Archive for February, 2010
Posted on February 24, 2010 - by Nurse Virginia
HEALTHCARE WORKERS GET TO KNOW THEIR CONFUSED ELDERLY PATIENTS FROM THEIR OBITUARIES
Mabel died today. Minutes later, a nurse hurried down the hall carrying two old books. She stopped and excitedly showed me what the staff found when they cleaned Mabel’s room. She held up books on physics. “Mabel wrote them! Can you believe that? I never knew she wrote anything.”
We had cared for Mabel for six years, but none of us staff knew she had written any books. When she came to us, Mabel was already afflicted with Alzheimer’s disease. We later learned that Mabel had been a prominent physicist.
As I listened to the nurse, I thought, Wouldn’t it have been wonderful if Mabel could have enjoyed our expressions of respect, awe, and admiration? Now it was too late.
That true story isn’t an isolated instance. Too often the nursing home staff learn about residents from reading the obituaries. The individual life stories never make it to the direct care staff, even if it had been reported to social workers on admission. The story had been diluted to minimum facts on a fill-in sheet at the back of the chart under the Social Service tab.
With the focus on patient confidentiality, the direct caregivers have access only to the information needed so they can do their jobs. They receive information such as whether the elders are continent, whether they can brush their teeth, bathe independently, or need walkers.
For quality of life, the information needed by the staff involves such things as who they are and something about their families, where they came from, and what they’ve accomplished in their lives. As it is now in the admission interviews, the conversation between families and caregivers revolves around the tasks of caring for the elder.
Too often the individuals become known only by their diagnosis. The new hip in 403, the Parkinson’s in 602, or the hip replacement in 403 – instead of Mrs. Jones who just had a hip replacement in 403. I became sensitive to that need early in my career, when I took care of an elderly man with Alzheimer’s disease. His children had hand written a letter to the staff and it was posted on his door. It began with these words: “Dad worked his entire life with cardboard.”
Excerpt from: Please Get To Know Me – Aging with Dignity and Relevance
By: Virginia Garberding with Cecil Murphey
Posted on February 23, 2010 - by Nurse Virginia
WHEN THE ELDER WITH ALZHEIMER’S DISEASE STOPS MOVING INDEPENDENTLY
The elder in the mid-stage of Alzheimer’s disease will often stop moving independently. Joints that stop moving quickly become stiff. When those joints become stiff and movement is reduced, muscles and ligaments shorten. Joints that now have a limited range of their previous motion; we call a “contracture.” Contractures are painful.
Elders with Alzheimer’s disease lose independent movement
This stopping of movement is called Apraxia. Apraxia happens when there is a disconnect in the brain from the thinking of doing something and the movement to do it. This loss of independent movement may first be noticeable, when the elder who used to speak with many gestures, no longer does. The family member notices the elder now only does passive things, like watching television.
As the disease progresses, the elder can physically still go through the motions of getting dressed, but no longer initiates that movement. He could still brush his teeth or comb his hair, but he no longer seems to know how to start, or what to do.
Contractures easier to prevent than to cure
Prevention of contractures involves simple movement and exercise of every joint. Whether it is an organized exercise class, watching an exercise DVD or just moving to music while you are getting the elder dressed - the moving is what matters. The caregiver needs to physically move the elder during hands-on care. Getting dressed and undressed are great opportunities to move all of those joints several times to keep them flexible.
A joint contracture can develop in as little as four days of no movement and require five hundred hours of movement to correct that contracture.
Reduce the contracture and improve quality of life
Whether the elder is in the home or in a Nursing Community, once they have contractures there are experienced professionals who can help. A company I am familiar with is Dynaspint Systems. Their logo is Stretch Beyond Your Expectations. This is a “Green” company that recycles the inner framework of their splints. Re-using splints saves money for Medicare and ultimately for all of us.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 22, 2010 - by Nurse Virginia
“NORMAL” AGING MEMORY LOSS NOT ALWAYS A PROBLEM WITH MEMORY AT ALL
Most people as they age start to question their memory. When a person in their 50′s or 60′s can’t find something they just had, they immediately blame their memory. Just as the 40′s are the time when the eyes change and the individual may need bifocals. When a person reaches their 50′s they start to experience increased distraction. It is increased distraction that the person is mistaking for memory loss.
