Alzheimer Patient Advice

LPN01112005 · Jul 9, 2005

I just started volunteering at a nursing home and have been assigned to an Alzheimer's floor. I will be starting Nursing School this September. I have not had any training or certification in any type of patient care so I realize that I am limited in what I can do for the nurses or patients. I helped nursing assistants distribute meals in the dining room then I staffed the phones at the nursing station while the nurses helped feed patients and took their breaks. Other than that the nurses told me to mingle with the patients.
I am a little bit nervous about what I should say or do with the patients. Many patients lapse into and out of lucid conversations. What can I do for these folks other than try to talk with them? When they go off on less than lucid tangents, should I just "go along with" their tangents. For example, one woman would have a seemingly reasonable conversation with me then randomly start talking about her son picking her up that night and taking her home (which I knew was not the case). Should I try to ask her about her son, his name, age, whatever? Or am I risking taking her to a sad place and would do her a better service by trying to get her on a different topic. I sincerely want to help the patients and nurses, but in retrospect I am a little afraid that I might say something that would upset the patients. Any advice would be appreciated. Also, I regret that I am not the best mingler/small talker. I was thinking of taking magazines with a lot of photographs with me the next time I work and trying to strike up conversations about the pictures with the patients (who have good enough vision).
Any advice would be appreciated! I am so afraid of doing more harm than good. Thank you!

With Alzheimers/dementia patients, it's pretty much useless to try to re-orient. Sometimes just going along with their "conversation" works. This type of resident is totally different from the normally oriented resident who is experiencing some type hallucination caused by drugs, illness or whatever. with those type of situations, re-orienting can be successful and should be attempted, but with the alzheimer's resident, especially the later stages, you will not re-orient them, and can anger them if you argue with them.

Safe toys such as plush dolls with buttons, zippers, laces will occupy them for a few minutes at a time. Most facilities with alzheimers units usually have some type of busy box with appropriate safe toys. So, you could just play with the residents. Just remember that their attention span can be quite short.

I don't work on a lock down unit, and I admire those who can do it day in and day out. It's just too draining for me. I'm much more suited for the skilled nursing area. But, it takes all kinds to be able to meet the needs of the LTC population. It is wonderful to have volunteers. Bless you. I'm sure that if you go in with a caring and willing heart, you will meet many, many needs and will be very appreciated by the facility staff.

lovingtheunloved, ASN, RN · Jul 10, 2005

Go with it. Ask them about their families, jobs, hobbies, lives. You'll be amazed at the lives some of these people have lived. And they LOVE and desperately need the attention. If someone loved to cook, let them help make something, like PB&J. If they always want to help, ask them to help you match socks or something. Feeling useful improves their quality of life so much.

CapeCodMermaid, RN · Jul 10, 2005

You should have received some sort of Alzheimer's training before starting on that unit. Even our volunteers have to have a certain amount of training before they go on the dementia unit. I agree with what everyone else here has said...go along with whatever the patient is telling you...white lies really. We have one woman who won't go anywhere without her "baby". She becomes aggrevated if someone tells her it's only a doll. I get her to eat lunch by telling her I'll mind the baby while she eats....I wash its face...put it down for a nap....I even made it a little elbow protector so the patient would keep hers on till the skin tear she had healed. Go with the flow sounds trite but it works on a dementia unit.

casi, ASN, RN · Jul 11, 2005

Join them in their world. If you try to correct them a lot of times it will only cause agitation which can be very unpleasant. Once you become comfortable with the residents, you will get to know some really amazing people. Those with alzheimers really do need a friend. As much as us aides try to do that, a lot of times we just don't have the time too. The residents will truely love any type of conversation you can bring them. Ask about what kind of activities they may have on the unit and try to engage some of the residents in those. There are some great reminising games or prompts that could help you get a good conversation going. Another really good activity that all of my residents love is bring a bottle or two of cheap nail polish with you and a bottle of lotion. You can do hand massages and paint fingernails.

Really don't be afraid to interact. Yes, some residents are easily aggetated, but just change the subject and see if that helps. Also the aides and nurses should be able to help you find ways to redirect, and once you know the residents you'll also know what are good subjects for them. You may see some frightening behaviors and some very sad things, but you can't let that get to you in a negative way.

One of the best things that has stuck with me from Alzheimers training is that someone with Alzheimers may not know your name, or who you are in relation to them, but they will reconize you as a friendly face and someone who cares about them.

