Dementia/rape trauma syndrome

[adrienurse, LPN]

deleted

[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.

[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!

[Zee_RN, BSN, 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.

[KRVRN, BSN, RN]

Man, that must be so hard. Sad.

[sjoe]

Pre-bath medication sounds like the best way to go.

[KaroSnowQueen, RN]

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.

[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...????

[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.

[adrienurse, LPN]

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?

[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

[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!