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grandmother with dementia

nurseshellyRN specializes in School Nurse.

My grandmother has dementia, and my family and I have been taking turns giving her full time care. It is very hard on us, and she has finally agreed to move into an assisted living facility. I think that will make our interactions so much more enjoyable. But as her dementia is getting worse, she has been having more episodes of confusion, thinking that her parents are still alive and that they live just down the street. Her oldest son also recently died, and my family told her about it, but she often forgets that and asks where he is.

My inclination is to act like I don't know, rather than break the news again that her son is dead and her parents have been dead for decades. My parents feel that they need to remind her when she gets confused, to try to minimize her confusion. I don't always feel that this is the best way to interact with her, since inevitably she will go back to her reality where everyone is alive and she still needs to get her parents' approval before she moves to a new place.

What are everyone's thoughts on this?

"Gram, we all know where you are going, where you will be, and you won't be alone."

"We will come and see you like we usually do."

"I know it must be confusing, but don't be afraid, we are here"

I would continue to try and reinforce that you all are there, you all know what's happening with her, as opposed to specific reminders of deaths.

Even with a question of "where's (oldest son)?" "He is not here, but we all are aware of your plans to move"

Best wishes and hoping your Grandma loves assisted living, and she is content there.

Reorientation is often the worst thing you can do with someone with dementia. You used the example of her oldest son being deceased. Reminding her of that can open the grief process all over again for her. Based on what you mentioned, she may be in the middle stage not the beginning stages. Her safety is also more at risk, she is more likely apt to wander, if she is the wandering type. Not all wander.

I would wonder about the staffing levels at this assisted living to make sure she would be safe at all hours.

Here.I.Stand specializes in SICU, trauma, neuro.

First of all, I'm very sorry she and your family are going through this. Please talk to the assisted living facility and find out what safeguards they have in place...I'm concerned about her belief that her parents are down the street, and possibly deciding to visit (wandering.) This hits close to home for me because we lost my grandma to dementia-related wandering not quite two years ago. (She left between 2000 and 2200 wearing only a shirt and slippers, in

I agree completely with you and the PPs. Reminding her that her son and parents are dead repeatedly is NOT going to bring her out of confusion. And actually--I don't have any evidence on this and am not an expert by any means--but I wonder if the repeated trauma of hearing that her son is dead would make things worse for her. I mean, no mother wants to outlive her child, and they're wanting to remind her at every turn that she has? What is that repeated tragic news going to do to her mental status? Maybe some of the geriatric or psych nurses on the board can say if I'm wrong or not, but that's just what I'm thinking.

It may be more upsetting to remind her of these loved family deaths. She may not be able to deal with the reality of their deaths and this could actually be a mix of dementia and repressed thoughts. Losing a child is devastating for a parent, no matter how old the child is. Instead of attempting to re-orient her to reality of the family deaths(which she will soon forget), it would be better to do as suggested and keep her in the current here and now by letting her know you all will be visiting her as usual in her new home. It is interesting how she has reverted back to a point where she needed to have her parents permission to do something. Does she bring them up with other decisions she needs to make. She is a high safety risk, so I hope the staffing at the ALF is adequate and you should find out what their falls program/prevention protocols are. Do they use restraints to prevent falls? Good luck, hope your grandma does OK in her new environment. I would expect her to show some signs of depression after she moves and possibly an elevation of her dementia as change is harder for older people and especially those who are a little confused.

amoLucia specializes in LTC.

Best wishes for you and your family as you go through this difficult time with your Gram. Like others have pointed out, reality orientation pretty much hits the pt over the head and is more disturbing to the pt.

Commuter called it 'therapeutic lying' - I like to call it 'therapeutic fibbing' (same thing). I have no desire to cause any more psychic pain to my pts. My communications are more like little white lies/fibs. And with the art of changing the subject, pts forget soooo fast. If you can communicate this to your parents and for your own benefit, just know that IT'S OK to avoid the harsh truth.

The dementia is irreversible - reality orientation WILL NOT CURE your Gram. It doesn't even help her. So the really best therapeutic approach would to be as non-upsetting as possible for your Gram and to try to make good times.

Another poster expressed concern about your Gram's safety in an AL environment. She may very well wander if she looking for people now. The level of oversight might just not be sufficient for your Gram's stage of dementia (unless it's a locked unit). The family REALLY REALLY needs to think along that line. It will serve her safety and your peace of mind.

You're on the right track. And if your Gram has ANY lucid episodes, it is time to make sure all her legal papers are in order and the family knows where important stuff is located. And this would include any decisions re Advanced Directives/Living Will. Not very easy to think about for many, but oh so necessary before you're all in a crisis situation.

Good luck.

motherof3sons specializes in LTC.

My Gram is in a LTC facility and her confusing is increasing but she never tried to leave the facility until just recently. She thought someone had dropped her off and went to leave to find them. Thankfully staff caught her and now has a ankle bracelet alarm on. As a precaution I would ask about this.

nurseshellyRN specializes in School Nurse.

Thank you for your replies everyone. I'm glad to know about therapeutic lying, I definitely think that's the way to go with her. As for the safeguards of the assisted living facility, we have talked about them with the facility. She will be wearing a wander bracelet, so if she leaves the premises the employees will know right away.

She actually lived in a facility before, although that one did not treat people with dementia. That was over a year ago, and she would call my parents every night asking to go home. So we finally took her home, but the constant care has become too much for us. We are so happy that she is agreeable to move to this new place, it will be great for her and us (I hope).

tyvin specializes in Hospice / Psych / RNAC.

Click on the link below for more information about therapeutic lying with dementia patients. In essence, reality orientation is not the most optimal way of dealing with persons who have progressed beyond the beginning stages of dementia.

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

Bingo! It drives me right out of my skull when healthcare workers feel the need to "orient" patients with dementia of all types.

Why keep breaking the person's heart by reminding them that a loved one is gone when they ask when the loved one will return from the store? Seriously, I have gotten in some pretty heated debates about this subject, but the only successful relationships I've had with dementia patients is with the friendly lying.

Red Kryptonite specializes in hospice.

One of my mantras is, "Don't argue with the confused people!" Join them where they are. Let them be happy and talk to you. How does it harm you to let them have what is their reality right now? How does it harm you to not repeatedly rip the scabs off their wounds? They're so much happier when you let them tell you about where they are, and they get defensive and wary if you try to tell them differently. That's when they might get fearful and angry and feel the need to act out.

Give your parents educational materials, and tell them they need to STOP trying to reattach her to reality. That's gone forever now, and this is her journey. Either your family joins it or they will ruin what time she has left on this earth.

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