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

WHY YOU DON’T ARGUE WITH A PERSON WITH DEMENTIA OR DELUSIONS

The elderly person with dementia, who has a persistent fixed incorrect idea or delusion, is literally unable to change their mind. The idea might be harmless, as in the case of the elderly woman who insisted she was always on a train. Or it might be dangerous as the person who is insisting he has to leave and go to work, when he hasn’t worked for many years. Harmless or not, these ideas frighten the family or caregiver because it demonstrates irrational thinking.  Using rational explanations or arguing doesn’t work when the person is unable to change their mind.

5 ways to address delusions without arguing:

  1. Let it go if at all possible. If the idea is not dangerous, doesn’t bother the person or others, let it go.
  2. If the idea or delusion is frightening, such as the woman who thought people were living on her patio, give reassuring , comforting words. “I am here and will stay with you,” while you use a distracting activity.
  3. A delusion might be an expression of some fear. Look to the environment. Are there shadows, do you need more light, are curtain or shades open at night creating reflections on a window?
  4. Support the feelings the person expresses, not the delusion.
  5. Ask the person to show you what they see. The shadow on a wall, when reality is distorted, may become a ghost to the confused.

Many delusions are just plain hurtful, as with the spouse who is no longer recognized and is accused of being an impostor. Some delusions are very embarrassing for the family, and require understanding and the education of others.  Well meaning friends and acquaintances may intercede and begin arguing the irrational  idea or delusion. Look at this as an opportunity to educate other people, so that they may support you, in creating your plan of care for this person.

When caring for the individual with irrational ideas, you never argue these thoughts away.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

DEMENTIA CARE – DECORATING FOR DEMENTIA – CREATING A SMART ENVIRONMENT

Lets face it we cannot get away from environment.  We are always in some kind of environment, but is it a healthy environment or troublesome environment? And for the person with dementia many things we take for granted in the environment are unhealthy as well as troublesome. These are environmental stressers that the person with dementia either hears, sees, or think they see.

Hearing stressors, are anything that is too loud. This can be the rattle and clink of utensils in a restaurant or even the voices when several people are talking at the same time, at the next table.  Anything that causes constant noise, like the TV or radio.  It will also be things that cause sporadic loud noises like a vacuum or landscapers.

A hearing stressor can also be when the person, who is trying to communicate with the confused person, just talks too fast. If the person is trying to understand, and can’t even catch the words, trying so hard will be stressful. And creates an environmental stress, where the person just seems to want to get away.

Things you commonly see in an environment can be very stressful for the confused person. When a person with advanced dementia looks at a shiny floor, it can appear as if there is water on the floor. Or even worse, that there is ice on the floor. A dark area of a carpet or tile can look like there is a big hole in the floor. Another frequent problem with flooring is small patterns. A carpet with obvious patterns will look like there is something on the floor. Many an elderly person has fallen trying to pick up something that wasn’t there.

The demented person does need contrast in color to be able to see the difference in surfaces. In a bathroom, if the tile floor is solid white and the toilet white, the person will have difficulty locating the toilet. He just doesn’t see white on white. In the same way when eating, a white plate on a white table, needs a colored place mat under the plate for the person to see it.

Keep this in mind, when walking around the house, think of contrast in doorways and furniture compared to wall color as well as floor color. Using the environment for great dementia care.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

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

 

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

MILD COGNITIVE IMPAIRMENT – NOT ALWAYS EARLY DEMENTIA

“I think mom might have early Alzheimer’s disease” says the worried son. “I saw the other day that she had left the burner on the stove on, and walked into another room.” I wouldn’t worry too much about one incident the dementia specialist said, “sometimes I do things like that myself.”

The dementia specialist is over sixty-five herself, and knows she has a problem with distraction. As a person ages they begin to become more easily distracted. The classic story is always about walking into a room and forgetting what you are there for. If someone talked to you while you were going to get something, or you answered the phone on the way, you became distracted. I frequently remind people of times they might have forgotten where their car was parked.

The concerned son should keep his eyes open for other changes. How is his mom doing cooking? If she always was a great cook and made many things from memory, and still does, nothing to worry about there. If on the other hand she now has problems with things like measuring, getting confused with familiar recipes or putting together a meal, these could indicate a problem.

If his mom always followed the news, and now seems to be having trouble remembering news and recent events, this would indicate a problem. The problem comes when there is a change. If the person never was interested in the news, this is just in line with their personality.

If mom never was much for handling finances, then her lack of money sense is just her. However if mom always knew the price of everything on her shopping list, and now shows problems with handling money, it is time to take a close look.

If mom knows what day it is, doesn’t get lost in familiar places and recognizes people around her, and there are no other noticeable changes, then the stove incident was a simple lapse. Yes, a potentially safety issue, and mom should be as concerned as everyone else that she had this lapse. She should vocalize, that she will make an effort to focus more on what she is doing. But if there are indications in the kitchen that there have been other safety events. Such as burned cutting boards, charred pots, pans, cooking utensils, or possibly missing items because they were discarded after an incident. It is now time to closely monitor mom.

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

 

DEMENTIA AND DELIRIUM INCREASE CHANCE OF FALLS

Confusion due to dementia and delirium are known risk factors for falls in healthcare. Researches have noted that persons with confusion have a risk of falling 1.8 times that of the elderly without dementia. Falls in the elderly are predictable when the elder has; balance problems, problems with dizziness or fainting, cardiac problems, arthritis, osteoporosis, vision problems, is weak from immobility or a recent infection, is taking numerous medications or a medication for anxiety, or depression.

But the risk of a fall increases to almost double the risk when the elderly have dementia or delirium as well as the other known risk factors.

Behavioral problems – the person with dementia or delirium will have decreased safety awareness and make poor decisions. The person with dementia or delirium are more likely to forget to use assistive devices such as canes and walkers, or stop and put on good safe footwear. If the person also experiences angry outbursts of a physical nature, this also greatly increases their risk of falling.

Dietary deficiency –  the person with dementia or delirium can suffer from a poor nutritional status due to bad food choices. Adequate protein, essential vitamins, and water are needed for good health.  And especially vitamin D and calcium are necessary for strong bones.

Vision changes – a person with dementia can experience a decline in the ability to sense where they are in space. This often results in sitting down and missing a chair. Added to that a decrease in visual accommodation to light and dark, glare intolerance, altered depth perception and possibly physical changes in eyes due to aging, increase the risk of falls to an even greater degree.

Chronic illness – arthritis causing stiffening of joints, osteoporosis and bone deterioration increases risk of injury related to a fall, stroke and Parkinson’s disease increase the risk of falls. These are known issues with aging, and the elder with dementia who has painful swollen joints from arthritis is at even more risk.

Acute illness – has been shown to be a factor in 10% to 20% of falls in the elderly. An acute infection will cause weakness, fatigue, even dizziness. But the person with dementia or delirium will have an increase in their confusion.

Continuous monitoring of the elder with dementia or delirium is necessary as well as monitoring for these increased risk factors.

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.