6 REASONS THE BEST CAREGIVER TAKES THE TIME TO DEVELOP TRUST

In 1950, Erikson talked about the basic concepts of trust vs mistrust in the development of an infant. This led to the concepts of patients having trust in their nurse, that also implies, someone they can rely on. The person caring for them that they have confidence in for continuous care, the person that they trust, and who gives them hope.

When there is a trusting relationship:

  • the patient is more likely to share information with the caregiver.
  • the patient is going to be more willing to cooperate with treatment.
  • the patient demonstrates that she knows the caregiver has her best interest at heart.
  • the patient who trusts will have decreased negative physical concerns.
  • the patient who trusts will experience fewer behavioral problems.
  • the patient will experience less stress.

This is not a social relationship due to the fact that the focus is always on the patient not the caregiver. The caregiver doesn’t share their personal problems with the patient. But, rather focuses their attention on the patient and the patient’s needs.

Listen, show and tell, to develop trust. Show your concern and respect for the patient. Show concern by being very sensitive to pain, discomfort, hunger and thirst. Show respect by being very sensitive using the patients preferred name, awareness of the patient’s age and to privacy issues. Listen to the patient, and let her know that you are taking her thoughts and ideas seriously. And, tell the patient often that you will be there, reassure that you will take care of her, tell her that you want her to be comfortable and happy. Tell her, that it means a lot to you to be able to take care of her.

When the relationship is well established it can certainly become social as the patient and caregiver bond through activities, shared laughs and experiences. But the first work of the caregiver is to build trust. The caregiver who is either unwilling or unable to put another person first, and develop that trust, will never be that best caregiver.

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

 

MEMORIAL DAY – GREAT FOR REMEMBERING – HONORING AND TELLING STORIES

What I remember most was that they (my family’s military men) never talked about it, the war, “their” war. Every generation has what they consider their war. The war for my generation was the Vietnam war. For my uncles it was WW II. My great uncle Ray had served in the Army and I wish to this day that I knew where he had served, and what he saw. But he never spoke of it, not to me, not to my great-grandmother, grandmother or my mother. What we knew of the war was through news papers and later history books.

Uncle Harvey also served, in the Air Force and came back in one piece. There was that dent in the metal cover of the Bible he carried next to his heart, that he never explained. Like Uncle Ray, he had nothing to say, yet in every other way he was the consummate talker.

When Uncle Harvey returned he became a car salesman and was always known to drive the latest convertible. He was a good-looking, cigar smoking, and fun loving talker. But not about that, his war. I wonder if he just wanted to forget it, and get back his life. He went on to marry a widow of one of his buddies in the war. He raised her daughter as his own, and they had a very happy life.

Mom worked in a factory during those war years, she was a Rosie the riveter. In her later years she loved to reminisce about her years of high school. She most liked to talk about when we were kids and always said that was the best part of her life. But about those, war years that she was so very much a part of, she was unusually quiet.

Uncle Harvey’s picture in his uniform, is on the cover of my book, Please Get To Know Me – Aging with Dignity and Relevance.  My mother is sitting in front of a piano her parents had given her for her birthday. It is early 1943 and her brother is away in the war. And so his picture is on the piano and a star is in the front window.

Everyone knew these uncles had served but they never claimed a bigger share of the American dream. They never held forth in political conversations as though their opinion was any more valuable than anyone else’s, because they had served. They never got those uniforms out again, never marched in parades, and most of all never talked about it.

Like so many others just like them, all they wanted was just to fit in and pick up their lives. This is probably the biggest difference with the wars. These men came back physically whole, medicine wasn’t advanced enough to save the kinds of war injuries seen later. By Vietnam, the medical community could save so many more and we now had those severely damaged warriors.  Much more damaged in body and spirit, than seen before.

I never was able to hear my families stories, but thanks to nursing, I have been able to hear others stories, from those who need to tell.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

EARLY STAGE ALZHEIMER’S DISEASE AND CAREGIVING

Caregiving for the person in early stage of Alzheimer’s disease, is in some ways very different from the mid-stage and late stage caregiver role.

The early stage caregiver is in many ways a companion. A very alert and involved companion. A person who is proactive in preventing accidents. Looking at the confused person’s environment, while not changing the environment, (which would increase confusion) but modifying as needed for safety. Knowing the confused elder may no longer be that aware of tripping hazards, the danger of walking in busy parking lots, or handling hot food. So many areas in our, day to day lives, where our own personal safety awareness and good judgement keep us safe.

