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mccardey
06-03-2016, 07:26 AM
I have a RL question about a lady in m-i-l's nursing home...

neandermagnon
06-04-2016, 11:19 AM
My cousin's a manager of a care home. I have some very limited work experience with old people plus a degree in human sciences and I'm qualified to teach biology up to A-level (equivalent to first year university in the USA). I can have a go at answering the question but can't guarantee I'll know the answer.

mccardey
06-04-2016, 11:44 AM
Oh, thank you.

There's an old woman on the high care ward who has dementia (I suppose). I don't know her - I saw her for the first time the other day because I heard what I thought was a little girl crying, and tracked it down. It was this lady, who was sobbing inconsolably because, she told me, the people had just told her that her mummy was dead and her daddy was dead and now she'd have to stay here for the rest of her life. It was just the saddest thing I'd ever seen - and I wondered what's the best way to deal with this? I'd have thought she was stuck in a memory-age of about five or six - but I didn't know whether to try to distract her, or listen, or what. In the end, I just held her hand and let her talk and tried to make comforting noises till she was calmer and then talked about her blanket.

Is there a better way of dealing with it, if it happens again? Poor little blossom. She was heart-broken and I think scared.

mrsmig
06-04-2016, 05:14 PM
Nothing to add. Just :cry:

Maryn
06-04-2016, 05:54 PM
My MIL's dementia was quite similar. She was often--not always--a young girl with no memory of her adulthood, no marriage, no children. She was waiting for her dad to come and pick her up and take her home, and didn't like This Place. At first, we tried to explain to her what the deal was, strokes and brain damage and a long and happy marriage, but this confused and upset her more often than not, because she didn't remember any of it.

The nursing staff suggested that we go along with Mom's notion of reality and not directly contradict her or attempt to make her see who we were. She was not unhappy, so we often asked if we could keep her company while she waited. That was how we got in our visits.

The woman you observed is unhappy, though, and that changes what's right. Do you know if the staff told her that her parents were dead? That should not be happening. If it's appropriate for you to interact with her, you might suggest that maybe whoever told her that made a mistake and her parents are probably fine. That way you accept her notion of who she is and ease her sorrow.

Maryn, with a hug for you and her

muse
06-04-2016, 06:05 PM
Oh, how very sad.

My dad's Alzheimers was similar. He thought he was a young boy and his wife was his aunt ,who he was very fond of and stayed with when he was young. We also found it better to go along with this, because to try and correct him made him very upset.

It was a lot harder on my mum who he never called by name again before he died. Her only consolation was that he thought of her as someone he loved very dearly, even if he called her by another name.

I really hope the staff didn't tell that poor woman her parents were dead. That seems unnecessarily cruel.

neandermagnon
06-04-2016, 06:15 PM
I'm not really sure if there is anything else you could have done. That's so sad though. Some forms of dementia like Alzheimer's rob people's memory in this way, so they can remember their early life but not their more recent memories. It's probably the case that she's going through the same thing every day (assuming that it is Alzheimer's or similar) because she won't be forming new memories properly so will often struggle to remember what's happening earlier in the day, even five minutes before. It's such as sad situation and must be terrible for her family to see her going through this. AFAIK being compassionate and understanding is the only thing anyone can do. It was so lovely of you to sit with her.

neandermagnon
06-04-2016, 06:19 PM
I really hope the staff didn't tell that poor woman her parents were dead. That seems unnecessarily cruel.

What else could they say if she was asking where they were, or calling for them, etc?

That's not a loaded question - I'm asking sincerely. I know about various brain injury/medical conditions that affect the brain but I don't know very much about caring for someone with dementia or any serious condition. My gran has a form of dementia (not Alzheimer's) - she can still recognise family members and has some recent memories - she knows me and that I have kids/her great-grandchildren, though she can't always remember their names. I can't imagine what it must be like seeing a family member go through what this lady's going through. :(

Maryn
06-04-2016, 07:38 PM
They can say, "I'm sorry, but your mother and father are not here just now." They can offer distractions or suggest an activity while the patient/resident waits for the parents. When she asks again, they can say, "My goodness, they're taking their time getting here, aren't they?" or "Maybe they'll come tomorrow. Let's get you to bed so you'll be all rested when they get here."

It's cruel to tell someone who believes she is a child with living parents that her parents are both dead. If that's what staff is doing, they're causing this woman repeated emotional trauma, whether that's their intention or not.

Anonymouse
06-04-2016, 07:58 PM
There's a story I heard on This American Life that talks about dealing with dementia without arguing with that person's reality. The woman who was interviewed uses improv techniques to help in this very situation. The interview is here (http://www.thisamericanlife.org/radio-archives/episode/532/magic-words?act=2), and her website is here (http://www.in-themoment.com/).

