GEMS Model of Classifying the Stages of Dementia
Submitted by Hannah Waterbury
Tags: adults advocate awareness care dementia nursing occupational patients
The Gems Model was created by Teepa Snow, an occupational therapist and founder of the company Positive Approach to Care, which provides support to those working with neurocognitive degeneration. The model likens the stages of dementia to gemstones, highlighting each stage's unique qualities and needs (Snow, 2018). It focuses on providing care that will bring out the best of each stage, so that family and healthcare workers may better interact and care for those suffering from dementia. Enacting the Gems Model into long-term living facilities will allow better care for adults with dementia.
The Gems Model
The Gems Model describes 6 different stages: Sapphire, Diamond, Emerald, Amber, Ruby, and Pearl (Nurse Partners, 2019).
Sapphire, the first stage, exhibits no cognitive impairment or signs of dementia. This is an aging adult, who may like assistance in the form of calendars, reminders, pill organizers, or other helpful tools. However, this stage is a self-sufficient adult.
Diamond is the first stage of dementia. They are “clear and sharp; routine and rituals rule” (Snow, 2018). These adults can still do things as they always have but may require some help in certain areas. They like to feel competent, and thrive with consistency (Nurse Partners, 2019). They have good cover skills to hide their disease process at this time and may see help from family or healthcare staff as a threat (Snow, 2018).
Emerald adults are “green and on the go with a purpose; naturally flawed” (Snow, 2018). They see themselves as independent but seek guidance. They want to know what is next and will vary from periods of clarity to periods of confusion (Snow, 2018). The Emerald adult may be lost in the past, and ask many Who? What? When? Where? and Why? questions (Nurse Partners, 2019).
Amber adults are “caught in a moment of time; caution required” (Snow, 2018). This individual may cross boundaries, and tends to visualize only pieces of a situation, not the whole picture. Their environment plays a large role in their mood, and sensation is heightened to them. They do not tolerate discomfort well but may not be able to vocalize their discomfort. The Amber adult’s mood can change rapidly (Snow, 2018).
Ruby adults are “deep and strong in color; others stop seeing what is possible” (Snow, 2018). This individual requires that their needs be anticipated for them but still maintains a strong sense of rhythm (Snow, 2018). Fine motor skills may be lost in this individual, and they require assistance with ADLs. The Ruby adult wants to feel safe and secure (Nurse Partners, 2019).
Last, the Pearl adult is “hidden within a shell; beautiful moments to behold” (Snow, 2018). Teepa Snow describes this final stage of dementia as being “layered and hidden in a shell; pearls are still and quiet, unable to actively move or respond and have limited awareness of the world” (Nurse Partners, 2019). This stage is not lost and still can recognize and respond to sound.
Aging adults experiencing dementia will flow through these phases. Caregivers who interact with them every day may be able to place them into a phase and recognize ways to offer compassionate, informed care (Snow, 2018).
Resistance to Care
Teepa Snow, while discussing her experience as an occupational therapist, stated, “resistance to care is one of the biggest challenges you’ll see throughout all the stages of dementia” (as cited in Gordon, n.d.). The care of those with dementia is full of many ethical dilemmas for both family and medical staff.
When an Amber adult is refusing incontinence care because sensation is heightened to them, and being washed is uncomfortable, this can create an ethical dilemma for healthcare staff. Yes, the patient is refusing care, but they don’t truly understand what they are refusing. Providing incontinence care is in their best interest. What is the right course?
While interviewing staff members of a local nursing home about how they deal with similar situations, a recurring strategy that came up was reapproaching. C. Hudson, a licensed nursing assistant in Vermont, states, “Though they are refusing, I still feel required to give them care, so I will wait and re-approach several times. Usually, I am successful. But, if you do not know some of these residents well, it may seem impossible to offer them care” (personal communication, September 29, 2019). The Gems Model offers awareness about the different stages of dementia in such a way that healthcare staff can find insight about how best to approach the different stages and be successful.
Setting Boundaries
A doctor speaking on behalf of Alzheimer’s Australia went into detail about a family friend who, in the care of her husband, never knew when to take over doing things for him. He would often seek to fix things around the house as he had done in the past but fix them incorrectly. She knew if she were to seek outside help in home repairs it would greatly distress him, as he did not realize that he no longer was capable of such repairs. For this woman, she did not know what was right in the care of her husband as he progressed through the stages of dementia (Hughes, 2010). How could she allow him freedom and set the boundaries he required?
One purpose of the Gems Model is to create awareness about what a person with dementia can do. Letting them do simple tasks allows them to keep their functions as long as possible. It gives them a voice and autonomy. However, to a person unused to dementia, it can be hard to watch them struggle with a task. It may feel like it is better to do things for them, but in the long run, allowing, for example, the Diamond or Sapphire adult to wash and dress themselves, even if it takes them longer, is beneficial to their mental and physical health (Snow, 2018).
Promoting Wellness
Communication becomes harder in the later stages of dementia. Because of this, so does care. Caregivers must anticipate the needs and wants of the adult with dementia. These needs go beyond physical needs, however. Though feeding, providing fluids, clean clothes and the right temperature may be the most obvious interventions for comfort for dementia patients; psychosocial needs are also important.
Hearing is one of the last senses to be lost (Being With, 2018). It is important to speak to patients as though they can hear you, because they likely can, even if they do not respond. Teepa Snow is an advocate for music in specific stages of dementia. Music can bring wellness to patients who experience the world mostly through sound. It is an easy intervention with big results.
C. Hudson states, “I like to play music in certain residents’ rooms when they are left alone in bed or in their chair. Radios are provided by activities in many rooms, but we are not educated about using them. However, some residents who are nonverbal will move with the music, and you know that they can hear it” (personal communication, September 29, 2019). The Gems Model points out to caregivers the interventions that may best interact with different stages of brain function found in dementia. Providing a small form of activity can make a big difference in the wellness of an individual with dementia (Snow, 2018).
Conclusion
Enacting the Gems Model into long-term living facilities will allow better care for adults with dementia. C. Hudson states, “[We want to] give them options to help as much as possible so they still feel they have their independence. We are here for what they need” (personal communication, September 29, 2019).
The purpose of the Gems Model is to create awareness, so the dementia population may be better catered to. Bringing this awareness to long-term care will allow staff to learn how to approach residents in a way that promotes acceptance of care, keeping their independence and giving meaning to the end stages of life. Teepa Snow states, “Providing supportive settings for everyone, including care providers, allows them to use what they have to be their best” (Snow, 2018).
References
Being with someone when they die. (2019, September 25). Retrieved September 29, 2019, from https://www.dyingmatters.org/page/being-someone-when-they-die.
Gordon, S. (n.d.). Polishing the gems who are Alzheimer’s patients. Retrieved September 29, 2019, from https://www.medicinenet.com/script/main/art.asp?articlekey=173357.
Hughes, J. (2010). Ethical issues and decision making in dementia care. Alzheimers Australia, Paper (20). Retrieved from https://www.dementia.org.au/files/20100600_Nat_NP_20HughesEthIssDecMakDemCare(1).pdf
Nurse Partners. (2019). The GEMS™. Retrieved September 29, 2019, from https://www.nursepartners.org/resources/the-gems/.
Snow, T. (2018). The GEMS: Brain change model. Retrieved September 29, 2019, from https://teepasnow.com/about/about-teepa-snow/the-gems-brain-change-model/.