Helping the confused elder with communication difficulties. Giving the person that extra time they now need to get their thoughts in order. Not rushing the person as they are searching for words, and when providing those words, doing it in a way that is supportive not critical.

By offering frequent reminders of where the person is and what is going on. When the person has a concerned puzzled look on her face, the caregiver gently reminds her that she is at the mall, close to her home. Providing information to the date, time of year, temperature and most of all who people are in relation to the confused elder.

Keeping to a routine and familiar places gives the mildly confused person a sense of security. When that is not possible, as in the case of a change in residence. The caregiver needs to use less verbal directions and more walking a person through the new environment. Accessing that body memory through repetition, by doing something over and over, can re-create that routine and familiarity. Routine and familiarity bring comfort.

Taking time, while stepping back and trying to see what might increase confusion, and what the caregiver can provide to decrease that confusion.

The need that remains is always the same throughout the disease process, is for the the caregiver to be so very kind and understanding. Understanding of the struggles the person is facing to still be here. Support to still maintain their independence as much and as long as possible.

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

 

TALKING ABOUT DEMENTIA – AND THE GIFT OF LISTENING

There they were cruising the Caribbean as she said they had done so many times before. They were Ben and Dahlia from Texas. They looked like so many of the other aging couples on that cruise ship. But after the brief introductions at the large dining room table, Dahlia found the need to tell the table that Ben has dementia.

What was so much more obvious than Ben’s confusion was Dahlia’s need to talk about it. Even to a table full of strangers, for one short meal on a seven day cruise, she felt the need to tell.

This information wasn’t needed for their table companions. Ben was impeccably dressed, even to the white sweater tied by it’s sleeves over his shoulders and sun glasses perched on top of his head. It wasn’t because of Ben’s table manners, although slow, Ben needed no assistance cutting his food or eating. Yes, Ben was very quite, but so are many older men who just sit back and let their wives do the talking.

No, Dahlia needed to tell for herself. She told of their 28 year marriage, the trips they had taken, how life had been before dementia robbed her of the life she once knew. You could see how she needed to tell, as she frequently repeated the same phrase “You should have seen him, he was something.” The listener could tell she has repeated this so many times over these last nine years since his diagnosis. Just saying it gave her a moment to remember, as she was still picturing him as he had been.

When they parted, you could see that people were trying to say something understanding, supportive, and comforting to Dahlia. So just as you do when you see that young mother who is struggling with a baby and toddlers in tow. You smile and say “wow, you have your hands full, and your children look so great and happy,” and you see that smile break out on her weary face. Someone has recognized, how hard her life is, and she is doing it well.

So now you tell Dahlia what an amazing job she is doing. Ben looks so content, and well taken care of, she is surly doing the hardest job there is, that of a caregiver. Dahlia gives you that same smile that you receive from the recognized mom. As you walk away you take one last look back, at this stranger with the big problem and the quiet husband.

7 QUESTIONS TO ASK ABOUT YOUR PATIENT FOR GOOD DEMENTIA CARE

Yes, John has dementia but that really doesn’t tell a lot about the person of John. In order to take really good care of John, you will need a lot of information.

  1. How alert and aware is John? Does he know his name, does he recognize his family, does he know their names, does he know the name of his caregiver? Can he find his way around inside his home? Can he perform a simple task by himself? Can he follow one or two step directions? How does John respond to people?
  2. How is John’s communication? What language would John most likely speak and understand? Is John’s speech usually clear and easy to understand? Does he get words mixed up, or does he make sense when he speaks?
  3. How well does he function? Does John walk, how much support does he need walking? Does John wash himself? Brush his own teeth? Can John comb his hair, or wash his face? How much assistance does he need with these daily tasks? How does John respond to help with these tasks?
  4. Can John eat by himself or does he need help?  How is his appetite, is this a problem? How much help does he need? Can he use a fork and knife safely or does he eat with a spoon? Does he have any swallowing problems, with liquids or with solid food? Does he need a special diet or soft ground up foods?
  5. Does John go to the bathroom by himself? The activity of being able to go to the bathroom independently involves several steps.  You need to know if John is able to wipe himself after a bowel movement. Is John incontinent of bowel or bladder? If John was on timed toileting would he be continent, does he just not make it there in time? Does John always go to the bathroom in the appropriate place? Does he give signs that he needs to use the bathroom?
  6. What are the usual or possibly problematic behaviors you might encounter with John? Is John’s disposition usually happy, sad, does he get angry often or easily? If John does get angry, what if anything does he do, yelling, striking out, hitting, or grabbing? If he is inclined to negative outbursts what usually calms him down? Does John have inappropriate sexual behaviors?
  7. Is John a safety hazard? If John walks does he leave, has he gotten lost? Why, has he gotten lost was he looking for someone, or did he think that there is some place he needs to be? Has he ever harmed himself or anyone else?

