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
• Alzheimer’s Association, Vermont Chapter (802) 316-3839
• Dartmouth-Hithcock Aging Resource Center
• Dartmouth – Hitchcock Medical Center (general) (603) 650-5000
• Service Link of New Hampshire
• Vermont Senior Help-Line
HEALTHY AGING AND BRAIN CARE (HABC) CLINIC
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 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 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 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.