Dementia Elderly Patients
Dementia is mean, mind stealing disease that affects many elderly patients in different ways. It begins with forgetting small things like where you put your car keys, and escalates into forgetting yourself and your family. Many can function well with dementia for a period of time, but then generally have to transition into receiving help from family caregivers and/or nursing facilities such as nursing homes or assisted living. Dementia can turn a normal thinking person into an irrational person who cannot be argued with or redirected, which causes much stress on caregiver’s. At home family caregivers receive the brunt of it, workers in nursing facilities can leave and go home at the end of the shift, while children and grandchildren generally
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cannot. When a loved one is caring for their family member the toll can be seen in many ways, from lack of self-care, to the use of many vices such as alcohol and smoking. Many will go into depression caused by the amount of pressure they feel to keep their family member at home instead of placing them in a nursing facility. This will generally continue until the person either gets further into the disease and cannot be cared for at home, or the patient dies.
Caregivers that keep dementia riddled people at home have many changes in their life. They have to be hypervigilant with making sure the patient doesn’t cause harm to themselves or others. This at times entails putting extra locks on doors that require a key so they cannot get outside alone, and locking up any medications so they don’t forget they took them and retake them. The caregiver generally cannot work, or must hire full or part-time help in order to do so. They don’t get to have as much social time, due to the constraints of taking care of the loved one and being unable to find someone else to care for them. Their extra time is spent doing things like cleaning and dressing the person with dementia, after a bit they may also have to feed the person. Seeing this happen to their loved one causes them to find ways to cope; some use healthy coping methods such as exercise and reading while others gravitate toward drinking and smoking. The caregiver may feel they should keep the parent or loved one at home because they feel the burden that they took care of them, now it’s their turn to return the favor, also because most of the older generations would never have admitted a loved one into a facility, you took care of your own. This idea can be good, until the person gets too far into the disease and then it can be detrimental to the caregiver and the loved one.
I personally have worked in a few nursing homes, some with assisted living since 2009. Dementia patients have many mood swings; one minute they can be the sweetest person you’ve ever met, the next they can be trying to cause harm to themselves or others. There are a few reasons for the extreme attitude changes, the most common being they can’t remember how to do something or why they did it. Can you imagine how it would feel to suddenly be awoken from a deep sleep to someone trying to get you out of bed and dressed? The first instinct would be to try to tell the person to leave you alone, which dementia patients may or may not be able to communicate correctly. The second would be getting frustrated and lashing out, possibly causing harm to your caregiver. Repeated questions are another trait, mostly because they cannot remember the answer even if you told them 20 times in the last hour. There is no reasoning with someone with dementia, either you join them in their delusion or you are conspiring against them. I have found in my years in the healthcare field its best to agree with the resident, even if they think you are working at Levi Strauss or going to the beach that day. Some residents repeat the same phrase one thousand times a day, a recent resident of mine said “ING and ER” very frequently with no explanation of why that was significant. To her it all made sense and she couldn’t figure out why we couldn’t understand what she was saying. Eventually we figured out it meant all kinds of different things, sometimes when she was soiled or hungry she would scream it until her needs were met. Other residents that don’t have dementia would always get upset with her not realizing she couldn’t help it or at all stop it. The part of the patient’s brain that houses impulse control is usually severely damaged or completely gone. They will not think before they act and even if they know they can’t do something they will try and possibly cause harm to themselves. I have seen multiple residents attempt to walk who haven’t in years, end up falling and have broken bones and be bruised all over. We as caregivers try to minimize those situations as much as possible, but we can’t be everywhere at once. Incidents will happen.
All this being said, dementia is no one’s fault, and has no cure. The patients cannot help how they are; it is a brain malfunction. There are medications that are for the treatment of Alzheimer’s and dementia patients, but they are no cure. They will help with the symptoms, but eventually none of them help as much as we would like them too. There is no cure for this disease at this time.
Many dementia patients cannot remember themselves, much less anyone else. The patient may remember your face, but they cannot connect your name or how they know you to it. If they have some long term memories left they will try to connect you to it, even if you didn’t know them then. This trait of dementia is normally one the hardest on family members. One of the residents I take care of has a wife that comes to see him every day with no fail, and he cannot remember her name nor is he able to talk to her, but she still comes to give him a sense of normalcy. This same resident was kept at home until he could no longer walk, his wife being sole caregiver. She shares stories of their life prior to dementia and tears up telling the tales closest to his admission to our facility, she always ends telling us with tears in her eyes “This isn’t the man I married, he was a great man who did great things in life, and I wish he was still with me”. Another type of family member is the family member that cannot cope with the disease and what it has done to their loved one. These are the family members that place their parent in a nursing home and visit periodically to ensure they are receiving the care they deserve, but do not generally stay long and most times leave in tears at what they see. Nobody wants to visit a parent or spouse and them not remember who you are. I have personally dealt with many family members like this, while they are generally very appreciative of the care their family member receives, but don’t always understand the dynamic of the disease because they don’t see it every day. Recently I was approached by a family member to a dying patient with Alzheimer’s Dementia, with tears in her eyes she said “Thank you for all you have done for my mother, there is no way to repay you for your kindness and your love. You loved her when we couldn’t be around, and for that we will always be grateful.” Needless to say it was a tearful event, this woman had been with me for 2 years and we had a special relationship, even though she couldn’t remember my name she knew me, and always told me I was special to her. At first she would seek me out when she hadn’t seen me for a couple of days. After the disease hit her the hardest it was a feat to get her to eat, but when I sat down to feed her she would arouse enough to at least smile and attempt to eat. This for me made me feel worthy to work with these patients, though frustrating they may be they always make you feel better about yourself and what you do in the end. There is an option that will help people keep their loved one home longer, but also get a break.
