Alzheimer's Lesson?

Ruby Vee, BSN · Oct 8, 2016

I've never worked in memory care and would never want to. My experience with Alzheimer's is a little more personal. My mother in law has it; my mother and four of her six brothers had it.

While I suspect that the common wisdom is NOT to tell an Alzheimer's patient that their loved one is dead (it makes them feel bad and they continue to feel bad even after they've forgotten about the interaction), I think it's more complicated that that.

My father's death precipitated my mother's move into assisted living. The trouble was, she couldn't remember that he was dead and she'd spend her days looking for him, becoming increasingly frustrated when she couldn't find him. She'd call me, frantic, because she was SURE Dad had divorced her, was planning to divorce her, had left her for some floozy, etc. She'd calm down when I'd tell her he was dead, because that meant he hadn't stopped loving her, hadn't left her. (Of course that made for some pretty strange phone calls.). In the small town where she lived, the staff of the ALF all knew to tell her "He's dead, Mary. He had a wonderful funeral and everyone in town was there to pay their respects."

When Mom forgot all about Dad and started looking for HER mother, she was comforted to know "she's with the Angels, Mary."

You're going to get to know your individual patients and figure out what works best for each of them. In the mean time, start with doing what your colleagues do.

CrunchRN, ADN, RN · Oct 9, 2016

Tell them anything that will comfort them.

TheCommuter, BSN, RN · Oct 10, 2016

I wrote about this issue several years ago...

https://allnurses.com/geriatric-nurses-ltc/therapeutic-lying-with-754397.html

If the resident is in the middle or late stages of Alzheimer's, I am usually opposed to telling him/her that a loved one is dead. First of all, they relive the grief repeatedly every time you tell him/her that the loved one is dead. Secondly, they often forget that their loved one has died, so they continually ask, and they grieve each time you remind them that the person is dead. Rinse and repeat.

To me, it is cruel and unusual punishment...

Nascar nurse, ASN, RN · Oct 12, 2016

I wrote about this issue several years ago...
https://allnurses.com/geriatric-nurses-ltc/therapeutic-lying-with-754397.html
If the resident is in the middle or late stages of Alzheimer's, I am usually opposed to telling him/her that a loved one is dead. First of all, they relive the grief repeatedly every time you tell him/her that the loved one is dead. Secondly, they often forget that their loved one has died, so they continually ask, and they grieve each time you remind them that the person is dead. Rinse and repeat.
To me, it is cruel and unusual punishment...

i completely agree (but I got knocked around on allnurses years ago for my term therapeutic lying...I still say those against that haven't spent enough time with that population). I do my very best to just try to distract them with a task, although they're sure to return to the topic.

With that said, I'll never forget my 80 year old confused resident that I was repeatedly distracting from trying to call her Mother...until the day I was confronted by a very alert 100 year old lady asking why I wouldn't let her daughter call her. Oops, now that was an awkward conversation. Haha!!!

KCMnurse, BSN, MSN, RN · Oct 12, 2016

This is difficult and as others have stated, depends largely on the individual. I would be reluctant to tell you that you should always lie or always tell the truth. My own experience is with my mother, who will tell me that her husband has left her - because she can't find him. Sometimes I tell her he's in heaven and other times I remind her of his funeral. It depends on her mood at the time. Sometimes she accepts that he is dead, but other times she is distraught that she is just finding out and why wasn't she told before?

Dementia is a horrible, horrible disease...

vintagemother, BSN, CNA, LVN, RN · Oct 14, 2016

I would try distraction. I'd try therapeutic communication techniques, such as restating. Ex:"so you want to call your mom and dad?"

or redirection, "what do you want to talk to them about?"

Or, "what are your mom and dads names?"

Done conscientiously, not telling the truth can be quite therapeutic.

AndiMac81 · Oct 15, 2016

There's a million things you can try, and a million things that won't work for one, but always do the trick for the next one. Welcome to memory care. í ½í¸

I never tell a resident their loved one's gone. As someone stated, it's all going to depend on each individual resident. It's cruel to make someone relive and restart the grieving process. I've gone as far as removing photos of a woman's dead husband her not so bright daughter left in her room of her sitting in her wheelchair next to the casket, and even went as far as muting the ringer on my personal cell and let them leave me messages from the facility phone. You do what works for them.

