GDS Stages

goal directed - can understand the beginning, middle and end of in activity, may require structure/set-up, decrease safety awareness

functional and socially appropriate, difficulty naming people, places, objects at times, limited reading comprehension, conversations tend to be very self-focused

well groomed, dresses appropriately for the season and event, able to walk and move around their environment (may not past the visual scanning) , no significant postural changes

Tx strategies for GDS 4 older adults

everyday is a new day, persons needs assistance for survival, frequent disorientation to time and place, lives in the immediate situation and clings to what is familiar, may become suspicious/paranoid, may perceive themselves as 20-40 years old, wandering with purpose, tunnel vision begins with decreased fine motor skills

not goal directed, do not recognize beginning, middle, end of a task, impaired problem recognition and solving for basic tasks

difficulty comprehending complex language, able to understand nouns, concrete words & simple statements, not able to answer detailed questions, "field of 2" works best for engaging patient input without overwhelming them, able to name common objects but may substitute similar words

have the physical capacity to perform ADL tasks but need increased cognitive support to be successful, sequencing of tasks is inconsistent, has difficulty selecting appropriate clothing, typically demonstrate normal posture & gait (increase fall risk due to visual deficits & lack of focus on surroundings), unable to regulate body temperature

Tx for GDS stage 5 older adults

THE LAST stage we can successfully introduce the assistance device

: abilities may resemble a two to a five year old, physical appearance changes, personality and emotional changes, has no personal boundaries/wanders, rummages, lack of social interaction (could be inappropriate, touching others) , may not sit down fro meals, misunderstood behaviors (anxiety, agitation, restlessness, change in sleep patterns), relies on others for safety (touch) , seeks reassurance

doesn't understand the purpose of basic tasks, unable to follow multiple steps or sequence a task without significant outside support, unable to attend to a task long enough to take action, poor safety awareness

significant decline in understanding information and expressing themselves (touching, verbalization, shadowing, no longer speaking in full sentences), body language and tone of voice are key, responds only to those directly in front, loss of peripheral vision (coming in front of the patient), can follow simple commands but may need additional visual/tactile cuing and modeling, still responds to name and immediate surroundings

need maximum assistance with complex tasks such as bathing, dressing, hygiene, increased difficulty with self-feeding, difficulty using common objects, significant decline in fine motor ability, gait speed and quality decline significantly/increased fall risk (true strength and functional deficits, only focus on what they can see) , increase swallowing difficulties - modified diets

Reason for gait speed and quality decline and significantly/increased fall risk in stage 6 older adults?

Tx for stage 6 older adults

loss basic psychomotor skills, no functional ability to verbalize or manage physical needs, dependent on others for survival, will be difficult to obtain eye contact, respond to sensory stimulation (massage therapy, music therapy, aroma therapy)

automatic response, may respond to high contrast stimuli

loses basic verbal abilities (pick up on non-verbal) , essential communication limited to one word verbal and non-verbal responses to environment and others, may respond with facial change, oral motor change, and/or some repetitive words, may express self with yelling or grunting, repetitive movements

incontinent, dependent in all cares including feeding, significant postural changes (unable to sit upright, losses ability for function mobility, high risk for contractures and skin breakdown), may maintain some trunk movement to assist in rolling & ability to move extremities against gravity, requires total care

Tx for olderly at stage 7