GREAT GIFT FOR THE ELDERLY WITH DEMENTIA CAN REDUCE ANXIETY

It certainly can be challenging finding a gift for the spouse, parent or grandparent with dementia. Yet you think about all the gifts you have received from this person and you want to find something really special. Something nice, well made, fun and most of all comforting. The Twiddle Cat or Dog fill the bill on all counts.

Rose had advanced dementia and had suffered a debilitating stroke years earlier. Rose was unable to walk or use her left arm. This combined with her declining vision as well as dementia left her few options for activities.  That is until she received her Twiddle Cat. Now Rose had not only something to hold, but an opportunity for visitors and staff to stop and engage her in conversation about her cat. While Rose’s right hand used to search all over her blanket for something to hold on to or do, she now could reach out for her cat.

The Twiddle Cat is made in the shape of a muff, for the elder to put their hands into.  Activities are attached to the muff to give the elder some variety of things to hold, beads, ribbons, items that are easy for old fingers to hold onto.

Rose took to her cat from the moment he was put into her anxious arms. She called him “Chuck” after a cat she had had as a child. Soon Rose and Chuck were inseparable.  Instead of being known in the nursing home, for always calling out for help, the staff now knew Rose as the lady with that cute little cat, Chuck.  Rose was less anxious       and was calling out for help, less and less often. She was just too busy now, now that she had Chuck.

The Twiddle Cat is made of a soft comforting fabric that launders beautifully. The muff provides a place to keep old hands warm, while the attached items give the elder something to twiddle with, entertaining the hands. The muff being a cat or dog is appropriate and provides a welcome distraction for the elderly man or woman.

The Twiddle Cat, something really special for the holidays.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

5 REASONS THE PERSON WITH ALZHEIMER’S DISEASE CAN HAVE BAD BEHAVIORS

When life begins to be a mystery and the person with Alzheimer’s disease no longer understands what people say, the meaning of words, and he no longer understands the environment, he can react with anger. That anger can lead to his being restless or even combative. Sometimes striking out at caregivers, strangers and even those he loves.

What causes bad behaviors in Alzheimer’s disease:

  1. His short term memory is affected, so no he doesn’t remember what he just had for lunch. And furthermore all of those questions, about things he can’t remember are getting on his nerves.
  2. He has poor judgement, so even though he has always been a cautious person he now is very impulsive. Even possibly having inappropriate social behavior, because he no longer exercises good judgement in actions or what he says.
  3.  He now is making poor decisions, due to Alzheimer’s disease and no longer understanding the environment. Spontaneously walking outside alone, to take a walk in winter without coat, hat gloves, etc.
  4. He now has an obvious short attention span, becoming impatient, fidgeting, having difficulty sitting still, becoming easily distracted or easily bored.
  5. He is losing verbal skills and having difficulty expressing wants and needs. So becomes angry when people do not meet those needs because of poor communication.

It turns out not to be such a mystery as to why the person with Alzheimer’s disease can have bad behaviors. The person with with Alzheimer’s disease is living in on ongoing mystery.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

HOW TO TALK TO SOMEONE WITH DEMENTIA

When a person with dementia has a difficult time understanding or following a long conversation. Breaking the conversation into small segments, with a repeat of important information will be more effective than a long talk. Help the person with dementia stay focused by making great eye contact, holding the person’s hand, any additional focused connection. Be very attuned to facial expressions. When one word doesn’t seem to be understood, use a simpler word. Adding gestures can not only demonstrate words, but can also bring more focus to the speaker.

A person with dementia may lose their train of thought during a conversation. Helping the person with dementia with a word, or forgotten idea depends on the relationship. If the confused person feels that they are being controlled, this form of “help” may be viewed as an intrusion. If it can be done in a lighthearted way, it can guide the person back to their train of thought.

A person with dementia can be very distracted in a noisy environment. One of the first things Sara noticed about her husband was that he seemed rattled when out in a restaurant. She started requesting a table far from the kitchen, where the slightest clang of utensils, would make her husband turn to the sound. He frequently complained about the noise, even though it seemed very normal to everyone else. As time went on it became apparent that in order to even conduct the simplest of table conversation, they would need to go dining at off hours, when the restaurants were almost empty.

A person with dementia may begin to avoid crowded events, or become anxious in crowds. Not only dining out can become a problem, but going to a theater, sporting event, church service, or any event where there are large amounts of people, can be an opportunity for the confused person to become anxious. Very good pre-planning for any event becomes so important. If the caregiver doesn’t plan well, and is running late to an event, the confused person will take on the anxiety as well.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

READING BETWEEN THE LINES, IS THE REAL STORY OF ALZHEIMER’S DISEASE

“Harvey died just before Thanksgiving,” his widow wrote, this is his story.

