The Dartmouth Memory Handbook

Section 12: Dementia Care In The Upper Valley

 

Upper Valley Resources

Robert B. Santulli, MD
(Updated September 2016)
 
Listed below are organizations that can provide the most up-to-date information about
specific programs and services in the region.
 
Alzheimer’s Association, Massachusetts/New Hampshire Chapter
(603) 606-6590
http://www.alz.org/manh/
 
Alzheimer’s Association, Vermont Chapter
(802) 316-3839
http://www.alz.org/vermont/
 
Dartmouth-Hithcock Aging Resource Center
(603) 653-3460
! http://www.dartmouth-hitchcock.org/aging_resource_center.html
 
Dartmouth – Hitchcock Medical Center (general)
(603) 650-5000
http://www.dartmouth-hitchcock.org/
 
Service Link of New Hampshire
(866) 634-9412
http://www.servicelink.nh.gov/
 
Vermont Senior Help-Line
(800) 642-5119
http://www.seniorsolutionsvt.org/
 

Healthy Aging and Brain Care (HABC) Clinic

At Dartmouth-Hitchcock

Heba Gad, MD
Director, Healthy Aging and Brain Care Clinic
(Revised September 2016)
 
The mission of the Healthy Aging and Brain Care (HABC) clinic at Dartmouth-Hitchcock
Medical Center is to evaluate and treat individuals with a wide range of memory and
other thinking problems, and to work closely with their families in an atmosphere of
warmth, comfort and partnership. Furthermore, we extend our services to include
evaluation and treatment of mood, anxiety and psychotic disorders in the elderly, which
often need an expert opinion in the field of geriatric psychiatry. We also work in close
collaboration with behavioral neurology to integrate the evaluation and management of
the neuropsychiatric disorders that result from dementia.
 
Patients come from the Upper Valley and beyond. Many have Alzheimer’s disease, but
others suffer from other dementias, mild cognitive impairment, or a variety of medical,
emotional, or mood difficulties that contribute to impairments in cognitive functioning.
Some are suffering from nothing more than the typical cognitive changes associated with
aging, but are concerned about the perceived difference in their memory abilities, and its
implications. Individuals seen are generally over 65, although occasionally younger
persons with probable early onset Alzheimer’s disease are accepted for evaluation and
treatment in the clinic as well.
 
Individuals may be referred to the Healthy Aging and Brain Care clinic by their primary
care physician, a specialty physician, a friend or relative, or may be self-referred.
Anyone who has concerns about his or her own memory or that of a loved one is
encouraged to schedule an appointment for a thorough evaluation. To preserve
individuals’ privacy, we will inquire about some written authorization from the patient or
documentation of power of attorney for family/loved ones to allow them to schedule
appointments and freely communicate with the health care providers.
 
Upon receiving a request for an appointment, the clinic director screens the referred
person’s electronic medical chart for relevant medical information. If there is not
adequate information, the clinic will request medical information to be faxed/sent from
the referring provider/primary care physician. Once we have records available, the
person gets scheduled for a new evaluation. Healthy Aging and Brain Care (HABC)
clinic meets at various times and days of the week, in order to accommodate the
different schedules of individuals and families, and of the clinic staff. There is usually a
waiting list of at least several weeks, but this can vary in either direction.
 
The person being evaluated and family members are generally seen together, and then
separately for the initial visit. We request that no more than two additional family
members sit in during the interview, but we do ask that all individuals who attend the
clinic come with at least one care partner who can be interviewed as well.
Given that we are part of an academic medical center, persons are mainly seen by one
of our resident physicians in training under the close supervision of one of the clinic
attendings who will discuss the case at length with the trainee and then see the
individual and family personally.
 
Appointments are limited to 90 minutes. It is our belief that a very lengthy session with
multiple sequential interviews or examinations is exhausting and often traumatic for the
individual and family, and degrades the quality and reliability of the information received.
It also works against our priority of establishing a comfortable rapport and alliance, to
minimize anxiety and/or the reluctance that persons often feel in these situations. We do
all we can to provide the individual and family a positive experience which they will
hopefully find enlightening and helpful. We do everything possible to avoid having the
individual feel traumatized, embarrassed or diminished by the evaluation process.
Based on the initial assessment, an individual may be referred for one other specialist
consultations. We may also recommend and schedule specific laboratory examinations,
perhaps including head imaging (CT scan, MRI or PET scan of the brain), and blood
tests.
 
Some people are seen in the clinic for a one-time evaluation or second opinion only, but
some persons who are seen initially are followed regularly by the clinic, at a variable
frequency depending on the clinical situation. In any case, we communicate all of our
findings and treatment to the primary physician, with the consent of the patient or
durable power of attorney.
 
