While caring for a patient suffering from Alzheimer's disease, it's inevitable that we, as professional caregivers, will at some point face challenging behaviors and situations. Here are some tips for dealing with some common behaviors:
*Catastrophic Reaction
A catastrophic reaction is a reaction to a stimulus which seems exagerrated and out of proportion to the cause. If you should witness a catastrophic reaction in one of your patients, I have found that it is usually not a good idea to try to reason with the person. The best method for dealing with these reactions, in my opinion, is gentle reassurance and time. It may be that the caregiver is the source of agitation. If this is the case, ensure the patients safety and calmly remove yourself from the situation. Sometimes, a change of face (having a different staff member approach the patient) is the best remedy.
*Wandering
Wandering is one of the hallmarks of Alzheimer's patients. Some patients have amazed me with their determination to keep moving. I have often mentioned it would be interesting to measure the distance covered by some heavy wanderers during the course of a day. Since there may be several wandering patients on any given unit, alarms on the doors are extremely helpful in ensuring the patients stay safe. Be sure that all doors remain locked, such as the doors to the clean & dirty utility rooms. Do not leave bottles of soap or other potentially harmful substances laying around the unit, as there are some patients who WILL try to drink or eat unusual items. (including plants, styrofoam cups, crayons etc.) If a unit is heavily populated with wanderers, it's a good idea to do a thorough check of each room, to ensure safety. Be sure there is nothing for patients to trip on (cords, etc) Picture frames should be made of plastic instead of glass. Staples are safer than thumbtacks in patients' bulletin boards. Wanderers will often rummage through others' belongings, and/or hoard items. (sometimes causing anger to other patients) If you become aware that a patient has a stash of some sort, do not raid this stash while the patient is around. This may cause a catastrophic reaction, as the patient will believe you are robbing him/her. If the patient is carrying around an item belonging to someone else and you must retrieve it, I have found that the best way to convince a patient to relinquish an item is to approach them EXTREMELY happy and smiling and thank them profusely for 'finding my ____' (fill in the blank) Often, the patient will gladly surrender the item to you if they feel they are being helpful. Do not be confrontational at any time with Alzheimer's patients, and do not argue (even if you feel you are right). You will get nowhere, fast, by employing these methods.
*Insomnia
When I worked the overnight shift on an Alzheimer's unit for about a year, I was amazed at all the activity some nights! It seemed as though every patient believed it was the middle of the afternoon. While it's true that the elderly require less sleep, some of the patients who were up wandering throughout the night on my unit were actually only awake at night because they spent all day sleeping. This is where cooperation from the day shift and evening shift is important. Naps are acceptable, however, there are some patients who will sleep through the entire day on a regular basis and their days and nights become confused! Having a floor full of wandering patients is more dangerous at night than during the day, since there's usually about half the number of staff to keep an eye on everyone. Re-adjusting a skewed sleep/wake cycle requires cooperation on the part of all three shifts.
Some patients may have worked the overnight shift their entire lives, and may be accustomed to being awake during the night. Other patients may be having some pain or anxiety and may need some medication or one-on-one attention. Or, quite often, a patient's medication could be the cause of the sleeplessness. (and obviously caffiene at night doesn't help, either!) Sometimes, patients will wander simply because they aren't sure what they're supposed to be doing at the time. Reassurance and redirection can sometimes help, however, never try to argue with a patient or insist they return to bed. This may cause anger, confusion and anxiety in the patient and create a problem for the night staff as well.
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