Archive for the ‘Behaviours’ Category
Posted on November 30, 2011 - by Nurse Virginia
WHEN THE ELDER WITH ALZHEIMER’S DISEASE BECOMES AGGRESSIVE BECAUSE OF PAIN
He started off every day angry, and his mood never got much better. Charlie was 92 years old and had Alzheimer’s disease for some time now. He could still respond when asked a question, and always answered no when asked if he had any pain.
Charlie’s son said he had always been a happy man with an easy going way. Yet now he always looked angry, and during times of direct care he was inclined to hit his caregivers and grab at their hands and arms. There were more than a few staff members with bruises from Charlie.
Then one day a nurse who had been trained in caring for elderly persons with Alzheimer’s disease worked a shift on Charlie’s unit. She didn’t ask Charlie if he was in pain, she just gave the Tylenol that was ordered “as needed.” She knew that Charlie had on open area on his bottom and was incontinent of urine and bowel. While sitting in his wheelchair she knew he must be uncomfortable.
Sure enough Charlie looked less angry and was now speaking more and even greeting people. The nurse carefully read through Charles’s chart and found that he had a history of pain in his left shoulder on movement. He had gone through much testing and it was never found what was causing this pain. However this nurse knew that there would be much movement of that arm helping Charlie to get dressed every morning.
No wonder Charlie had started every day angry. His arm had been moved to dress him, and he hadn’t been given anything for pain before the open area on his bottom had been cleaned and medicated.
The ability of this nurse to put herself in Charlie’s place and think about how he must be feeling, not how he was answering questions, when he could no longer express himself accurately made all the difference. Now the staff could see and enjoy the man that his son had been telling them about. The man who was always happy and had an easy going way.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 19, 2011 - by Nurse Virginia
WHEN THE CONFUSED ELDER WITH ALZHEIMER’S DISEASE ALSO HAS DELIRIUM
June got the call from the nursing home that her mother Lily was on the way to the hospital. “Oh no, not again,” thought June. She knew what this meant; increased confusion, increased restlessness and Lily sure wouldn’t be sleeping while she was in the hospital. June knew all of this because she had gone through it so many times before.
You see every time Lily is admitted to the hospital she suffers from delirium. Lily has Alzheimer’s disease and her delirium can be brought on by medication side effects, infection or dehydration.
Unlike her usual state of confusion due to her dementia, when she suffers from delirium her confusion really escalates. Lily has increased negative behaviors, more difficulty paying attention, is less aware of her environment, her speech is rambling and nonsensical and she doesn’t sleep. If she is hospitalized for several days, the lack of sleep may escalate to hallucinations and illusions.
She may also suffer from delusions and become paranoid thinking the hospital staff are “out to get her.”
The way to help Lily is to identify and treat the underlying condition causing the delirium. Whether it is addressing dehydration, treating an infection, balancing a thyroid problem, relieving pain, or the many other possible causes of the delirium. Identifying the cause while giving Lily the emotional support, which June is so good at, until this stressful situation is resolved, is what Lily needs now.
Delirium is in no way “normal” for the elderly, and should be treated as the medical emergency it is.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on September 8, 2011 - by Nurse Virginia
WHEN THE CONFUSED ELDER CANNOT CONTROL HIS EMOTIONS – FRONTAL LOBE DEMENTIA
Emma can’t remember exactly when the “incidents” started coming everyday instead or every once in a while. Today’s episode was the missing fry pan. Bob called her at work frantic because he wanted to make himself some eggs and couldn’t find a fry pan. “What did you do with our fry pans?” Bob yelled over the phone.
Emma could hear the clatter of bowls in the background; so she asked “What drawer are you looking in?” Bob said he had been through every cabinet and drawer, even checked inside the oven and refrigerator, and there just weren’t any fry pans to be found. Emma consciously kept her voice low and controlled to not further fuel the situation. All the while she kept telling Bob that she was sure the pans would be found in the drawer next to the stove where they always were.
No, he had checked there, and Bob was sure that Emma had “done something” with all those pans. This was turning into an on-going answer for all of Bob’s problems, it probably was Emma. She had done something, moved something, touched something, not told him something, or kept something from him – whatever, it had to be Emma.
When you are making mistakes, daily, constantly, don’t you want to put the blame somewhere else? Everyone makes mistakes but when it is a chronic condition for you, wouldn’t you want to look elsewhere? For Bob it was going to be Emma, she was right there in his life, right in his field of vision – easy access. Certainly no stranger was following him around mucking up his life, (although Bob was extremely afraid of the random intruder because of all the crime drama he watched on TV) so it must be Emma.
