How do you deal with/ reason with pt with frontal lobe dysfunction?

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Hi, I am only currently a nursing student, but I work as a home healthcare aid. One of my clients has a dysfunctional frontal lobe and is unable to go up and down the stairs alone. Therefore, he stays in his room upstairs all day. When I showed up yesterday he answered the door (shocking!) He went down the stairs alone so him and his sister argued for over an hour because to my understanding there is no reasoning or impulse control with someone with a frontal lobe dysfunction because that part of the brain is where it happens. His sister and I are trying to find a way to make him understand that he is not strong enough to go up and down the steps without someone there atleast watching him in case of an accident. Any ideas or ways to deal with this?

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I am so sorry to tell you this, but there is no real reasoning with people that have this type of disorder. It is a total waste of your time to try to make them understand. It only causes frustration on your part, and may cause anger on theirs.

You can only try to guide them 'in the moment', and hope that with constant reinforcement some small amount of new information will sink in.

You yourself said he has a dysfunctional frontal lobe, and that is where reasoning resides. This is one of the constellation of dementias. Look up Pick's disease/dementia for more info.

Do not bother to argue with these people, as I said earlier.

Best Wishes!

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Specializes in Neuro ICU.

You can't argue. The brain just isn't working the way it needs to to protect him.

You'll need to come up with strategies to compensate.

The first thing I thought about was moving his bed to the first floor. If he doesn't need to use the stairs ever, your problem is solved.

If not, think about suggesting they put a door with an alarm at the top of the stairs so that when he opens it you hear the beep and can get to him quickly. An alarmed barrier might save his life.

He also should be getting PT/OT to help get him strong and safe for stairs. It's a basic ADL.

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It is very difficult to do. There are some you can be firm with in the moment but reasoning with them so they will not do it again is difficult at best, but don't forget there are ways to get through to them, just not in the long term generally.

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I knew that becasue of the brain condition it was basically impossible but I just figured any advice is better than not trying at all. I've seen that suggesting things more than telling him to do things seems to work. I was just trying to see if I could find any hope for his sister she's really stressed and feels like there is no plan and she just has to wing everything. Thanks for the imput

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