Distinguishing the AGS and Teepa Snow 'GEM' Tools
Many caregivers and family members searching for a 'gem tool' for dementia patients are actually looking for the GEMS® model developed by Teepa Snow. However, the American Geriatrics Society (AGS) does offer a set of Geriatrics Evaluation & Management (GEM) tools used by healthcare professionals. It is crucial to differentiate between these two distinct resources to ensure both clinicians and family caregivers access the correct information for their specific needs.
The American Geriatrics Society (AGS) GEM Tool
The AGS GEM tool is a collection of concise, clinical templates designed primarily for healthcare providers and trainees who care for older adults. It is not a patient-facing tool but rather a quick-reference guide following a standard History & Physical (H&P) format. The suite of tools covers more than 20 clinical topics, one of which directly pertains to dementia care: "Behavioral Disturbances in Dementia".
How the AGS GEM Tool is Used by Clinicians
- Quick Consults: Experienced geriatricians can use it for a rapid refresher on a specific condition.
- Checklists: Less experienced clinicians can use it as a checklist to ensure a comprehensive evaluation.
- Teaching Tool: It serves as an educational resource for students and trainees in geriatrics.
The AGS tool on dementia specifically focuses on the clinical management of difficult behaviors, providing evidence-based recommendations for managing symptoms when necessary.
The Teepa Snow GEMS® Model
The GEMS® State Model is a person-centered care approach developed by dementia care expert Teepa Snow. This model uses an analogy of gemstones to represent different states of brain function and abilities in individuals with dementia. Unlike traditional, rigid stages, the GEMS® states are dynamic, reflecting that a person's abilities can fluctuate daily or even moment-to-moment. This perspective encourages caregivers to focus on what abilities the individual retains rather than what has been lost, fostering a more positive and collaborative care partnership.
The Six GEMS® States
- Sapphire (True Blue): The individual is adaptable and flexible, still mostly functioning as they always have.
- Diamond (Clear and Sharp): The individual relies on habit and routine but is still mostly capable.
- Emerald (Green and On the Go): The individual is traveling in time and place, often appearing busy with a purpose, though their perception of reality may be altered.
- Amber (Yellow-Orange): The individual is caught in a moment of time, driven by needs and instincts with a short attention span.
- Ruby (Red and Strong): The individual retains strength but loses skill and may exhibit resistance to help or strong emotional reactions.
- Pearl (White and Hidden): The individual is in an advanced state, often withdrawn and communicating primarily through nonverbal cues, with the caregiver needing to find the “pearl” within the “shell”.
Comparison of AGS GEM and Teepa Snow GEMS®
| Aspect | AGS GEM Tool | Teepa Snow GEMS® Model |
|---|---|---|
| Primary Purpose | A clinical reference for healthcare professionals. | A caregiving framework to understand and adapt to dementia behaviors. |
| Audience | Clinicians, physicians, nurses, and trainees. | Family caregivers, professional caregivers, and memory care staff. |
| Format | Concise clinical templates, often accessed via an app or online. | A conceptual model using gemstone analogies and trained care techniques. |
| Focus | Evidence-based medical evaluation and management. | Person-centered communication, engagement, and behavior adaptation. |
| Dementia Role | Focuses on managing the clinical condition, e.g., behavioral disturbances. | Provides a framework for understanding the individual's changing abilities and emotional states. |
The Synergy of Both Approaches
While the AGS and Teepa Snow's models serve different purposes, they are not mutually exclusive. A medical professional may use the AGS GEM tool to evaluate a patient's agitation and guide prescribing, while a family caregiver, informed by the GEMS® model, uses their understanding of the patient's current state to communicate and interact more effectively. The AGS also provides other valuable resources, like their Cognitive Screening Toolkit, to aid clinicians in the diagnostic process. For comprehensive dementia care, a holistic approach that integrates both clinical knowledge and person-centered strategies is most effective. Resources from respected organizations like the AGS offer the necessary clinical backbone, while interpretive models like the GEMS® give caregivers a compassionate and practical way to connect with their loved ones.
Conclusion: Finding the Right Framework
Ultimately, the key to effective dementia care is not about choosing one tool over another, but understanding what each provides. The AGS GEM tool is a vital clinical resource for professionals, while the Teepa Snow GEMS® model offers a compassionate framework for caregivers. By understanding the distinction and potential synergy, caregivers can better navigate the complexities of dementia and provide more empathetic, person-centered support.
For more clinical resources and tools related to geriatric care, healthcare professionals can consult the AGS Geriatrics Evaluation & Management Tools.