Pay attention and lay down a memory
When they built a new mall by my house, I determined that I would always park in the same place, in the center of the mall outside of Penny’s. Over the years I have seldom deviated from this routine. This way I always know where I parked my car. When going to an unfamiliar mall; as I enter I stop, look around and lay down a memory of where I am. Because I realize I am distracted, if I am talking to a friend, thinking about where I need to go, watching a grandchild, I won’t really notice what is around me and where I am and lay down that memory.
Create routines, habits and systems
A good friend of mine, after losing her keys (and all the inconvenience that caused her) determined to always buy the same purse. She had a favorite purse, and she went out and bought three more of them. This way in the years to come, the pockets of her purse would always be familiar and in the same place.
Just the same as putting everything away in the same place in your kitchen. Putting your keys, cell phone, TV remote, everything you find yourself searching for, in the same place will help during times of distraction.
Decrease problems of distraction; get in the habit of doing more than one thing at a time
I seldom just watch TV, most of the time I am also knitting. Doing more than one thing at a time increases your ability to focus. Watch TV and do a puzzle, studying each piece for size, shape and color requires attention. Try to do something physical at the same time you are doing something passive.
Plan ahead and organize so you don’t feel rushed
As I age, I find myself writing more and more things down. I now keep three calendars, one for social and family events, and one for tracking bill payments and the third is at work and coordinates all of my professional obligations. I use calendars with large spaces so I can make notes. I don’t want to spend one moment, or any brain power trying to remember if I paid the garbage bill.
See Also: Aging – is it a Senior Moment or Alzheimer’s Disease – 2/12/2009
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 19, 2010 - by Nurse Virginia
Conditions and Behaviors that Indicate an Immediate Safety Risk for the Confused Elder
When the elder lives alone, it becomes hard for family to know just when it is time to step in. What are the conditions or behaviors that need an immediate response and what might indicate an immediate threat to safety.
Conditions that require an immediate response:
Distinct signs of weight loss, loose clothing, little or no food in the house, spoiled food, (see blog: First Sign Weight Loss – posted January 22, 2009)
Signs of a fire in the kitchen or misuse of stove or microwave – for Dad, my sister noted a cutting board in the kitchen that was burned, which led to us having the stove turned off
Medications not taken or the suspicion that medications are being taken inappropriately – especially dangerous is out of control hypertension or diabetes
Frequent falls, trips to the emergency room or hospitalizations
Car accidents – (see blog: Alzheimer’s Disease, When he Realizes he Can’t Drive Anymore – August 29, 2009)
Utilities turned off or plumping that no longer functions – especially when the elder no longer has a functioning toilet and hasn’t let anyone know
Non-payment of mortgage or rent – eviction notice
Evidence that the elder has wandered and been lost in the community
Temperature inside home inappropriate for season – thermostat set incorrectly – elder does not seem to notice
Environment appears to pose a health risk, accumulation of garbage, signs of hoarding behavior, signs of rodent or bug infestation
Elder appears paranoid, has signs of anxiety, expresses feelings of unrealistic worry or concern
Family members do not always agree on when it is time to step in, and assist their parents. Or the very involved family member sees behaviors, that infrequent visitors miss. (see blog: Alzheimer’s Disease, When the Person Still Looks so Good - April 17, 2009)
See also blogs:
Alzheimer’s Disease, Symptoms Haven’t Changed for 100 years – January 3, 2009
Alzheimer’s Disease Not a Part of Normal Aging Memory Loss – June 12, 2009
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on February 17, 2010 - by Nurse Virginia
STILL ALICE – PUTS THE READER IN THE MOMENT WITH EARLY ONSET ALZHEIMER’S DISEASE
Just before leaving for our weekend get away, I received a package from my niece in the mail. No note, just the book. Thinking this might be a good read at the resort, I took it along. Little did I suspect what a page turner this book would be. Lisa Genova puts the reader in the moment with her character, as she goes through the journey of Alzheimer’s disease.
Excerpt from Still Alice – as Alice experiences for the first time the embarrassment of incontinence.
