A gentle approach to dementia...

  1. OK, truth-in-posting: I'm preparing a presentation for relatively new nurses on dementia. I wanted to include input from the allnurse experts on creative ways that you deal with confused patients, particularly in this restraint-free current atmosphere. Any input would be GREATLY appreciated!!! :kiss Thanks! Nursemouse
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  2. 19 Comments

  3. by   bellehill
    nursemouse...I think the way to deal with confused patients depends on the level of confusion. If they are confused and agressive, never hesitate to use restraints and get security involved if needed until they calm down. If the patient is simply confused and not agressive; ask the family to sit with them, move the patient out to the nurse's station to sit in view of everyone, give them something to do (folding towels, magazines, puzzles). A lot of times restraints will only make the situation worse and agitate the patient. Just try to keep them calm and make sure they feel safe.
  4. by   Jenny P
    What type of facility are you talking about? Bellehill gave a good answer for a pt. in an acute care facility; but I think the approach would be different for a LTC facility.
  5. by   BrandyBSN
    haldol? just kidding....

    TV (nick at nite really seems to help), family members at the bedside, and songs from their time... also calendars and clocks to keep them as oriented as possible.
  6. by   howie122832
    All of the above, but I really found the folding of towels or socks in a basket worked really well to occupy their time. We had an alzheimers patient that was very loud and combative if she wasn't otherwise occupied, so we got a laundry basket full of socks and towels and told her that she needed to "do" the childrens laundry, and she would sit there and mate the socks and fold the towels. When she was finfished, we would un-do everything she had done and she would start over again!... she also like to color, do childrens puzzles, blocks, etc... Good luck with your presentation!
  7. by   ktwlpn
    Originally posted by nursemouse
    OK, truth-in-posting: I'm preparing a presentation for relatively new nurses on dementia. I wanted to include input from the allnurse experts on creative ways that you deal with confused patients, particularly in this restraint-free current atmosphere. Any input would be GREATLY appreciated!!! :kiss Thanks! Nursemouse
    I have found that therapeutic touch,a calm approach and a potty break and FOOD work wonders in LTC....One of the major factors I see that staff is responsible for that contributes to agitating the dementia residents on my unit is loud noise...If you can keep things calm around them you see a difference-age appropriate music is good but not too loud...Laughing and joking in a loud way can really upset and make a resident escalate-so can talking to them loudly and in a condescending tone.Also-if you have someone unable to safely ambulate independently an inexpensive and often very effective method to keep them safe is a low chair-we got maintenance to actually cut down the legs of some of our chair-at and angle with the front slightly higher-like a low Adirondack chair-very comfortable.Not considered a restraint because our friends can get up but these chairs slow them down so that you can get there and walk with them....Doll babies,folding,washing and wiping can all work-you just have to know your resident.But THE KEY is realizing (and teaching the significant others) that THERE IS NO PILL TO FIX THIS-and the best we can do is keep them safe,fed and as clean as possible-and maintaining as high a level of function for as long as possible........Can't MAKE them do anything....If they want to walk-walk with them.Crawl? Do the same-and give them a safe area to move in....I absolutely love getting to know my residents and trying to determine what causes their behaviors and finding ways to manage them-
  8. by   gwenith
    Please! Include the concept of diminished processing. All too often i have seen my colleagues approach a confused patient (whether post head injury alzhiemers or Korsakoff's it doesn't matter) one will stand one side and the other will stand the other side and talk to them. Then they wonder why the patient errupts violently! Basic priciple - with pts who have reduced capacity to process information the more information given the less they are able to process and the more likely the violent outcome.

    The Ranchos Los Amigos Scale - levels of cognitive functioning does give a good assessement of cognitive state and in some texts also has interventions appropriate to each state. Althoough this scale was originally designed for post head trauma victims it should be applicable - at least in some instace to the patient with deteriorating mental function.

