Advice on dealing with dementia patient

[Ms. Nurse Assistant]

I started a job as a HMA, and the patient I have has dementia. When I first got the assignment, her condition was not that bad. She would only repeatedly ask me "what time it was?" and a few other things. She even understood that I was there to help and look after her.

Shortly, her dementia had gotten worse. On several ocassions she has tried to kick me out of her house, charged after me with her cane and threaten to hit me with it, and even punched me. At one point she had cornered me in the house, while hurling her cane trying to strike me with it. It had gotten so bad that I had to call her son so he could calm her down. I notified the nurse and let her know about her change of behavior. She said that she'll have a doctor prescribe her sedatives so she will sleep through the night.

I don't think the sedatives are working well enough, because she still gets up a few times in the middle of the night, turning the lights on and off, walking in and out of the room confused before she eventually goes back to lay down. I usually have to remain VERY silent so she doesn't hear or see me. If she hears or sees me, she will become very irate and will spend the entire duration of my shift threatening to kick me out, and asking "who sent me" and "why I am here" nonstop. You cannot make a sound with her, even the slightest. she hears everything if I change position on the couch or open a stick of gum, she hears it, and she wakes up asking "what's that sound? where is that coming from? why are you here? get out of my house now.." And she will not go to sleep.

The other midnight aide who visits, reported that she pulled a knife on her and came charging at her with it, telling her to leave or she'll call the police. She had to hide all of the kitchen knives

The only time patient is not easily agitated is in the morning when my shift is almost over, which is why the aides on the morning shift don't have any problems with her.

[ktwlpn, LPN]

Do you all wear some type of uniform or smock? If not it may be a good idea to start doing so.The elderly really respond to an old fashioned whites-thay may help her recognize what you all are doing there.And do remove all sharp objects immediatly.Is the house dementia proofed throughout? It has to be done to keep her safe.Good Luck-these cases can be very challenging.

[suespets]

You can agree, or distract. or say "you remember me I'm ----. I'm always here noc's!!!!,keep talking, try shoulder touch, as your talking,etc.Do you want a drink or ----- some times anything you say , distraction(that has nothing to do with what was said, is helpful). Does she play cards(or think she can,or whatever) friendly gesture, etc. always works for me(well, 90 % of the time)& no ,it's not in the books!

[NurseKatie08, MSN]

Okay that is a good idea. She hasn't gotten to know me very well. When I was doing the afternoon shift briefly I told her what I was going to school for. And when I switched to midnights I kinda became a stranger all over again.

Yes, there are different aides coming in at midnight. All together there is 3-4 of us, and this is just causing confusion. I don't blame her for feeling this way, it is a major adjustment to get used to a different person sitting on your couch while you sleep at night

I agree with previous posters in checking a UA to see if a UTI could be the source of this problem.

Also, pts with Alzheimer's disease are typically more confused at night, d/t sundowning.

I can't tell you how many LOL's have screamed at me for "being in their house" (they were in the hospital/nsg home), or "who was going to pay the electric bill" (i had some nerve turning on all those lights at 2am.)

After you gain experience in working with Alzheimer's pts, it'll get easier. You learn each pt & learn what to say in certain situations. You'll then become invaluable to others around you who have no experience working with AD.

Two pearls of wisdom:

When you have met one person with Alzheimer's disease--you have met ONE person with Alzheimer's disease (because they are all so different.)

You will never win an argument with an Alzheimer's patient (so don't try).

[shlay51]

I didn't read through all the post so if I repeat something that as already been said I'm sorry.

I'm currently in my last year of nursing school, but spent 3 years taking care of my grandmother who has Alzhiemer's Disease. She lived with my mother and I after my grandfather passed away. When we first got her she was capable of taking care of herself for the most part with the acception of making her meals and administering her own medication. She was also very combative when we first got, mainly due to not being on the correct medications and the correct doses. The thing we found to work the best is to talk to them at their level. In other words, don't stand over them and talk, try and sit in a chair eye level with them or squat down so you don't seem as threatening to them.

Another thing that seemed to work really well is to talk to them like they are a younger child....not I don't mean baby talk or anything like that, but you can't talk to them like you would a person without dementia. These types of diseases tend to make people revert back and kind of act like a child. Don't tell her what she is going to do, give her the option of doing this and then this or doing this or that.

The not sleeping things is extremely common and we had many sleepless nights over those 3 years. That is something that is really hard to get under control. We had my grandma on sleep aides that only seemed to work for about 3 hours.

