David's Alzheimer's Fight
Hosted by David Uhlfelder, who is facing early-stage Alzheimer’s with resilience and humor, alongside co-host Dr. Karen Gilbert, this podcast shines a light on living well with the disease. Together, they share personal stories, expert insights, and practical tips to help others navigate the journey with strength, knowledge, and hope.
David's Alzheimer's Fight
Revolutionizing Hospital Care for Alzheimer's Patients with Dr. Jill Shutes Innovative Program
Hospital stays can be especially challenging for people with Alzheimer’s and dementia. Dr. Jill Schutes, geriatric nurse practitioner at Jupiter Medical Center, shares how her groundbreaking program is transforming dementia care in hospitals through staff training, safer medication practices, and creative environmental changes like sound machines and specialized pain assessments. She also highlights research-backed prevention strategies such as diet, exercise, and treating sleep apnea. This episode offers practical solutions for families and healthcare providers alike.
This podcast shares insights, not medical advice. Please consult a professional for your care. Welcome to David's Alzheimer's Fight. I'm David and I'm joined by my co-host, Karen Gilbert, Vice President of Education for Alzheimer's Community Care. Karen will be introducing our guest today, Jill Schutz.
Speaker 2:Thank you, David. It is my absolute pleasure to have Dr Jill Schutz with us. Geriatric nurse practitioner, I have known Jill since 2010. Jill has extensive experience caring for this most vulnerable population older adults who are experiencing Alzheimer's disease or a related disorder. What I've experienced in interacting with many, many hospitals in Southeast Florida is that the staff really wants more education. They're not mandated to have any by the state, but they want education on how to care for this specific population, how to understand them, how to increase their safety while they are in the hospital for illness or injury. And we are aware that you have created a very innovative program at Jupiter Medical Center in Jupiter, Florida, and we would love for you to describe what that entails. Tell us about the program.
Speaker 3:Yeah, well, first, thank you, David and Karen, for having me on this podcast and being able to share, have an opportunity to share this. So it all started with a couple, johnny and Terry Gray, who had someone come through the hospital system years ago and realized that there really wasn't something available for those that were struggling and living with dementia, and they created the Johnny and Terry Gray Alzheimer's and Dementia Caregiver Support Program. So that's how it started out, really just with some support. So that's how it started out, really just with some support groups that we were running, but really focusing on how can we educate the staff and how can we treat people living with dementia differently in the hospital. I come from long-term care and it was mandatory right that everybody go through training all of the staff go through training on how to care for someone living with those potential behavioral and psychological symptoms of dementia, and we don't do that here in the hospital. It's not mandatory yet it is so needed because once they go potentially to the nursing home or back home or to their assisted living, those behaviors could have been worsened in the hospital because we were not aware of how to care for them. Statistically, 75% of people that are living with dementia or other neuropsychological disorders have behaviors in the hospital during an acute stay. So if 75% of them are having that type of reaction while they're in the hospital, it behooves us to train them. So we first start out doing training during orientation. So everyone gets an hour, so all nursing staff get an hour of training related to anything related to dementia. We have people come up and we have some role plays METCHA. We have people come up and we have some role plays, and I'm actually starting to orient the security officers because they actually come in contact with a lot of patients with behaviors in the hospital and we've now gotten that through. So we're going to start that training very soon.
Speaker 3:But what we also do is, along with that training, we show the staff what we have available in the hospital to distract people while they're in the hospital, distracting them from pulling out their IVs or pulling out their catheters or fiddling with their telemetry packs where we have to monitor their heart, but they're taking it off more than they're allowing us to monitor it. So we got a wonderful grant from the community and we were able to get together with the occupational therapists and nurses, nursing assistants, to fill these little activity bags for the patients with living with dementia and they include sorting cards, they include stress balls, fidget tools, word searches, coloring books, different things that can help distract them. But you can't just give someone a bag, right, you have to teach the nursing assistants, you have to teach the staff how to introduce these items to the patients while they're in the hospital to distract them from the potential interventions that they're receiving while they're in the hospital. We also have a program called the Happiness Program and that was developed in the United Kingdom and that actually is a light projector that interacts with the patient when you show it on the wall or you show it on the table and they're able to do some painting, they're able to do fishing, they're able to do lots of different activities in the room. It also provides them with some quiet time, often in the hospital.
