THE CHANGING PERSONALITY AND THE ELDER WITH DEMENTIA

A person’s personality may change dramatically as they go through the stages of dementia. The once very dominant father may become the passive, cheerful confused old man that the nursing home staff just loves and the family hardly recognizes.

Just as the quiet, and always agreeable old aunt you remember might now be the most difficult and uncooperative person in the dementia unit. When the elder with dementia becomes difficult consider the following:

  • An inability to communicate. When the confused elder knows what they want, or more likely what they don’t want and the caregiver doesn’t understand. Or the caregiver didn’t take that crucial time before the activity to make a connection.
  • If the elder is asked to do something that is too difficult the stress could very well trigger an angry outburst.
  • PAIN can cause a change in personality. Some elderly act out from pain and some retreat. The pain may come from an acute condition such as a urinary infection, or a chronic condition such as arthritis.
  • A personality change can be a side effect of medication. The once active and engaged elder might now suffer from extreme fatigue due to a medication side effect.
  • An elder with dementia may have a problem with their emotional well-being due to changes in the environment. The environment is too noisy and over stimulating or just the opposite and too quiet with little to do. There may be a change in the direct caregiver causing the elder to feel anxious.

While the elder with dementia may display a personality quite different from their former self, he has the same needs as everyone else. The need to feel a sense of control, the need to feel included in whatever is going on, the need for positive self- esteem, the need to feel purposeful, the need to feel secure and the need to be loved.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

FAST ONSET DEMENTIA – PROBABLY DELIRIUM

PART II

Delirium is a sudden change in a person’s mental abilities and is common in the elderly with acute medical illness. The elder with dementia will have a greater risk of developing delirium when ill, than the elder without dementia.

Delirium can be caused by infections, pain, sleep deprivation, dehydration, metabolic or electrolyte disturbances, constipation, and many times medications especially psychoactive medications. The evaluation process can be extensive because of the large number of possible causes.

Finding out the cause of the delirium is the first priority. Once the medical cause is brought under control it will usually still take some time for the delirium to resolve, even months.  During the time of recovery it is important to:

  • Provide optimal nutrition and hydration
  • Ensure the elder’s safety
  • Encourage a routine sleep – wake cycle
  • Provide a calm environment
  • Make sure that eye glasses are clean, hearing aids are working and dentures are in.
  • Provide good lighting, even during the day keep lights on
  • Simplify – reduce clutter, noise, few visitors

 

In his later years my father would become delirious every time he was hospitalized. I would position myself in front of him, smile and reassure him all was well. When staff would come into the room I would introduce them to Dad and tell him why they were there and what they were doing. I avoided side conversations with staff or visitors and only concentrated on Dad. When he recovered he would remember the bugs running up and down the walls, but he would also remember me just sitting there smiling.

 

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

 

SUGAR CRAVINGS AND THE ELDER WITH DEMENTIA

Please, please can’t you open the ice cream parlor now?” the elderly woman begged the activity aide. Once again the young activity aide explained to Hannah, that it was 8 o’clock in the morning, and they don’t open the ice cream parlor till 2 in the afternoon.

The pain was easy to see in the elderly woman as she was turned away. Anyone who has experienced cravings can understand how she felt. Sugar craving is nothing new to millions of people with diabetes and pre-diabetes.

The craving for sugar is physical and so mental. For the elder with dementia and sugar cravings the time of day doesn’t matter. The fact that she had just had breakfast doesn’t matter. The fact that this tiny old lady just couldn’t be physically hungry doesn’t matter.

Hannah doesn’t remember that breakfast she just had. She will clearly tell you that no body feeds her at the nursing home. Because she believes it. Hannah knows what it feels like to be hungry and right now she is craving some ice cream and so she must be hungry.

For persons like Hannah it might have been the toast loaded with “sugar free” jam that triggered this craving. Or the large bowl of corn cereal she had with the toast. Maybe the 5 packets of sugar substitute she insists on putting in her morning coffee.

Loading up on a breakfast with empty carbs and sugar free products – served up by kind hearted nursing assistants, wanting to make all those Hannah’s happy is her problem.

Would she go back to her unit in the nursing home angry? Of course she did.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

LET MUSIC HELP WITH DEMENTIA CARE

Anyone who has ever attended a concert has experienced a large group of people with synchronized brains. As a piece of music is played with emotion, dopamine is released in the brain and a person experiences pleasure. Added to that, a recognizable rhythm pattern and everyone’s brain is happy and synchronized.

Music affects deep emotions in the brain, releasing dopamine. As soon as a well-loved melody begins, small amounts of dopamine are released in the brain in anticipation. Anticipation, of the strong emotional, well remembered places in the music, yet to come. You know those parts that everyone remembers and sings along to. During especially emotional moments in the music an increase of dopamine is released. Dopamine makes, listening to familiar music with familiar rhythm, very rewarding for the listener.

Dopamine has long been considered the feel good neurotransmitter in the brain. A high level of dopamine helps with physical movement, positive emotions and is the reward transmitter. Many positive things in life can increase dopamine in the brain and music is one of them.

When a piece of music is unfamiliar the brain tries to search for that familiar rhythm, or note sequence. In the case of a jazz piece where there are odd or unexpected rhythms. The brain can’t connect to something familiar. Not only will dopamine not be released, but the experience may become difficult, stressful and unpleasant.

Give the confused person with dementia an opportunity to have that happy, good feeling music has to offer. Play some familiar music that allows the listener to “feel” a memory. Then go the extra step and synchronize your brains, sing along.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing

DEMENTIA CARE – DRESSING FOR CAREGIVING, USING COLOR

The traditional color for healthcare workers has been white. There are good reasons for this. Many times when I have walked into a bedroom of an elderly confused person to check on them, if the elder wakes they immediately say “nurse”. I would reassure them that everything was alright, but that white uniform said much more.

White of course reflects and stands out in a dark room making the caregiver easier to see. White is connected in everyone’s brain with good, pure, heavenly, and clean. This perception doesn’t change when a person gets old or confused.

On the other hand when an athletic team wants to intimidate their opponent they will wear black. A team dressed in all black will look larger and more dangerous. Add a little red to that athletic uniform and red adds the message stay away, danger.

Any clothing in very dark, almost black, colors might be difficult for a confused elder to see, and they may only see black. Happy colors are in the yellow family. Also light green is considered a color that improves mental functioning. Green has been shown to improve test results with students, and light blue is shown to be a stay-awake color. The combination of white with yellow, light green or light blue is the perfect combination for caregiving.

Archive pictures show Florence Nightingale in her familiar uniform of long black dress. But that dress was softened by her white lace collar and lacy cap. Even pictures in her old age showed her in the same combination with the addition of a white lace shawl. However, for many years the color of healthcare has been white.

Every time research is conducted on what profession people think is the most trustworthy, nursing rises to the top. So dress the part, especially if you provide care at night, wear white and you will hear your elder say “nurse.”

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing