Debbie Hommel's A.D. Tips
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by Debbie Hommel, BA, ACC, CTRS, Executive Director of DH Special Services
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Executive Director
DH Special Services
About Debbie

Debbie Hommel, BA, ACC,
CTRS, is the Executive
Director of DH Special
Services. She is a Certified
Activity Consultant on State
and National level, with over
twenty-seven years of
experience in providing direct
care and consultation to long
term care, medical day care,
assisted living, and ICF/MR
facilities throughout New
Jersey, New York, Maryland,
and Pennsylvania. She is an
experienced trainer and
workshop presenter,
conducting a variety of
seminars throughout the
Tri-State area for the Activity
Professional, Administrator,
and allied healthcare
professional. Debbie Hommel
is an active member of Activity
Professional Associations on
State and National levels. She
is ACC certified through the
NCCAP. She is a founding
member of the New Jersey
Activity Professionals'
Association, serving terms as
Vice President and President.
She received the Weidner
Lifetime Achievement Award
in 1994 and the Monmouth &
Ocean County Activity
Professionals Life
Achievement Award in 1999.
Let Debbie answer your
Activity Questions
Providing Internet Resources
for Activity Professionals
in Long Term Care Settings

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“They say she’s confused….”
By Debbie Hommel, ACC/MC/EDU, CTRS

As I approach the front door to leave the building, a well dressed woman politely
approaches me.  She is elderly, nicely dressed, accessorized well, with purse in hand.  
“Can you take me to the bus station?” she asks.  Looking into her eyes, I see she is
anxious and my immediate response is to help and say “of course, it’s on my way
home.”  But quickly I realize this seemingly “normal” looking person may be “confused”.  
Confused is a commonly utilized word to describe many of the residents residing in our
long term care facilities.  It is a catch all word that is non-descriptive.   The number of
elders with cognitive impairments is increasing at staggering rates.  According to the
Alzheimer’s Association, the number of individuals with Alzheimer’s disease is
expected to quadruple from today’s number of 5.5 million people to 19 million people by
the year 2050.   

As activity professionals working with individuals with cognitive loss, it is imperative we
become familiar with more descriptive terms than “confused”.  Individuals with
dementia have varying degrees of cognitive dysfunction which go beyond memory loss
and time disorientation.  To lump all residents or clients with cognitive loss into a
“confused” category of residents does them a disservice and is not individualized care.   
There are a number of terms and functions associated with cognitive loss which should
be considered, identified and evaluated within the assessment process.  Once the true
scope of cognitive loss is defined, specific programs, approaches and adaptations can
be introduced.  Here are some of the terms associated with cognitive function:
   Cognition refers to the mental functions which focus on being aware of one’s
surroundings; one’s ability to perceive events and cues in one’s surroundings; and one’
s ability to reason, make decisions and use sound judgment.  

   Confusion, when used in a psychological sense, refers to an individual’s impaired
orientation to their surroundings (place), the current time or passage of time (time) and
people (person).  Person, place and time are often referred to as the three spheres of
Memory includes registering (understanding and processing), retention (storing in the
brain for future access) and retrieval (being able to recall the information when needed
or desired) of new information.  Short term memory (more recent information)
impairment is a common symptom of dementing illnesses; while long term memory
(information from one’s youth and many years past) remains more intact.

   Reasoning is the mental ability to interpret cues and information while coming to
some sort of sound conclusion.  Listening to the weather report will provide an
individual with enough information to know what kind of outer garment might be
necessary.  With poor reasoning, elders begin to put themselves at risk.

   Decision making is the act of making up one’s mind about various options and
choosing the best option.  Making poor decisions, the inability to make a decision and
not being able to follow through with decisions is a common concern and also puts the
resident at risk.  

   Intelligence is one’s ability to learn and apply information.  Crystallized intelligence is
accumulated knowledge over a life time which includes data and factual information.  
Fluid intelligence is focused more on problem solving and reasoning.  Research has
found that crystallized intelligence increases with age while fluid intelligence begins to
decline in middle age. The decline of fluid intelligence can be slowed through cognitive
exercise or “brain aerobics”.  The old adage of “you don’t use it, you lose it” holds true
with fluid intelligence.   The success of trivia and word games within our care facilities
demonstrates the validity of stimulating intellectual functioning.  

In normal aging, one begins to see a slowing down of cognitive function.  The elder may
need additional time to process information and respond.  However, the older person
can still learn, problem solve and use complex thought processes.    Becoming
“confused” is not a normal part of aging.

With Alzheimer’s disease and the many secondary diseases which affect brain
function, one begins to see decline in the mental abilities we all take for granted.  We
need to identify the remaining skills of our residents and structure cognitive approaches
for success.  There are many programs and books available today which focus on
Brain Fitness.  Some are costly however some are within reach of most budgets.  
Some are programs to buy and some are free websites.