Good luck and enjoy!

txspadequeenRN, BSN, RN · Jul 11, 2005

Well first thank you for voluntering. I am a Alzheimers nurse and can tell you it makes a great difference. You will notice most of the typical Alzheimers patients have more of a intact long term memory than short term. You will frequently be reminising about their childhood and marriage. It also depends on the what stage of Alzheimers they have, as they progress of course they loose memory and have a decline in function. The first thing I would do is talk with the nurse or aides and find out which patients some one- on- one. Alot of patients are busy doing no-no things and you could possibly pre-occupy their time with games and activities. Buy a newspaper and read to them. When you talk to them just go with what they are saying. Never try to correct a patient , like if they are saying "Im going to see my moma this afternoon". Just say "Really, is it a long ride for you to make that visit". If you try to correct a alzheimers patient who thinks their moma is alive, alot of times the nurse winds up having to medicate the resident. I have a patient that has a pet (stuffed animal ) cat, but she thinks it is real. I have to feed that cat twice a day (with real cat food and water) or she goes bonkers and requires IM ativan.Just go with the flow and spare the resident the painful thoughts. I call it playing the game. You can learn so much from these people. I knew a lady once who made the best hamburgers in town, but she had Alzheimers. She couldnt give me the recipe all at once it, took 2 years to get the complete recipe. She would remember and ingredient and write it down to give to me. Eventually I got the whole thing. I took care of the lady who was one of the first people to know about the bombing of Pearl Harbor. She was standing in front of the news reel at the White House when the information came over. You will never be sorry for working with type of people. Good luck to you!!!!!!!!

CoffeeRTC, BSN, RN · Jul 11, 2005

Well first thank you for voluntering. I am a Alzheimers nurse and can tell you it makes a great difference. You will notice most of the typical Alzheimers patients have more of a intact long term memory than short term. You will frequently be reminising about their childhood and marriage. It also depends on the what stage of Alzheimers they have, as they progress of course they loose memory and have a decline in function. The first thing I would do is talk with the nurse or aides and find out which patients some one- on- one. Alot of patients are busy doing no-no things and you could possibly pre-occupy their time with games and activities. Buy a newspaper and read to them. When you talk to them just go with what they are saying. Never try to correct a patient , like if they are saying "Im going to see my moma this afternoon". Just say "Really, is it a long ride for you to make that visit". If you try to correct a alzheimers patient who thinks their moma is alive, alot of times the nurse winds up having to medicate the resident. I have a patient that has a pet (stuffed animal ) cat, but she thinks it is real. I have to feed that cat twice a day (with real cat food and water) or she goes bonkers and requires IM ativan.Just go with the flow and spare the resident the painful thoughts. I call it playing the game. You can learn so much from these people. I knew a lady once who made the best hamburgers in town, but she had Alzheimers. She couldnt give me the recipe all at once it, took 2 years to get the complete recipe. She would remember and ingredient and write it down to give to me. Eventually I got the whole thing. I took care of the lady who was one of the first people to know about the bombing of Pearl Harbor. She was standing in front of the news reel at the White House when the information came over. You will never be sorry for working with type of people. Good luck to you!!!!!!!!

Yep. Thank you for volunteering. Even answering the phones is such a big help. It might seem depressing or sad, but you are making a difference for these residents. Letting them talk and acknowledging them helps. Heck, we all want attention. So do they.

debroh1 · Jul 21, 2005

You'r an angel for volunteering, especially on an Alzheimers floor. I work a secure care dementia unit. They need more than anything someone to talk to. To them their world is very real, and it's not only useless to try to re orient but also scary and threatening to them. Ask them about their family and children. Go along with whatever they answer with and build from there. If they think they are in their teens, twenties etc. ask about their job, if they were a veteran, etc. Most Alzheimer residents become combative because they are scared and really don't understand what is going on around them. Having someone to talk to is calming to most of them and helps to redirect them from other things (leaving, fighting with the others). As you spend more time on the unit you will realize who you can and can't connect with, and what they most remember and want to talk about. As a nurse I've realized that 1:1 conversation with my residents is the best activity, but frequently don't have the time due to the demands of the job. I work at a VA home so all my residents are veterans. Makes it a little easier to find a topic they want to talk about.

dinkymouse · Jul 21, 2005

I am working to become a alzheimer's nurse specialist and your volunteering is awesome. Like others have said, talk to them, walk with them, and play with them. We have wander guards on our patients and they love to take them off. We tell them to keep them on so that we can find them to ask questions that only they know the answers to. Find out what occupation they had before and find things that relate to that and talk about it. Many Alzheimer patients have a tendancy to remove clothes and walk out in the halls. One gets extremely agitated if you try to lead her back to her room so I dance with her down the hall. She loves to dance.

dmrnurse · Jul 28, 2005

I just wanted to thank all of you who shared advice and good wishes with me. This is my third week volunteerting on the dementia floor of a nursing home (2 days per week, 3 hours a day), and it has been an incredible experience. Occasionally I still feel a little in the way or that I should be doing more, but many times I feel down right useful. I had some HIPAA training, so I can help out with the filing while I am covering the phones and I get to distribute juice and trays during lunch. I also get to open up the milk and juice cartons and sometimes even help cut up the food for the folks who can feed themselves but have fine dexterity problems. As a pre-nursing student this is an invaluable experience in that I get to see how a nursing station is run and how the healthcare team interacts.

And, I love working with the residents. I have so many wonderful stories in only 3 weeks! With some folks I can have great conversations, with others I just do as you all advised and go along with whatever it is that they're doing (as long as it is safe!).

Well thank you again for your encouragement and advice. And kudos to all of you who work in LTC and Geriatrics. You guys and gals are incredible!!

Darlene