Meeting Patients Where (and When) They Are: How Nurses can Redirect and Calm Alzheimer's and Dementia Patients

Meeting Patients Where (and When) They Are: How Nurses can Redirect and Calm Alzheimer's and Dementia Patients

Christy Cox, LPN Christy Cox, LPN
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Every year, 500,000 people are diagnosed with Dementia and Alzheimer's in the United States alone according to the Bright Focus Foundation. As nurses, some will be our patients and sadly, some will be our relatives. It takes a very special person to care for Alzheimer’s and dementia patients, both in secured settings and especially at home as a homecare nurse or family member.

In my 34-year career, I have gathered skills and strategies for nurses to help calm and redirect dementia and Alzheimer's patients, which I would love to share with you.

A Little Background on Alzheimer's and Dementia

Patients with dementia and Alzheimer’s become extremely confused and tend to displace time and place. Many believe they are still working and others think they are much younger than they are, even children. Some are pleasantly confused, but others become extremely agitated and can be abusive. Wandering about town is a possibility. I've had three or four experiences in which patients were brought to the nursing home where I worked by the police. However, they were not patients; and they had no idea who they were. It's very heart wrenching when they forget who their loved ones are. It takes a very special person to care for Alzheimer’s and Dementia patients in a secured setting.

Tips & Strategies for Nursing Home Staff

1. Please do not try to bring them into our reality. They have their own reality and we must try to understand theirs. For example, I've had patients who will be waiting for their parents to pick them up. Please don't remind them their parents have passed, it confuses them more. In this instance, I've explained to them that it's getting late and their parents called and will arrive in the morning. They would very much like you to stay with us overnight. Generally this will help calm them.

The gentleman who gets up and tries to go to work every day... I've had a few patients who would do this. One was a farmer. So, we would help him shower every morning to get ready. We would ask if he could wait for breakfast. Most of the time after breakfast he would go lie down and not try to go to work. The other was in advertising, we explained to him several times he could do that easily from here, as it was so cold out. We made sure he had plenty of magazines, newspapers, etc. He would line them up and cut out what he needed and make pages of advertising with them.

2. If they feel like walking or pacing up and down the hall, let them. If they are a fall risk, walk with them for a while. Why? How does this make them feel? Does it relax them to be on the move? Is the exercise helpful?

3. Yes, really, baking. This familiar activity works great with the ladies! It takes their minds off whatever is agitating them. Ask if they would like to help you bake something. Set up Baking days if needed. Watch the oven if in their area so they do not burn themselves. You would be surprised how well this works. And… you just might get a sweet treat at the end of the day.

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4. Self care redirection. This works for numerous agitated or upset patients or loved ones with Alzheimer's or dementia. Offer a manicure for the ladies. Definitely offer foot rubs and lotion (even a pedicure!); men love these. Redirect to a snack if there is no time for these. Showers, hairstyling, and playing cards and games are other options.

5. Approach agitated patients or loved ones gently. Ask what is upsetting them in a very calm voice. For example, "Miss. Jones, you seem awfully upset… I was hoping I could be of some help… Would you like to have a cup of tea with me and talk? This is a good example of simultaneous calming and redirecting.

6. Never rush a confused patient - it upsets them more. Take your time and visit with them about anything, really.

7. Roaming. (This is a hard one, especially at home.) Remember just because they are confused doesn't mean they aren't smart. The people the police brought were in nightclothes. I'm not sure how they got out, but when we were young, I'm sure some of us snuck out as well.

  • In a secured facility: Bracelets and/or locked doors, staff etc.
  • At home: I've heard of deadbolts up high and locked deadbolts as well. I would recommend a whole house alarm system, if you don't have the help needed.

8. Adapt to the specific patient’s personality when loved ones forget their family members. There will be good days and bad days. Sometimes your patients may think a grandchild is their child, and others who may no longer recognize friends and family at all. This is a “play it by specific patient's personality” situation. Some patients don't mind being reminded who these people are and even find it funny they forgot. And, there are those who try to argue and say, “I don't have any children.” However heartbreaking, do not correct them.

Explain the disease process to the family. Watch the patient for what time of day they seem the most lucid and suggest the family visit them during those times.

9. The more calming and home-like the atmosphere, the better. My best suggestion is to try to make a setting with calming colors and calming lights. Put up lots of family photos in their rooms, especially with themselves in the pictures. Try to stick to a specific routine every day, this does help ease their anxiety. Schedule the same staff consistently. Always find out from their families what they enjoy doing, their interests, games and TV programs they like, etc. That way, you will be able to redirect them to something familiar that they have always enjoyed. It very much helps to keep them as busy with activities and conversation.

10. Make sure your staff is suited to these kinds of patients. My last tip is for managers and supervisors- everything will run much more smoothly with the right team.

These suggestions are by no means a comprehensive list and may or may not work with specifics patient or loved ones. In my 34-year career with many years in a secured unit and also having a few loved ones who were unfortunately diagnosed with dementia, I have found these ideas to be extremely helpful. As I mentioned earlier, dementia and Alzheimer’s patients and loved ones live in their own realities, attempts to bring them into ours will only agitate and upset them. Always be gentle and kind, it really does take special healthcare to work with them.

About the Author:

Christy Cox is an LPN who is a Director of Nursing Services. She has been in nursing for over 34 years working in many areas including Med-surg, the OR, L&D, Rehab, Skilled, ICU and LTC. She prefers working with the elderly population as it feels the most gratifying. She was involved in writing the state regulations for Assisted Living in Kansas. During her spare time, she enjoys reading, family and her new passion writing.

References

Bright Focus Foundation

Alzhiemer’s Disease Facts and Figures

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