Archive for the ‘Behaviours’ Category
Posted on April 18, 2013 - by Nurse Virginia
WHEN TALKING ABOUT HER MAKES THE ELDER WITH ALZHEIMER’S DISEASE ANXIOUS
The elder’s behavior can tell you how negative the environment is.
Mom started walking through the house, wringing her hands and shaking her head. We tried to find out what was upsetting her. She didn’t know and couldn’t seem to stop.
We tried to reason with her, but that didn’t work. Then we grasped that Mom perceived the mood in the household. We were discussing her ultimate care. How long could we continue to care for her? Should we place her in a nursing home?
We think she picked up on the mood even though she didn’t understand the conversation. The discussion upset our whole family. We also felt we were failing her. She can feel it when things aren’t right, even though she doesn’t seem to know what they are.
Reduce the stressful environment.
We’ve been careful to discuss emotional issues away from her, and she has not been noticeably upset since.
Excerpt from: When Someone You Love Has Alzheimer’s by Cecil Murphey
Beacon Hill Press of Kansas City, Missouri
Available on line at: Amazon – Barnes and Noble – Christian Books
When the elder with Alzheimer’s disease seems anxious take a good look at what is going on in the environment. Is the music too loud, are people talking loudly, do they sound like they are arguing?
When the elder can no longer tell you what the problem is, you need to play detective and first – look around through the eyes of the elder.
Virginia Garberding RN
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on April 2, 2013 - by Nurse Virginia
KICKING, BITING, SWEARING, SPITTING, PUSHING, YELLING, HITTING, WHEN THE ELDER WITH ALZHEIMER’S DISEASE HAS NEGATIVE BEHAVIORS
Max is still strong and active and he has Alzheimer’s disease. He becomes fearful during daily care and hits the caregiver while yelling verbal abuses. Using chewing gum as a distraction technique occupied Max’s attention so that he did not strike out. He also appeared unable to chew gum and swear at the same time, which allowed him to join others and be socially appropriate. Gum chewing wouldn’t be recommended for all physically aggressive elders, but it worked for Max.
Possible triggers for negative behaviors:
- Being surprised. Always approach a person with Alzheimer’s disease from the front – especially if the caregiver is a man – a man coming from behind you or from the side can frighten a confused elder. And always say the person’s name so that they know someone is there.
- Feeling that your privacy has been invaded. This can often happen during personal care. The approach of the caregiver is so important, to create a connection with the elder before you attempt any personal care.
- The approach of the caregiver. If the caregiver is perceived as being angry, critical or hurried, it can scare the confused elder and cause negative behaviors.
- A physical stress such as being over tired or an illness can trigger negative behaviors in a confused elder. Everyone is a little cranky when they are sick or tired and the elder may not be able to communicate that they just want to be left alone, so they strike out.
- If the elder has recently changed medication, consult the pharmacist and see if the new behavior could be a side effect of medication.
Primary cause of physical aggression is fear
When the confused elder is striking out, it is usually fear speaking out through behavior. Fear can turn to anger especially if this has been the elder’s coping response in the past. Many times combativeness and physical aggression are the behaviors that precipitate Nursing Home placement.
Virginia Garberding, R.N.
Director of Education, The Wealshire
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on November 5, 2012 - by Nurse Virginia
KICKING, BITING, PUSHING, YELLING, HITTING – WHEN THE ELDER WITH ALZHEIMER’S DISEASE HAS AGGRESSIVE BEHAVIORS
Part II
The confused elderly may strike out at times when they are afraid, or misunderstand what is happening. Doing an activity or exercise that uses large muscles can give the elder an opportunity to use those physical movements in appositive way.
Exercises that can reduce aggressive behavior:
- Participate in an exercise program – if the elder is especially physically aggressive – they could exercise more than once a day.
- Encourage loud counting with exercise movements – to get out those aggressive sounds.
- Encourage using hand held objects, especially large colorful objects during exercise.
- Large colorful foam noodles
- Thera-band or stretchy cords
- Large colorful bean bags
- Therapy Balls
- Over the door pulleys
- Encourage throwing exercises/activities
- All kinds of large colorful balls (beach, foam, therapy)
- Throwing things into something – laundry basket, over nets, through hoops, bean bag toss
- Throw plastic horse shoes, plastic air planes,
- Hitting activities/exercises
- Inflatable bouncing figure with weighted bottom (clown)
- Drums
- Punching bag
- Punching ball on elastic band
- Hitting balloons or beach balls to each other in a group activity
- Tearing and ripping activities
- Old fabrics into strips
- Newspaper
- Paper that needs to be shredded
- Magazines
- Any kind of food item that needs to be torn (lettuce)
- Kicking Activities/exercises – using a beach ball, large foam balls (make sure the elder has good balance before trying kicking any object)
- Clapping hands to music with a good beat
- Dancing
- Walking
Any activity, exercise or hobby the confused elder enjoyed in the past that used large muscle groups, will give the elder a positive opportunity to be physical.
