Dementia/rape trauma syndrome

  1. deleted
    Last edit by adrienurse on Sep 17, '08
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  2. 17 Comments

  3. by   Sleepyeyes
    Yes, we once had a dementia pt who had been in a concentration camp. Just bringing her into the shower room freaked her out so bad that she was literally wild, trying to get outta there.

    So they finally got the doc to write a prn antianxiety to give her a couple of hours before her shower, and that helped. Tried everything else first, and frankly, it was horrible to watch her go through this, so i really think that the med was the best alternative in this case.
  4. by   Youda
    Oh, yes! This happens often enough with dementia/alzheimer patients, and I have seen this often.

    Bathing and personal hygiene is the most personal and private activity. Many people, prior to their illness, never undressed in front of others. To do so now, is a very uncomfortable experience that causes the personal to be completely vulnerable. It is a strong statement that the person is no longer able to do for herself. The loss of independence can be terribly difficult. It is important to recognize that these feelings may be contributing to the resistence. The dementia may also cause a person to BELIEVE they are being raped when you attempt to give care. Also consider that changes in the hypothalmus region of the brain can cause mixed signals causing changed sense of perception of hot and cold. The sensations of bathing may also become much different than you or I would experience for the same reason. A warm, soft washcloth can feel like a searing hot bristle brush. Other factors that can cause this behavior include:
    fear of falling
    fear of water or being hurt by it
    disruption in daily routine or schedule
    unfamiliar caregivers
    mechanics of taking a bath too overwhelming
    purpose of bath forgotten
    humiliation of being reminded to take a bath
    agitated from another unrelated cause
    feelings of being rushed by caregiver
    Feeling embarrassed and vulnerable about being naked in front of others
    fatigue
    fear of hair washing, a task which is no longer understood
    kept waiting too long while caregiver prepares bath
    fear of soap, washcloth, sound of running water
    depression causing loss of interest in hygiene
    physical illness
    changes in gross motor skills
    changes in fine motor skills
    memory loss (can't remember why they're getting undressed)
    side effects oof medication causing dizziness
    too many distractions such as noise, people, clutter in room
    lack of privacy
    room temperature
    task too complicated
    caregiver not giving simple or clear instructions
    attention span too short for task
    no longer able to recognize bodyparts
    Etc.

    This is a really tough problem as you know! I'd suggest first trying to figure out what is causing it from some of the possible causes. Since you know the patient better, you might be able to zero in on even another cause of it. But, if you can't find the cause of the behavior and a good intervention, AS A LAST RESORT, you should get an order for a haldol or ativan to be given about 30-minutes before attempting hygiene. The risk of injury is too great without calming the patient first. As much as we all hate to medicate, it's kinder and gentler than allowing the patient to suffer this trauma every time hygiene is needed. Good luck to you. You're a caring, wonderful nurse!
  5. by   Zee_RN
    Cared for an elderly, demented woman who was very docile most of the times. But once you needed to clean up her peri-area, she would begin sobbing and pulling her night gown down and calling "Mother, oh, Mother!" and also "Oh no, Mr. so-and-so, oh no!" I can't remember the name of the Mr. but she would sob "oh no" and "oh, Mother!" and it was heartbreaking. I think she must have been raped as a young girl too.
  6. by   KRVRN
    Man, that must be so hard. Sad.
  7. by   sjoe
    Pre-bath medication sounds like the best way to go.
  8. by   KaroSnowQueen
    I tend to think she is acting out something that happened years ago. We had a patient who would hold a dolly all day long, and when you took it away for bath time or whatever, if she couldn't see it, she would cry pitifully, "Oh Mommy don't make me give my baby away, I want to keep it." Her husband , who was not demented and lived at home, said they had never had any children, but we always thought perhaps she had one given up for adoption before or something. Things that seem trivial to us seem to trigger something deep inside these patients. It is so sad and pitiful to see this happen.
  9. by   sunnygirl272
    sleepy---this is in no way an attack on you....but...
    In the case of the concentration camp survivor...why make her shower? seems even with drugs to be a cruel and inhumane thing to put her through...????
  10. by   Sleepyeyes
    Originally posted by sunnygirl272
    sleepy---this is in no way an attack on you....but...
    In the case of the concentration camp survivor...why make her shower? seems even with drugs to be a cruel and inhumane thing to put her through...????
    it wasn't the shower, i don't think--- it was the shower ROOM that reminded her of the gas chamber. I was a CNA and this method was worked out in Care Plan before I was ever employed there.