Speaker 3:I'm sure across the United States where we put patients that have dementia is right across the hallway from the nurse's station, which happens to be the noisiest place on the whole unit, and folks that are living with dementia sometimes you know that laughter out in the nurse's station is misinterpreted. It's misinterpreted as they're laughing at me and what's happening. So we also have sound machines that we can put in the rooms right across from the nurse's station. We have monitors where we can shut the door, but we're monitoring the patient with the door shut. So the noise canceling is available for these patients because it's very important not to have too much stimulation. So we do a whole bunch of things like that to try and figure out how to help each individual patient while they're hospitalized.
Speaker 2:So what you're doing is similar to what we do in our specialized day centers. We are redirecting the person to a purposeful activity and this will it will distract from pulling out the IV or the urinary catheter or trying to climb out of bed. Yeah, absolutely, Because they may not really understand why they're there. So the more we can connect them with something to focus on, the better the course of that hospitalization will be. I do have a question here. Falls are often a real issue for cognitively impaired patients in the hospital. Are you finding that that's less of an issue in Jupiter Medical Center since this program started?
Speaker 3:One of the things that we're very fortunate we also do sitters. If someone is really having a lot of behaviors, that's not going to help, right. What's really going to help sometimes is having somebody in the room working with them individually. And what I really focus on with the staff education is you ask somebody that is living with some type of dementia whether or not they need to go to the bathroom. Do you need to go to the bathroom? I can guarantee you the answer will always be no. So what we're really training the staff on is let's go to the bathroom, it's time to go, it's time to go, we need to change your sheets. And really focusing on that instead of do you need to go, instead of saying are you in pain, because no one is going to say yes, I'm in pain. When they have dementia, they it's not registering right.
Speaker 3:So how do we assess pain differently in someone that has dementia in the hospital? And really focusing that's been my focus over the past two months. It's really stressing that because I think one of the issues and not training staff across the country in the hospital for dementia is we're missing a lot of pain and that's where the behaviors are. We're doing things where someone comes in and they've had a fall. If they have dementia, they're going to have pain. They're not going to tell you they have any pain.
Speaker 3:If anyone recently listening to this podcast has fallen, I can guarantee you in two days you're going to be sore and you are going to reach for your Tylenol or your Advil. If you had dementia and we asked you if you had pain, you would say no, I do not, but you really do. So how do we address that? Are we looking at these behaviors as something else happening? Right? There's always a reason for behaviors, and really addressing that in the acute care stay will help one, lessen length of stay and, two, decrease their chances of coming back into the hospital. It's potentially the same problem.
Speaker 2:Now this is something we really drive home with the nursing students. Behaviors change for a reason you must always remember that and behaviors do not change for no reason, and so we don't want to just medicate behavior. We want to try to get to the root cause and, as you say, often it could be pain that they just can't express. And it doesn't mean they need a narcotic. The Tylenol could do the trick, so super important to identify pain.
Speaker 1:It sounds like a wonderful program and it's very new. I'm sure Not a lot of hospitals are doing it, and so, really, how's the staff reacting? What are they telling you? What is their feedback? Are they appreciative of what you're teaching them, and does it really help them?
Speaker 3:You know, any program takes a while to catch on right. I can tell you, just within the past two months I have received more phone calls from the floors asking me it's almost to the point where I need another person. I need a tag here. It because I'm receiving multiple phone calls a day saying can you come up and help me evaluate this person? Can you help me with this person? What else can I do? I had I had a nurse two days ago ask me what else can I do to help this patient be successful throughout the day? How else can I speak to him? I've been watching you and I've learned so much from watching you interact. What else can I do? You've seen me interact.
Speaker 3:How else can I improve dealing with someone that has dementia in the hospital and I mean for someone that has started this program two years ago to get to the point where the nurses are passing me by in the hallway saying there's the dementia whisperer. They're recognizing that I am there to help and it decreases I don't have the numbers yet, but I could pretty much guarantee right it's decreasing the length of stay and the return to hospital. I've just embarked on looking at all of our re-hospitalizations for those that have dementia and checking to see what those numbers look like compared to what they looked like a year ago. Because when we're not medicating with antipsychotics and when we're addressing behaviors differently, the chances of folks not returning because of an adverse event is greatly increased. And that's our ultimate goal. We do not. We want to have people go home and have an improved quality of life because we did something incorrectly here. We gave medication when maybe we shouldn't have.
Speaker 2:Right, and that is phenomenal, and often medications are the source of a problem more than they are helping, particularly in this age group, and I know that you had specific initiatives with the hospital pharmacy in terms of what medications probably should not be given in this age group with this diagnosis. Tell us about that.