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 25, 2012 - by Nurse Virginia
KICKING, BITING, SWEARING, SPITTING, PUSHING, YELLING, HITTING, WHEN THE ELDER WITH ALZHEIMER’S DISEASE HAS NEGATIVE BEHAVIORS
(Part I)
Max is still strong and active and he has Alzheimer’s disease. He becomes fearful during daily care and hits the caregiver while yelling verbal abuses. Using chewing gum as a distraction technique occupied Max’s attention so that he did not strike out. He also appeared unable to chew gum and swear at the same time, which allowed him to join others and be socially appropriate. Gum chewing wouldn’t be recommended for all physically aggressive elders, but it worked for Max.
Possible triggers for negative behaviors:
- Being surprised. Always approach a person with Alzheimer’s disease from the front – especially if the caregiver is a man – a man coming from behind you or from the side can frighten a confused elder. And always say the person’s name so that they know someone is there.
- Feeling that your privacy has been invaded. This can often happen during personal care. The approach of the caregiver is so important, to create a connection with the elder before you attempt any personal care.
- The approach of the caregiver. If the caregiver is perceived as being angry, critical or hurried, it can scare the confused elder and cause negative behaviors.
- A physical stress such as being over tired or an illness can trigger negative behaviors in a confused elder. Everyone is a little cranky when they are sick or tired and the elder may not be able to communicate that they just want to be left alone, so they strike out.
- If the elder has recently changed medication, consult the pharmacist and see if the new behavior could be a side effect of medication.
Primary cause of physical aggression is fear
When the confused elder is striking out, it is usually fear speaking out through behavior. Fear can turn to anger especially if this has been the elder’s coping response in the past. Many times combativeness and physical aggression are the behaviors that precipitate Nursing Home placement.
Virginia Garberding, R.N.
Director of Education, The Wealshire
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on September 26, 2012 - by Nurse Virginia
CARING GUIDELINES FOR THE COMBATIVE ELDER
First and foremost – take a deep breath, recognize that all behaviors have meaning and are a form of communication. Behaviors are triggered by physical/emotional causes, environmental stimulants, caregiver approach or are task related.
- Look for a possible need behind the behavior and do not concentrate on the behavior itself. But try to identify and fill that need.
- Try to take a few steps back from the emotional impact of the behavior and assess the situation. This is so difficult especially for someone related to the elder. It is very hard sometimes not to take combative behaviors personally.
- Eliminate the triggers to challenging behaviors.
TRIGGERS
ENVIRONMENT:
- Excessive stimulation – noise, clutter, crowding.
- Unfamiliar environment – unfamiliar people, unfamiliar space.
- Unstructured environment – need for structure and routine
- Uncomfortable – elder is to hot or to cold.
PHYSICAL/EMOTIONAL:
- Not being understood – lack of ability to express needs verbally or nonverbally.
- Pain – chronic illness, arthritis, infection.
- Medication – too much/ too little.
- The need to go to the bathroom, and being unable to express it.
- Sensory deficits – visual, auditory, spatial
CAREGIVER APPROACH/TASK RELATED
- Caregiver going to fast with task.
- Caregiver giving to many directions.
- Caregiver trying to “control” the elder.
- Caregiver not being sensitive to the modesty of the elder.
REMEMBER:
If the elder is upset you can; come back later when the elder is calm, and try again.
If it seems that you have to become a detective – you do. It is only the person right there, on the scene, who can really find out what the problem is and solves it.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on March 30, 2012 - by Nurse Virginia
DEALING WITH DIFFICULT PHYSICAL BEHAVIORS
ACT – Do not over react – a physically aggressive or combative elder is a frightened elder. Remain Calm- The elder has usually shown signs of aggression before they have started to strike out.
- Be alert – the care giver knows their elder. Look for signs of restlessness, agitation.
- Be prepared Size up the situation and have help ready to assist if a combative incident occurres.
- Know the elder Know the elder’s body language – red face, shaking fists, refusing to respond to re-direction, calling out, raised voice etc.
- Initiate “rescue” intervention one caregiver starts the activity of daily living (ADL) if opposition is met, whether in the form of verbal or physical anxiety or aggression, a second caregiver arrives on the scene. The second caregiver is the “rescuer” and sends the first caregiver away – making the elder feel as though they have been rescued.
- Speak in positive tones acknowledge that the elder is upset “You look upset” “You look frightened, everything is fine now” “I’m sorry your upset”
- Stand to the side of the elder do not stand in front of the elder that can be perceived as being confrontational.
- Show concern for the situation/without anger KEEP YOUR HANDS ATYOUR SIDE and don’t make large gestures with your hands.
- Be ready to use objects – grabbing a pillow to protect against a swinging cane or to place between angry elders.
IF TWO ELDERS ARE INVOLVED IN COMBATIVE BEHAVIOR Do not raise your voice – during a violent episode things can escalate with increased noise in the environment. Identify which elder will be easiest to re-direct and attempt to move that elder away from the other aggressive elder. Or initiate a hold technique on the more aggressive elder.
THE HOLD TECHNIQUE is when a care giver reaches their arms around an elder’s mid-section from the back, over their arms, and holds them. While another caregiver comes to the front to reassure the elder. It is very important to provide that reassurance.
TAKE A DEEP BREATH – RECOGNIZE THAT CONFRONTATIONS ARE DIFFICULT FOR EVERYONE
EVEN THE CONFUSED ELDER
Virginia Garberding R.N.
Director of Education – The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
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
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