By Shelley Matthes, RN-BC, BSN, RAC-CT , Director of Quality Improvement at Ecumen
You often hear about “behaviors” that can accompany Alzheimer’s disease and other dementias. They can be manifested in many different ways, such as yelling, extreme sleeplessness and physical outbursts. Psychotropic drugs are often used as interventions to such behaviors, even when the person doesn’t have a diagnosis of psychosis.
Care providers used to think that little could be done to help people through these episodes, but we now know there are ways in which we can help in many situations that don’t necessarily involve drugs. Most often, such “outbursts” are expressions of frustration or unmet needs, so an essential starting point is asking:
Are there triggering clues that help you identify why a person is exhibiting a certain behavior?
Most often we find that certain situational, environmental and social factors trigger behavioral symptoms. Sometimes the answer to reducing these behavioral expressions is quite simple. Bright light, for example, can cause stress for some people and, for other people, loud sounds can create fear. Proactively removing the person from a stressful situation, and, perhaps using healing touch, such as providing a gentle back rub or holding the person’s hand, can go a long way to easing the tension.
Other times, we have to explore a variety of alternatives. There is no cookie-cutter solution to calming those with Alzheimer’s or other dementias. It is often a trial and error approach. Following are two examples:
Janet, is in her 80s and has had Alzheimer’s for a decade and often believes she is a young person. She has a pattern where many afternoons, she begins searching for her long-deceased parents.
Care team members were once taught to use reality orientation in these situations. In other words, Janet would be corrected over and over with little effect. Not only didn’t reality orientation work, but the constant correcting invalidated the person’s feelings and created even more behavioral symptoms. Imagine if you were told something wasn’t true, yet it was very real to you. How would you feel?
A more successful approach is to validate the individual and share in his or her reality. Only then can the care team member give comfort and alternatives to help the person.
In Janet’s case, participating in her reality could mean helping redirect her attention or thoughts. Ways of doing this might include comforting her in the moment by letting her know that you saw her parents and that they said they were coming back soon; it might mean asking her to make a drawing for her parents and share it with them; or sitting down with Janet to talk about her parents or helping do a house chore for her parents. You’ll see that each of these calming techniques focuses on at least one of Janet’s five senses.
I’ll relay the experience of one resident empowered by Ecumen Awakenings:
Robert, usually a mild-mannered resident, became very agitated during music events. If a musical group came to perform, Robert became disruptive, attempting to drag his chair to the front and waving his arms in the air. After talking to his family, we learned Robert had been in a jazz band when he was a young man. Later, Robert married and took a job working for a large company, but he always recalled his “days with the band” with great fondness.
The next time there was a musical performance; the staff asked if Robert could participate. With some assistance, he conducted the group and even played tambourine on several songs. The staff began calling him ‘The Jazz Man,” which always brought a smile to Robert’s face.
Allowing Robert to be part of the performance made all the difference. Suddenly, music was his favorite activity and the disruptive outbursts became fewer and fewer.
While tactics used by the care teams in the examples shared here differ, several commonalities exist: the care team takes the time to know the person in their care, which gives them greater insight into potential causes of a resident’s behavioral expression; they take a much more holistic, expansive view of care, it’s not simply a physical transaction, and they look to involve a person’s abilities, including their senses to work through behavioral expressions. I think both examples show that learning occurs on both sides of the care partnership – learning by the care team and the person entrusted in our care.