Dementia/Alzheimers residents

heartflutter, ADN, BSN · Mar 3, 2011

Every dementia patient is different and as is with all new CNA jobs, you'll have to learn how they all are. Reality therapy can be very helpful (go along with whatever they're saying). I work in an LTC and most of my patients have dementia.

When someone is exit seeking or asking to go home, try to persuade them to go tomorrow. Or darn it, the taxi rescheduled. How about we go to bed and call them tomorrow?

I have a certain patient who absolutely refuses showers. Very paranoid about doing her own cares (but she forgets about them anyways). We write down "A shower will make me feel nice and clean" on a sheet of paper and let her read it aloud. There's research to support that writing things down like this will help persuade dementia patients.

It's not always fun and games like that though. You can end up with very combative or verbally abusive patients. My suggestion is to pull in another aide to assist with transfers and cares on these individuals. Any hitting, cursing, threats, etc. towards you should be documented in your flow chart (my facility has "nursing notes" on the backs of our sheets to chart incidents on).

If you have any more questions, feel free to PM me. I've been at this for over a year now and have quite a few tips and stories. :)

interceptinglight, CNA · Mar 4, 2011

I also work in a lockdown dementia/Alzheimer's unit in the LTC facility where I've been employed for the past six months. The best way to handle this job is simply to get to really know the residents you'll be taking care of. Don't be nervous, you may find that it's not difficult to deal with the strange questions some of your people will ask. Some of our ladies have husbands that passed away 10 or more years ago, and still they say, "My husband is supposed to pick me up, where is he?" Basically you just say.....oh, he's going to be late...here let's get ready for lunch.....or sometimes I'll say, yes he'll be here in the morning and wants you to get a good night's sleep. People with dementia are sometimes very easy to distract with simple activities or conversation. Moments later they'll forget they even asked you that question and won't be upset if their husband doesn't come for them. This is called 'validation therapy', you basically validate what they are saying.

CoffeemateCNA · Mar 4, 2011

Always approach from the front.

Get on their level: squat or kneel down when talking to them or asking questions.

Try to stick to a routine as much as possible.

Find out their social history (especially occupation). It can help you interact more effectively and give you insight into behaviors.

Never mention the "S" word (shower). Say, "Let's go get cleaned up."

Try to "get into their heads." If they ask where mom is, tell them she had to run to the grocery store to buy some flour, etc. It's not considered lying.

If they refuse care, try again in 10 minutes. Chances are, they will have forgotten your last attempt and be more cooperative.

Don't mix their puree food together and then feed it to them.

Be mindful of what is playing on their televisions and change it when appropriate. You may notice some residents become very agitated and combative when crime/mystery shows are on but be calm and relaxed during comedies, nature shows, etc.

Consistency, consistency, consistency.

If someone keeps trying to get up out of their wheelchair or bed every 5 minutes, ambulate them for awhile (if time and/or their condition permits). They'll be much more likely to rest/sleep if you get out that pent-up energy.

heartflutter, ADN, BSN · Mar 4, 2011

Don't mix their puree food together and then feed it to them.

I HATE it when coworkers do this. UGH.

nurse2b013 · Mar 4, 2011

Thank you so much for the replies! My first shift is Sunday, and I feel better about it now! :yeah:

LaterAlligator · Mar 5, 2011

Ask your coworkers what the most important thing for you to know about that person is; they'll probably tell you anything from "she only hears out of her left ear" to "you'll know she's awake if she's humming to herself" to "she gets really mad if you try to make her wear socks, so just let her wear shoes without them". People with dementia have more pronounced quirks like that, and it's better to go along with them and not try to change the resident's ways, since that won't work anyway.

Remember they may well still have their sense of humor, and can joke around even in a nonverbal way, and will likely appreciate it if you pal around with them.

Good luck! You may find that you really love working with this population; it can be a lot of fun, and is rarely boring.

yousoldtheworld · Mar 5, 2011

I loved working in a dementia unit! In fact, it was the only area of geriatrics I liked. My unit was for the early to mid stages of dementia, most of them were able to walk and talk well, so the work was mostly behavioral and assistive.

I wholeheartedly agree with the others who advised you to step into the resident's reality. It does no good to try to orient them to the current time - that part of their memory is gone, and trying to convince them otherwise is just going to be stressful for both of you and can increase combativeness and uncooperativeness.

Little things that can spark old memories can help. If they are asking for their mother, you can tell them she'll be home later, and ask them to tell you about her. If they ask when their husband will be home from work, tell them he called and said he'd be late, and ask what he does for a living, ask when they got married or to tell you about their lives.

If they can't remember, don't press the issue, but often these are the parts of their minds that still work, and talking about what is familiar to them can be very soothing.

Keep in mind that many times, they regress in age. A lady who thought she was 30 one day might think she's 15 the next. Go along with it. Get them talking about what they think is going on in their lives, it can make things like bathing and dressing easier, if they're focused on what they're telling you instead of wondering why some lady is taking their clothes off, you know?

If a resident is agitated, I often found that singing to them can help. Pick a song they would know...if they have certain music they listen to, that can give you an idea of what they like. If not, songs like "This Little Light of Mine" are generally known by the older generations.

It can be a really cool area to work in. Good luck! :)

CNA2day · Mar 11, 2011

It seems a lot of these residents will remember old songs... sometimes it is a great activity and a great distraction.

Basically talk to everyone like they know what is going on and like they are human beings. You will learn their quirks soon enough, but if you are not sure what to say just talk to them like you would talk to any other person. Many respond better that way...

I can't stand nursing staff that talk to residents like they are two years old and not able to have likes and dislikes!

Don't bark orders at them... treat them like you would want your mother to be treated!

oh yeah and SMILEEEEE

adampricecna · Mar 26, 2011

Patience is KEY!!!!

Never give a alzheimers patient a large task. Break it up into small tasks.

Ex. (Patient is in bed) You need the patient up for breakfast.

Don't Say: Let's get dressed and go to breakfast.

Say: Let's get out of bed. Let's go to the bathroom. Let's put your shirt on. Let's put your pant's on. Let's put your shoes on. Can I comb your hair?

*Alzheimer's patients can get overwhelmed and agitated if a big task is presented to them. And you don't need a agitated Alzheimer's patient.

Jen411 · Apr 5, 2011

I worked on the same dementia unit for 10 years! (sometimes I think I was demented for staying that long!!)

I loved the residents, well some of them :)

I worked on a lock down dementia/elopement floor.Keeping the residents stimulated in activities was key, on dayshift. On 2 and 3rd, you were on your own!

We barely ever had callbells ringers. We instead had chair and bed alarm ringers. Residents jumping out of bed,chairs,etc. Many Abusive,aggressive residents, but on the other hand alot of sweet granny type residents.

Key was keeping them fed,toileted,repo'd,entertained, and constantly REDIRECTED away from exit seeking and altercations with fellow residents.

I loved my floor, and the residents, It's the people you work with that make you job what it is..