Archive for the ‘Behaviours’ Category
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
Posted on April 7, 2011 - by Nurse Virginia
WORRY – ONE OF THE DIFFERENCES BETWEEN US AND THE ANIMALS
When a gazelle is grazing they always have heightened awareness – instinct keeps them alert to any sign of danger. But the gazelle isn’t thinking “I better keep a look out, yesterday I remember a pretty brutal looking tiger around here.”
No, the gazelle is in the moment, always ready to bolt at a moment’s notice, but full of worry? No. The gazelle isn’t worried as well about running out of food, or where to sleep tonight.
People on the other hand are full of worries. Many are prisoners of their past, they think the same thoughts day after day. Instead of filling their minds with new ideas, spending time with positive people, reading quality books and articles, thinking positive thoughts, they constantly return to the negative. And their negative thoughts are filled with regrets from the past and worries about the future.
Molly indulged herself in many memories of how her mother had hurt her. Molly often recalled the day she was about eight years old and was on a carnival ride. She was riding a pony and loving it until her Mother started calling out to her. “Hold on Molly, you’re holding the reins wrong,” “Look at how everyone else is doing it,” “Don’t fall off; the way you are sitting you are sure to fall off.”
Even though Molly’s mother had been dead many years, her hurtful words went on in Molly’s mind. Molly relived, in her mind, that short ride so many years ago and how her mother had embarrassed her that day.
Molly became so unsure of herself she could barely drive in her own neighborhood. She could only drive any distance with her husband at the wheel, anyone else driving worried her so, she made herself sick. Molly became afraid of everything; her worries were making her world smaller and smaller.
Molly realized she had developed a real anxiety disorder, and she didn’t want to pass it on to her children. When Molly saw her children could be doing something “better” or her way, she held her tongue and let them learn by doing. She kept her critical thoughts to herself and she didn’t fill her children with worries, just to keep them close to herself.
Molly needed professional help to see what had been done to her; she would never know who had made her mother such a worrier. But this was one legacy she wasn’t passing on.
Christ gave us the best advice about worry see: Matthew 6: 25-34 and Luke 12: 22-34.
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 29, 2011 - by Nurse Virginia
FRONTAL LOBE DEMENTIA, ALZHEIMER’S DISEASE – THE LOSS OF REASON
We have all met or known people who appear to have little ability to take facts and think through what is practical and possible. Not a difference of opinion, but a real lack of thinking through or about a situation, and coming up with a logical conclusion. Not brain surgery, but everyday simple decisions we all make.
I think of Myrtle, her husband Phil had Alzheimer’s disease and still very much wanted to “help.” Phil had never been involved in the kitchen for the 45 years of their marriage. Now, since he was home all the time, he had evidently decided to get involved in what had always been Myrtle’s territory. His “help” was making Myrtle feel on guard all the time – guarding her kitchen and her things.
Since Phil became involved, kitchen items Myrtle had had all their married life, were now disappearing at a frightening rate. Myrtle’s favorite spatula she had for 40 years was gone. They were down to one steak knife, the others had all disappeared. She knew Phil, in his confusion was throwing things away; she had found enough things in the garbage to know that.
Phil also really liked to run water and took every opportunity to get to the kitchen sink and run water. If Myrtle didn’t immediately get grease and stuck on food out of pots and pans she could expect hamburger, pieces of fish, a piece of paper towel, just about anything to be floating in the sink. Phil was fast!
Myrtle could have tried to reason with Phil. Try to get him to see that the things he was doing didn’t make sense. It just wasn’t reasonable or practical to dump just anything and everything in the sink, but Phil was no longer able to think this through. It wasn’t that Phil was unreasonable, his actions weren’t intentional. Phil was just always acting in the moment and not even aware of the logical conclusion to throwing away a knife. (You soon won’t have any knives.)
Myrtle’s solution was to try as best she could to stay one step ahead of Phil. In the kitchen her policy was to simplify-simplify. Although she would like to make the traditional meals, Phil so much enjoyed. It now was too hard for Myrtle to keep up all that cooking and still monitor Phil. So she started making less involved meals, grilling outside more, making a simple chicken breast and a salad was now their usual meal.