I guess the best advise i can give you is to try and stay calm...they tend to feed off your anger and anxiety. Patience is a great thing with these people, and if you don't have a lot of them, you will learn.

I wish you the best of luck and hopefully things will get better for you.

[mondkmondk]

I worked in an Alz. Unit for approx. 10 years...actually there were 2 units...one was actual Alz. and the other was called TU (transitional unit) for those in the very early stages. Nighttime was one of the hardest shifts for most of our nurses due to Sundown Syndrome. Despite plenty of sleep meds, about half of them stayed up til 2-3am just wandering the halls, occasionally would stop to chit chat and repeat the same chit chat periodically throughout the night.

I remember this one lady we had who was very difficult...but loved to have her hair played with and pin curled. So we would get out all the hair things and work with her hair for about an hour or so. By the end of that, she was very relaxed and would conk out in one of the recliners (she never slept in her bed there). Of course, relaxing things like massages and brushing hair releases the body's natural painkillers...endorphins. Others prone to Sundowner's syndrome would fold laundry for us and talk to us and relax that way. With others, photo albums...some of our patients, male ones too, loved to look at photos of their families and tell us their memories. Some would stay up all night and sleep during the day, no matter how hard we tried to reverse this with meds and daily activities, that is just how they were and we were there to make sure they stayed safe.

We also had a huge screen TV there and a DVD player and would play Shirley Temple DVD's for those that couldn't sleep...most would sit and watch them over and over until they were sleepy enough to go to bed.

I hope I've given you some good ideas and I will sure "pray" for you and your patient.

Blessings, Michelle

[Hygiene Queen]

So much of the advice you have gotten is darn good advice.

Alzheimers patients are truly a breed of their own and it takes a person with good imagination to work effectively with them.

I'll bet after you have worked with her more and have figured some things out about her, you will figure out little "tricks" that will carry you through your assignment safely.

I never show fear. That is a BIG mistake. They do sense fear and that upsets them further.

When I have been grabbed on the arm, for example, I have stood calmly and said things such as, "That doesn't hurt. Let go." Often they will do just that... it depends.

I will go into "their world". I've helped them "catch the bus" or reminded them that there is no school today.

Sometimes they worry because they think their mothers are looking for them. You have to find "where" they are mentally and try to enter that world.

If they think there is an intruder, show concern and tell them you are there to protect them.

ANYTHING that works is good.

Just use your imagination.

And, yes, they usually LOVE to get their hair or nails done. It is soothing to them. I usually set up a corner, pretend I'm a beautician and do their hair.

If she is really dangerously unredirectable, you may need to call for help. This is not a failure on your part. It is a reality of the disease... it can be very difficult to settle some patients down.

Your safety and her safety are important and your pride can't get in the way.

Remove the knives or anything else and let the family know. It's like watching a child... remove anything dangerous.

I believe you will figure her out. It just takes time.

Eventually, others could be asking YOU, "Wow! What do you do for Patient X? You seem to be able to handle her well. She's always good for you!"

Be safe and good luck!

[Sehille4774]

Yeah, I love that trick as a distraction. I ask about their kids, where they grew up, what kind of work they did..many love reminiscing..and then you know what--surprize suddenly they will cooperate for me with whatever I need them to do like taking a bath or whatever. ---its also so much more pleasant then the alternative.

[Sehille4774]

omg i think u hit like the top 5 things i hear on the dementia unit. 1. i have to go to school. 2. where is my mom i have to find/help her. 3. i have to go to work now. 4. where is my baby? lol. Its kind of a cruel joke that at 80-90 years old we will probablly still be trying to work, clean, take care of the kids, ect. LOL

[tewdles, RN]

All good advice. As a nurse I would do a very thorough review of her meds. Too many elderly have a laundry list of meds that can alter even the non-demented persons thought processes. I sounds like she is simply experiencing a decline. Paranoia is a classic finding in elderly women with alzheimers. The advice about creating a safe environment is spot on. You need to keep her safe and you need to keep yourself safe. Redirecting her thought and actions generally works. Looking at photo albums might be a nice past time for the two of you. Don't however expect her to remember the people, just enjoy the pictures. Sounds like she might benefit from a sleep aid, but again, ambulating and sedated are not a good combination. Good luck.

[Whispera, MSN, RN]

Also, if it hasn't been said before, is there any possibility that the patient has a UTI? That's one of the top reasons elders experience acute confusion....