Whether you are a paid caregiver or a member of the family, in order to take care of someone with a dementia for a short time or consistently you need information. Important information.

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

5 CRITICAL AREAS OF DEMENTIA CARE

Dementia care involves first and foremost, providing for the safety of the person with dementia. One of the major symptoms of dementia, is the loss of safety awareness. Hand in hand with that, is the loss of the ability to reason, or think your way out of a situation. A real problem, if the situation is dangerous.

Added to providing for safety, is having good dementia communication, knowing what a happy environment looks like for someone with dementia, providing for social and spiritual needs as well as addressing everything physical.

5 Critical Areas of Dementia Care:

  1. Safety – walking alone across a busy highway, putting something on a hot burner and walking away forgetting about it, going outside in sub-zero temperatures without a coat, and more. Protecting the confused elder without having him feel he is being controlled, is good dementia care.
  2. Communication – just having the most beautiful home, with the best security system, won’t lead to great dementia care. Especially if the caregiver doesn’t know how to effectively communicate with a confused person. Good communication involves the speaker and the listener. When the confused elder is no longer able to communicate well, the burden is on the caregiver. The caregiver must know how to communicate through touch, gestures, smiles, patience and kindness.
  3. Environment – the environment needs constant review, and may change over time. Thinking of the environment as a way to make the elder with dementia know where they are and what is expected, is great dementia care. Clutter needs to be eliminated as it contributes to confusion. A kitchen needs to be used for preparing and eating meals. Having a TV running at all times in a kitchen reduces the environmental cues, that are telling the confused person, where he is. Creating a happy environment involves using music, activities, creating enjoyable smells, like the smell of cookies baking.
  4. Social and spiritual needs – whether this means continuing in church attendance, or participating in social groups, these connections remain important.  When the elder can no longer play that card game they won at for years, continuing the activity, while changing the level of the game is what is important. Getting together with familiar people, playing a game, laughing together, watching a movie together, these are important parts of dementia care.
  5. Physical – involves really knowing the person physically. What are the physical problems the person is challenged with other than dementia? Does this person have a vision or hearing deficit? Also good dementia care means knowing when the confused person has had a physical change in condition, when they cannot tell you. Physical also literally means engaging in physical activity to keep the body strong.

Many of these areas crossover to other areas. The person with a hearing deficit, will have an added burden of communication, increasing their confusion. The person who may be diabetic, will no longer be able to understand, how unsafe it is to not follow their diet restrictions.

To provide over all wellness, only 5 areas of dementia care turns, into a very big job.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

Dementia 101 – The First Case of Alzheimer’s Disease

Auguste Deter was born in 1850, and met Dr. Alzheimer in 1901 at the Institute for the Mentally Ill, Frankfurt, Germany. Dr Alzheimer was a psychiatrist and neuropathologist at the institute. This is Auguste’s story.

Auguste was married to Karl Deter, and was a housewife.  At the time Karl sought help at the institute, Auguste; had no sense of time/or place, and she wasn’t sleeping at night. During the day she was dragging sheets all over the house, she was very paranoid and was constantly accusing Karl of having affairs. She was having trouble with language and writing, as well as having signs of anxiety, mistrust and withdrawal, and oh yes, Auguste would also scream for hours.

Auguste was a danger to herself, especially in the kitchen using knives. She was recorded as saying repeatedly “I have lost myself.” Even though the institute was a scary place, known to the locals as the “Castle of the Insane,” her husband had no choice but to bring her there.  Karl was a middle aged man who had to work and no one else was able to care for her.

For thousands of years when the elderly had symptoms of memory loss doctors thought this was just normal aging.  Auguste Deter on the other hand wasn’t elderly, she was only 51 when she first met Dr. Alzheimer. He worked with her documenting her behaviors, memory problems, lose of her words, anger issues and constant paranoia. And later when he left the institute he requested that on her death Auguste’s brain be sent to him.

Auguste died at the age of 55, and her brain was sent to Dr. Alzheimer. Dr. Alzheimer had a very famous friend at that time, Carl Zeiss who had just invented the first distortion free microscope. Dr. Alzheimer took Auguste’s brain tissue, froze it and then sliced and stained the tissue. Putting it under the microscope, magnified 100’s of times he saw for the first time the plaques and tangles later to be known as Alzheimer’s disease.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology