Feelings of joy...

I just finished my usual newspaper column in the South Shore Senior News for April. The editor Greg always gives columnists ideas on what to write about. This month's idea struck me as a good subject to explore here too; that of laughter and positive emotions. Research shows that even if a person with memory loss doesn't hold on to the content of a pleasant movie, the positive feelings last for hours. The opposite is true of negative movies.
In the hospital I work in part time we are promoting sensory modalities; those evoking calm and pleasure through the senses. This treatment is especially helpful for persons who have experienced trauma through life (many if not most with mental illness have continuously experienced trauma) and persons with cognitive disorders. For the person with trauma, it taps the amygdala (a-mig-dil-a) to respond to positive experience instead of the negative ones remembered. For the person with dementia who now often cannot initiate, plan or execute a formerly pleasant activity,sensory experiences calm and bring joy. There we use music, rhythm like dance and exercise, smells like lemon or lavendar (even bakiing cookies),visual items like pictures and tactile sensory items like fur, suede or velvet (maybe a puppy or kitten). These therapies reduce psychiatric symptoms, confusion and restlessness by inserting positive emotive experience into the patient's life.
Have you used these activities, especially in the late afternoon when persons with dementia often are feeling lost, confused and sometimes slip into delirium.
When my father in law was restless and confused in the evening due to his Alzheimer's disease, we put a can of coins in front of him to sort. He was a 'candy man' so quite used to handling coins. Within minutes, he was 'remembering' the positive memory of his work and doing something very familiar, humming a tune as he did. This replaced the confusion and prepared him for sound sleep.

Caregiver Education a Must

We at StilMee are very pleased to announce a new coach, Janet Williams, who is based in Dallas/Fort Worth, Texas. We believe every caregiver of someone with a cognitive disorder needs education. How stressful it is when a caregiver sees things changing with their family member or friend and doesn't know how to help. Relating to a person with Alzheimer's disease is unique, counter-intuitive, and seemingly not common sense. I call the communication approach uncommon common sense. When one knows how the brain has changed and what is now difficult for the person, the caregiver learns that now what s/he knows is common sense; Alzheimer sense! The brain cannot hold onto information taken in, cannot attend to or concentrate easily on a task, is unable to adequately control impulses, and perhaps have trouble even understanding what is being said. This must be a scary place for that person. We as caregivers, sensitive to the new needs of the person, must change the way we relate or we in essense dishonor the person. If you live in Dallas/Fort Worth, call Janet (go to our website www.StilMee.com for information. If in the Massachusetts state, call the main office 617-328-3440 or go to the website and choose your coach. We want to make sure no caregiver has to go the journey alone.

Is anyone not touched by Alzheimer's?

I just read a news brief that spoke about the aging population in prisons and that dementia has become a huge concern and challenge. The inmates with dementia were often taken advantage of, made fun of,and generally unsafe.
An interesting solution has been tried with the training of other inmates in the care of the person with dementia. They are called Gold Coats as they wear a different color than the other inmates. They too are antagonized by the inmates who feel they are siding with the authorities in taking on this new role.
I wonder what changes this care giver role will make in these prisoners. I hope to follow this for some time and see the change. Everyone is changed in care giving. No one is so tough that they are not impressed with the challenges of being unable to think clearly and respond to the environment accurately. Stay tuned.

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.