Most of all, Myrtle learned how to let go and let God. Myrtle thought about how she could make their life run more smoothly and put these changes into place because, thank the Lord, Myrtle could still reason.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 28, 2011 - by Nurse Virginia
THE DAY THE UNTHINKABLE HAPPENED – WHEN TV IS JUST TOO STRESSFUL
Twenty-five years ago today, I was working in a Psychiatric ward, watching TV with staff and patients. When a tall young man reached for the TV, ripped it from its perch high on the wall, and threw it across the room.
We had just witnessed, with the rest of the country, the explosion of the Challenger. The reaction of the staff was so great – shock, crying, shouts of “Oh, No!” That it was just too much for that patient who didn’t understand what had happened but he was in the moment with us.
Our reaction was not only the horror of that moment, but knowing that school children all over the country were watching the first teacher to go into space. It had been all they talked about on the news for days. Televisions were brought into class rooms so that children could watch this historic event. The whole country was watching, as were we.
When that fireball exploded, our patient couldn’t take the stress and lunged for the TV, and with incredible strength, got rid of it the best he knew how. That moment was very real for all of us, but so much more so, for the patients we had with us in that moment. Because of our extreme reactions, those that we were there to care for, just couldn’t take our grief.
Bad news, sad news. For the very fragile in our society; children, elderly, demented and mentally ill, extreme situations in person are no different than on a TV screen. They are all very real and upsetting.
Memories that are tied to a strong emotion are more vividly remembered than if there was less emotion in that moment. That was one of those days that so many won’t forget. Where they were and what they were doing, when “it”, the unthinkable happened.
(See blog 2/2/2010 – Natural Disasters – When Watching TV is bad for the Elderly with Alzheimer’s disease)
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 January 25, 2011 - by Nurse Virginia
THE AGITATED ELDER WITH DEMENTIA NEEDS TIMES OF HIGH STIMULATION ALTERNATING WITH TIMES OF LOW STIMULATION TO PREVENT AGITATION
Balancing times of high stimulation and low stimulation throughout the day will decrease agitation.
Agitation:
Is excessive movement, such as pacing, inability to sit still as well as excessive verbal activity that is without purpose. This excessive movement or talking is connected to some internal stress or mental decline. The behavior would not be seen in a non-demented person put in the same situation. Agitation is not the result of dementia but rather a sign of to much environmental stimulation.
Reasons the elderly with dementia become agitated:
- Having dementia makes the elder more vulnerable to stress or increased stimulation from their environment.
- Increased agitation can also be seen in an elder with dementia who has an unmet need, maybe the need to use the bathroom. If the elder is unable to understand their need or make the need known it may trigger agitation.
- Cognitive changes may make it difficult for the elder with dementia to control their behavior. (the elder may be just as afraid of their agitated outburst as everyone else)
Persons with dementia do not realize what is triggering an emotion and are unable to control their environment.
Possible causes of high stimulation: too many visitors, too much talking and inability to follow the conversation, inability to do something requiring fine motor skills causing frustration.
Activities that are both high and low stimulation: music, (depending on the type) massage, natural outdoor environments and pets.
Activities that are low stimulation: quiet slow music, napping, reading, (or someone reading to the elder) looking at art, or personal pictures and reminiscing.
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 December 8, 2010 - by Nurse Virginia
MANAGING DIFFICULT BEHAVIORS IN THE ELDERLY WITHOUT DRUGS– TRY WALKING, LAUGHING OR FOOD
All too often the first thing tried with the confused elderly with unwanted behaviors are drugs.
The major problem with giving drugs to the elderly is the side effects. I have seen elderly with very knowledgeable family members, still get caught up in a downward spiral of adding more and more drugs. When the first drug causes side effects then another is added to combat those side effects and add even more. Many side effects make the resident sleepy which can lead to more safety issues. Side effects can affect the elder’s walking and balance once again leading to safety problems.
7 –Non-drug related ways to manage difficult behaviors in the confused elderly.
- Make sure the elder is getting enough exercise – exercise releases pent up energy. Walking is always the first choice, go to a mall and really get a good walk in. It will increase a person’s appetite as well as improve their mood.
- Laughter is a great way to work out. Laughing for one minute is equal to 10 minutes on a treadmill. Especially for the elder in a wheelchair – laughing is a great way to release energy and promote some deep breathing.
