Welcome to another edition of the Dementia Care Partner Talk Show.
Now here's dementia care expert Teepa Snow and your host, Greg Phelps.
Hello and welcome to the Positive Approach to Care
Dementia Care Partners
podcast series brought to you in part by Trualta, extending the length of time
that seniors age and place
by building skills to help families manage care at home.
I'm your host, Greg Phelps.
And joining me as usual is Teepa Snow and Teepa,
we recently did a program on temperature regulation.
However, I think I focused on persons living with dementia who are hot often
to the point of dehydration.
But we have this from one of our podcast listeners, and she says, my
question is about the opposite or persons who are cold. Didn't even cross my mind.
Will you be addressing this at another time?
Well, here's another time.
Yeah. So what the podcast listener is referring to is classically now,
this is, typically mid to late dementia, this is not something we often
see early in dementia, although we can with certain dementias like Lewy body
dementia or vascular dementia, because they have auto regulation.
It's called auto regulation.
And it's a system within the core of the brain
that regulates core temperature.
And it has control
over a lot of things, including blood flow into the periphery.
So what happens is as people
lose their subcutaneous fat,
they're padding under their skin on their extremities.
What starts to happen is the blood vessels are closer to the surface.
And without that fat pad, without that covering, that protective covering,
what can happen is, what do you have your room temperature set at Greg?
I'm just curious.
Well, I'm trying to get my AC down to 72 because I'm in the hot
cycle at the moment.
Yeah, yeah, exactly.
So let's say it's even 74.
OK, what's your core temperature in your body?
What, I mean you're Canadian,
so you'd probably do it in Celsius, but I still remember the 98 point
something degrees. 98.6, 98.6, 98.6.
So if I say it's 98.6
and the outside temperature is only 74.
If my brain is damaged, what is it trying to.
What's it registering then?
Probably feeling cold, yeah, I'm feeling cold because the blood vessels and the skin,
everything is saying, wow, it's only wow, it's let's see, 20.
4 degrees, 24 degrees colder,
so my brain goes, I need a layer,
I need covering because I'm freezing.
And in fact, my brain goes, well, if you're freezing
and it's really cold, I need to protect the core of the body.
So what I'm going to do is constrict all the blood vessels in your extremities,
in your hands, in your feet, up
to your knees, up to your elbows.
I'm going to make those colder so we can keep the blood flow heated
that you need to stay heated in the core of you.
So, in fact, when you touch my hands and my feet, guess what
you'll feel? Actually cold yeah.
They're cold. My hands
and my feet are cold, now because my hands and my feet are cold.
Guess what I want?
You ought to warm yourself up somehow.
I want to warm myself up.
Unfortunately, if I'm in the middle of the disease
or even further along, I might think, OK, I need another layer.
But where's the cold?
Where is the constriction in in blood flow at?
We have the extremities, right? Yes, extremities.
And so when I put another layer on another shirt, another sweater,
another pair of pants.
You're still not addressing your hands and your feet. I'm not addressing it.
And so my hands are continuing to register
cold and in fact, my fingertips might still feel cold.
Unfortunately, I'm overheating in the core, but
my system is broken to an extent that it doesn't go, hello
just expand the flow all the way up to the hands.
And so that doesn't happen.
I may be dripping sweat on my head and face.
I may be pooling sweat in my armpits and yet.
You still might think, yeah it's still cold.
So what does, so now that I've laid the puzzle out for you,
what comes to mind that we could do that might be helpful?
Oh, well, I wouldn't even know where to begin on this one,
because I'm not going to put you in mittens
and I'm not going to put you in booties, so that's really not going to work.
And so I'm going to give you hot soup or I'm going to give you coffee.
Is that actually helping your body or am I sort of causing
another problem with that? No, you got it.
So what I want to do is this is where we might warm rice socks or bean socks
in the microwave, where we might offer someone a warmed cup or our warmed hands,
because what happens is when we provide
warmth to the hands and the feet, the blood vessels
go, oooh good.
So you're warm, and they start to relax.
When they start to relax, the blood starts to flow more openly in those areas.
And as the blood flows, that blood is
warm because it's been running around in the core.
And so guess what?
It literally helps you do, warm.
Is it going to last? No.
But do we want to think about episodically
offering things that are warm, things that can be held can be manipulated,
things that you can put on the feet around the feet?
Now, do we have to watch?
Do we want a heating pad that gets real warm?
There's dangers, yeah.
There is risk.
So you do want to be thoughtful.
So I should be checking out everything, laying it on me for a period of time
and thinking, OK, is this OK or not?
This is where you warm a towel in the in the dryer and then you bring it out
and you lay it across my feet and I might be, oh, yeah.
And you can watch me actually relax because it's
it's giving me that peripheral circulation.
It won't be retained.
We would be using sort of the same cautions.
We we would with it, perhaps an infant.
Well, we check temperatures
and make sure that we're doing all of those safety things.
Yeah and infants are actually safer than an older adult
who has advanced state dementia because they have that fat layer.
Yeah, baby fat. Yeah and elders don't.
And so we do have to be incredibly cautious about anything that's warm.
So we want to think warm, not hot.
So we don't want hot stuff on people.
We want warmed things, things that are maybe, you know,
like a few degrees, certainly some degrees above the room temperature.
So they'll feel warm.
So it's partly intuitive.
But then as a rational person yourself, it seems almost counterintuitive
because you're in somebody's home
and the temperatures cranked up and they're wearing three sweaters
and you're sweating and they're still cold.
So it does seem a little intuitive but counterintuitive.
So guess what you may be able to do after you warm their hands and their feet?
Well, you might be able to cool the place down a bit
or get the sweater off, because now they're not cold.
And so that idea of recognizing
whatever's happening in their brain, I wish it were different, it isn't.
How do I work with what is and rather than trying to strip
somebody out of something, they're hot, you know, they're hot.
They need to come out of it.
The problem is they don't realize that.
So, I mean, you can certainly dampen
the clothing and water obviously transmits heat outward.
I mean, if you wanted to wet somebody down.
But I hope you're ready for a what do they call that?
Mad as a wet, mad as a wet hen, isn't it?
Yeah because hens don't like it when you wet them down because they're down feathers.
And so you got to be prepared for that anger kind of thing.
So there we go. We know that heat can be dangerous.
It has serious and almost immediate consequences if it's not dealt with.
Is the cold a little less risky or should you be sort of paying
as much attention to it as you would the cold? Good question, Greg.
It is less risky, but is more annoying for the person who's living with dementia.
So the risk comes that they don't want to do things.
They don't want to move out.
They don't want to use their hands. They don't want to use their their feet.
And so they start trying to curl up and hide.
And what that means is we lose abilities if we're not using abilities.
But if everything I touch, I feel like my hands are cold
all the time, then I don't want to use my hands.
And what I might do is clasp things or close my hands up more.
And then that risk of developing something that's called contractures, closed hands
that can't open, could go up because I'm so cold that I'm curling up.
It can also affect posture and fall risk.
Teepa, is there somewhere we can go to get more information from
you on this? Probably our late state care
videos and information is the best place to look.
You know, it's a topic that if our listener hadn't brought it up,
I wouldn't have talked about it.
I know this stuff.
But, you know, just like many things, what
I know, I don't necessarily say unless someone asks me a question.
So, you know, this may be one of the few places
where you can actually hear us talk openly about it.
As much as I would like to say, I think we got it other places.
Other things, I'm not sure.
So I'll be honest.
I don't know Greg,
you've done one or two videos and one or two talk shows.
So I don't expect you to remember each and every topic.
Yeah, well, I do know that we do have a resource and we also have people.
And so if you're still interested and you can't find what you're looking for.
Call us or email us or chat us online,
because we are certainly open to answering and figuring things out with you.
Teepa, thank you very much.
Thank you, Greg.
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