Speaker 3:First of all, we recently, within the past month, became an age-friendly health system, and an age-friendly health system is a quality measure that has come out across the country to monitor how we're addressing folks that are over the age of 65 in the hospital. So it doesn't even only include those that have dementia, but it includes everyone across the board that are over the age of 65. We have to do certain things, and one of those four things is we have to look at what matters. We have to look at their mobility, we have to look at their mentation and we have to look at medications, and there are eight different types of medications that we have to send alerts out. They're part of the BEERS criteria and we have to send alerts out to the providers that, hey, did you know that your patient is 65 and older and is now on one of these medications that's not recommended? So that already had been done. But what I found was that there were still some standing orders that were not sitting well with folks that have dementia, and a few of those standing orders were Benadryl, an extremely anticholinergic medication that can increase confusion in anyone, nevermind someone that has dementia. It just makes it so much worse when you receive an anticholinergic medication.
Speaker 3:So just this week I was on the pharmacy meeting. I gave them the data as to how many people that had dementia in the hospital were prescribed that medication and Valium, which Valium is a medication that many people have been on for many, many years but what it does is it hangs in your system 96 hours for half of the medication to leave your system and it can take 30 days for all of it to leave your system. Not real good when we're taking care of folks that have cognitive impairments. So we met with them and they're now working with our system. Pharmacy is now working with our electronic health record to send like a hard stop right to the provider saying you know, this patient has dementia, vascular Alzheimer's, any one of the diagnoses and that it's contraindicated to prescribe this medication. So that should be coming out within the next month or two.
Speaker 3:But they were they meaning the people on the pharmacy committee responded in such a way that I actually left so happy because it was an immediate response. It wasn't something like, oh, we need to table this, we need to talk about this, that's nice. No, it was an immediate response, an immediate response to our electronic health record saying how can we do this and how soon can we get this done. So that's something that I'm going to be monitoring as well.
Speaker 2:Also phenomenal and I think for people in the community. They just need to be aware. When they go and pick out over-the-counter medications they may not realize you've got Benadryl or the generic diphenhydramine and you don't want to choose those. You want to be. If in doubt, take it up to the pharmacy counter. The pharmacist is an incredible resource to tell you whether this is something on that beers list. The beers list is a long list of medications that are not recommended for older adults and many further not recommended if that older adult has some dementia-causing disorder. So yeah, you know things that are over the counter. Yes, you can buy them, but should you?
Speaker 3:Correct. Anything that has PM on it means Benadryl. So diphenhydramine, right Advil PM, tylenol, pm, pm, pm. Anything with diphenhydramine will only cause you to wake up in the morning and potentially be more confused.
Speaker 2:More confused, also higher fall risk, and I know Jill and I have seen this. One fall can take someone who was fully ambulatory and now put them in a wheelchair, you know. So falls are actually in this country. There are from 750,000 to 1 million falls a year in hospitals. 11,000 of them result in death and about 20% of them result in a significant injury. That's an area for prevention as well, and your efforts will certainly accomplish that. I'm thrilled to hear how the hospital staff is embracing this education and actually wanting more, and it will spread exponentially because the nurse that asks you for some additional assistance, he or she will pass it on to their colleague. Ultimately, it really does make their job easier.
Speaker 3:Oh, tremendously. And they are seeing that now that when I go in the room and I explain things and I make sure that I am connected with the patient visually, auditorily, physically and then explain what they need to do, the behaviors don't occur nearly as much. And they even said that, wow, this was much better than it had been in the past, like, yes, because we're explaining and it takes a little time, but we can explain that process. But I did want to mention one thing, karen, that I know is on your soapbox we can address these issues when folks have the diagnosis right.
Speaker 3:But between 50 to 80% of people that are walking around that have some type of neurocognitive disorder never get a diagnosis. So they come into the hospital and they have behaviors and what I'm trying to tell the staff is you know, you may want to consider that this person does have a neurocognitive disorder. It's just not been identified yet. So don't assume that the person is just not nice right that we're taking every single time someone has a behavior, refuses a treatment, acts out that this potentially could be someone that has an undiagnosed neurocognitive disorder, and it is a problem worldwide. You know, david, that's why I'm so grateful that you're. You know you're talking about it, you're you know you're sharing your story because recognizing that there is something right, you can do something about it.
