Allen Level 4

I have therapists ask me all the time why so many of their SNF patients have dementia. That's easy. Dementia is the number one reason people are admitted to sub-acute rehab units so it stands to reason that a majority of people will have some form of dementia. The Allen Cognitive Levels go from 1 (end stage before death) to 6 (Normal). Levels 5 and 6 are fairly normal and can live alone without difficulty. But when the cognitive ability dips down to a Level 4, then major problems begin to interfere with a person's ability to be safe without help. You'll recognize someone in this early stage of dementia because they begin to talk A LOT. In fact, it's difficult to get a word in edgewise. Patients at this level blame everyone else for their difficulties or failures. Often he/she have personality changes and have a very difficult time understanding reason/ logic especially when it applies to his/her health/safety. This level often will answer all questions correctly, yet they do things impulsively/unsafely. This is the type of patient that will tell you he/she has to use their walker or they will fall down and break their hip...... yet when you leave the room he/she gets up and goes to the bathroom without the walker. It's because their cognition is fine (WHAT they know), but his/her executive functions (WHAT THEY DO with what they know) is impaired. Often these patients carry their walker down the hall and lift it up and over obstacles instead of navigating safely around them. To keep walkers on the floor put weights on the walker and then gradually take the heavy weight away until the patient is using the walker appropriately without the help of weights. These patients require 4x as much color contrast as the normal person and they use what they see. Often the front of his/her hair will be fixed nicely, but the back will be unkept/stick up. So since this patient uses what they see... to get a patient like this to use his/her walker... color it up!! Tape it up with colorful tape...spray paint it a fluorescent color etc. Want this patient to use the brakes on the wheelchair? Color them up. Always look at things from the patient's perspective.... color helps him/her pay attention to the borders of furniture like sofas or chairs or beds. I recommend to families to throw a colorful bedspread on the bed... a colorful throw on the sofa or chair so the patient doesn't miss the furniture when they try to sit down and fall. Color can be used all over their house to help this patient be more independent and keep him/her off the floor.