So there they were again in yet another situation, finally Emma said, “Do you want me to leave work and come home to find your fry pan?” There was dead silence on the phone, the clatter had stopped – and then Bob softly said “I think I found them.”
What a surprise, they were in the drawer next to the stove all the time. Bob said the fry pans looked just like the lids. Emma knew Bob wanted to say that she had put them in the drawer wrong; somehow he was going to need to get her into the problem.
But just as abruptly as Bob had started the conversation, yelling into the phone his accusation, it was now all over and he just hung up to go make his eggs. It was all over for Bob, but somehow Emma knew this wasn’t over, not by a long shot.
Virginia Garberding R.N.
Director of Education, the Wilshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with dignity and Relevance
Posted on June 22, 2011 - by Nurse Virginia
TAKING CARE OF THE ANGRY, AGGRESSIVE, CONFUSED ELDER-THE WAY THE NURSING HOME DOES
Bob was clearly out of control, with an angry look in his eyes. It was scary. That look certainly scared his wife of 62 years as well as the caregiver. Bob had been known to hit, bite and even kick on occasion when he was very upset.
These behaviors were even more upsetting to his wife Ann because Bob had always been such a gentleman, before he was diagnosed with Alzheimer’s disease. Ann called her daughter who had worked in a Nursing Home for many years with confused and sometimes aggressive elderly people.
Ann and the caregiver learned:
- To be alert for any signs that Bob was restless and might become aggressive.
- To be ready – have a plan in place to either distract Bob or have assistance on stand-by ready to step in.
- A good distraction for someone confused who is becoming aggressive, is to have someone in another room drop something loud. Dropping a handful of silverware – that causes a clatter can easily distract an angry, confused elder.
- Know the body language of the one you are caring for. – A red face, shaking fists, loud voice will be signals that you need to distract the elder.
- Don’t raise your voice; speak in calm, quiet reassuring tone. Say reassuring things, “You look frightened, don’t worry I will stay with you.”
- Don’t stand directly in front of the angry elder, stand a little to the side and keep your arms at your sides and hands down. Don’t make any large movements that might be perceived as aggressive.
- Be ready with an object – a pillow, a throw from the couch, anything that might protect.
Do not react in an angry way; the elder who is physically aggressive is really a frightened person. The hardest thing, and the best thing, Ann learned to do was to remain calm, when Bob couldn’t.
Most of all Ann learned ways to still let Bob be that gentleman she remembered. She guided him to open doors for her, thanked him for even the smallest thing he did. Ann created opportunities for Bob to be helpful and useful. Using a big smile and please / thank you with Bob, made him feel more useful and less in the way.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on June 16, 2011 - by Nurse Virginia
WHEN THE ELDER JUST CAN’T TELL THE TRUTH – DOES HE SUFFER FROM DELUSIONS, CONFABULATIONS OR IS HE JUST A LIAR?
(PART II)
Charles always was a talker. He had been a salesman, and as a child his mother had said he would stop people walking down the street. Charles would then join them and while walking along, talk all the way. So having Alzheimer’s disease just wasn’t going to stop Charles from talking. If he was asked a question, and he no longer remembered the answer, he made something up as he went.
Charles didn’t notice the questioning looks on people’s faces who had indeed lived through the same event he was retelling. What? You served in the Navy; we thought it was the Army. But that was a pretty convincing story of your service on that destroyer during the war.
His wife Ethel over heard him on the phone many times twisting and turning stories and facts. Ethel would just calmly ask, when Charles got off the phone “Who were you just talking to?” Ethel wanted to know who Charles was giving misinformation to, in case she needed to “undo” the information. Most of the time those fine points of “the truth” really didn’t matter in the long run.
If anyone had suggested to Charles that he was lying he would have been very much offended. He was no liar. But he did confabulate stories due to his Alzheimer’s disease.
Confabulation is the telling of a story or facts that never happened. Confabulation isn’t lying and it doesn’t even resemble a delusion because a delusion is a held or fixed belief. The confabulated tale is usually forgotten rather quickly and even denied.
No Charles is no liar; he just has a neurological condition with a great imagination that is being confused with memory. Charles’ imagination is creating false memories for himself, just when he feels he needs them.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on June 14, 2011 - by Nurse Virginia
WHEN THE ELDER JUST CAN’T TELL THE TRUTH – DOES HE SUFFER FROM DELUSIONS, CONFABULATIONS OR IS HE JUST A LIAR?