“Harvey showed signs of memory loss three or four years ago. Then after Christmas last year it got worse. In April he fell off our front step and all tests were negative, then it seemed to escalate. Through the summer the nights were really bad. Pills were not working. The month of August after what seemed like hundreds of phone calls we found a care center. Harvey had two good months there. Then one night he wanted to get up to go to the bathroom. Afterwards, the staff took him back to bed and he died in his sleep. What a blessing!”

One brief paragraph, nine short sentences, not really enough to tell the story of Harvey. But maybe it is, his story is like so many others.

Just a few years when the family identifies his memory loss?  We know he was struggling for longer than that. The time of mild cognitive impairment, when the person is mildly confused, yet functioning, can be many years. Years when the person doesn’t need any help dressing, bathing, eating, but might be having trouble remembering a word or an event. He could remember how to drive the car, and as long as his wife was giving him directions, they didn’t get lost. By having a routine to life and sticking to the routine, it makes it harder to see the changes, they just creep up on you.

The 3-4 years of memory problems she remembers, was most likely when his struggles were becoming more obvious. Especially if other people now noticed. Having a fall, any injury, infection, anything to change the normal routine tends to escalate the symptoms. And the person no longer bounces back to their previous level of function.

Pills were not working. No, medications for Alzheimer’s disease tend to only help for a period of time.

Nights were really bad. So many people caregiving for someone with Alzheimer’s disease come to that place where they are looking for a care center because the nights are bad.

But it wasn’t all bad. Between these few lines you know there were holidays and birthday celebrations. Grandchildren were born and many family get togethers were enjoyed by Harvey. The elderly couple enjoyed going to a movie, or out to eat. They were faithful members of their church, where Harvey was well known. He died at the age of 85, and only lived those last two months in a nursing home.  What a blessing!

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

HOW THE NURSING HOME PREVENTS FALLS

Every year the average nursing home will have between 100 to 200 patient falls. The people who fall the most often are men, and patients who are confused. Men fall almost twice as often as women because they are less likely to call for assistance, because it is more difficult for them to admit needing help. Patients with Alzheimer’s disease or another form of dementia fall frequently, because they no longer have safety awareness.  Statistics tell us that 35% of those patients who fall are unable to walk, yet they try.

Most patient falls happen in the patient’s room, when the person is attempting something without assistance. Few falls happen in places like a dining room or at a nurses station where many staff members are available to monitor for unsafe behaviors. The majority of those falls in patient rooms have to do with needing to go to the bathroom. Being incontinent of urine, having diarrhea, and having to urinate frequently at night all contribute to the high number of falls.

Added risk factors are poor vision, going bare foot, clutter on the floor, poor lighting and possible a slippery/wet floor from the patient becoming incontinent. As well as the patient forgetting to reach for their cane or walker in their rush to the bathroom.

A nursing home fall prevention program includes assessing each and every patient for their fall risk. All of the above mentioned problems are identified. A plan of care is developed and all staff members are informed of the plan. Safety devices are put in place, most of those devices are in the form of alarms. A good web site for safety devices is -www.Rehabmart.com. Their site is very user friendly and they have a large selection of safety alarms.

Looking at the environment, follows the assessment. Are the grab bars placed correctly? If the patinet is getting out of bed, is the bed in a low position, with an alarm? Is the lighting adequate, are there motion sensors in place? Is the patient on a regular toileting schedule before bed? How often does the staff check on them during the night?

A big deterrent for falls is a busy, engaged patient, a patient who has activities to go to that they enjoy. A patient who is really tired when it is time for bed, that they enjoy a good nights sleep.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology

MILD COGNITIVE IMPAIRMENT AND REASONING

Dorothy is 80 years old and anyone would say she looks just great. Today she is volunteering at her local nursing home, as she has done for the last 15 years. Her hair looks perfect, her clothes always matching and becoming. She has her usual great smile and good humor for all of the residents.

However there had been a particularly bad snow and ice storm the night before. A nurse seeing Dorothy remarked that she was surprised to see her out on such a bad day. Dorothy seemed unfazed by the weather. “Aren’t you afraid of falling?” the nurse asked. Oh no, Dorothy assured her she never falls. Looking down at Dorothy’s feet the nurse commented on the dress shoes with 2 inch heels,  Dorothy was wearing. Pointing to all of the snow and ice patches still on the driveway, the nurse asked why she was going out in those shoes. As the conversation continued it was clear that Dorothy was not connecting the dots between safety, caution, weather, common sense and those very pretty and impractical shoes. In fact, Dorothy showed signs of losing her good humor, if pressed on the subject.

