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

 

THE ANGRY AND AGGRESSIVE CONFUSED ELDER

Many an angry confused old man goes to live in a nursing facility because the caregiver can no longer manage the aggressive behaviors. And in many cases the caregiver might even be frightened and concerned that they may get hurt. The elder who becomes physically aggressive, hostile and combative puts everyone including himself in harms way.

Sometimes the behavior follows a pattern and you can see the anger building until there is an act of aggression.  But for some the aggressive act comes suddenly, almost from nowhere.

Ed, was the suddenly aggressive type. Ed married late in life and he and his wife never had children. Ed became the favorite uncle to his nieces and nephew.  He was the one who tirelessly pushed them around the block on their bikes until they got the hang of balance, and could take off on their own. Yes, Ed was known as a very kind, thoughtful, and quiet man. Well, respected in his community.

Now he was confused, diagnosed with mid-stage Alzheimer’s Disease and living in a nursing community. The first thing the family did when Ed moved into the community, was to inform the nursing staff that Ed could become physically aggressive. They realized that when Ed was asked to do something he no longer could do, he would quickly become frustrated and then angry.

They told the staff that what worked very well with Ed was to use courtesy, say “please” when giving directions. Words that were inclusive worked well, “Walk with me to the dining room,” “Lets get dressed, its almost time for breakfast.” Using specific, concrete, and positive words, while avoiding negative words like “No,” or “Don’t.”

When a confused elder shows signs of getting annoyed, uncomfortable and uneasy in a situation, the caregiver can use humor. If the elder, like Ed, looks like he is struggling with putting his shirt on, turn the focus to the caregiver. Blame yourself. “Oh no, what did I do now, did I give you that shirt inside out?” Then laughing say you don’t know what you are doing, it is a crazy day.

Give the elder that gift of preserving their dignity, by not pointing out mistakes. Ed knows he is making mistakes, his day is full of them. And when he is frustrated and angry, he is really angry at himself.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

DEMENTIA 101 – DISEASES THAT CAUSE DEMENTIA

Dementia is not a disease. The word dementia refers to a number of symptoms such as a decline in the ability to reason, remember, and even focus and think. There are many diseases that cause dementia and because each disease affects the brain in different ways, the word “dementia” is a broad term.

The most prominent disease is Alzheimer’s because it affects so many more people than Parkinson’s, Huntington’s, even stroke. Not only do the diseases resulting in dementia, affect the brain in many different ways, the cause and rate at which the dementia progresses is also variable.

In Alzheimer’s disease the outer layers of the brain are most affected resulting in the loss of memory and language. Other diseases such as Parkinson’s, and Hydrocephalus (fluid on the brain), affect the inner parts of the brain. This results in a decrease in the speed of thinking and an inability to initiate movement. Many times a person with Parkinson’s will actually get “stuck” in place while walking. They had a sudden inability to move and need to take a step backwards before they can once again go forward.

Dementia can also be the result of a severe trauma to the brain. Head injury resulting in blood clots can cause dementia. Brain tumors, a Vitamin B-12 deficiency, hypothyroidism, and of course multiple strokes may result in dementia.

As in all conditions what you are looking for is a change. If a person never could remember names, and they run into someone at the mall that they haven’t seen for years, and don’t know their name, it doesn’t mean they have Alzheimer’s disease. But when something is different and unusual for the person, especially if it has come on quickly, that requires a visit to the doctor for testing. Testing to rule out infection, drug interactions, depression, nutritional deficiencies, all of those things that can make a person appear to have Alzheimer’s disease.

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

DEMENTIA 101 – WHAT IS DEMENTIA?

Many people use “dementia” and “Alzheimer’s disease” interchangeably as though they are one and the same. Dementia is not a disease in itself, it is a combination of symptoms, which may accompany a disease.  Those symptoms are; the ability to reason, think, remember and often a change in behavior. There are many diseases that can cause dementia. Diseases such as Parkinson’s, Huntington’s, Pick’s, stroke, Creutzfeld-Jakob, as well as many physical conditions result in dementia.

Symptoms of dementia:

The ability to reason. Grace was in her late 70’s, living alone and coping just fine. That is until her local  grocery store decided to remodel. They relocated all of their products, moving them about all over the store. While Grace was in a routine, she had been able to locate all of her frequently purchased items, and she functioned well.

But this drastic change caused Grace to walk the store for hours a day, not buying anything. Grace was no longer able to reason and figure out for herself where new locations would be, nor was she able to ask for assistance. Very soon her daughter noticed that Grace was losing weight, and taking a closer look at her mother’s life, found out about the store re-model and her mother’s problem with reasoning.

The ability to think. In the early stages the person may have times when he appears confused, perplexed or is struggling to organize his thoughts. He may appear as if in a dream world and fail to respond to questions. He may report strange thoughts or be unable to think of the date or time.  He may be having trouble participating in small talk with friends or participate in activities.

The ability to remember. In normal aging memory loss, the elderly person has been distracted and failed to form a memory. As in those infamous lost keys, cell phone, pen, all of those things that everyone misplaces daily. As people age they begin to have distraction problems. If two older people  walk into a department store and they are talking, they may be distracted. When they leave they might not remember where they parked the car, because they never laid down that memory, due to distraction.

In Alzheimer’s disease this memory loss is not particularly worrisome for the elder. The elder with normal memory loss will be concerned about it, and just take a little longer to access memories. If given a few clues or reminders they will be able to retrieve those memories. For the person with Alzheimer’s disease the memory is just gone.

The public is more aware of Alzheimer’s disease because it is the most common cause of dementia. While many other diseases and conditions cause dementia, the most often source is Alzheimer’s disease.

Virginia Garberding R.N.

Certified in Gerontology and Restorative Nursing