AW Admin
06-04-2016, 08:08 PM
Is there a better way of dealing with it, if it happens again? Poor little blossom. She was heart-broken and I think scared.
[/I]

No. That's the thing to do, and be prepared for it to happen again, or for her to not know you.

Treat her as someone who lives in the moment. And that moment may reside in the distant past.

Those feelings are completely true for her, and so is her suffering and despair. You are a very kind person to reach out to her.

Not a gerontologist but worked in the nursing home where my mom was the social worker, and later, worked with early onset Alzheimer's and TBI people using memory training software I helped create.

AW Admin
06-04-2016, 08:11 PM
It's cruel to tell someone who believes she is a child with living parents that her parents are both dead. If that's what staff is doing, they're causing this woman repeated emotional trauma, whether that's their intention or not.

It might be poorly trained staff; it might be that her parents did in fact die when she was a child. Sometimes people get stuck in an early traumatic part of their life and re-live it over and over, because those memories were rehearsed frequently during their life, and so have easier/sharper recall. Sometimes that's chemistry based, frankly, in that trauma is recorded in a more detailed way by the brain than certain other kinds of memory.

mirandashell
06-04-2016, 08:17 PM
It's cruel to tell someone who believes she is a child with living parents that her parents are both dead. If that's what staff is doing, they're causing this woman repeated emotional trauma, whether that's their intention or not.

I agree.

Usually with this situation, you learn your parents are dead, there is shock and grief and pain. Then you go through the stages of grief and mourning and then come out the other side.

This poor woman is stuck in the first stage. She feels that shock and grief every time they say her parents are dead.

Siri Kirpal
06-04-2016, 09:54 PM
Sat Nam! (Literally "Truth Name"--a Sikh greeting)

I have no experience myself. But Mccardey, I think you get a gold star and a crown for your kindness.

Blessings,

Siri Kirpal

frimble3
06-05-2016, 12:05 AM
I'm wondering, if she's an old lady who lost her parents when she was young, she might not have been put in an orphanage or some sort of facility, at least until relatives were found? The sense of being institutionalized might be bringing those memories back.
Bless your kindness in sitting with her, McCardey, when others might have just looked for a chance to ease away. (And for looking for more information on how to help next time.)

Rufus Coppertop
06-08-2016, 01:11 PM
Is there a better way of dealing with it, if it happens again? Poor little blossom. She was heart-broken and I think scared.
Maybe let the nurse in charge know that the woman's extremely upset and why she's extremely upset. That gives the staff there a chance to deal with the situation professionally which may well include finding out who-the-hell told her that and making sure they don't do it again.

GeorgeK
06-08-2016, 04:32 PM
My MIL's dementia was quite similar. She was often--not always--a young girl with no memory of her adulthood, no marriage, no children. She was waiting for her dad to come and pick her up and take her home, and didn't like This Place. At first, we tried to explain to her what the deal was, strokes and brain damage and a long and happy marriage, but this confused and upset her more often than not, because she didn't remember any of it.

The nursing staff suggested that we go along with Mom's notion of reality and not directly contradict her or attempt to make her see who we were. She was not unhappy, so we often asked if we could keep her company while she waited. That was how we got in our visits.

The woman you observed is unhappy, though, and that changes what's right. Do you know if the staff told her that her parents were dead? That should not be happening. If it's appropriate for you to interact with her, you might suggest that maybe whoever told her that made a mistake and her parents are probably fine. That way you accept her notion of who she is and ease her sorrow.

Maryn, with a hug for you and her
True, it's better for everyone if the patient is pleasantly demented. That said there are also issues with random strangers, not medical people or friends or relatives dealing with patients.

Cyia
06-08-2016, 04:41 PM
You see cases like this in every nursing facility in the country. I've had decades of dealing with it because of multiple family members in long-term care situations. (And I've seen some monstrous facilities.)

I don't know what the policy is where you're talking about, but sometimes a doll helps. If she thinks she's a child, then try cheering her up like one. "Mummy and Daddy sent you a doll to keep you company." can brighten someone's day - and life, if they're stuck in child-mode. There were always a handful of residents dragging soft-bodied dolls around while they rolled through the halls in their wheelchairs.

MDSchafer
06-08-2016, 06:29 PM
I've worked in Neurology and it's a tricky decision. Some people believe you shouldn't lie to patients, and you can make case that lying to your patients is unethical. Depending on how they fixate which is worse? Allowing an 90-year-old woman to think that the father of her youth will walk through the door at any moment, knowing that will never happen, can be just as cruel. Also, that hope, and the eventual frustration when the family member doesn't arrive, can also cause agitation. And unfortunately a lot of the time whatever you do will cause agitation.