Mild cognitive impairment is considered a condition that might indicate that the diagnosis of Alzheimer’s disease will be next. It is considered a condition that really doesn’t interfere with normal life or activities. Mild cognitive impairment may improve, stay the same or progress. Mild cognitive impairment involves issues like searching for words, losing your train of thought in a conversation, mild forgetfulness, feeling sad or overwhelmed. Many things can account for these such as poor diet, anxiety, depression and especially loss of sleep can cause many of these problems in the elderly.

But the decline in reasoning and judgement are particularly worrisome. Reason involves thinking through a problem and coming up with a solution. It involves higher thinking abilities such as applying logic, verifying facts and making sense of a situation. When the loss of judgement or reasoning skills is lost, this now does interfere with normal life and activities. The loss of reason can have consequences, like Dorothy in her pretty shoes sliding around on ice.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

SENIOR WITH ALZHEIMER’S DEMENTIA CHANGES TRYING TO COMMUNICATE

Of all of the changes the family sees in their loved one with Alzheimer’s dementia, the most frightening is personality and behavioral changes.  When the senior with dementia acts childish, irrational, stubborn, suspicious, paranoid, or becomes physically combative, the caregiver can be frightened.  The caregiver can feel that the relationship is over, this person is now a stranger.

These behaviors are not only frightening for the caregiver but even more so for the person with dementia.  Preventing behaviors is always the goal, and so much easier that dealing with a full burst of anger.

Preventing bad behaviors:

  • be alert and aware to what is going on in the environment – if the last time Grandpa became angry were there too many people, too much talking, too much noise, just too much stimulation?
  • arguing with a person with dementia never works, the person just doesn’t have the reasoning skills any longer to engage in finding solutions – divert attention and head off any confrontations
  • respect and protect the elder’s dignity , there is a real reason why bathing is such a hard task for someone with dementia – being undressed is a huge loss of control
  • make every task as simple as possible – breakdown the task into one step at a time – even though this slows progress – slow and happy is much better than fast and unhappy
  • reassure, and reassure again and again – the elder is very afraid of being abandoned – even the most demanding elder is basically afraid of abandonment

The elder with dementia doesn’t mean to be difficult. Difficult behaviors are a means of communication by the elder. The elder knows that they are missing something everyone else understands. The changes the elder feels they are no longer able to communicate with words. So the elder will try to gain control over their environment through – behaviors.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

ADULT COLORING BOOKS – GREAT ACTIVITY FOR SENIOR WITH DEMENTIA

Adult coloring books are everywhere, from the internet to your neighborhood craft or book store. The choices are suddenly endless from floral, to animals and even the chance to color the masters of the art world. In this fast paced, goal driven, digital age, opening a fresh new coloring book and colors is soothing in itself. Taking any individual to a place of quiet and relaxation, but especially so for the senior with dementia..

For the person with Alzheimer’s disease, or another related disease causing dementia, coloring brings many benefits.  Coloring is among other things, an activity of reminiscing. Everyone remembers the wonderful feeling of opening a new box of crayons. And if you were the fortunate child who had the set of 64 with the built in sharpener, the feeling was quite amazing.

Coloring, gives the senior with dementia an opportunity to be successful. When you color it gives you chances to make decisions about which picture to color, where to start and which color to use. For a person with dementia who makes many mistakes all day long, due to memory loss, coloring is very safe. Art is in the eye of the beholder and there is no way to be wrong.

Find a quiet place, avoid a cluttered kitchen table, instead pick a place where the supplies can be spread out and enjoyed as well. Do not have the distraction of a TV, or even a radio unless it offers soft background music, preferably without lyrics. Even if the person with dementia never cared for art or crafts before, this is an area where they can do well now. This activity doesn’t require remembering facts, people, places or use any language skills. Just the ability to hold onto a coloring pencil or crayon.

When a person does an activity mainly engaging the right side of the brain where art, music and the softer side of life resides, it becomes a little vacation for the mind. As almost a form of meditation it can bring mindfulness to the person and make them more focused. Distraction is a major problem with dementia and developing activities which bring greater focus are worth the effort.

Having many coloring books and colored pencils or crayons around is a great way for the senior to do an activity with a child. The child knows instinctively how to get to the right side of the brain where there is only color, choices to be made and those spaces to be filled in.

