Collaboration means we are working together towards a common goal and/or for a common purpose. Collaboration requires shared knowledge, understanding, and beliefs.

One of the most critical and foundational components for quality dementia care is a shared understanding of the symptoms associated with dementia stages. This is because those with Alzheimer’s disease and related dementias will go through a rather predictable decline through the dementia stage continuum.

With full recognition that no two people will experience dementia exactly the same way with some degree of variability being normal, the stages can provide clarity to our observations and predictability about the progression of symptoms and their impact on function and safety.

In dementia care, members of the interdisciplinary team (and different provider settings within a continuum of care) will accelerate their collaborative approach and reap the many benefits by defining stages in the same way, using the same definitions and language. 

Your Training

Training in a silo is far less effective than learning as a team. Your chosen dementia training program should prepare all those who work together (e.g. therapists, nurses, activities, nursing assistants, social workers, managers, and others) with the same fundamental understandings about the stages of dementia and the variables that impact the cognitive functional capabilities the person demonstrates in any given moment. Think about this as you answer the following questions. 

• How would you describe the stages of dementia?
• Is this the same way your team members would define early-stage dementia, as an example? 
• Do you hold the same understanding as to your client’s capabilities and challenges, functional potential, and support needs, at that early stage of dementia?
• Can you make sense of any inconsistencies in your dementia assessment results?

Your Process

There are many cognitive screens and tests and a variety of dementia staging assessment tools. Some that come to mind are the Saint Louis University Mental Status Exam (SLUMS), Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating Scale (CDR), Brief Interview of Mental Status (BIMS), Functional Assessment Staging Tool (FAST) and FAST stages, the Cognitive Disabilities Model and the Allen Cognitive Levels. 

For a collaborative approach to be effective, we want to be clear on who is doing what, when, and why? As examples:

• Some tools are used by a physician or a nurse for diagnostic purposes, measuring dementia progression, and determining effectiveness of cognitive enhancing medications.
• Those used by Speech Language Pathologists help determine cognitive status and their treatment plan to optimize (if a chronic progressive disease) or rehabilitate/restore (if acute diagnosis) capabilities in the various cognitive domains such as attention, short-term memory or problem-solving. 
• Occupational Therapists (OTs) may use functional/performance-based assessments, like Allen, to identify cognitive level, then determine the highest level of function possible and implement treatment to optimize functional performance in meaningful activities, within their cognitive capacity. As part of treatment when working with someone with Alzheimer’s disease, OT will modify the activity to create task equivalence, modify the environment to be a support and not a hindrance, and train family or hired caregivers to be able to support the person living with dementia. The goal is to optimize and maintain function, safety, health, and quality of life, and ease caregiver burden, at every dementia stage.

The use of many different tools and approaches is common and appropriate within a healthcare team. But to be effective we must also find agreement and commonality. I suggest finding studies or conducting your own to provide some insight as to how results on these various tools tend to correlate. 

In my own practice I stored and analyzed assessment results that were used across the disciplines and created a crosswalk that identified the correlation we observed between results from the different types of tools. For example:

• I compared the results of our resident’s cognitive tests, such as the test scores on the MMSE or SLUMS, with their Allen Cognitive Level identified through our Allen Cognitive Disabilities Model performance-based assessments.
• I also analyzed the descriptions of dementia stage severity levels in various tools that were function based which included comparing Allen with the FAST and the Global Deterioration Scale (GDS) stages. Therefore, if OT was using Allen and the memory care manager, social work, or nursing was using the FAST or GDS, we could understand how the results correlated.

We all experienced the same dementia care training (Dementia Capable Care). This grounding enabled us to agree upon (a) the key abilities and challenges of a dementia stage and (b) understand what impacted how someone functioned in life or performed on a test in any given moment. Therefore, we were able to use our clinical reasoning to make sense of any differences or inconsistencies in test results. 

This is so important because many factors can influence how someone attends and functions in any given moment, and therefore, how they score on a test. We must understand the influence of factors such as whether the activity holds relevance or value to the person, how that person was feeling at the time, whether the assessor gained their trust and agreement, any external conditions that may have hindered performance, etc. 

Another reason mutual understanding and collaboration is so important is that we often make big decisions and recommendations together as a team such as creating a care plan with goals and approaches and making discharge or admission decisions.

The bottom line is collaborative, quality dementia care training suggests:

1. Each discipline may use different tools for cognitive assessment within the process and the results will be applied within their discipline for different purposes.
2. The entire team has an understanding of how all the test results correlate so we can use the information to guide us and identify any fluctuations in cognition.
3. The team holds shared understandings as to definitions of stages of dementia or severity levels so we can create plans and advise patients/clients from a congruent point of view.

Once you have this solid foundation established within the organization and team, you can use it in many ways beyond individual patient/client care. For example, we established and help our customers implement memory care admission and discharge criteria, programming, and acuity-based pricing models around the stages of dementia/cognitive levels. You see the sky is the limit as to the value of a team having a collaborative approach to dementia care and dementia staging. 

Summary

Yes, each professional discipline may acquire advanced training to enable them to conduct the assessments and deliver the treatment interventions that are appropriate for their discipline. And as stated, one common dementia care training program should be consumed by all on a team so that it serves as the foundation and glue for a common language, approach, and vital decisions made as a team. 

One of the most rewarding moments I have had when training Dementia Capable Care is to observe the nursing assistant, the nurse, activities, therapists, directors, and social work all brainstorming around how to support a specific client, based on what they are learning together about the stages of dementia and the influence of personhood. I know we are sending them off into the real world stronger than before because we have enlightened and empowered the team, not just one individual. 

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Posted: March 2025

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