Just as she reached the front door, an urgent pressure in her bladder announced itself, and she remembered that she really had to pee. She hastened back down the hall and opened the door to the bathroom. Only, to her utter disbelief, it wasn’t the bathroom. A broom, mop, bucket, vacuum cleaner, stool, toolbox, light bulbs, flashlights, bleach. The utility closet.
She looked farther down the hall. The kitchen to the left, the living room to the right, and that was it. There was a half bath on this floor, wasn’t there? There had to be. It was right here. But it wasn’t. She hurried to the kitchen but found only one door, and it led to the back porch. She raced over to the living room, but of course, there wasn’t a bathroom off the living room. She rushed back to the hallway and held the doorknob.
“Please God, please God, please God.”
She swung the door open like an illusionist revealing her most mystifying trick, but the bathroom didn’t magically reappear.
How can I be lost in my own home?
She thought about bolting upstairs to the full bath, but she was strangely struck and dumbfounded in the Twilight Zone-like, bathroomless dimension of the first floor. She had an ethereal sense of observing herself, this poor, unfamiliar woman crying in the hallway. It didn’t sound like the somewhat guarded cry of an adult woman. It was the scared, defeated, and unrestrained crying of a small child.
Her tears weren’t all she wasn’t able to contain any longer. John burst through the front door just in time to witness the urine streaming down her right leg, soaking her sweatpants, sock, and sneaker.
“Don’t look at me!”
From: Still Alice by Lisa Genova- Simon & Schuster, New York, N.Y.
I highly recommend Still Alice as a unique look inside the mind of a woman with Alzheimer’s disease, as she shares her perceptions. The reader never really knows what the truth is, because we never get inside the minds of the other characters. We just know as time goes on and Alice tells us, how much more assistance and cues she needs to understand her environment.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 10, 2010 - by Nurse Virginia
HOME SAFETY FOR THE CONFUSED ELDER REMOVE ENVIRONMENTAL HAZARDS
The confused elder needs a safe environment. The first step in safety is to make sure vision and hearing are tested regularly. Remember that with aging the elder loses sensation through their sense of touch. The environment needs to provide sturdy landmarks that the elder can easily reach for when walking around the house. The confused elder needs furniture that stays in place, to provide visual cueing as to where the person is.
Support the senses: vision, hearing and touch
- Yearly vision testing
- Yearly hearing testing
- Motion sensor lights in hallways, bedrooms and bathrooms
- Elder lose the ability to sense hot surfaces – no heating pads or electric blankets
(see three part blog series on “Vision”)
The confused elder will at some time have balance problems –these suggestions will support the elder’s ability to remain safe.
- Add railings to both sides of stairways
- Non-skid materials on steps
- Use sturdy furniture – no light weight decorative furniture
- Chairs with arm rests and chair legs that splay out slightly to decrease chance of tipping yet do not create a tripping hazard when walking past
- Use glider rockers not the traditional rocker base model which can create a tripping hazard
- On hardwood floors use non-skid caps on chair legs to reduce sliding
- All walkways free of clutter
- All thresholds between inside rooms flat
- No scatter rugs
- All phone and electrical cords out of the way.
- No glass table tops
- No swinging doors
Maintain consistent furniture arrangement. When furniture wears out, replace the item as soon as possible with a similar piece. Place sturdy furniture so that backs can be used as a support when needed.
Bathroom safety is a must
- Raised toilet seat (depending on the height of the elder, feet should always be placed firmly on the floor when elder is seated)
- Sturdy shower chair
- Handheld showerhead
- Consistent water temperature
- Sturdy grab bars
- No scatter rugs or loose carpet
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 8, 2010 - by Nurse Virginia
How to Use Cues to help the Confused Elder Understand What is Happening
Helping the confused elderly through cues.
Oxford Dictionary defines cue as” a signal to do something.”
The cue may be a smell, a touch, a sound, an item, or a visual symbol. Using a full complement of cues through out the day can help the confused elderly understand the environment, and what is happening at any given moment.
A familiar smell can tell the confused elder it is time to eat
A smell can be a cue that is time to eat, if the cue you smell is pot roast. A smell can stimulate your appetite such as passing a bakery and smelling the cookies, may make you feel like having a cookie. A fragrance such as baby powder cues you that there is a baby around. The smell of laundry soap cues you that you are wearing clean clothes.