Not only is coloring a great activity for the senior with dementia, it is also great for his caregiver. Time can fly when you are engrossed only in choosing which page to color next or what color to use. And the companionship created while you compliment each others work of art creates a pleasant feeling of friendship for both. Feelings that can last long after the crayons are put away.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology

 

GRANDMA CAN’T FIND THE BATHROOM – WHEN THE ELDER IS INCONTINENT

Grandma Lucy always has a big smile on her face. She is already in the late stage of Alzheimer’s disease. Grandma no longer talks or seems to understand what others are saying to her. She now needs total assistance bathing, dressing and eating.  Yet, Grandma Lucy can still walk and while she cannot go through the many steps of dressing. Once dressed she is able to pull down her slacks, as well as  incontinent brief, and then go to the bathroom.

The problem arises because Grandma no longer can identify the correct place to toilet. When she feels the urge to go to the bathroom, any flat surface she can sit on, will do. She no longer plans or anticipates that she will be needing a bathroom. In the moment when she feels the urge, she answers the call in a public place, secret place, anywhere she finds an opportunity to sit.

Missing the toilet, and using either another object such as a waste basket, or a flat surface such as a chair, sofa, or recliner is common, in a dementia unit, in a nursing home setting. Especially common, for those elderly who continue to be able to walk independently. Grandma Lucy always was a great walker, and has continued to be able to walk, even though now she walks without a destination. She just appears to be wandering as she keeps retracing her steps, all day long.

But contrary to the many who are no longer this active, she has no problems with constipation. On the contrary, Grandma is as regular as clock work. And this fact provides the solution for Grandma’s problem.

When a confused elder like Grandma Lucy can’t plan or anticipate needing to use a toilet, the caregiver needs to provide this service. Her caregiver knows that Grandma Lucy has a bowel movement everyday, about a half hour after breakfast.  As many people know, having a cup of hot coffee in the morning, and chewing breakfast, stimulates the colon and bowel.

Now the caregiver keeps a close eye on Grandma Lucy after breakfast, and right on time walks her to the bathroom. Grandma Lucy is now greeted with smiles and welcome during her wanderings instead of looks of suspicion.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

EARLY SIGN OF DEMENTIA – GRANDPA WEARS SWEAT SUIT TO HOLIDAY DINNER

Where is grand-pa? All the family were comparing notes, before dinner, on Thanksgiving. “Did you talk to Dad?” “Did he seem to understand where to go and what time?”  And so the conversation went, while the sisters were getting ready to put the dinner on the table. Then right before dinner time, there was the door bell, and the sound of Grandpa letting himself in.

There was Grandpa, smiling, joking and also sporting his old grey sweat suit. On closer inspection he hadn’t shaved, his hair looked greasy, and he was covered in dog hair. When asked by one of his son-in-laws why he was wearing a sweat suit for Thanksgiving, he gave his now customary response. “This is so comfortable,” “This is so warm,” and ” I am afraid of catching cold.”

When asked why he didn’t go to church that morning, it became clear that it was just too hard to get out of that sweat suit, too much trouble. Once again it is just too comfortable, and warm.

Once dressed the confused elder has a sense of security, feeling put together. And more mentally together as well, as the favorite outfit now becomes a security blanket. And what could be more secure than the feel of  fleece, the feel of a sweat suit. So the confused elder then begins to resist bathing, getting into pajamas or even changing that sweat suit for a clean one.

This chosen outfit is then worn everyday, to eat in, sleep in, work in, relax in, for every season, and on every occasion. Grand-pa doesn’t know that he is wearing his confusion out there, for everyone to see.

So for this family as well as for many families during the holidays, the private conversations turn to “how bad is Dad?” “Should we be doing something?” “Is it time for him to go to a nursing home?”

No, its not time yet. Grand-pa drove himself over, seems to only drive with-in a few miles of his home, and has had no accidents. He is able to monitor his gas, and maintain his very old car. He appears well fed, so he must still be able to get his own food.

What can be done now, is to keep in close touch with him. Get in the habit of calling frequently, asking what he has eaten, where he has gone, and what he is doing. Make sure that he is able to use his telephone and that it is user friendly. Go to his house and make sure he has an adequate amount of fire alarms, especially one in the kitchen and by the clothes drier. Get in a schedule of checking the batteries for those alarms. Look at his kitchen items for any signs of burning.

Look carefully around the house for tripping hazards and move furniture to create clear walk ways. If clutter is beginning to be a problem, ask for some of the things instead of suggesting throwing things away.

Get more people involved. Start having food delivered, especially grocery staples. Start having a cleaning service come in  on a regular schedule. The important thing is to start these services, so the confused elder gets used to having these people around. Then, over time, these services can be increased as needed.

As annoying as the Thanksgiving sweat suit can be, it is really just a sign of things to come, and a sign it is time to plan.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing