Your Questions About: What ‘s The Time

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Chris asks…

What’s the best way to communicate with Alzheimer’s patients?

I’m an LPN at a nursing home. Many of our residents have Alzheimer‘s Disease. Some are mildly forgetful, others have “10 second Tom” symptoms (in reference to a character from the movie “50 First Dates”) and forget what you just told them 10 seconds prior.
We have one lady “Sara” (not her real name) who asks where her room is and what time she eats dinner literally 500 times per shift. We tell Sara the information she asks, and then, seconds later, she‘s asking again. You feel bad for her at first, but after the 30th time in 15 minutes, it gets to be annoying, and oftentimes you have to walk away from her. I’ve heard some people telling Sara, “You just asked me a minute ago, leave me alone already”. Obviously, this isn’t the right thing to say and may even be classified as “abuse” with how strict nursing home regulations are.
One woman, “Jean” (not her real name) is 95 years old, but believes she is 31, recently married, and has a baby at home with no one to look after it. Jean often has episodes of crying and pleading iwth us, “Just let me go home and get my baby and I’ll come back”. She‘s a sweet little old lady, with the kindest, most gentle personality, and it breaks my heart that she doesn’t realize that she‘s not 31, that her “baby” is an adult who put her in a nursing home and refuses to come visit her. Someone offered her a realistic baby doll to perhaps help her with the longing for her baby, and she looks at us, and says, “You’ve got to be kidding me, this is a doll, what do you think I’m stupid?” Other times, she’ll tell us, “This is a cute baby (the doll), but she‘s not mine, I know my baby and this isn’t her, just let me go home and take care of my baby!”
We have another lady, “Betty” (not her real name) who has had multiple falls and therefore is unable to be left alone in her room, she is brought out to the nurse‘s station for the entire shift, until she goes to bed at night. This woman has a memory that lasts for about an hour, she’ll repeatedly ask for her son, and why did he leave her there, and when can she go home, and why are we holding her prisoner. Sometimes we go along with Betty‘s dementia and tell her the roads are closed and she can go home tomorrow, and other times we’ll call her son and he explains to her that she lives at the nursing home and cannot come home. Sometimes a nurse or aide will explain to Betty that she is at the nursing home for therapy and can go home once she‘s better (obviously, we know she’ll never be well enough to go home). We’ve tried to explain to her about her past history of falls (she‘s fallen three times in the last 4 months), and she denies that she‘s ever fallen. And she denies that she needs therapy. Last night, Betty was at the nurse‘s station for 6 hours yelling, being combative, verbally abusive, she almost fell twice while getting up out of her chair. Betty was telling other Alzheimer‘s residents that its not right that they’re being held captive and that they should get up out of their wheelchairs and try to leave
Another resident, “Irene” (not her real name) has many of the same behaviors and verbal outbursts as Betty, and got up out of her wheelchair and almost fell 5 times in 10 minutes because Betty was telling her to get up and walk around!!!
Obviously, after Betty‘s behavior last night, its best to separate her from other Alzheimer‘s residents, but, is there an effective way of communicating with someone who is so confused? Do you play into their reality or try to explain to them how things really are? Is it best to call the family? (Sometimes these families just create additional problems, some will come in for 5 minutes to see the resident, then leave and the resident is left wondering when they’re coming back, others refuse to talk to their “loved one” because they know the confusion they’re going to have to deal with, and still others, such as Betty‘s son, will tell them “No, you’re not coming home, you’re not safe at home, and we sold your house to help pay the bills” which obviously creates a lot of trauma for the resident).
I’ve asked supervisors and administration on how to best speak with someone with such intense confusion, and no one seems to have any good answers. Some say to go with their reality, others say that we MUST reorientate them to reality.
Any input would be greatly appreciated. Thank you.

Clip from “50 First Dates” movie

Potter answers:

Many years ago I worked as a CNA in a nursing home and had one client in particular with Alzheimer’s. Each night I would come in and each night he would greet me with “is it true?” And each night I would have to tell him the sad news. Each night this patient repeated the moment when he first learned his wife had been killed by a street car. To me, this is the definition of Hell, to have to relive this moment every day for the rest of your life (they were married about 15 years).

By all means do not enter their fantasy life and do constantly bring them back to reality. One thing that worked for this guy, and I really don’t know why, but I invented a little fantasy life of my own. A life filled with dilemmas that required seeking his advice. The nightly inquiry of “is it true?” decreased markedly as I allowed this client to contribute his own experience to my “made-up” dilemmas. There’s something about feeling needed or “valuable” that has amazing medicinal properties. Let me know how this works for you.

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