Understanding Alzheimer's

Long Term Care Columnist / Guide · Jun 6, 2004

I've always felt that inside even the most severely affected Alzheimer's/dementia patient, there remains a tiny spark of the person he or she once was, and that's who I address when caring for such patients. Even if they're behaving like a two-year-old, they are still an ADULT who has lived a full life, raised a family, contributed to society in some fashion, and I treat them with the respect they deserve. Somewhere deep inside is a person who would be absolutely mortified that they've lost control over their bodily functions, or hit people, or scream and yell and smear feces all over the wall.

I have yet to care for someone who doesn't respond well to this. I have never been punched, kicked, or bitten by a dementia patient (although I've had to dodge a few flying objects before I was able to get to them); when you're calm and quiet, they tend to respond in kind. I also disagree with the nursing-school theory that says you always should try to re-orient them to reality; I say that whatever twilight world they live in IS their reality, that if they think it's 1940 and they're a young wife with a new baby, it's perfectly OK. They don't need to know that it's really 2004 and their "new baby" is a gray-haired grandma who's dying of cancer in another hospital a thousand miles away; if living in that other world makes them happy and helps them to stay calm, who's to say that that's wrong?

Just my 2 cents' worth. :)

Blackcat99 · Jun 6, 2004

:chuckle Can I send you my mom for 2 weeks PLEASE. The best way I get along with my Mom who has Alzheimer's is to agree with her no matter what.

If I disagree or anyhing like that she freaks out. The best thing to do is keep telling yourself "It's not her fault" because it isn't. However, somedays it really gets to me. I try hard to make her life easier despite her constant criticisms and condemnation about me. Anyway, if you want my Mom for 2 weeks she can teach you all about Alzheimer's. :rotfl:

suzy253, RN · Jun 6, 2004

mj--thanks so much for the info. Just what I wanted to know.

blackcat---erm.....I don't think I'll take you up on your generous offer but thanks anyway!

:)

allnurses Guide · Jun 6, 2004

Marla, you are so right about orientation. After a fall that broke her hip and a lengthy stay in a hospital and nursing home, my grandmother has dementia but not sure if it is Alzheimers. She lived alone before the fall, took great care of herself, painted, gardened, walked, etc. A/O x 3 so to speak. :) Now she holds a baby doll in her arms nursing it and asks when her parents are coming to visit. We just play along.

I've worked a few times in our Alzheimer's unit. There was one particular man who simply walked in circles, mute. Every once in awhile you could reach him by dancing with him. He was a great dancer.

I say go with what they know and don't try to force reality on them. Seems cruel. And yes, you can reach them.

steph

kathy_79 · Jun 7, 2004

i worked as cna with Alzheimer's pts for 3 years. yes, you can get reach them. you are the only contact for them with a life. they are like children. they depend on you, they love you even if they do not know how to show it. i had really good experience and i know they appreciate what i did for them even if they would not be able to show it. they huge you, they follow you and it can make you crazy, they scream, they cry, but these are the ways they show you their care of you. do not try to fight them or talk too loud to them, these things make them irritable and they usually do not want to listen for a while. even if it sounds silly what i write, but this is how i experienced them. i was with my pts most of the time even more than nurses, who just pass meds, change dressings, (i do not have nothing to nurses, it just looks like that), and by giving them every day care, physical, psychological, emotional support i learned lots from them and about them. some day this will become routine duty and even you get bored you just try to find new things about them, like we look at our children who learn about their world.

good luck,

Long Term Care Columnist / Guide · Jun 7, 2004

I know that I would be terribly upset if someone told me my perception of the world was wrong.........what makes anyone think Alzheimer's/dementia patients are any different? I really wish the people who write the textbooks and teach nursing courses would think about that, and put themselves in the place of these poor folks......even now, with all the knowledge there is about dementia, some are still preaching "reorientation", with the usual result being increased agitation and other "undesirable" behaviors.

Reminds me of a resident who lived in the first LTC I worked in after graduating from nursing school. The staff called him Olie; he'd been a doctor in China between world wars, and while diabetes had stolen his sight, Alzheimer's had taken most of his dignity and his inhibitions, and at times he could be meaner than a barracuda with a toothache! He'd kick, hit, bite, pinch, or twist anything he could get hold of when such a mood struck him, and at the very least he regularly refused treatments and pranced around the halls naked.

