Nurses in all specialties and in all areas will, at some point, work with patients who have Alzheimer’s disease or dementia. Because the disease impacts each person in a different way, caring for patients can be challenging, especially for nurses who aren’t used to the intricate interactions that might give them the most success.
Families often find out how their loved one responds best through their own trial and error. The music that may soothe one person may trigger agitation in another. A soft wrap that one person finds comforting may feel confining to another. But nurses who haven’t worked with that person before don’t have the same advantage. And sometimes what worked last week won’t work this week with the same patient.
Keith suggests nurses begin by meeting the patient where they are. “First and foremost, they live in an alternate reality, and it does more harm than good to try to orient them to the current reality,” she says. “You must get into their reality and work with them on that level.”
What does that mean for a typical interaction? Keith suggests that when a patient with Alzheimer’s disease repeatedly calls for a loved one, a nurse can ask about that person in a calm manner to redirect the conversation. Sometimes that will redirect a patient enough so that they are able to talk about their loved one and they do not continue to want the person with them, but not always. If, for instance, a patient repeatedly calls out for his wife or wants to see his wife and redirecting doesn’t work, Keith suggests a different approach for nurses who are especially aware of the patient’s memory. “Then if he persists and his mind cannot be redirected, say something like ‘Your wife has told us she is on her way and will be here in an hour or so. She asked that we remind you that she loves you and is on her way,’” she says.
This kind of “therapeutic fib,” she says, can often defuse a tense or ongoing situation. It also helps build trust so you’re able to provide the care they need. The important “if” factor is that you must be sure the patient won’t remember what you told them in an hour. If that approach works, then other staff can use it to help calm the patient at other times. “Remember that a smile and gentle touch go a long way to getting them to trust you,” she says.
Nurses can also use a team approach to help patients cope with processes or procedures they may not understand or may not like. “If the person is in the ER and the lab staff has just drawn blood and the elder is furious about it—then you can be the good guy and tell the elder you’ll make sure that person never touches you again,” Keith says. Having that kind of balance helps caregivers, the patient, and the family who can become upset when their loved one is upset or agitated.
What other tips come in handy? Keith says you don’t have correct patients when they talk about being in a different time. “Get into their reality,” she says. “If the guy thinks he’s back in the war in a POW camp, then act like a comrade who is going to help get him out. Say anything to help calm the person.”
Nurses who work with patients who have Alzheimer’s or dementia, should recognize that delirium is quite frequently present along with the dementia, says Keith. People may think they are in a time that was decades ago—situations like that are common when you’re working with patients with Alzheimer’s disease.
And, says Keith, nurses have to learn that patients aren’t going to always say nice things to you, but it’s best to not take it personally. Again, their reality is altered and they may think they are perfectly healthy or okay and that you are actually the one with a problem or causing a problem.
“They know they are an adult,” she says, “and they will get angry if you treat them like a child. They will do childlike things, but you will make the situation worse if you talk to them or treat them like a child.” So redirect your instructions and continue to check in with yourself to see if you are communicating with respect and humor and with a calm, gentle manner. Watch for how you say something, especially when you’re frustrated. (Saying “No, you can’t do that! You have to do this whether you want to or not!” will probably not result in your patient complying and may, in fact, make things worse.)
As you work with each new patient, you’ll find ways of communicating effectively when you aren’t sure how they are going to present to you. Learning how to navigate each case is going to help your team give the best care which is the end result everyone wants.
Dementia and Alzheimer’s, a severe form of dementia, are devastating brain diseases that impact families across the world. As people live longer, the prevalence of brain diseases increases because the risk of developing dementia and similar diseases rises with advancing age.
Your career as a nurse means you can have a direct impact in your personal and professional life on the ravages of this disease. As a nurse, you can learn more about how patients with Alzheimer’s might react in unfamiliar situations (like a health care facility or hospital) so you can offer them even more effective care. You can also learn more about the signs and symptoms to help people who might be concerned about loved ones’ behavior or lapses in their own memory. You can also ease fear by debunking some of the common myths of Alzheimer’s (like that Alzheimer’s is only something elderly people get).
In your personal life, your authority as a nurse can help others in your life who might come to you privately with concerns. You can offer the reassurance and guidance that comes from learning more about brain diseases.
According to the Alzheimer’s Association, these are a few warning signs to notice:
Memory lapses that disrupt daily life
Lots of people forget where they put the car keys. It’s troublesome if they can’t remember what the keys are for.
Trouble completing normal tasks
It’s normal to forget how to get to the restaurant you only go to once a year. Getting lost while heading to the regular supermarket should be a red flag.
Distinct mood changes
Getting a little grouchy at the end of a long day with family is okay. A sharp, noticeable change in normal mood is something to pay attention to.
Confusion about time and place
In your office, a patient might not remember they are due for a tetanus shot. A patient who can’t tell you why they are in your office is showing warning signs.
As a medical professional, you always focus on prevention, but there is no proven treatment to prevent Alzheimer’s. However, it’s never too late to encourage activities that are good for overall brain health including a healthy diet rich in antioxidants, exercise, social interaction, and remaining interested in many activities whether that’s an interest in a certain historical period, trail walking, kickboxing, building model airplanes, or learning the intricacies of the stock market. Keeping your brain busy is good for your brain health.
Alzheimer’s disease and other brain conditions and diseases continue to affect ever-greater numbers of people. And while scientists are making advances in treatments, the cure for these complex, devastating diseases is still uncertain.
But there are things you can do to protect your brain health. June is Alzheimer’s and Brain Awareness Month, so it’s a good time to check in on your own self-care and also to see how your patients are taking care of their brain health. African Americans and Latinos bear greater risk of developing Alzheimer’s than older whites, so it’s especially important for some minority populations to understand their increased risk.
According to the Alzheimer’s Association, Alzheimer’s is not a normal aging process that happens to everyone as they get older. People may have typical memory slips, but Alzheimer’s involves much more than just forgetting where you put your keys.
With early detection, Alzheimer’s treatment can begin earlier and hopefully slow the progression, but as of right now, there is no cure for Alzheimer’s.
Learn the Signs
There are warning signs for Alzheimer’s that will let you know you, a loved one, or a patient is struggling with more than a little memory loss. While it’s normal aging to forget someone’s name, it’s not normal aging to forget who the person is. Other things to consider are disruptive mood changes (more than irritability about the dog walker being late), poor self care, and severe confusion about where they are or even what year it is.
Know How to Protect Your Brain
Experts say what’s good for your heart is good for your brain. Take care of yourself by getting rest, eating nutritious foods, socializing with people you enjoy, staying hydrated, not smoking, drinking alcohol minimally, and keeping at a healthy weight and blood pressure. But there’s more you can also do. Keep your brain active. As a nurse, you’re days are hardly ever the same and that’s good for your brain. Check in with your patients to see if they are keeping their brains stimulated with anything from hobbies to social clubs to trying new puzzles, reading or listening to new books, or even listening to unfamiliar music.
Brain injury is serious and some of it is preventable. Wear a helmet while biking, skiing, skateboarding, rollerblading, for any extreme sports, or riding a motorcycle or ATV (and make sure family members and friends do the same). Always wear a seat belt in the car. Check your home for tripping dangers like loose carpets, items on the stairs, or things on the floors. Take care in winter weather for icy spots. Anything you can do to prevent brain injury is good for both your long-term and short-term brain health.
Alzheimer’s and other brain diseases are a real health threat to all aging Americans, so you have a right to be concerned. But there are promising therapies on the horizon and there are things you can do now to help protect yourself as much as is possible. Spread the word about brain health and chat about it with your patients to pass along a few tips.
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