In between clinic appointments, individuals or family members are encouraged to
communicate significant changes, questions or concerns directly to the clinic physician,
by email or telephone. All phone calls and emails are returned within 48 hours, unless
no response is needed. Best ways to communicate with the clinic staff will be discussed
at the initial appointment.
 
We are especially concerned about and attentive to the behavioral and mood symptoms
that are so frequently associated with memory and other cognitive disorders. We will
actively address those issues in addition to the cognitive disorder. We are also most
interested in the mood and emotional reactions of care partners as they cope with a
loved one with a memory disorder. At times, care partners are referred for individual
counseling or treatment if that is felt to be helpful above and beyond the regular visits to
the clinic for the person who has been evaluated.
 
We stress the importance of educating family members about memory disorders, and
encourage them to attend educational programs about Alzheimer’s disease and other
memory disorders which are regularly offered in the region. In addition, we strongly
encourage attendance at one of the monthly support groups for care partners, and the
various Upper Valley engagement activities for people with dementia and their care
partners (see page 285). Families who live beyond the Upper Valley area will be referred
to appropriate groups in their area.
 

Dartmouth-Hitchcock Aging Resource Center

Lori A. Fortini, MEd, Program Leader
Dartmouth-Hitchcock Aging Resource Center
Added September 2016
 
Dartmouth-Hitchcock Aging Resource Center provides free-of-charge health education,
resource information, community outreach, and support to older adults and their family
members. Visitors will find a comfortable and restful space in which to read, browse the
Internet, view an exhibit of art by local senior artists and find plentiful information about
community resources and health issues. The Center offers advance directive forms for
both VT and NH, exercise DVDs, the Dartmouth Memory Handbook, flu shots, periodic
fall screenings, and many other free materials and services.
 
Over 100 free-of-charge classes are offered each year on topics including managing
chronic illness, memory health and dementia, mental and spiritual wellness, caregiving,
planning ahead for a healthy retirement, and arts and aging. Classes are designed for
older adults, their family care partners, or community members, and require preregistration
due to limited space.
 
The Resource Center also offers several support groups, including the Alzheimer’s
disease Support and Education Group twice a month. The Aging Resource Center also
sponsors and supports three collaborations between Dartmouth students and people
with dementia with their care partners - the Upper Valley Memory CafŽ, the
Recollections singing group, and Perspectives, a monthly art-viewing program.
 
Two new programs involving collaboration with Dartmouth students will begin in early
2017: My Story with New Eyes, an activity that will use photography as an expressive
tool; and Storyboard, a creative storytelling program (see p. 285 for more information
about these offerings).
 
Twice during the year, we offer the six-week series, “Savvy caregivers,” which provides
information, strategies, and support to people caring for loved ones with a progressive
brain disease or disorder.
 
In addition to providing information, health education and support groups, the staff of the
Aging Resource Center provides personalized assistance to help older adults and their
family members make informed decisions and maintain a high quality of life.
The Center’s resource specialists, chaplain, and on-site experts in Alzheimer’s disease
and Parkinson’s disease can offer consultations by appointment. Individuals or families
may request assistance with long-term care planning, managing caregiver stress, finding
a health care provider, coping with loss and change, or any other issue related to older
adult health and wellbeing. Those who cannot travel to the Aging Resource Center are
welcome to call or email the center for assistance.
 
The Dartmouth-Hitchcock Aging Resource Center is a component of the Dartmouth
Centers for Health and Aging (DCHA). DCHA focuses on improving the physical, mental
and spiritual health and wellbeing of older adults and their family caregivers. DCHA
conducts wellness research, collaborates with health care teams and community groups,
provides education for health care professionals and the public, and offers support to
older adults, care partners and family caregivers.
 
The Dartmouth-Hitchcock Aging Resource Center is located at the Evergreen Center
Building, 46 Centerra Parkway, Lebanon NH. It is open to the public Monday through
Friday except holidays between 9am and 4pm. Directions and a list of programs can be
found at their website: www.dhaging.org. Contact AgingCenter@hitchcock.org or (603)
653-3460 for more information.
 

Upper Valley Dementia Support Groups

Robert B. Santulli, MD
(modified September 2016)
 
The value of attending a support group for care partners was discussed on p. 245. To
reiterate briefly, support groups are extremely valuable for family members and others
who are caring for someone with Alzheimer’s disease or other form of dementia. They
offer an opportunity for persons who have a loved one with the disease to talk to others
in the same situation; to vent feelings about the burdens of the task; to ask questions of
those who have been in similar situations; and to feel, as is often said about support
groups, that “you are not alone”. Persons with dementia do not attend, so that care
partners can speak freely without concern that they might offend or upset their own
loved one, or someone else’s.
 