Luckily, I found out what worked with him: I would address him as Doctor so-and-so, and we would proceed to have a "professional consultation" as he put it.......yes, as the nurse I was in the subservient role, but once he had questioned me about what I was giving him or asking him to do, he usually would give me a set of "orders" to carry out, and then he'd take the meds, or go back and put his clothes back on, or stop fighting with the staff. Sometimes he'd yell at me or send me out of the room, but overall he was mostly cooperative when he was treated with the respect he still felt his status as an MD warranted.

:)

ktwlpn, LPN · Jun 13, 2004

Hi all. I have a question about Alzheimer's pts. I'm currently a student and one of the interests I'm leaning towards in Geriatrics. I've only done a few clinical assignments in LTC facilities and am interested in Alzheimer's patients. Are you able to 'reach' them in anyway--guess this depends on the advanced stage of the disease but for the most part, are they able to acknowledge you and your care, able to be comforted, etc.
Thanks so much for any in put.
Sue :)

I recommend that you do some research on the net and also look for some Alzheimer support message boards.I have found several really good ones and several regular posters have been diagnosed with dementia...Their posts have taught me a great deal about Alzheimers and related dementias.I love working with these residents and I have learned some valuable lessons...The first priority for care is safety...There is no pill to fix them and the best we can offer is keeping them safe in a secure environment and helping them maintain their dignity by treating them with respect.Meeting nutritional needs is next-and you must be flexible...No law says you have to have breakfast at 8am and lunch and noon...When they are awake-snacks and drinks are the rule....Providing hygiene also calls for flexibilty-whatever you can do you do.....Tubs and showers can be horror shows..So-first you have to get in their world with them..Find out what their agenda is and go with it.....Re-orientation does not work...Nor does force and inflexibilty....Quiet approach and gentle touch does work....if you have to you walk away and re-approach moments later as if it is a whole new day...Usually works like a charm..Educating the loved ones it very important-especially in LTC..Good luck..I find working with these people to be very rewarding....I hope you will too

suzy253, RN · Jun 13, 2004

Want to thank you all for your most informative posts. Plan to read up a lot more on this--as soon as I finish my summer courses!!!

leslie :-D · Jun 13, 2004

i need to reinforce what marla stated. i don't know if they still teach this in school but i was adamantly taught about reorienting to reality- i find this is a bunch of bunk, esp in mod-late stage dementia. even in their late and final stages, there's always that one little spark, however brief, that a profound reality hits them. but even when imprisoned within their disease process, they know who you are (even when they forget their family)...their eyes say it all. it's very important for you to be a part of their reality and not vice-versa.

ktwlpn, LPN · Jun 13, 2004

TEN REQUESTS OF THE ALZHEIMER'S VICTIM 03/10/03 09:46 AM

PLEASE BE PATIENT WITH ME

Remember, I am the helpless victim of an organic brain

disease which is out of my control.

TALK TO ME

Even though I can not always answer you. I can hear

your voice and sometimes comprehend your words.

BE KIND TO ME

For each day of my life is a long and desperate struggle.

Your kindness may be the most special and important

event of my day.

CONSIDER MY FEELINGS

For they are still very much alive within me.

TREAT ME WITH DIGNITY AND RESPECT

As I would have gladly treated you if you had been in

this bed.

REMEMBER MY PAST

For I was once a healthy, vibrant person full of life, love

and laughter with abilities and intelligence.

REMEMBER MY PRESENT

I am a fearful person, loving husband, wife, father, mother

grandmother, grandfather, aunt, uncle or a dear friend who

misses my family and home very much.

REMEMBER MY FUTURE

Though it may seem bleak to you, I am always filled with hope for

tomorrow.

PRAY FOR ME

For I am a person who lingers in the mists that drift between time and eternity. Your presence may do more for me than any other outreach of compassion you could extend to me.

LOVE ME

And the gifts of love you give will be a blessng from which will fill both our lives with light forever.

>This was written by a member of the Alzheimer's support board......

stressednurse · Jun 13, 2004

They reach us from their world, those that understand that are so awesome.