This service is provided by nursing homes; it is called respite care. The loved one would enter the nursing home for a short time, generally 5-10 days. This gives the caregiver time for a “mental health break” and lets them either go on vacation, or just time to spend elsewhere other than caring for their family member. The respite break gives the caregiver time to recollect and regain ability to care for their loved one again without getting burnt out. More often than not, the caregiver does not utilize respite. Claudia Jardim and Kenneth I. Pankenham elaborate on this in their study “Carers' Views on Respite Care for Adults with Mental Disorders” stating that “Of the 106 carers, 36% had accessed respite care and 64% had never accessed respite care; from here-on these two groups will be referred to as respite care users and non-users, respectively.” This fact could be that the caregiver doesn’t realize these services are available, or they choose not to utilize them. Many caregivers in my personal experience benefit well from respite care, they always seem less stressed and tired at the end of it than they did at the beginning. It really depends on the caregiver; some also feel that the nursing staff do not provide the same quality of care that they receive at home to their loved one. This could be true, or be contributing to the guilt most feel for admitting them, even if for a few short days. In my opinion, everyone caring for a sick relative needs to utilize respite care at least once or twice a year. Working with the elderly, especially with dementia, is very draining of not only strength but your mind as well. The mood swings make you think constantly if you are doing the right thing, or if you could do something differently to make them feel
better. In conclusion, Alzheimer’s and dementia are a very debilitating duo, for patients and caregivers. Generally, these patients will be cared for at home by family or private caregivers until the decision is made they need further care outside of the families’ scope. This decision is not an easy one for any family member. Most will do anything to keep them at home, even if it means sacrificing their lives mentally and socially. Some utilize the respite care provided by many facilities, others feel it is not needed, some do not even know it is available. Caregivers need to understand that it’s ok to ask for help, and to take time for themselves even if they feel they don’t have it or deserve it. They also need to keep some social life, if only to stave off the feelings of depression from only seeing their loved one.
cannot. When a loved one is caring for their family member the toll can be seen in many ways, from lack of self-care, to the use of many vices such as alcohol and smoking. Many will go into depression caused by the amount of pressure they feel to keep their family member at home instead of placing them in a nursing facility. This will generally continue until the person either gets further into the disease and cannot be cared for at home, or the patient dies.
Caregivers that keep dementia riddled people at home have many changes in their life. They have to be hypervigilant with making sure the patient doesn’t cause harm to themselves or others. This at times entails putting extra locks on doors that require a key so they cannot get outside alone, and locking up any medications so they don’t forget they took them and retake them. The caregiver generally cannot work, or must hire full or part-time help in order to do so. They don’t get to have as much social time, due to the constraints of taking care of the loved one and being unable to find someone else to care for them. Their extra time is spent doing things like cleaning and dressing the person with dementia, after a bit they may also have to feed the person. Seeing this happen to their loved one causes them to find ways to cope; some use healthy coping methods such as exercise and reading while others gravitate toward drinking and smoking. The caregiver may feel they should keep the parent or loved one at home because they feel the burden that they took care of them, now it’s their turn to return the favor, also because most of the older generations would never have admitted a loved one into a facility, you took care of your own. This idea can be good, until the person gets too far into the disease and then it can be detrimental to the caregiver and the loved one.
I personally have worked in a few nursing homes, some with assisted living since 2009. Dementia patients have many mood swings; one minute they can be the sweetest person you’ve ever met, the next they can be trying to cause harm to themselves or others. There are a few reasons for the extreme attitude changes, the most common being they can’t remember how to do something or why they did it. Can you imagine how it would feel to suddenly be awoken from a deep sleep to someone trying to get you out of bed and dressed? The first instinct would be to try to tell the person to leave you alone, which dementia patients may or may not be able to communicate correctly. The second would be getting frustrated and lashing out, possibly causing harm to your caregiver. Repeated questions are another trait, mostly because they cannot remember the answer even if you told them 20 times in the last hour. There is no reasoning with someone with dementia, either you join them in their delusion or you are conspiring against them. I have found in my years in the healthcare field its best to agree with the resident, even if they think you are working at Levi Strauss or going to the beach that day. Some residents repeat the same phrase one thousand times a day, a recent resident of mine said “ING and ER” very frequently with no explanation of why that was significant. To her it all made sense and she couldn’t figure out why we couldn’t understand what she was saying. Eventually we figured out it meant all kinds of different things, sometimes when she was soiled or hungry she would scream it until her needs were met. Other residents that don’t have dementia would always get upset with her not realizing she couldn’t help it or at all stop it. The part of the patient’s brain that houses impulse control is usually severely damaged or completely gone. They will not think before they act and even if they know they can’t do something they will try and possibly cause harm to themselves. I have seen multiple residents attempt to walk who haven’t in years, end up falling and have broken bones and be bruised all over. We as caregivers try to minimize those situations as much as possible, but we can’t be everywhere at once. Incidents will happen.
