Wednesday, June 27, 2012

Dealing with Alzheimer's

A good friend of mine inspired me to write this blog post.

One day my friend and I were hiking and he was talking about his mom who has started to show signs of dementia. I work with people who have Alzheimer's (Alzheimer's is a specific form of dementia, which by the way, is not a normal aging process) on a daily basis and I believe that I approach them in a unique way that helps to keep them calm while allowing me to provide the care they need. I was walking through the disease process with him when I happened to mention that I thought the kindest thing a person or family member could do for someone with Alzheimer's is to recognize the point where "reorientation" was no longer appropriate or helpful.

Reorientation is a term we (healthcare professionals) use to describe the process of helping the patient orient to reality. It may be a simple reminder of where they are, what the date is or even what time it is. As Alzheimer's progresses, reorienting simply becomes stressful and the person starts to feel paranoid. Their reality has changed. In those instances, it becomes time to go where they go. I have the benefit of having been involved in the theatre. Improvisation is second nature to me. That said, although I know it's incredibly frustrating and painful for family to see their loved one in such a altered state, going where they are is the kindest thing to do for everyone.

A little story (or two):
We have a resident were I work who spent much of his life working as a security guard. He has reached a point where he now thinks that he is working security for a hotel and that he has a room there. Instead of reorienting him, which wouldn't be helpful and only confusing, when he comes up to ask if he's on shift, depending on what I'd heard in report, I'll usually ask him if he's eaten because it's break time and I don't want him to miss his meal. If he'd been up "patrolling" all night, then I suggest that he go and get a nap because he's "on shift" later that night and we don't want him to miss his sleep. I'm able to manage his care by going where he is and using his experience to make sure that his needs are met.

We had another resident that was very, very proper. She liked manners. So, I called her Miss Eve (name has been changed for privacy). She was very paranoid and didn't like people to touch her. So, instead of just coming up and shoving her meds in her mouth, I would kneel down so that I was eye-to-eye with her and say in an enthusiastic tone of voice, "Hello, Miss Eve, how are you this morning?" I would have a quick dialogue with her and because I'd spoken to her and discovered what she likes, I knew she loved applesauce. So I'd put her crushed meds in that. Because I also knew she liked manners, I knew she wouldn't refuse me if I told her that I'd specifically made the applesauce for her. Getting her to take meds was... simple. When she was no longer able to swallow effectively and her meds were put into a gel, I told her that her skin was very dry and that I wanted to put lotion on her. Whereas other staff really struggled giving her care, I never once had an issue. Because I would go where she was and offer what she was familiar with. No stress for either of us.

These basic things have helped me to have a relatively stress free interaction with those who have some sort of memory impairment.
  1. Have patience. Their thought process is slower than ours. If you think of memory like a file cabinet, we all store our memories (everything from words to the first time we saw Santa) within the cabinets, in their own, perfectly labeled files. And, if you're like me, then they're all nicely color coded with a neatly typed label. We are able to access these memories, for the most part, with quick accuracy that doesn't hinder our interactions. When someone has a memory impairment, it's like ALL of their files where tossed into the air. Some of them were put back in the correct file but others weren't and some files are now empty. It takes time for them to access those memories. It's not helpful when we attempt to complete their sentences or express frustration. They're frustrated, too. What helps is to use short sentences. Ask "yes" or "no" questions. Express one thought at a time. Use pauses in order to let them catch up. Sit quietly while they find the words. If you don't understand them, ask the same question... don't try to rephrase it, that only confuses them more because they think you're asking a different question.
  2. You don't need to be right. Being correct is unnecessary and you can't win... because their reality is not your reality. When you deny their reality, it creates paranoia, greater confusion and anxiety.
  3. Go where they are. If they think that you're their great grandmother... then be their great grandmother. What harm does it cause? None. And it provides them with a companionship that is familiar and comforting to them.
  4. Remember that Alzheimer's has stages and that each of those stages must be approached in a different manner. The person may not behave in a way that you are familiar with. They may not seem like the person that you love. But they cannot help their behavior. Some wander, unable to sit still. Some cuss or become overly sexually inappropriate. Remember that this is a stage and will eventually pass. 
Watching a loved one go through the changes of Alzheimer's can be very, very painful and exhausting. If you're a caregiver... find support (other family members, a professional support group, church, etc.) because it's not easy and caregiver fatigue is common. You're also really, really amazing for making the commitment (and it's definitely a commitment) caring for your loved one. If you find that it's too much, please don't suffer guilt. It's exhausting work. And there are wonderful facilities that can care for your loved one... just do your research.

If wish you every luck and my heart goes out to you.

**For more information about Alzheimer's and dementia, please click on the link above.


  1. I am SO glad you became a nurse. Thank you. I will be needing you when my mom starts to go -- I can think of no better resource than a compassionate, intelligent friend with amazing gifts and experience.

  2. Great advice. We took my grandfather about 6 years ago- he's since passed away. This was around the time my mother got sick- cancer and lupus- and couldn't take care of him. He had vascular Alzheimer's- a series of small strokes. People used to get mad at us because we used to "play along with him" when he thought he was on a cruise ship in Korea. We'd just tell him that breakfast was being served in the dining hall. Eventually after eating a meal with the family, he would reorient himself.

    Another thing we found useful was picture timelines of my kids. He never forgot me or my husband. But the kids... we had pictures of them with him from birth to present all in order on his wall. When he would forget them he'd look at the pictures and gradually remember them.

    1. What a wonderful story! I'm thrilled that you all let him be on his cruise ship without attempting to correct him! It sounds like you all were very thoughtful, kind and generous and went where he needed you to go! I love it!