I have a few very food oriented residents that will do cart wheels for snacks, assisting them to walk outside, check out the flowers and fall colors, music from their era is a huge hit for some. Talking about their family, occupation, children ... distraction distraction distraction ... I've offered some women to do their nails, help them pick out clothes for the next day ... But generally, attempting to reorient an Alzheimer's/dementia resident is a bust. Some times it frustrates them because they can't remember, it can cause more anxiety than they started with.

One mental health facility I worked at allowed pet visitors, as long as all paperwork was on file and in compliance with DPH, etc. I used to take my pug to work with me. You wouldn't believe the smiles and decrease in anxiety over something as simple as a snorting fat pug waddling up and down the hall behind me.

It takes months to learn each resident and what works for each one. You have to remember also, you may ALWAYS be a new face to them.

AndiMac81 · Oct 15, 2016

Oh, and something we've implemented for a few residents that aren't quite that far into the dementia stages, are simple note books. In those note books, we keep on their bed side tables, we write down exactly what has happened that day.

Example:

7am: Sally helped me get dressed and brush my teeth, ate breakfast.

9am: BillyBob gave me my morning pills

10am: went to activities with Lucy and had coffee

12pm: got ready for lunch, ate lunch and took my pills from nurse Billy Bob.

Again, this doesn't help some residents. The ones that this does help, we encourage ALL staff, right down to housekeeping, enter a note in their book, even if it's a Hello from Cindy, cleaned your room and emptied your trash. Families are encouraged to write in these books also. This helps them to remember that they aren't alone, and they do have family that visits them. It helps comfort the ones that are constantly fidgety because they have that "oh my, I forgot to do this, I forgot to do that" feeling. Like I said, this works only for the ones in the very beginning stages, which may have already passed if she's asking for her parents.

Ruby Vee, BSN · Oct 15, 2016

This is difficult and as others have stated, depends largely on the individual. I would be reluctant to tell you that you should always lie or always tell the truth. My own experience is with my mother, who will tell me that her husband has left her - because she can't find him. Sometimes I tell her he's in heaven and other times I remind her of his funeral. It depends on her mood at the time. Sometimes she accepts that he is dead, but other times she is distraught that she is just finding out and why wasn't she told before?
Dementia is a horrible, horrible disease...

For a long time, my mother would cry endlessly about "why did your father leave me?" And "I'll bet he's living with some floozy now". Hearing that he was dead, that he hadn't left her made her happy. One of the caregivers at the assisted living told me how cruel I was to tell my mother such a thing, but at the time, the only thing that would comfort her was to explain in great detail that Dad was dead, I was sure he was dead, I was there when he died, and I'm a nurse so I can tell when someone is dead. Later on, when her memory deteriorated to the point where she was looking for her Mommy and Daddy rather than for her husband, things were different. I'd tell her they were fine, but it was harvest season and they were busy on the farm or it was planting season, or it was Sunday and you know how Grandma spends all day Sunday at church -- etc.

It not only depends upon the individual, but it depends on their mood at the time and their stage of the disease.

Mother is gone now, and hopefully she's with Dad and my grandparents. I'm so thankful her ordeal is over.

litbitblack, ASN, RN · Oct 18, 2016

I work in a certified dementia facility. We are not lying to the residents we are redirecting them. I highly suggest you check out some Teepa Snow videos on online-there are some short ones and if you are in an area where she does a seminar it is worth attending just for the information. Everyone in nursing has the opportunity to come into contact with someone with dementia and preparedness is beneficial...

mspaintedeyes · Apr 25, 2017

Memory care is tough. If there's one thing I learned, even at CNA school is that direct care is the most important care. This means, looking out for the patient's emotional well-being can make a huge difference in their restoration. In the case of memory care, truly the ends justifies the means.

I'll give you a real life example from working at the dementia floor at a nursing home. A resident in her late 80's, would ask me every day when her husband was coming, and she would ask me to set the table for him because she was sure he would be there. From what I was told she was a widow, but could you imagine me crashing the little bit of hope she had, for the sake of the truth? The truth is relative! What is most important is maintaining balance. So I set the table for her husband at during those 5 minutes, she was happy - that's what mattered!

Another resident was always talking about his lost puppy. He would always bring up this mystery puppy. So what did I do? I asked him how his puppy was, and if he walked him today, and if he played with him. And that's it. You allow them to go on and on about things that aren't there, relationships that don't exist, etc, etc. You do it because you care, because you don't want to see them falling into despair. A dose of reality is quite relative as well. Just go with the flow, validate them as much as possible, you never know if this is the thing that keeps them going.

Alzheimer's Lesson?

Would you tell the patient with Alzheimer's their loved one is dead?