All this being said, dementia is no one’s fault, and has no cure. The patients cannot help how they are; it is a brain malfunction. There are medications that are for the treatment of Alzheimer’s and dementia patients, but they are no cure. They will help with the symptoms, but eventually none of them help as much as we would like them too. There is no cure for this disease at this time.
Many dementia patients cannot remember themselves, much less anyone else. The patient may remember your face, but they cannot connect your name or how they know you to it. If they have some long term memories left they will try to connect you to it, even if you didn’t know them then. This trait of dementia is normally one the hardest on family members. One of the residents I take care of has a wife that comes to see him every day with no fail, and he cannot remember her name nor is he able to talk to her, but she still comes to give him a sense of normalcy. This same resident was kept at home until he could no longer walk, his wife being sole caregiver. She shares stories of their life prior to dementia and tears up telling the tales closest to his admission to our facility, she always ends telling us with tears in her eyes “This isn’t the man I married, he was a great man who did great things in life, and I wish he was still with me”. Another type of family member is the family member that cannot cope with the disease and what it has done to their loved one. These are the family members that place their parent in a nursing home and visit periodically to ensure they are receiving the care they deserve, but do not generally stay long and most times leave in tears at what they see. Nobody wants to visit a parent or spouse and them not remember who you are. I have personally dealt with many family members like this, while they are generally very appreciative of the care their family member receives, but don’t always understand the dynamic of the disease because they don’t see it every day. Recently I was approached by a family member to a dying patient with Alzheimer’s Dementia, with tears in her eyes she said “Thank you for all you have done for my mother, there is no way to repay you for your kindness and your love. You loved her when we couldn’t be around, and for that we will always be grateful.” Needless to say it was a tearful event, this woman had been with me for 2 years and we had a special relationship, even though she couldn’t remember my name she knew me, and always told me I was special to her. At first she would seek me out when she hadn’t seen me for a couple of days. After the disease hit her the hardest it was a feat to get her to eat, but when I sat down to feed her she would arouse enough to at least smile and attempt to eat. This for me made me feel worthy to work with these patients, though frustrating they may be they always make you feel better about yourself and what you do in the end. There is an option that will help people keep their loved one home longer, but also get a break.
This service is provided by nursing homes; it is called respite care. The loved one would enter the nursing home for a short time, generally 5-10 days. This gives the caregiver time for a “mental health break” and lets them either go on vacation, or just time to spend elsewhere other than caring for their family member. The respite break gives the caregiver time to recollect and regain ability to care for their loved one again without getting burnt out. More often than not, the caregiver does not utilize respite. Claudia Jardim and Kenneth I. Pankenham elaborate on this in their study “Carers' Views on Respite Care for Adults with Mental Disorders” stating that “Of the 106 carers, 36% had accessed respite care and 64% had never accessed respite care; from here-on these two groups will be referred to as respite care users and non-users, respectively.” This fact could be that the caregiver doesn’t realize these services are available, or they choose not to utilize them. Many caregivers in my personal experience benefit well from respite care, they always seem less stressed and tired at the end of it than they did at the beginning. It really depends on the caregiver; some also feel that the nursing staff do not provide the same quality of care that they receive at home to their loved one. This could be true, or be contributing to the guilt most feel for admitting them, even if for a few short days. In my opinion, everyone caring for a sick relative needs to utilize respite care at least once or twice a year. Working with the elderly, especially with dementia, is very draining of not only strength but your mind as well. The mood swings make you think constantly if you are doing the right thing, or if you could do something differently to make them feel
better. In conclusion, Alzheimer’s and dementia are a very debilitating duo, for patients and caregivers. Generally, these patients will be cared for at home by family or private caregivers until the decision is made they need further care outside of the families’ scope. This decision is not an easy one for any family member. Most will do anything to keep them at home, even if it means sacrificing their lives mentally and socially. Some utilize the respite care provided by many facilities, others feel it is not needed, some do not even know it is available. Caregivers need to understand that it’s ok to ask for help, and to take time for themselves even if they feel they don’t have it or deserve it. They also need to keep some social life, if only to stave off the feelings of depression from only seeing their loved one.