Delirium

The prevalance of delirium in dementia is well known in the hospital setting as well as in the home setting. Delirium is a sudden change in cognition and alertness and has many causes. A change of environment that is confusing, such as being in an emergency room or inpatient setting, an infection that perhaps the person cannot describe its impact on him are two major causes of delirium. Sundowning, a common increase in confusion in the late afternoon is a form of delirium. Caregivers do well to plan a way to structure that time of confusion to meet the needs of the person with dementia. A quieter environment, few if any demands on the person cognitively, perhaps company that is calming (sitting with the person, walking with the person) may help. I have a theory that sundowning is like a toddler's meltdown in the late afternoon; being over-stimulated or having lack of stimulation impacts the ability of the person to cope with demands on him. In the hospital this might be a time for a snack, calming music or a staff member sitting quietly with the elder or walking the hall with him. Group activities should be soothing and fun rather than taxing cognitively. A sensory room might fill the bill for a patient that cannot tolerate a group.

Last Days

Recently a former caregiver client I coached years ago, presented me with a book she and her dad wrote about the last year with her mom who had Alzheimer's and the first year of his being without her. I am anxious to find the time to read this story. It is called Her Final Year; a Care-Giving Memoir and His First Year; A Journey of Recovery. The authors are James Downey and John Bourke with Martha John and Kathi Bourke. Kathi was my coaching client. In the section How to Use This Book, the authors write,"...some of it is more than a little embarrassing. We have decided to share it, and show it as it was, because we deeply believe that it is extremely important that anyone entering into a care-giving relationship understand the reality of what they will likely experience. You will make mistakes. You will think you are going to go crazy. You will sometimes feel crushed by the isolation and stress. You will sometimes resent, or even hate, the person for whom you are caring. You will get into arguments with family and friends and say and do things you might later regret. These things are all completely normal human reactions to the situation you will be is."
This gives me courage again to write my second book; my journey with me mother in law Bette over 14 years until her death at 99 1/2 years of age in 2009. Thanks Kathi for reminding me to expose true feelings both good, bad and ugly at times, to help others who are going through the caregiving experience. It also is 2 books; the first exploring changes in attitudes and treatment of dementia and the second, a personal story. Perhaps because it has been almost 3 years I'm ready to finish it.

New Blog on Mental Health

Please note my new blog focusing on understanding mental health and illness. It is a slight but important deviation from my educating about dementia. The new blog is www.coach-nurse.blogspot.com Visit it and post a comment. I'm going to try to post something each week. Now with my inpatient experience renewed, I have plenty to say.

Hospitalized Elders with Dementia

I have recently taken a position as one of the nurse educators in psychiatry at a Boston hospital. I'm glad to be back in the thick of it and notice once again what a therapeutic milieu is for people with dementia. Research shows that it isn't really the ratio of staff to patients but the number of contacts the patient has with staff on any given day. This cements the practice of frequent connection with a confused and frightened elder reduces the likelihood of agitation and/or aggression. We've seen that aggression is most often the result of not understanding what is going on around them or misperceiving the intent of the caregiver. Smiling, connecting by calling him or her by their name, asking, "how are you today?'(the only open ended questions that is OK),making a positive comment about the person all go towards creating a therapeutic milieu (environment). Therapeutic communication is the practice of being clear, keeping eye contact, speaking slowly, simply and concretely. One patient who recently returned to the hospital after an outburst at the assisted living residence he had been discharged to,recognized staff's faces and voices but thought he had been on a cruise last time he was hospitalized. Sometimes delusions can be helpful I guess. Happily with the right dose of medication he was able to be returned to his new home at the residence.

FTD

FTD or Fronto-temporal lobe dementia is different from Alzheimer's disease in that memory is intact for a while but other frontal and temporal lobe functions are impaired. The temporal lobe is responsible for understanding and using language so that is impaired. Visual hallucinations are not uncommon in the early stages of FTD as are tremors that mimic Parkinson's. These are called Parkinsonian symptoms, often mistaken for Parkinsons. Some have received a diagnosis of Parkinson's disease until things change. The frontal lobe, responsible for giving us social awareness, regulating impulsivity and mood, is also involved in FTD. The person may have mood fluctuations, impulsivity, and personality shifts. This is a hard disease on both the person affected and the caregivers. Caregivers, often overwhelmed with the changes that have occurred in their family member, need stability and this disease manifests itself in unstable ways. If you are dealing with FTD get as much information as you can. Join a FTD specific support group. Use the Alzheimer's Association 24/7 caregiver line. Google your state's Alzheimer's Association and get the number. The people who man the lines are well trained and available when you need them.

Care for the Caregiver...YOU

Summer is here even though it doesn't look like it in New England; mid-60s and raining. I'm home with a nasty cold, laryngitis, ear infectiions, so my orienting at my new position in psychiatric nursing is on hold until I can hear adequately to do my job. I wonder how our body knows we are stretched to our limit? It does, though, and gets sick, laying us up to rest. I think that is what this sickness is all about. Caregivers, whether informal family caregivers, or professional caregivers (social workers, nurses, homecare aides, doctors), need to tend to their need for rest. If we don't pay attention, the body makes us take a rest. What happens to you when you are forced to rest? Can you give in and let nature heal you, or do you, like so many of the caregivers we coach here at StilMee, keep plowing along, not asking for help, and not able to give the attention to caregiving that they want.
This summer take stock of yourself. Do you take time for yourself to refresh and revive your energy? I used to say to myself, "I think I need an Abby fix." referring to delicious time with my granddaughter. An hour or so with an innocent child who expected nothing but smiles and hugs, made me feel whole again.
Whether it be visiting with family members or friends who are light-hearted and can laugh, reading a good book, listening to music, sitting outdoors doing nothing but gazing at the sky, or exercising at a local gym, you MUST take time away from your caregiver duties and refresh yourself. I've learned that when I'm sick, I stay out of work, trusting the place won't fold if I'm not there. As I give over the reins of StilMee to the coaches, I find the company runs well, I can see what strength and knowledge the coaches have without me, and my body heals. I hope you've learned this lesson too. It has taken me a long time but I learned. Practice taking care of yourself. It will pay off generously.
BEv

Missing too long

I can't believe it's been two months since I blogged. At StilMee we've been busy with presentations, trainings (there is one in Tiverton Rhode Island on June 11), and welcoming a new coach for Plymouth and Cape Cod. I'm also re-entering the psychiatric nursing field in an effort to regain patient contact. My first love is psychiatry; I learned so much about behavior management psychiatric nursing. I plan to work with elders with mental health issues and dementia. I can practice and perfect my skills in working with this population. My goal; to empower each to be in control of his or her own life to the greatest safest extent possible.
We coaches are working on a 'memory' handout which I'll add to the blog. It discusses the types of memory (working, episodic, semantic and procedural), their normal function, the impaired function and the appropriate approaches/interventions that will help the person function better. To whet your appetite for new knowledge, the working memory and episodic memory are impaired in memory loss, the procedural and semantic can be tapped with cues both visual and auditory. I'll share more as I get the handout edited and checked for accuracy and readability. I promise I will blog before another 2 weeks has gone by. I'll share my new journey into psyciatric nursing; what I am learning and what the patients are teaching me about what they need.
Good to be back.. I just returned from eight days bare boating (the boat is bare, not the sailor and first mate!) It was a restful and exciting time to relax before the next leg of my journey into caregiving...Bev