Seeing a symbol works best as a cue, when the symbol looks the most like what it represents. So a picture of a lawnmower will be a better cue than a line drawing of the same mower. A picture of a banana will not be as good a cue for “do you want a banana” as holding out a real banana to the confused elder.
Helping the confused elderly through combining cues.
Putting a favorite hand lotion on the elder’s hands and massaging it in is using the cues of touch as well as smell. Hearing running water, holding a bath towel and smelling their life long favorite soap, Dove can cue the elder that they are taking a bath.
Communicating with the confused elderly using cues is non-verbal communication. When the elders have lost their “words” and no longer understand what is being said to them. They can still understand what is going on around them, through your cues.
Cues are forms of communication – helping the confused elder do more for themselves, better understand the environment and know what is going on around them, is the reason for offering cues.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 3, 2010 - by Nurse Virginia
THE ELDER WITH ALZHIEMER’S DISEASE NEEDS A CAREGIVER WITH PATIENCE MORE THAN ANYTHING
When working with someone with dementia, patience is a must
Shirley was a thirty-five year old career caregiver, helping a patient re-learn to walk and build strength. The patient was an elderly woman with Alzheimer’s disease and a new hip replacement. This was the woman’s third try at a successful surgery and outcome. Her son was wondering out loud if they should have even tried again.
While Shirley was encouraging her patient to “take just one more step”, on the parallel bars. The confused patient was yelling, cursing and spitting on Shirley. Spitting in Shirley’s hair, on her clothes, while Shirley just kept giving her patient more words of encouragement.
Knowing the family and how important this was to them and the patient, made it just that important to Shirley.
It takes special people to work with the confused elderly population
Is this for you?
Ask yourself, if always being right, is important to you, you may not want to work with someone with Alzheimer’s disease. They often think they are right too.
If you are a nervous person and you know, hearing someone call out “help me, I’m falling” over and over all day long, (even when you know they are safe and not falling) will drive you crazy. You may not be cut out to be a caregiver for an elder with Alzheimer’s disease.
If you are known for getting things done fast and right. Taking care of someone who is in the moment, and sees no reason to hurry and thinks they are already doing it right. This work might not be for you.
The right person for the special job
If you are like Shirley, a person who always puts the patient’s best interest before her own. A person who will take the time to listen to the same story over and over. A caregiver who never tires of reassuring a confused elder that they are safe and not falling. Then you are one of the “special people.”
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on February 2, 2010 - by Nurse Virginia
Natural Disasters – When Watching TV is Bad for the Elderly with Alzheimer’s Disease
When the TV is always on!
Some people live with the TV always on, like background music. The caregiver may start their day with turning on the TV to catch the morning news and then just leave the TV on. A few years ago my husband and I owned but didn’t operate a small assisted living home in Florida. We had residents up to age 102 years, but they all had some level of confusion or dementia. Our biggest challenge was caregivers. Even though the home had a large beautiful four season’s room over looking the backyard pool. The residents spent their days getting up, getting dressed, eating and then sitting in the living room in front of a TV all day with all of the drapes closed so they could see the picture better.
This wasn’t the way I wanted to care for the elderly, so we had to close that home. I pictured a home where the drapes were open, people moved around the house helping make lunch – not only eating, sitting in the four seasons and enjoying nature and maybe a simple board game. And most of all soft music playing, not the constant drone of the TV.
Negative TV!
Bad News! Sad News! That is repeated over and over throughout the day. When news breaks that is frightening, like an earthquake or flood, some major disaster, the confused person might think it involves a loved one or themselves.
Crime dramas – soap operas, stories of personal tragedy where people are crying, yelling and angry or screaming in fear. People with Alzheimer’s disease no longer see the difference between the picture on the TV and reality.
Positive TV!
Shows from the past that the person always enjoyed. Lawrence Welk Show, always the favorite. Wheel of Fortune hasn’t changed its format for years and so remains very familiar. Re-runs of shows from early TV days, Andy Griffith, Dick Van Dyke and always I Love Lucy.
Make it a happy day – turn off the TV.
Virginia Garberding, R N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
- Help your elder find comfort, relevance and respect no matter how frail he or she is.
Find out why the quality of life depends so much on the family no matter who the direct caregiver may be.
Find out how to have a meaningful visit with your parent when they have dementia.
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