Re-directing tips needed for Alzheimer's/behavior pts

lookingbeyond, BSN, RN · Jul 29, 2008

For me or the resident? Just kidding. The one who wants to go home was a server for most of her life, and the other was a noc nurse for a long, long time. She doesn't remember being a nurse, though. I've had the former fold towels and such, but she was very fixated on "home" last night. I've never seen her that excited for that long before. She is a sundowner and will usually settle in by 2230. I guess they will just have nocs like that. I feel bad, though, because she was obviously very agitated and there was nothing I could do to help her. She even has a steno pad her daughter brought her filled with info on where she is, why she's there, etc. She kept saying, "Well, I just don't believe THAT" and on and on. Well, it's a new day, and a new opportunity to try again!

I can sooo relate. I hope your next time with her is smoother?

achot chavi · Jul 31, 2008

I can empathize and here are some tips= not necessarily a quick fix but we put in a snoezelen sensory room (if you don't know know it is- google it) and it really helps. also we got neighborhood volunteers to take patients for walks. humor is always good and last but not least- take a day off and pamper yourself. Alzheimers patients require the patience of a saint. there are many new strides in treatements- pills and vaccine etc- so hopefully our generation will not suffer- try empathizing- remember these patients die twice- first their personality then their body goes. they need our tlc more than ever

sweetmagnolia1439 · Aug 10, 2008

As a nurse who works with Alzheimer's and dementia patients, I've found that redirecting works 'part' of the time. Most of the time, Ive found that you just have to try and enter "their world". Agree with them, talk to them about anything they say and it calms them down. If you agree and talk to them from their perspective....it leaves no room for arguments, etc. Of course, I'm not saying this works ALL the time, but in the vast majority of cases I've encountered, it does. Try it...it's fun to 'role play' with them and it makes them feel as if they know exactly what they are referring to. If "Bob" isn't coming back for 8 hours, tell them he is coming back in a "little while". They don't understand the difference in 8 hours and 'a little while', but it makes them feel better. That's what it's all about....keeping them safe and making them feel secure and knowledgeable.. REMEMBER....Alzheimer's pts. and severe dementia pts. CAN NOT BE REORIENTED! You have to enter 'their world' in order to better understand them.......don't try to make them enter 'our world' as it's a lost cause and only causes more frustration and anxiety for them. Trust me...it WORKS!!

nurse_clown · Sep 10, 2008

One thing we found out on our unit was to monitor the TV programs that were on. A lot of your advanced stages believe that what they are seeing on the screen is real and happening to them. One lady swore her husband who was in the unit with her was cheating on her and kept attacking other female residents. Her TV was being tuned to daytime soaps by CNA's. Once we instigated no TV except by resident request, our agitation and combative behaviors decreased dramatically. The complaining by staff about the policy stopped when they realized they were getting hit less!

:up: Do you have any suggestions for more appropriate shows they could watch? I wonder if keeping a liabrary of DVD's would help the ones that don't sleep at night very well. We have one resident in particular who watches tv a lot. We've also had a recent increase in new tv's over the last little while. The residents don't really know how to use them. Or would music be more appropriate at night time? :)

joyflnoyz, LPN · Sep 14, 2008

Often what I do is use TVLAND channel with all the old shows they would be familiar with- things like Andy Griffith, Bonanza, Lucy, Ozzie and Harriet.

Familiar is good.

I've noticed behaviors increase when the weather is changing to rain and/or thunderstorms. When they want to "go home" I just tell them that there are storms rolling in (the truth btw :nurse: ), and every one is staying here for the night. OH! YES! I've got a bed all set up in the guest room, and you DID promise to stay for breakfast...

Most of the time they are worried about getting home- someone is worried about them, waiting for them.

As sweetmagnolia said, you MUST enter their world. I have turned off stoves, taken the cake out of the oven, checked on the baby, turned off the faucet; you name it, I'll do it to settle down my precious ones.

lvn888 · Sep 25, 2008

ask the md for seroquel 25mg at 1000 ...25mg at 1700 ...50 mg at hs...its sad when residents have to feel that anxiety ...........

neonatal3 · Nov 15, 2008

Hello all!

Yesterday I had with a tough job while working only one rare day with a home health Alzheimer patient! Since this 99 year old,blind,and bedfast patient was not my regular assignment, she was not familiar with my voice --- she became very agitated and combative as I kindly and gently tried to give her care. As joyflnoyz wrote on this site, I tried to "enter her world" and tried to understand that a new nurse which she could not see might be scary to her. As other nurses wrote, I just started kindly responding to her shouting by frequently saying "OK, Ms. Smith" and turned on her TV to a simple garden tip program and that seemed to gradually calm her part of the time.