There's no one right answer, and with brain injuries you often have the fight the same battle hour after hour, day after day for the rest of their lives.

mccardey
06-09-2016, 12:30 AM
Thank you all for your replies here - and for the PM that said don't correct, redirect. I've seen her a couple of times now, and (thank heavens!) sometimes she's happy and sometimes she's not. She's always a little girl, though, and she's often just been told her parents are dead. I don't think it's the staff who are careless - I think it must be her childhood returning. And she does have family who visit as well, and it must be horrible for them. It's good to know that she can be redirected, though.

ETA: When she tells you her name, she always says it very clearly, using all three names and then she tells you her address - or what her address used to be. She was very loved when she was little, I think, and it shows. Dear little thing.

heza
06-09-2016, 08:10 PM
My paternal grandmother and maternal grandfather both had Alzheimer's.

I think, when someone first starts to develop it, some amount of helping them to remember what's real and what's a memory or reminding them of things—keeping notebooks and putting notes around the house, etc.—are good and necessary. At some point, though, it's going to progress to a stage where they aren't going to get better and any mitigation is possibly unhelpful. Unfortunately, you come to a place where keeping someone comfortable is often more important than keeping them healthy (or sane). Just to say, when they can no longer care for themselves and are constantly bouncing around in their own memories or completely oblivious to what's going on, reality ceases to be important.

When we would care for my grandmother, I would play along. For example, she would say things like, "Do you ever get married anymore?" And I would say, "Sometimes, but not as much as I used to." And she would nod, as if satisfied with that answer and change the subject... It was a lot easier for both of us to just have exchanges like those than for me to go into a long attempt at trying to get her to remember who I was and that I was only seventeen and had never been married.

My other grandmother, for some reason, was very honest with my grandfather (whom we only recently lost). My mother died some years ago, and when he asked for her, my grandmother would tell him she was dead. I felt like that confused and upset him. So when he asked me (he didn't remember from one day to the next what we told him about her), I would say that she wasn't there right now but he would probably see her soon.

There was a period where he didn't know me at all, but he thought I was my mother (his daughter). When that happened, I just assumed the role and pretended to be her. When he asked about my husband, I told him what Dad was up to. When he asked about my children, I told him what my sisters and I had been doing lately. When he got to where he really didn't know any of us and didn't seem to remember anything about his life (and was mostly not even communicating anymore), we just acted as if we were kindly strangers he'd met and told him pleasant things, but we didn't try to make him remember us.

wheelwriter
06-10-2016, 07:57 AM
This is such a sad situation.
Thank you all for your replies here - and for the PM that said
don't correct, redirect. I've seen her a couple of times now, and (thank heavens!) sometimes she's happy and sometimes she's not. She's always a little girl, though, and she's often just been told her parents are dead. I don't think it's the staff who are careless - I think it must be her childhood returning.

I was the Director of Social Services in a nursing home for eight years, and now I am a hospice social worker (many of my patients have had dementia). I'll second the don't correct advice. Usually I see people asking for their parents, and wandering or calling out. Kind "fiblettes" are absolutely ok, if it eases the distress. For someone who absolutely will not lie, "She's resting" can be a potential answer to the question, "Where's my mother?" Your situation is a little different because she's telling you her parents are dead. Depending on where she is at in her memory loss, she may get some comfort talking about them. "Who was more strict, your mom or your dad? What was your house like? Do you have any brothers or sisters? Was your mom a good cook?" Usually long-term memories are much easier for someone with dementia to recall. She can't remember what she had for lunch, but knows the name of the street she lived on seventy years ago. You taking time with her and showing that you care is gold.

mccardey
06-10-2016, 09:25 AM
Depending on where she is at in her memory loss, she may get some comfort talking about them. "Who was more strict, your mom or your dad? What was your house like? Do you have any brothers or sisters? Was your mom a good cook?" Usually long-term memories are much easier for someone with dementia to recall. She can't remember what she had for lunch, but knows the name of the street she lived on seventy years ago.

That's a wonderful idea - thank you! I didn't think of that because she was so distressed, but next time I see her, I'll try to direct her into happier old memories. I'll do that with M-i-L too - she's not been her usual self after a spate of falls. :(

Not for the faint-hearted, old age....

GeorgeK
06-11-2016, 07:37 PM
I don't know what the policy is where you're talking about, but sometimes a doll helps. If she thinks she's a child, then try cheering her up like one. "Mummy and Daddy sent you a doll to keep you company." can brighten someone's day - and life, if they're stuck in child-mode. There were always a handful of residents dragging soft-bodied dolls around while they rolled through the halls in their wheelchairs.Excellent idea but you'd want to be sure it didn't have any buttons or other such parts that could be pulled off and swallowed. Demented people do strange things with all sorts of stuff for reasons that only make sense to them. Turkeys in the grocery store often have plastic thermometer/timers inserted into the breastmeat. I had one patient who was sent in for UTI's and found that he had managed to get a hold of one of those things and had inserted it up his urethra. Those things have barbs on them.