Above all, don’t lie to yourself. The man who lies to himself and listens to his own lie comes to such a pass that he cannot distinguish the truth within him or around him, and so loses all respect for himself and for others.
And having no respect he ceases to love, and in order to occupy and distract himself without love he gives way to passions and coarse pleasures, and sinks to a brute in his vices, all from continual lying to other men and to himself.
The man who lies to himself can more easily pretend offence than any one. You know it is sometimes very pleasant to take offense, isn’t it?
A man may know that nobody has insulted him, but that he has invented the insult himself for himself, has lied and exaggerated to make it picturesque, has caught at a word and made a mountain out of a molehill-he knows that himself, yet he will be the first to take offense, and will revel in his resentment till he feels great pleasure in it, and so passes to genuine vindictiveness.
(Book excerpt from THE BROTHERS KARAMAZOV by Fyodor Dostoevsky)
This was first published in 1879 and is as true today as it was then. Many liars believe their own lies. We have all heard that person who tells a lie, then turns around and claims to have “heard” this story. Knowing all along that they heard it from themselves, they are the one who said it, and heard themselves say it.
If someone points out to them that what they have just said is untrue, they will immediately take offense and play the injured party. And the liar plays the injured party better then anyone, obviously getting a lot of satisfaction out of the attention.
The liar is all about having an audience and creating theatre, whenever and wherever it suits him. But what about the elder who tells a story about events that never happened, due to a neurological condition. Then does he confabulate, is he delusional or is he still just a plain liar?
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on June 1, 2011 - by Nurse Virginia
FRONTAL LOBE DEMENTIA – BECOMING SOCIALLY INNAPPROPRIATE
They were at the local community theatre, it was intermission and as Marge was exiting the ladies room she could hear Carl’s voice. Above all the noise of the crowd she could just make out Carl’s voice rising. Not knowing if he was angry with someone (his anger could appear suddenly these days with little provocation) Marge hurried to the sound of his voice.
As Marge rounded the corner to the sitting area outside the theatre, she saw Carl and the focus of his tirade. Marge could now hear the subject of his monologue. How Carl had been cheated out of his inheritance by his step-mother and her children. All the sins of the step-mother, and her handling of his father’s estate, were being aired in a very public forum.
Marge joined this small group and saw that it included one of Carl’s father’s former business acquaintances and his wife. Marge saw the “dear in the headlights” look on both of their faces as they listened to this story of deceit and treachery. Neither did Marge didn’t miss the looks of interest on the faces of the on-lookers in the area as they listened to this horrible tale.
As soon as Carl saw Marge he announced that he also should go to the bathroom before the intermission was over. While he was gone Marge attempted to make small talk with the now bewildered couple. She asked how their family was and how they were enjoying retirement.
On returning from the men’s room, as soon as Carl makes eye contact with Marge he announces in a loud voice “Bad news Marge, I have blood in my urine!”
Marge just told Carl they could talk about it later, and they had better get back to their seats as the show was starting.
Frontal Lobe Dementia – lack of social awareness
Persons with Frontal Lobe Dementia – just seem to have lost their social filtering system. They can’t read other people’s faces and get their cues from the reactions of others. Things they never would have said before, now just kind of pour out of them with no warning.
It could be an off color joke – told by an otherwise very controlled, dignified and conservative person. It could be a very personal comment made to a stranger. The person with Frontal Lobe Dementia is in the moment, and whatever occurs to them in the moment, comes out of their mouth.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on April 27, 2011 - by Nurse Virginia
KEEPING THE ELDER WITH CONFUSION FROM WANDERING OUTSIDE
When spring comes, the warm weather might beckon the confused elder outside. The elder who is in the moment – might just see the sunshine and flowers blooming, walk right out the door and keep on walking.
The unattended confused elder, will be at risk outside unattended due to a decrease in safety awareness. We may be safe walking along a highway with speeding cars but the person without safety awareness is at risk for injury walking that same highway alone. The confused elder with poor judgment may be at risk for injury during a storm or extreme weather conditions such as extreme heat. Because the confused elder lacks the ability to reason their decision making skills will be poor.
Many things may trigger the elder with Alzheimer’s disease to walk out the door.
When you store outdoor things right next to the door, it can trigger or cue an elder to go outside. Store all purses, gloves, coats, shoes, hats and scarves out of sight and away from the area of the exit door. For a person living in the moment, just seeing a coat can trigger opening a door and walking out.
