aspects of care for the caregiver are mandatory self care and warning signs of emotional overload.  We will also discuss the COPE technique.  The COPE technique can be used to help remind a caregiver of his or her daily needs.

Two Important Aspects of Care for the Caregiver

♦ Aspect #1 - Mandatory Self Care
As you know, caring for a client with dementia can be stressful. Caregivers may become so involved with the needs of the client that they overlook mandatory self care. For example, Hugh, age 74, often got out of bed around midnight. Hugh would check the front door and the back door to make sure they were locked.

Hugh stated, "I go back to bed, and wake up again around 1:30. Then I check the locks again and wander around the house."  Sometimes Hugh would go back to his bedroom, put on the pants he wore the previous day, and go outside with his axe to chop wood until 4 a.m.  Hugh stated, "When I come back in around 4, Rose is usually sitting on the stairs. Then we’ll curl up on the couch together and fall asleep." 

Hugh did not have dementia, but Rose did. I stated to Hugh, "It sounds like you are burning out from the stress of your role as a caregiver." Because Hugh struggled to remain alert to Rose’s needs, he went without adequate sleep. Clearly, Hugh’s lack of sleep made it difficult for Hugh to maintain his physical and emotional stamina.

I stated to Hugh, "Sleep deprivation is the primary reason that aging clients with dementia are placed in nursing homes. Your care is as important as Rose’s. If your physical or emotional health is challenged beyond repair, then Rose’s care may be nonexistent or problematic." In addition to sleep, other mandatory self care include a proper diet and exercise. Think of your Rose. Is your client’s caregiver being pushed to the edge of his or her abilities due to a lack of mandatory self care?  Later we will discuss a technique that helped Hugh ensure his mandatory self care. 

♦ Aspect #2 - Warning Signs of Emotional Overload
After I explained how important Hugh’s mandatory self care was to Rose’s well being, I asked Hugh a few questions to identify his level of emotional overload. Warning signs I looked for in Hugh included the following symptoms. As I list these warning signs, you might compare them to any symptoms the caregiver of you client has mentioned to find out if he or she is neglecting his or her mandatory self care.

Here are the warning signs I looked for in Hugh:

• Mood swings
• Unusual irritability
• Inability to fall asleep
• Inability to stay asleep
• Difficulty concentrating
• Digestive problems
• Unfamiliar aches and pains
• Increased desire for or use of drugs or alcohol
• Sense of failure or hopelessness
• Frequent bouts of crying, fearfulness, or sadness
• Lack of interest in normal activities or family

Hugh presented two of these warning signs. The two warning signs that Hugh presented were an inability to fall asleep and an inability to stay asleep. Are you treating an aging client with dementia whose caregiver is displaying one or more of these warning signs? Could the following techniques benefit your Hugh?

♦ Technique:  COPE, 4 Steps
In order to help Hugh remind himself of his own daily needs and to simplify his daily life, I shared with him the COPE technique. This technique uses the word COPE as an acronym for four steps that a caregiver can take to help ensure mandatory self care. I stated to Hugh,
-- 1. C - Communicate
"The letter ‘C’ stands for communicate. Consider communicating not only with Rose, but also with friends, family, other helpers, and doctors. Let them know how you are doing. Mention your level of fatigue or stress just like you did with me." 

-- 2. O - Organize
Second, I explained to Hugh that the letter ‘O’ stands for organize. Hugh planned to implement the second step by organizing and simplifying the details of his own life and Rose’s.  Hugh stated, "I’ll organize the house. If I throw away stuff I don’t need and don’t use, it’ll help me relax." Would you agree that being organized can help a caregiver manage time more effectively? 

-- 3. P - Prioritize
In addition to ‘C’ for communicate and ‘O’ for organize, the third step in the COPE technique is ‘P’ for prioritize. I stated to Hugh, "Ask yourself what needs to happen next? Can some things be done later? You might find it helpful to make a timeline of how you need to proceed.  Include medical, legal, and financial matters. Also, a regularly reviewed plan of care may be productive in prioritizing." 

-- 4. E - Energize
As I explained to Hugh, the fourth step in the COPE technique is ‘E’ for energize. Hugh stated, "I could probably energize my body and my mind if I took the time to exercise and read a few books. I’ve got a few at home I’ve been meaning to read." Think of the caregiver of the client you are treating. Could the COPE technique help him or her to focus on personal needs or to make more time for mandatory self care? After considering this, if stress is still a problem, you might consider one of the following relaxation techniques.

For caregivers who experience a high level of stress, I begin with three basic relaxation techniques. As you hear these techniques described, compare them to the ones you are currently using.     

♦ Three Relaxation Techniques

-- 1. One technique that I have found to be useful is a simple breathing exercise. I explain to clients, "Close your eyes. Take a deep breath through your nose, and exhale through your mouth.  Repeat ten to twelve times."

-- 2. Another technique is to sit down, relax your muscles, and visualize the place where you feel most relaxed.

-- 3. A third relaxation technique is body relaxation. A client can focus on their toes, trying to relax them as much as possible. Then the client focuses on his or her feet, ankles, calves, and so forth, until he or she works their way all the way up to the head, making sure to relax the jaw muscles and the muscles around the eyes.

Think of the caregiver of the client you are treating. What other methods could you use to help the caregiver calm down and cope? Would playing this section for him or her help to foster an understanding of the importance of mandatory self care?

In this section, we discussed care for the caregiver. Two important aspects of care for the caregiver are mandatory self care and warning signs of emotional overload. We also discussed the COPE technique. The COPE technique can be used to help remind a caregiver of his or her daily needs.

In the next section, we will discuss cognitive retraining. There are three basic steps to the application of cognitive retraining techniques. These three steps are to acknowledge the cognitive deficit, base interventions on relatively well preserved skills, and enhance the encoding and retrieval memory processes. 
Reviewed 2023

Peer-Reviewed Journal Article References:
Basak, C., Qin, S., & O'Connell, M. A. (2020). Differential effects of cognitive training modules in healthy aging and mild cognitive impairment: A comprehensive meta-analysis of randomized controlled trials. Psychology and Aging, 35(2), 220–249.

Batthyány, A., & Greyson, B. (2021). Spontaneous remission of dementia before death: Results from a study on paradoxical lucidity. Psychology of Consciousness: Theory, Research, and Practice, 8(1), 1–8.

De Lucia, N., Grossi, D., Milan, G., & Trojano, L. (2020). The closing-in phenomenon in constructional tasks in dementia and mild cognitive impairment. Neuropsychology, 34(2), 168–175.

Hayden, L. J., Glynn, S. M., Hahn, T. J., Randall, F., & Randolph, E. (2012). The use of Internet technology for psychoeducation and support with dementia caregivers. Psychological Services, 9(2), 215–218.

Mavandadi, S., Wright, E. M., Graydon, M. M., Oslin, D. W., & Wray, L. O. (2017). A randomized pilot trial of a telephone-based collaborative care management program for caregivers of individuals with dementia. Psychological Services, 14(1), 102–111.

Trujillo, M. A., Perrin, P. B., Panyavin, I., Peralta, S. V., Stolfi, M. E., Morelli, E., & Arango-Lasprilla, J. C. (2016). Mediation of family dynamics, personal strengths, and mental health in dementia caregivers. Journal of Latina/o Psychology, 4(1), 1–17.

QUESTION 5
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