The Aging Resource Center’s Dementia Care Partner Support and
Education Group:
Alzheimer’s Care Partner Support and Education Groups are held 12:30 – 1:30 PM on
the fourth Wednesday of the month, and 5:30 – 6:30 PM on the second Wednesday of
the month. Groups meet at the Dartmouth-Hitchcock Aging Resource Center, 46
Centerra Parkway, Lebanon, NH. No pre-registration is necessary.
 
Other New Hampshire or Vermont Care Partner Support Groups:
Contact the Vermont or New Hampshire Chapter of the Alzheimer’s Association (see p.
277 for contact information) to find out the latest information about other support groups
in the bi-state area.
 
Upper Valley Engagement Activities For
Persons with Dementia and their Care Partners
 
Robert B. Santulli, MD
(Created September 2016)
 
The importance of engagement activities for people with dementia and their care
partners was discussed on p.191.
 
The Upper Valley engagement programs described here are provided under the
auspices of the Dartmouth-Hitchcock Aging Resource Center. Other programs for
people suffering from cognitive impairment are planned for the future. Check with the
Aging Resource Center for the latest information about current programs.
 
These engagement activities have been modeled after similar programs elsewhere,
although the integral part played by Dartmouth undergraduate and medical students
makes these programs unique. Combining elders in the community with college and
medical students creates a valuable “grandparent-grandchild” dynamic that enlivens
each program greatly, and significantly benefits both the community participants and
the students.
 
Please contact the Aging Resource Center at (603) 653-3460 for current dates and
times of each program, and to register, when necessary.
 
The Upper Valley Memory CafŽ
Memory CafŽ is a monthly program for people with cognitive disorders, their families and
friends. It is an informal and welcoming environment that provides socialization,
entertainment, and other activities that are appropriate both for persons with memory
disorders and their care partners. Staff members from the Dartmouth-Hitchcock Aging
Resource Center organize and run Memory CafŽ, with the assistance of students from
Dartmouth College and the Geisel School of Medicine. Memory CafŽ meets for two
hours on the first Saturday morning of each month. Meetings are held at the Howe
Library, in Hanover.
 
Perspectives
Perspectives is a monthly program that brings people who suffer from memory disorders
and their care partners to The Black Family Visual Arts Center on the Dartmouth
campus, for the purpose of viewing and discussing artworks. Generally, these are works
created by students or interns in the Dartmouth Department of Studio Art. One or two
additional undergraduates facilitate the discussions of each work of art, following which
the student artist will talk about his or her creation and answer questions. After viewing
and discussing three to five works of art, refreshments are served and discussion and
socialization ensue for another 30 minutes or so.
Perspectives meets one Saturday a month from 1:30 to 3:30 PM at the Black Family
Visual Arts Center at Dartmouth. Pre-registration is required through the Aging
Resource Center.
 
The Recollections
The Recollections is a singing chorus for people with memory disorders, their care
partners, and an approximately equal number of Dartmouth students. Each season
(summer, fall, winter and spring), five or six songs that are well-loved old favorites are
selected to rehearse and perform. Rehearsals are generally held twice a month, and one
or more performances are given in the community each season. Refreshments or a
luncheon and socialization period is part of every meeting. Absolutely no experience,
singing talent, or ability to read music is necessary.
The Recollections generally meets two Saturday mornings a month at the Howe Library
in Hanover, and performs once each quarter at various locations around the region.
 
My Story with New Eyes
My Story with New Eyes is a new program utilizing photography. Like the other
engagement activities discussed here, it will be for individuals with cognitive impairment
and their care partners. A number of Dartmouth students will also participate as
program assistants. “My Story with New Eyes” will give participants an opportunity to
capture different aspects of their lives through taking photographs. A professional
photographer who has utilized this medium as an expressive tool with a variety of
different groups will run the program. Both the person with cognitive problems and his or
her primary care partner will participate equally in the photographic activities The primary
aim of the program will be to engage people in an interesting group activity that will
enhance quality of life and relationships through shared creative expression.
 
The program will meet weekly, for eight sessions. There will be regular photographic
“assignments” on specific themes. These will result in visually interesting images that
will also capture important aspects of the participant’s lives. The program will culminate
in an exhibit of photographs, to be held at the Dartmouth Hitchcock Aging Resource
Center.
 
The initial series of sessions for of “My Story with New Eyes” is scheduled to begin in
January 2017. Please contact the Aging Resource Center for information about
registration for this or a future series.
 
Storyboard
Storyboard is another new program that involves creative storytelling for persons with
dementia and their care partners. Participants will be asked to select three photographs
at random, and create a brief story utilizing these images. Dartmouth students will assist
in the program, and will type out the stories once they have been created. At the end of
the series (four sessions), a book will be created containing of the stories that have been
written, and a copy given to each participant. There may also be an on-line version.
The program begins in January 2017, and will be repeated at intervals during the year.