WHAT DO THE ELDERLY AND TEENAGERS HAVE IN COMMON – MAKING BAD DECISIONS

They were clearly elderly, possibly in late 70’s. He walked with a four leg quad cane, very slowly as though he was chronically stiff in the joints. He probably had been about 5’9″ at one time, but now he was so stooped over, that he was the same height as his wife, who appeared to be about 5’2″. Yet, as they left the grocery store they were walking to a brand new, bright red, SUV in the parking lot.

In passing I remarked,  “boy, that car is very pretty, but looks hard to get into.” The wife sadly smiled at me and said “yes, but it is a little better since we got the running boards.”, Wow, a car with running boards at their age. Sure enough as she opened the door, she stepped up on the shiny chrome running board, as she tried to steady herself to slide onto the car seat.

I just knew this car was not her choice, yet there she was perched way up in the air as they crept out of the parking lot. I thought, what is going to happen to her when there is snow on the ground, or that running board is slick from rain or slush.

The frontal lobe of the brain, is where reason, judgement and decision making is located. As the frontal lobe of their brain begins to shrink and die, the elderly begin to make poor decisions. A newborn baby’s brain begins to develop fully from the back, neck area, going forward. A teenager’s brain hasn’t fully developed in their frontal lobe, which results in risky choices or bad decisions. The end result is in both cases a frontal lobe that isn’t very functional. Driving and safety turn out to be frequent concerns and conversations in families, for both generations.

Is buying a SUV, a red flag when it is clearly dangerous for you to enter and exit the vehicle? Yes, that is a red flag, even more so is this elderly man’s disregard for his wife and her safety. The first troubling sign families notice when the elderly have frontal lobe shrinkage, is the apparent disregard for others.

Would this be dementia? Yes, shrinkage in the frontal lobes of the brain are a form of dementia. Frontal-temporal dementia is probably the least diagnosed form of dementia. Families know that there is something wrong with the elder, that he is difficult to get along with, easy to anger, unable to change behaviors, decrease in personal hygiene, etc., but few use the word dementia.

Cars, driving, and bad decision making, whether very young or very old, a bad combination.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

STRANGE AND EMBARRASSING BEHAVIORS IN THE ELDERLY – FRONTOTEMPORAL DEMENTIA

Urinating in public, touching strangers, angry outbursts, running stop lights, driving on the wrong side of the road, shoplifting, indecent exposure, and so many more behaviors that those very elders would have found shockingly inappropriate in the past.

However for families the most troubling and strange behavior that is first noticed is the disregard for other people. Fran first noticed this in Charles when he traded in his sedan for a huge truck. A vehicle that she would never be able to get into. This purchase demonstrated a disregard for his wife’s arthritic condition which she had struggled with for the past 20 years. A disregard for her height, as she is a very petite woman. A disregard for her age, basically a disregard for Fran.

Now, whenever the couple went anywhere together, they had to use Fran’s car. This meant that now Charles was very involved every time Fran bought a new car. If Fran liked a car, no Charles needed more leg room, you can’t get that car. Instead of driving a car she liked, Fran now had to drive a large sedan, more to Charles’s liking.

Fran now was paying for a more expensive vehicle than she needed. Her up keep on the car was more expensive, as it always was a gas guzzler that Charles insisted upon. And no, Charles felt no need to contribute in any way, as he continually showed no regard for Fran.

With frontotemporal dementia, as these areas of the brain shrink, the person you once knew changes into another person. A person with increasingly strange and often embarrassing behaviors.

The frontal lobe of the brain is where reason, judgement, safety awareness, organization, planning, all of a person’s higher functions are located. Once this form of dementia, this disease progresses, those higher functioning abilities are diminished.

So now as Fran can see that Charles is showing little regard for societies norms, while he drives on the opposite side of the road because as he says “whats the problem, no one is coming!” She remember years ago when he started showing no regard for her, when buying his truck.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

WHEN THE PERSON WITH DEMENTIA HITS, PUSHES, OR GRABS

When a person with dementia strikes out, it is upsetting for all involved. Whether it is hitting, shoving, grabbing or whatever physically aggressive episode, finding out the cause is most important.

Start keeping a journal of these outbursts. Include the time the incident happened, the date and most important what was happening right before the outburst. Who was with the elder during the outburst, and what worked to change the situation.

Every caregiver needs to know the elder’s routine and realize how important it is to stay with the routine. Approach is all important. Always approach a person with dementia from the front, in a calm and caring manner. Quick movements or coming from behind the person can be perceived as a threat to the person due to his dementia.

Make direct eye contact with the elder, use his chosen name, and explain what you will be doing step by step. Do not overwhelm the elder with too much information too fast. When giving directions, make them easy to understand, one step at a time and wait at least 10 seconds for a response. Persons with dementia have slower reaction time and need more time to process directions.

When the elder attempts to hit, or act aggressively, step back, making direct eye contact assure him of his safety. Using his name, state his inappropriateness, and tell him that you are leaving the room. Return in 5-10 minutes acting as if nothing has happened and start fresh.  Do not turn your back on an angry confused person, and stay at least 2-3 feet away, out of arms reach.

If the elder is doing something dangerous to himself of others, in a very firm voice say “”No” or “Stop.” Once the outburst is over assure the elder that he is safe, this incident upset him as much as everyone else involved.

Keeping track of outbursts by writing them down will help in identifying triggers. Is the elder over stimulated, tired, hungry, thirsty, are there too many people and the environment too stimulating? Is the task you are doing with the elder too difficult?

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