    I have heard where reality reorientation combined with aromatherapy has had a significant impact unpon aggression and behaviour.
  9. by   Rapheal
    I greet them with a big smile everytime I am in the room. I also try to redirect them if I can. I will question them about something they were talking about before such as "So you lived in Memphis for how long? or "What did you and Ellen like to do, remember you told me you and Ellen liked to play bridge" and so on. Good luck on your presentation!!
  10. by   nursemouse
    Wow! Awesome responses, and many things I hadn't heard of before. Yes, I do work in an acute care facility. Gwenith, I hadn't heard of the scale you mentioned, but I'm going to the web to see if I can download a copy and include it. Please post or PM me if you have a link I truly appreciate the answers and anymore you can provide. I knew you would come through. Many thanks!!! :kiss :kiss Nursemouse
  11. by   oramar
    Cargal talked abput and once posted about a seminar she took called Validation Therapy. Go to search and type in Validation Therapy and read her post. I for one hope to take a seminar like that someday.
    Last edit by oramar on Apr 29, '03
  12. by   betts
    Mood and Emotional Behavior. Alzheimer's patients display abrupt mood swings and many become aggressive and angry. Some of this erratic behavior is caused by chemical changes in the brain. But certainly, it can also be attributed to the terrible and real experience of losing the knowledge and understanding of one's surroundings, causing fear and frustration that they can no longer express verbally.

    The following recommendations for caregivers may help reduce agitation:


    Keep environmental distractions and noise at a minimum if possible. (Even normal noises, such as people talking outside a room, may seem threatening and trigger agitation or aggression.)
    Speak clearly. Most experts recommend speaking slowly to an Alzheimer's patient, but some caregivers report that Alzheimer's patients respond better to clear, quickly spoken, short sentences that they can more easily remember.
    Limit choices (such as clothing selection).
    Offer a diversion, such as a snack or car ride, if the patient starts shouting or exhibiting other disruptive behavior.
    Simply touching and talking may also help.
    Maintain as natural an attitude as possible. Alzheimer's patients can be highly sensitive to the caregiver's underlying emotions and react negatively to patronization or signals of anger and frustration.
    Showing movies or videos of family members and events from the patient's past may be comforting.

    Although much attention is given to the negative emotions of Alzheimer's patients, some become extremely gentle, retaining an ability to laugh at themselves or appreciate simple visual jokes even after their verbal abilities have disappeared. Some appear not unhappy, but to be in a drug-like or "mystical" state focusing on the present experience as their past and future slip away. Encouraging and even enjoying such states may bring some comfort to a caregiver.
    There is no single Alzheimer's personality, just as there is no single human personality. All patients must be treated as the individuals they continue to be, even after the social selves have vanished.

    Appearance and Cleanliness. For the caregiver, grooming the Alzheimer's patient may be an alienating experience. For one thing, many patients resist bathing or taking a shower. Some spouses find that showering with their afflicted mate can solve the problem for a while. Often the Alzheimer's patient loses the sense of color and design and will put on odd or mismatched clothing. This may be very frustrating to a loved one, particularly since (certainly in the beginning) embarrassment is a common and painful emotion experienced by the caregiver. It is important to maintain a sense of humor and perspective and to learn which battles are worth fighting and which ones are best abandoned.
  13. by   ktwlpn
    Originally posted by nursemouse
    Wow! Awesome responses, and many things I hadn't heard of before. Yes, I do work in an acute care facility.
    I have often wondered why acute care facilities don't have "geriatric units" We have peds, etc, Geriatric pts have unique needs and should be treated by staff with understanding of same.....
  14. by   perfectbluebuildings
    I agree ktw. Also, I work with residents of a long term care facility as a coordinator of an adopted grandparent program, and I was wondering what you do when a resident thinks they know you and talks to you about people in their family as if you know them too, or other similar things. A lot of times with certain residents I will just go with the flow and pretend, maybe this is a bad idea? It always seems to keep them calm and we visit pleasantly, of course that is a different kind of interaction than nursing. So what do you all think?

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