Re-directing tips needed for Alzheimer's/behavior pts

Specialties Geriatric

Published

What tricks of the trade do you have for re-directing Alzheimer's or behavior pts? There are 2 in particular on my unit that drive me up the wall! One is so very fixated on "going home" that it seems no amount of attempts at redirecting will work. For instance, last night the 2 were hell-on-wheels. I had 2 skin issues, a fall, and a med pass to take care of. After 11.5 hrs of hearing, "who can help me move my stuff?", and "I want to go home" and watching her pace up and down the halls, go in others peoples' rooms, "pack" some of her stuff and drag it to the nurses' station from 1 res, then the other who wails like a banshee at any attempt at redirection had me pulling my hair out by the time I (mercifully) left. We offered snacks, drinks, turned on the t.v., radio, gave them pain meds, anti-anxiety meds, and sat with them in their rooms and NOTHING WORKED. I am sooooo very frustrated I could scream!!!:banghead: And, naturally, both are up ad-lib. The lady who was trying to move all night sat RIGHT IN FRONT OF ME FOR HOURS going on about wanting to leave, call the police, etc. She, however, was not violent or any other behavior to warrant a chemical restraint. Any tips on keeping my sanity during such occasions would be GREATLY appreciated!:plsebeg:

On the issue of "sundowning", there is thought that this is more related to fatigue then the disease itself or the time of day. The person just cannot express what is bugging them so it sets off a host of behaviours. Schedualing afternoon rest periods may work. Of course there are no quick fixes or absolutes when working with these guys.

For me or the resident? :D Just kidding. The one who wants to go home was a server for most of her life, and the other was a noc nurse for a long, long time. She doesn't remember being a nurse, though. I've had the former fold towels and such, but she was very fixated on "home" last night. I've never seen her that excited for that long before. She is a sundowner and will usually settle in by 2230. I guess they will just have nocs like that. I feel bad, though, because she was obviously very agitated and there was nothing I could do to help her. :( She even has a steno pad her daughter brought her filled with info on where she is, why she's there, etc. She kept saying, "Well, I just don't believe THAT" and on and on. Well, it's a new day, and a new opportunity to try again!

did her daughter visit that day, and leave that note ?...if so, there may lie your problem.....perhaps the daughter needs a little educating.....

Specializes in LTC.

"did her daughter visit that day, and leave that note ?...if so, there may lie your problem.....perhaps the daughter needs a little educating....."

No and no. The family thought it would be a "good idea" to leave that pad with her when she arrived to "help" her understand why she's here. They have also greatly limited their visits d/t the behaviors that inevitably occur when they arrive/leave. I think I will be "losing" that pad for her, after I explain to the family that it may be doing more harm than good.

"did her daughter visit that day, and leave that note ?...if so, there may lie your problem.....perhaps the daughter needs a little educating....."

No and no. The family thought it would be a "good idea" to leave that pad with her when she arrived to "help" her understand why she's here. They have also greatly limited their visits d/t the behaviors that inevitably occur when they arrive/leave. I think I will be "losing" that pad for her, after I explain to the family that it may be doing more harm than good.

good idea

Specializes in RN- Med/surg.

WHen I worked LTC we had an inservice on dementia pt's. They recommended giving the pt a suitcase and let them pack up if you are unable to distract them otherwise. (this only works if they're pretty far along) They rarely stay on task long enough for it to be a problem. They said they'd pack up..and get distracted or fall asleep. When asleep..you can unpack and take away the suit case.

I never tried this..as it was my last semester of nursing school and I quit that job shortly after.

Specializes in LTC.

I was going to say, I'd hand the resident a suitcase or box, let them pack and tell them their ride/the movers would be there in the morning.

Specializes in Geriatrics, Med-Surg..

There is never an easy way to deal with this behaviour, sometimes they just have to wear themselves out. I let a lady rumble around in her room attempting to pack and she eventually fell asleep on her bed and forgot about the whole incident. Another time, I had one get out of her robe and nighshirt and get dressed to go out after midnight. I was able to get her back to bed after some coaxing and redirecting, however she was in the early stages of alzheimers and it is always harder to redirect when they are further along in the disease process. I am still learning how to handle these brutal and time consuming behaviours.

Specializes in LTC,Hospice/palliative care,acute care.
For me or the resident? :D Just kidding. The one who wants to go home was a server for most of her life, and the other was a noc nurse for a long, long time. She doesn't remember being a nurse, though. I've had the former fold towels and such, but she was very fixated on "home" last night. I've never seen her that excited for that long before. She is a sundowner and will usually settle in by 2230. I guess they will just have nocs like that. I feel bad, though, because she was obviously very agitated and there was nothing I could do to help her. :( She even has a steno pad her daughter brought her filled with info on where she is, why she's there, etc. She kept saying, "Well, I just don't believe THAT" and on and on. Well, it's a new day, and a new opportunity to try again!

You said you've never seen her this bad before-if this continues maybe a urine and a cbc to rule out an infection? Sometimes all attempts to re-direct just make the situation worse and all you can do is quietly observe.I gave meds Saturday am with a 99 yr old attached to my leg screeching for about an hour. By the time the med pass was over I was as exhausted as she was and nothing helped her at all. We just had to keep her safe until she wore herself out.I know what you mean-I was a wreck! I felt like I was going to jump out of my skin.I tried to remember to take nice deep breaths and relax my jaws and my back but it was tough. I believe as we get tense they feel it from us and we feed into each other.We also had a death at that time and we all saw behaviors from the residents in close proximity to the dying one. This is really strange-my 99yr old friend asked one of the cna's if the "Sandman" was gone. That gave us pause for thought.I think they see and know things tht we don't. On the bright side my friend wore herself out and was quiet Sunday.

Specializes in Geriatrics, Med-Surg..

Urine check for sure. I have seen a patient go from semi confused to almost delirium with a UTI. Great post ktwlpn.

I agree on checking urine and blood work to rule out anything. We had a resident that did the exact same thing day after day. She ended up being harmful to herself and other residents and staff. She was moved to a geriatric/psych facility that has a smaller unit with more 1:1, which did help some from what I heard. Sometimes nothing is going to help and all you can do is keep her safe from harm.

This is a great thread. I think it needs to be a sticky.

Specializes in LTC, Acute Care.

Another thing that worked sometimes was to tell the resident that the room was already paid for that night. If they worried about who paid, I told him or her, "It's on the house." Sometimes it put the resident's mind at ease to know they were somewhere he or she could stay for the night without worry of money. I had that happen a lot of times, oddly enough.

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