- Mange the confused elder’s fatigue by making sure they have regular rest times.
- For the occasional outbursts be ready to provide a distraction – especially a food the elder might really like.
- Make sure the elder is regularly toileted, due to the agitation caused by not being able to communicate that need.
- Make sure the elder is wearing their glasses, hearing aid, what ever device they need to increase their ability to understand their environment.
- Provide on-going reassurance that you are there and everything is all right.
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 October 29, 2010 - by Nurse Virginia
THE CONFUSED ELDER CONTINUES TO HAVE PERSONALITY AND STYLE OF BEHAVIOR
Everyone has their own personality or character, but that isn’t always a clear description of that person. Everyone also has a style of interacting with other people, situations and the environment. The confused elder continues to display their own style of behavior. Knowing the elder’s behavioral style prior to their dementia, can help the family know how to more effectively help the elder.
Styles of behavior:
The Thinker – Analytical Style:
The analytical person is usually slow at taking action and likes to think things through before making a decision. The thinker preferred an intellectual work environment and liked working alone. The caregiver may not always give the thinker enough time to answer a question, or do a task.
The thinker is organized and likes structure in their day. The thinker seeks security and having a routine, gives them that feeling of security. Meals at the same time, having a morning and evening routine would give the thinker structure in their day. The thinker is good at problem solving and may now ask many questions and want the details.
The Feeler – Emotional Style:
The feeler likes and seeks close personal relationships. The feeler would like to hear about the caregiver’s family, they are good listeners. The feeler is uncomfortable with hearing people argue or quarrel. They like security and the feeling of belonging. Hearing conflict even on the television could be troublesome for a feeler.
The feeler is probably the easiest behavior to identify. They probably have been told many times that they are too emotional. But being emotional makes them good listeners, has given them good counseling skills and brought them friends,
The Imaginative – Expressive Style:
The imaginative person will be considered stimulating and maybe does things a little too quickly. They might have been thought of as being reckless at one time. They dislike being alone and like to be involved. They would like a caregiver who stays close.
The imaginative person may exaggerate things and generally has good persuasive skills. They get good ideas that they tend to get others caught up in. In the old movies this would have been the person to shout “Let’s put on a show!” The imaginative person needs respect and admiration. The caregiver would do well to compliment this person.
The Driver – Active Style:
The driver style likes action, dislikes inaction and really likes control. This person was competitive, independent and considered “cool.” This person wants to manage himself, wants freedom and little advice from others. The driver would have little tolerance for the feelings of others, might not even notice.
The driver style would need a caregiver who can keep up with them, but keep their distance. Keep them safe while giving them some freedom to have and complete goals.
Caregiver should compliment elder’s style.
Knowing the style of the elder may also help the family more effectively pick a caregiver. If the elder always was very active and had a driving behavior style – they would require a caregiver with a lot of energy. After all caregivers also have “style.”
Virginia Garberding, R.N.
Director of The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on October 12, 2010 - by Nurse Virginia
APPROACHES FOR WORKING WITH ELDERS WITH ALZHEIMER’S DIEASE WHEN THEY ARE AGITATED
The elder with Alzheimer’s disease may be unable to understand, interpret or cope with a real or imagined stressful situation. Identifying the cause that triggered the negative reaction, as well developing safe approaches for this person, is the key to success. The caregiver knows when a certain stressor will cause a negative behavior. The stressor may be physical or emotional. When the caregiver can anticipate the stressor, the use of a distraction can be put in place pro-actively.
I think of a couple who were faithful in their Church attendance. The wife was the caregiver for her husband who had a diagnosis of Alzheimer’s disease. The husband Earl became easily agitated in Church, when he didn’t understand what was happening. If there were too many people for him to cope and he didn’t know what was expected of him, Earl became stressed and he bolted. If the congregation stood, Earl not only stood but hurriedly walked out of the pew and frantically looked for where he was supposed to be. In order to continue to worship with the congregation his wife Edith needed a plan.
Edith told Earl to keep an eye on her purse, when she picked up the purse it would be time to go. Earl kept an eye on that purse; in fact his eyes never left that purse during the service. But when at the end of the service Edith picked it up, Earl could join the congregation exiting the church. This plan made it possible for the couple to worship together for much longer than they would otherwise have experienced.