This patient had a PRN order for Ativan but the son chose not to give her this medication because he said she would sleep the rest of the day and then be up all night. The only time I lost my cool and had to step out of the patient's room to regroup was when this frail little lady suddenly grabbed my finger and strongly jerked my finger---so I pulled back before she could do any damage to my finger!!!

I sincerely salute any of you who have the courage to work long term with any Alzheimer's patients! Take a bow! (Most of my many years of nursing have been in maternal/child health---unfortunately, geriatrics is just not my thing.) Peace to all of you.

managing just · Nov 16, 2008

icon_hug. In our dementia specific area the nurses are experts at redirection techniques. They find out what makes the residents tick and what they used to like and redirect using this information. We also installed a "bus stop" and waiting seat. This provided the resident with something to do while they waited. They aslo offered a cup of tea or coffee. When the "Bus" didnt' arrive or was late they offered a place to stay for the night and to come back in the morning to cach the first bus. By then they had forgotten that they wanted to get the bus. Dementia is demanding and repetitive at times but so rewarding when intervenions are effective and the resident calms and is happy. We also tried a few drops of lavender oil on colars and some quiet calming music activities in the early evenings this also was helpful. No interventions work every time but a large repetoir of things to try helps.

Aspen1 · Jan 1, 2009

What tricks of the trade do you have for re-directing Alzheimer's or behavior pts? There are 2 in particular on my unit that drive me up the wall! One is so very fixated on "going home" that it seems no amount of attempts at redirecting will work. For instance, last night the 2 were hell-on-wheels. I had 2 skin issues, a fall, and a med pass to take care of. After 11.5 hrs of hearing, "who can help me move my stuff?", and "I want to go home" and watching her pace up and down the halls, go in others peoples' rooms, "pack" some of her stuff and drag it to the nurses' station from 1 res, then the other who wails like a banshee at any attempt at redirection had me pulling my hair out by the time I (mercifully) left. We offered snacks, drinks, turned on the t.v., radio, gave them pain meds, anti-anxiety meds, and sat with them in their rooms and NOTHING WORKED. I am sooooo very frustrated I could scream!!! And, naturally, both are up ad-lib. The lady who was trying to move all night sat RIGHT IN FRONT OF ME FOR HOURS going on about wanting to leave, call the police, etc. She, however, was not violent or any other behavior to warrant a chemical restraint. Any tips on keeping my sanity during such occasions would be GREATLY appreciated!:plsebeg:

I have a few on my Alzheimer's Unit that are tough to redirect. My best bet is to keep them busy all day, but especially starting around 2 PM. I have activites and programming going straight time.

If that fails, and sometimes is does, I enter their world. I ask them to tell me about their home, their neighborhood, how long did they live there, where did they grow up? Any pets? Children? Who lives with them? What do they like best about their home? Did they garden? On and on until they move on. This usually works, but not always. Dementia is difficult to deal with, I know. You have to be able to handle repetitive questions.

Another techique that is successful for me--get everybody singing. Old songs, hymns, silly songs, anything. They will all usually join in. Singing is uplifting.

For the resident that wails, that seems a tougher situation. I don't have any ideas there, except hugs, if she will allow. I always think that these behaviors are a way of communicating, since their ability to effectively communicate is impaired.

makes needs known · Jan 11, 2009

We are always told to to try interventions and redirecting to alleviate anxiety and dementia related problems, before we use medications. But it's very hard to come up with good ideas from pts who are confused. It takes trial and error. I talk to people in other departments,(pt, ot, and activities) and family members for ideas. Its an ongoing process.

Paulred · Feb 2, 2009

or 34 others...

Posted by: adrienurse

Original Content:

"i want to go home" is usually Alzheimer's code for "I'm tired and uncomfortable and don't feel secure here". Looking into fixing any of these 3 issues will usually help. Distraction also sometimes helps but not if the person is pre-occupied with the above 3.
It can also mean that the person is bored. Understanding something about them and what they like to do and talk about also helps to occupy them. No small task though when you're taking care of 20 others, right?

Trishalishus, PhD, CNS · Jul 18, 2009

... here are some tips= not necessarily a quick fix but we put in a snoezelen sensory room (if you don't know know it is- google it) and it really helps. also we got neighborhood volunteers to take patients for walks. humor is always good ... - try empathizing- remember these patients die twice- first their personality then their body goes. they need our tlc more than ever

Thanks for the tip about snoezelen - what a marvellous idea! I am going to do some research on this. Very exciting.

Best wishes

ps I don't know if there's a later post that already says this, but other "calming" suggestions that work for me (often) are hugs; back rubs; manicures; rubbing moisturiser into their hands+massage