When a confused elder is continuing to go to the door avoid saying “Don’t go outside” This will tend to make the person think about doing exactly what you told him not to. Bettor to say “Stay inside” and avoid conversation with negative words like “Don’t.” A positive word will always work more effectively than a negative. A negative can prompt a response such as “Don’t tell me what to do.”
A confused elder may be trying to get away from something, a loud environment, too much activity, arguing. Always look first to the environment when a confused elder is trying to walk away. An overwhelming controlling caregiver can create a negative environment that the elder wants to walk away from.
Being able to see right through a window in the door can prompt a confused elder to open that door and walk right out. Trying to block out the view with a large picture or putting pictures on a exit door and all around an exit door can prompt the elder to naturally walk right past all the pictures and turn around.
For a free Guide to “Visiting” with the elderly go to: www.pleasegettokniowme.com
(Click on Products)
Virginia Garberding, R.N.
Director of Education, The Wealshire
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on April 12, 2011 - by Nurse Virginia
WHEN THE BULLY IN THE NURSING HOME IS THE NURSING ASSISTANT
The night before the big “event” (taking mother out of the nursing home to a restaurant for a family celebration) we selected Mom’s clothes and hung them outside her closet door for the staff who would be getting her up the next day.
Saturday morning we went back to the nursing community for a final run through of the evening plans. Mother was dressed in the chosen clothes, but at breakfast, she spilled food all over the front of her outfit. Again, we notified the staff by speaking directly with the caregiver, as well as the nurse. “Please pass this information on to the evening shift,” I said. I pointed out the new clothing we had hung outside the closet.
“Yes, we’ll do that,” the supervisor assured me.
While Mother took an afternoon nap, we went to our hotel. We felt such a sense of relief: Everything was ready. Just to make sure, we arrived at the nursing community an hour earlier than planned. There sat Mother, up early from her nap and re-dressed in her breakfast encrusted clothes. I notified the nursing assistants. “Mother is going out with the family for dinner.”
The nursing assistant turned to my mother and, with her fingernail, scraped at the stained food. “Do you want to be changed, Verona?”
Before mother could answer, I knew where the conversation was headed. If she said no, the assistant would insist. “If she doesn’t want to be changed, she doesn’t have to change.” She might also remind me of my mother’s rights. The matter of rights is like the proverbial two-edged sword, and the staff can be very savvy in using it. If the nurse or assistant stands over a resident and uses a tone that indicates wanting and agreement, the elder can be easily intimidated into cooperation with the staff.
“Do you want to be changed?” the assistant asked again.
“Yes, I want to change,” Mother said, to my surprise.
“We will get back to you when we have time, the nursing assistant answered, as she walked away.
(Book excerpt: Please Get To Know Me – Aging with Dignity and Relevance)
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on April 11, 2011 - by Nurse Virginia
ELDER TO ELDER RUDENESS– WHEN BULLYING HAPPENS IN THE NURSING HOME
I was a student nurse and Mabel was a sweet little white haired woman in her early eighties who had had a major stroke. Mabel didn’t have the use of her left side. Taking care of her was what we referred to as “total care.” Totally changing her incontinent product (in those days they were cloth) and washing her privates. Struggling to dress her, a woman who was unable to assist in any way.
Mabel couldn’t even sit up without some hands on support. Yet she continued to wear hose, a slip, dress, sweater a little make-up and jewelry. By the time I was done it looked like I had just taken a shower. But Mabel looked like a million bucks, at least I thought so. I remember she was so sweet and thankful, and I thought it was so cute that a nursing home resident (we called them patients in those days) still wanted to carry her “pocket book.”
So all decked out and holding her pocketbook, I proudly pushed Mabel to the beautiful day room where other sweet little old ladies were seated. When I pushed Mabel up to a group, the apparent spokesperson turned to me and said “She can’t sit here with us.” Very much surprised I asked why not and was immediately informed “She wets her pants; she can’t sit with us because she wets her pants, she has to sit over there.” The spokesperson gestured to the far end of the day room.
These many years later I still feel Mabel’s pain, as it was announced to the room that day, that she wet her pants. Would it have made a difference to inform those ladies that Mabel couldn’t walk to the bathroom? That in fact if they had had such a stroke they too would be wetting their pants.
Instead I seated Mabel on the other side of the room with another group of ladies who didn’t protest. And while I was in my rotation at that facility I tried to spend extra time with Mabel.
Why was I so shocked? Was it because I thought every little old lady was a sweet little old lady? Why was I so surprised to find a bully in the nursing home? I wouldn’t have been surprised to find a bully in a Kindergarten or on the playground.
Come to think about it, that is probably right where this bully started out.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
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