Alzheimer’s
The Stranger in the Mirror
PART 2
After an extended hospital stay for medication management for our mother, my sister and I found an exceptional
Alzheimer’s unit in a new nursing home. Our experience taught us to search for a small unit, where the residents
appeared calm, clean, and happy. They had a ratio of 1 aide to 4 patients. With my mother, there were eight
patients in the unit. My sister and I became very close to the aides, due to their exceptional caring for our
mother and sometimes due to insults and injuries caused to them by our mother. The home was also closer in distance
to me, which enabled my sister and I to effectively switch places in our mother’s care. The change was helpful to
both of us. It gave my sister some distance from the problems and allowed assuagement of my guilt for not being
close enough to help when needed.
In the later stages of the disease, the person with Alzheimer’s with a little guidance can still perform simple
activities. My mother would look at her food tray but be unable to process where to start. By handing her the fork,
she was then able to eat by herself. Everything that we do is a process of many very simple steps. Alzheimer’s
denies the person the ability to break down those steps. If caregivers observe closely, they can determine where
the process breaks down and assist the person with Alzheimer’s to retain as many skills as possible for as long as
possible.
Behavior problems can occur for many reasons including medication, environment, over-stimulation, and disease
progression. The effects of medication can be different for each person and should be reassessed by a physician
often. A change in environment is very disturbing in an already strange world. Admission to a hospital or nursing
home has to be extremely frightening. It is a whole new environment with a whole new set of strangers, which can
set off the fight or flight response. These patients need to be close to the nurses’ station and they need
reassurance that there is someone there that cares about them, stranger or not.
The staff or the family is most often the cause of over-stimulation. I am reminded of an incident at the geriatric
psychiatric unit where my mother had been admitted for medication adjustment. My mother wandered behind the nurses’
desk. From my psychiatric rotation as a student nurse, I knew that going behind the nurses’ desk was not allowed.
It is considered a threat to the nurses. Three aides tried to pull her back from the desk, instead of one person
redirecting her. She could not understand what they were trying to do and in frustration, she swung her arms out to
make them go away. It worked. Being 5’10”tall, her reach was rather far. For the longest moment in time, I stood
there. I was puzzled to see the aides scatter away from my mother. The realization that they were afraid of my
kind, beautiful mother was my undoing. For the first time in my life, I cried tears of silence. I could make no
sound as the tears streamed down my face. The staff’s lack of understanding regarding Alzheimer’s disease was the
cause of her behavior problem. Geriatric Psychiatric Units need to have more education regarding changing their
behavior to prevent their patient’s “bad” behavior.
Family is often the major cause of behavior problems. Imagine having five or six strangers surrounding you, hugging
you, telling you that you are their mother and grandmother. In your mind, you are 10 years old; therefore you
cannot be anyone’s mother. “Who are these people and why are they lying? They just need to go away. Everyone thinks
I’m stupid. Please, someone, make them go away! Please.” *
*An amalgam of my mother’s words.
It is very important that family does not come in mass when visiting someone with Alzheimer’s. My sister and I
quickly learned that our mother could only deal with one of us at a time. As our mother forgot who we were, we
would just tell her our names and that we were someone who loved her. Trying to orient her to us was worse than
useless; it was hurtful to her. You cannot make someone remember you when they have regressed to a time prior to
your existence. My sister and I could not hurt our mother by making her feel “stupid”. Therefore, we put aside our
feelings and considered what was best for her. I make it sound easy, but it was incredibly difficult. We lost our
mother, even though she was standing before us.
This past summer, through the University of Louisiana at Monroe, I attended a course in Scotland on dementia. It
was conducted at the Iris Murdock Center for Dementia on the campus of Stirling University just outside Stirling,
Scotland. The course focused on person-centered care for people with dementia. I prepared for the course by reading
two excellent books regarding Alzheimer’s disease. The Person with Alzheimer’s Disease by Phyllis Braudy Harris
focused on the perspective of the individual with the disease. This book gave me insight into my mother’s world.
Everything that I had read previously presented the caregiver’s voice. Finally with the help of this book, I found
my mother’s voice. The second book that I reviewed for the course was Rethinking Alzheimer’s Care by Sam Fazio,
Dorothy Seman, and Jane Stansell. The first book allowed me into the world of the person with Alzheimer’s and the
second book instructed me on how to care for this person within their world. Person-centered care would be a
wonderful new slogan for nursing. It is more to the point than individualized care and reminds us specifically of
the person receiving our care.
Cont'd
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