Speaker 3:But when people think it's part of normal aging and they never go for a diagnosis, then it's always going to be thought of as part of normal aging and it's not. And getting that message out as well to the staff as well as to the families, is a challenge, right, and that's one of the things that also we do is I have a volunteer who calls every single patient's family that has come in here that has somewhere in their record a diagnosis of cognitive impairment, dementia, alzheimer's, anything that may look like, and may offer support. Through our support groups and through our education, we're reaching out to somewhere in the midst of 50 people a week. We are calling to address this situation so that if I get even one of those people in a support group, I feel like we have been successful.
Speaker 2:Absolutely. And you know, david is a living, breathing example of the benefit of not being afraid to get a diagnosis, because I think he knew the sooner I find out what's going on, the sooner I can do something about it, right, david?
Speaker 1:That's right and it's so important. That's one of the things I tell people. I know a lot of people are afraid to ask and one of the big questions is when you do start getting evaluated and they do start doing the test, especially when my neurologist said do you want to know? And there's a way to know? And I said, yes, and people need to know Because, again, the earlier you can do this, the earlier you realize what's going on, the better off you're going to be for yourself and your people around you, and that's what I've found.
Speaker 3:Because there are things, david, right, there are things that you can do to improve.
Speaker 2:In May of this year the New York Times had a front page article that intimated that lifestyle approaches could be giving false hope, and they profiled one patient who did not do exceptionally well with the lifestyle approaches. However, it was noted in the article that she was even turned down from clinical trials because her disease was so far progressed. So it's understandable why she may not have gotten the benefit, the type of benefit David is seeing, because he started early. Fast forward to the end of July. Two months later, the Alzheimer's Association held its international conference in Toronto and big news coming out of that conference was the findings of a study called the Pointer Study, which was conducted in the United States and it specifically looked at whether or not lifestyle approaches could accomplish improvement or reversal in symptoms.
Speaker 2:Now, again in that New York Times article, her physician she had been working with Dr Dale Bredesen in California. We were very concerned about how the article really dismissed his protocol because again, that was one patient who was far along in the disease and did not see these fantastic results, but so many more have. So we are aware that you have trained in that protocol and we want to restore the hope, especially since the US Poynter study is saying, yes, these things work. Healthy lifestyles will work. So tell us about your experience with learning the recode, the Dale Bredesen recode protocol, but in general, how it focuses on healthy lifestyles.
Speaker 3:Probably one of my most favorite things to talk about as of the past six months, because I've never had as much hope as I have now in prevention and in treatment of Alzheimer's. Because of this, dr Bredesen has been studying Alzheimer's for as long as he's been alive. He actually does have two published proof of concept trials that show an 84% increase in cognitive improvement. So that's actually not true that there is no proof, because there is proof. Unfortunately, because it's not attached to a medication. Sometimes that's more difficult to get out to the population. There's not a commercial about it, right? Advertising for lifestyle change isn't something that people can say, oh, I'm going to take that, right, I'm going to change my diet and exercise and do all of these things. It's not one medication Currently. In October of this year should be coming out the study that he has in six cities across the country, which is randomized controlled trials of his program of recode, and that information is showing already statistically significant improvements in cognition. So I'm really looking forward to that coming out in October.
Speaker 3:But on a personal note, why did I take the Apollo Health course Probably one of the most difficult courses I've ever taken, honestly and I have my doctorate, so I've been through it right. I've been through a lot of difficult courses. This was so in detail, the pathophysiology behind the root causes of Alzheimer's Unbelievable Five different types of Alzheimer's, starting from inflammation to toxins to. I had no idea, and I have been in this field right, for 30 years. Well, jill, how did you have no idea, since you've been in this field for 30 years? Well, because typically research takes anywhere between 16 to 20 years. Once it's been proved, once there's been a study, it can take 16 to 20 years for research to get into current practice. Okay, so we're, and that's like lifestyle changes as well. So we're on the cusp of something that we're trying to bring this. I don't feel like waiting 20 years for the for this information to come out.
Speaker 3:To be honest with you, there are people like David who need this information and and to to be aware of what you can be doing to decrease your risk and or treat those early signs right of Alzheimer's. Now, that's what the study has been showing that it works much better right with the earlier signs. And why is that? Can you make someone with moderate stage Alzheimer's exercise and do word puzzles and eat a certain diet and take a whole bunch of different supplements if their vitamin levels are low or if they have mold toxicity or any of those. No, you can't right. It's really very, very difficult. So that's why, when this reporter looked at this one person like Karen and made it was because they're looking at someone that it's a difficult, it's difficult to follow, right, it's not something simple to follow. What they're having great success in, though, is the mind diet right. Exercise looking at sleep apnea If you have sleep apnea or if you are hard of hearing, those are two very easy fixes.