    Was there some other way to get this woman's hair washed that was overlooked? Still open to suggestions; dementia pts are quite a challenge and any ideas for helping them through it are welcome.
  11. by   adrienurse
    I am quite used to people being resistive to personal care done by a "stranger". This seems different though. She is reacting is so much TERROR to the situation. She says things like "you always hurt me!" and "you dirty bugger, don't touch me!". We do give her pre-shower sedation before her weekly shower (not bath--way more traumatic) -- but to sedate her 3X a day is too much. She's really sensitive to anything but quetiapine and olanzapine and ativan just snows her for a long time. I'm not aware of any fast acting anxiolytics that do not later cause a risk for falls (she is ambulatory). Any suggestions?
  12. by   RN from OZ
    This is a not uncommon situation.
    I have seen this many times before, but the terror that you are
    refering to is like a lady we had who was in a concentration camp, and had her pregnacny treminated by a camp Dr, and was also repetedly raped during her time in the camp.
    We obtained this information from her family.
    We had a very difficuilt time with her and tried everything...even down to a shower/bath every 3 days, and also had the issues of over sedation as she was a walker.
    We have had good results with a drug called Kalma...or Xanax...I do not know if you have it in the US but it takes effect in 30 min and has a 3-4 hour half life.
    It has not irradicated the fear she has but has made her more compliant and she will listen to your explanations .
    Best of luck
  13. by   semstr
    Did you try to do the Validation-method from Naomi Feil with her?
    You'll need trained people for that though, but it always work.

    Naturally, I have been caring for a lot of old people who survived WW2 in camps (either in Nazicamps or Japanese camps) and most of them were never able or had the possibilities to talk about their camplives. Now when they get old and demented all these horrorstories are being relived. Naomi Feil calls this "a person's rucksack".
    And not until this rucksack is empty, the demented people will calm down.
    (I am sure there is a internetadres on Validation)
    I only had a basictraining, that took a week, but it is a miracle what you can do for these poor people!
    Take care, Renee

    PS: NEVER take Nazicampsurvivors to an empty bathroom!
  14. by   rncountry
    Renee, I will have to look up the information that you posted. In a facility that I was a DON in we had a patient who was a Nazi Camp survivor. She had alzheimers, and doing nearly anything with her was a trauma for her, and often had staff in tears as well.
    I went in on a night shift once because I had a nurse who was ill and needed to go home. I was sitting at the desk when the most God awful howls started and had me running down the hallway. When I got to this woman's room she was standing on her bed, howling, screaming wildly and pulling at her hair. The whole scene was so shocking that I literally stood there frozen not knowing what the hell to do. A couple of CNA's came running in past me, got on the bed with her and talked and cooed to her until she was calmer. One of the CNA's, old enough to be my mother, then got the patient out of the bed and held her in her lap and rocked her like a baby. They told me that this situation happened frequently. I did not know that, had been working there about a month. To watch another human being going through what this patient did, day after day, was absolutely heartrending. She seemed to relive her concentration camp days each and every day. I can hardly think of anything so awful as to have alzheimers, yet to be able to remember the terror one went through.
    I no longer work at this facility and have never had another patient like her, but the information that you passed along would be useful to know just in case. Particularly because were I work now we do get vets from WWII more frequently than we used to.
    The only other situation I had that could compare was a woman who had nearly drowned as a child who would fight like a tiger when we bathed her. Had her two or three months before we found out that information from her family. After we knew what the problem was we only did an actual shower once a week and sedated with xanax first. The rest of the time she received a bed bath, which did not bother her. We never put her in a tub again, only the shower.
    Wish I had some answer andrienurse. Very sad situation.

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