Friday, November 21, 2014

Why Do People with Alzheimer's Have So Many Behaviors?

When I first became a nurse, I found a job at what I still call ‘the best job I ever had.’  I’d already discovered my passion for Alzheimer/Dementia patients, and this was a private, skilled nursing facility for Alzheimer and Dementia patients.  I could honestly go on and on about the amazing features of this place, along with increased number of staff and the activities, they had round the clock music therapy and art therapy.  How many places can say that?

One of the things that really stuck out to me was that they had 3 full days of ‘office’ orientation.  You know, the boring stuff where you go over policies and procedures, expectations, handbook, etc.  Anywhere else I’ve ever worked had 1 day.  There was a reason why they had 3.  They spent the first day on the normal stuff, but then they took two whole days training us on what to expect with the Alzheimer’s/Dementia population.

There were many memorable lessons I gleaned in those two days, but they had us participate in one activity that just made me rethink everything I knew about nursing, care, and nursing homes.  I know I’ve mentioned this before, but it was so incredible, I think I’ll repeat it again.

We were given six slips of paper and told to write down the things most important to us.
I honestly don’t remember what I put all those years ago, but sitting here right now, here’s what I would put:

1.       Family
2.       Church/Religion
3.       Chocolate
4.       Colors
5.       Music
6.       Somewhere safe to live

We were then asked to fold our responses and mix them up.  Then we were asked to pick one of the cards out of the pile.  Once we’d picked it, we were told that we could no longer have that one particular object.  It was no longer a part of or life, and we’d have to learn to live without it.

I can’t tell you how devastated I felt.  It was something so simple, and I still had 5 other cards, but losing that one particular item made me want to cry.  Then they asked us to pick the second card.  You can probably see where they were going at this point.

They wanted us to see what our residents were giving up when they move into a facility, or even if their children have them stay with them.  Suddenly, they don’t have the independence they once had, and everything has changed.  Maybe they don’t have easy access to a piano anymore, or they can’t get the food they used to eat at home.  Any drastic change like that can throw anyone off, but when you already have difficulty adapting to new environments or maintaining a grip on reality, it can be even worse.

Most Alzheimer’s patients who move into facilities are going to have increased behaviors.  It’s a natural reaction to the upheaval their life has just endured.  They may not understand what’s going on.  I know that my Great Grandpa believed he was in a gas station.  Others have thought that they were at the store, waiting to be picked up by family. 

Imagine how you would feel, if you woke up and you didn’t recognize anything around you.  And then when you get out of the room, a bunch of (hopefully) friendly people tell you that this is your new home.  You don’t know where your family is, and the food they give you doesn’t taste like home.  How would you feel?



And if you can’t properly communicate, the only way to let them know is by acting out.  Maybe you just scream for several days, hoping that someone would hear you and rescue you from these strangers.  Or maybe you think that they’ve kidnapped you from your home and you start attacking them.  Or you could try to escape, checking each door to see if they’re actually locked.

Unfortunately, this natural, and really – understandable – behavior can cause families and healthcare workers to get impatient.  Instead of looking at the situation from the perspective of their residents/patients, they might punish them, perhaps by not letting them eat a dessert, or by forcing them to stay in a chair.  But the person with Alzheimer’s doesn’t understand why they’re being punished.  It may cause even more behaviors because now they’re even more angry or scared.  It’s a vicious cycle that can’t be broken with the person who has Alzheimer’s. 

It is something that needs to be broken by the people who are there to take care of them – whether that be their family, nurse, CNA or doctor.  They have to realize that they won’t always be able to vocalize their needs or their concerns.  They need someone who can look beyond the physical obvious action and realize the reason behind it.

It can be exhausting, and it can take weeks, maybe even months to find what the patient needs.  Families should not try and do it on their own.  Burnout and exhaustion can often lead to impatience and anger on the part of the provider.  Make sure that you have a good support system, and make sure that you voice your own needs when they arise.