Speaker 3:Don't go your rest of your life hard of hearing, you'll get dementia. Don't have sleep apnea, or you will get dementia. Treat these things. Treat mold toxicity, if there's any mold. If you've worked anywhere where there's mold, if you live in an environment where there's mold, if you live in Florida, you better get checked for mold because somewhere in your life you've been in contact with that. There are things that we can do to reverse those changes, and I'm just so grateful that Dave is trying to get that out to the masses.
Speaker 2:To me. What is just so incredibly important I'm so glad to see more and more people coming out with this information is that lifestyle choices someone can do immediately, like David did. It's not a drug. You don't have to have a consult. You look at these strategies. Getting the hearing test is easy At many providers it's actually free so no one should have untreated hearing loss.
Speaker 2:The Mediterranean, mind or DASH diets the MIND is a combination of the Mediterranean and the DASH, but basically they are mostly plant-based, with poultry and high fatty fish like salmon, high omega-3 fish, meat maybe a couple of times a month, but as little as possible, because meat is inflammatory. Sugar gone, fried food gone and if people knew the connection. You truly are what you eat. We are learning that Foods that are inflammatory cause inflammation immediately when you eat them, but likewise, when you switch to anti-inflammatory foods, you get that benefit immediately also, so you can undo this really quickly also. So you can undo this really quickly.
Speaker 2:And then of course, you want to prevent or reverse, to the degree you can, type 2 diabetes and high blood pressure, because they are a consequence of inflammation. So getting inflammation down generally could prevent so many things, not just Alzheimer's. So very glad to see louder voices about this. In fact an article came out last week about if you carry one or two copies of APOE4, if you carry that gene you do have a higher risk to develop Alzheimer's, but not a guarantee gene. You do have a higher risk to develop Alzheimer's, but not a guarantee, just a higher risk. But evidence came out last week that the Mediterranean diet is very helpful for those who carry that gene. You know, as Dr Richard Isaacson says in all of his webinars, you can win the tug of war with your genes, with your lifestyle.
Speaker 3:Yeah, I wanted to make sure that everybody knew, though this isn't like secret and it's not being kept secret. Dr Bredesen wrote the end of Alzheimer's program. If you're someone that wants to learn about it, wants to prevent and or treat it, that program is written out for you, step-by-step what you, what tests you need, what you need to do. It's almost like a checklist throughout the book to kind of evaluate and get yourself treated, or prevention of this by starting pretty much as a teen right, pretty much as a teen right, making sure that we're introducing that healthier lifestyle as well, increasing your brain-derived neurotrophic factor by exercising.
Speaker 2:Right, but it's never too late, Better early. The anti-inflammatory efforts will show up right away. So yeah, we have to teach our younger people. What they do in midlife will probably determine what their brain is like in late life. So they may want to pay a little bit more attention to diet and exercise then. But studies have proven Dr Galvin's study. He got improvement in all stages of the disease, but of course less improvement if people were working through middle stage disease. He even got some improvement in late stage patients, but of course it was much less. Where did he see the most improvement with lifestyle? Early stage.
Speaker 3:You can adhere better to that when you were in the earlier stages.
Speaker 2:So our hope is, you know, primary care will embrace this and do more and more education with their patients about how they can be preventive. Always better to prevent than to try to treat and, of course, should something emerge, follow David's example.
Speaker 1:Thank you so much, jill and Karen, for today's episode. I think we've covered a lot of territory, very useful, and Karen will give you our email addresses and the phone number you can reach us at, if you would like, for any questions you may have, any suggestions you may have. We would certainly appreciate it and we certainly appreciate you tuning in and watching all of our podcasts.
Speaker 2:Thank you so much. You can reach David by email david at davidalzheimersfightorg. You can reach me very simply, education at alzcareorg. That's A-L-Z-C-A-R-Eorg. You can reach me by phone at 561-683-2700. So we'd love the feedback, love to know what you want to drill down even more on. And, Jill, thank you so very much. It is so critically important what you're doing at Jupiter Medical Center. This will have a wider effect. Word will get out. So thank you so much for those efforts.
Speaker 1:We are here on this earth as humans to help others. That's what I believe. Please note this podcast provides information only. Podcasts should not be considered professional advice or a substitute for professional advice. Viewers of the speakers do not necessarily reflect those of Alzheimer's, Community Care or David Ufelder. Listeners and viewers are encouraged to consult with appropriate professionals and are responsible for how the information provided is used.