So what did Edith do?
- She asked Earl to “keep an eye on her purse.” People like to be helpful. A caregiver can ask the elder “to hold this for me, I will be needing this later.” This also allows the caregiver an opportunity to thank the patient.
- Edith gave Earl something positive to do. When working with a person with Alzheimer’s disease you want to avoid words like “don’t” and “no.” Try to turn conversation to a positive response. Instead of “Don’t do that”, try “We can do it this way”.
- Edith realized what the trigger was (the congregation standing) and since this was something she had no control over, she used a distraction technique.
Other Suggestions:
- Distract with food
- Make use of a familiar routine
- Allow the person time to response
- Reduce environmental stimuli
- Allow and encourage the use of physical movement to defuse agitation.
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 July 14, 2010 - by Nurse Virginia
WHEN THE ELDER IS SO ANXIOUS THEY JUST CAN’T STOP WORRYING
“Your Mother has been waiting for you; she needs to talk to you right away.” Said the nursing assistant, when she saw May’s daughter walk into the nursing home. When the daughter arrived at her mother’s room there was the church lady visiting as usual. “Oh good, your Mother has been waiting to talk to you, she thinks they want her to leave,” said the church lady, who left soon after the daughter’s arrival.
May told her daughter her whole story about “someone” telling her “you can leave whenever you want to.” May said she doesn’t have anywhere to go, she needs to get her things together, she needs her pictures off the walls and someone is going to have to arrange for a new apartment.
May’s daughter tried to reassure and then to reassure again, but it wasn’t taking, the subject kept coming up. The daughter called for the nurse, and asked that May’s medical chart be checked to see if there was any plan for her to move. The nurse returned with the reassuring report that everything is good and “No, there are no plans for you to move.”
Yet after the nurse left, May showed her concern on her face with a wrinkled brow and the question “Where should I go?”
It is not uncommon for the elderly to be very anxious when in a nursing home. Their concern usually involves “who is going to pay for this?” Especially during meal time if the staff puts the meal ticket on the table. The elder will think the dining room is a restaurant and the meal ticket is the check. And they don’t have the money to pay, so they just don’t eat.
For the elderly with Alzheimer’s disease anxiety can be created by the environment, negative caregiving (being repeatedly corrected and argued with), the frustration of forgetting how to do something and so many other situations that are no long understood. For the elder with Alzheimer’s disease, the distress will be felt long after the situation that caused it is forgotten.
I am not a proponent of using a drug instead of an explanation, diversion or distraction being tried first. But when the elder is truly worried, anxious, concerned and upset. Sometimes it is a great comfort that we have a drug like Xanax that can take that worry away.
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 29, 2010 - by Nurse Virginia
AGITATION AND AGGRESSION IN THE CONFUSED ELDERLY WITH ALZHEIMER’S DISEASE
Aggression on the part of an elderly person with Alzheimer’s disease is usually a reaction, and triggered by a small unimportant incident.
Aggression on the part of a confused elder is typically:
Not planned
Not premeditated
Doesn’t have a long-term goal
Can be explosive with no obvious buildup
Unusually is periodic
Is part of brief outbursts between long periods of calm behavior
More likely to be a burst of aggression and quickly forgotten by the elder
Seen in a married man who is taken care of by his spouse
A confused elder with few social contacts
Is likely to occur during times of direct hands-on care; bathing, toileting, dressing, shaving, eating
We are told that 70-90% of the elderly with Alzheimer’s disease have some behavioral problem. Who wouldn’t? If you don’t understand what is going on around you, what people are saying to you, what’s happening to you, why wouldn’t you become agitated or aggressive.
Leading cause of agitation and aggression -is loss of physical function
When the confused elderly person, wants is to take care of themselves, put their shirt on by themselves and they can’t seem to remember how. And then someone tries to help them, when they struggle with that shirt. The elder can become agitated. A decline in physical function will lead to aggressive behavior faster, than a decline in cognitive function.. The caregiver many times doesn’t even know what the elder wants or what they are trying to do for themselves.
Aggressive and agitated behavior is one of the leading reasons a confused elderly is admitted to a Nursing Home. The family is able to handle the forgetfulness and confusion in the elder. But the aggression, especially on the part of an elderly man who is still very strong, becomes just too much for the family.
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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