Dad, age 96 and a Dementia patient had to leave AL due to aspiration pneumonia and his dementia progressed to where he needed more care than AL could provide. His demeanor at AL wasn't great. In the NH, they realize that he did "paperwork" at his job when he was employed. He also wanted to stand, but AL wouldn't allow him to stand alone. He had a behavior issue early on at AL so I had to hire a 24.hr live in aide to stay with him. Anyway, I digress.... NH has a folder of papers with his name on it. Every day they have him write his name and the date on a paper. He's treated as though he's doing work for them. It helps him feel good, improves his behavior and keeps him occupied. He fixes those papers 100 times a day. As a nurse who cares for dementia patients, I think that you have to be innovative when dealing with their issues. Behavioral, maybe, cognitive, yes, but you have to balance the 2 to do the best for each patient.
The nurse needs to better informed about dementia. Dementia is a way to classify diseases that affect memory and functioning, including Alzheimer's,vascular dementia, dementia with Lewy bodies, Parkinsons with dementia, frontotemporal dementia are the most common. Here is a link to ALZ Association's classification for types of dementia. Quite often, the lesser known types of dementia are called by slightly different names, which is confusing to most, including me. But it is alway Dementia due to one of the major types. If someone tells you that a person has dementia, it is about as useful as telling someone that a person has hair because it does not tell you what type of dementia. All types of dementia affect the brain and the functions it performs. Thus, memory loss, inability to control one;s body, weight loss, speech and language impairment and behavioral are common symptoms of dementia. Glad you asked because the medical world needs to understand dementia more fully than it does.
It is a new way of thinking and talking about dementia. The professionals used to spend a lot of time trying to classify and figure out what stage A person with dementia is. Because of research, and the beginning of understanding dementia as "brain failure" the new language has been simplified. Thinking about dementia in terms of behaviors empowers staff to think of strategies on how to address behaviors. When someone with dementia wanders, for example, that is a behavior that can be observed, described; when, where, how often,etc And a treatment strategy devised- behaviorally, environmentally or with medication. For example one woman would pace the halls and try to leave in the afternoon. When she told the staff she needed to meet her children at the bus stop, they put a chair opposite the nurses station with a sign over it: Bus stop and now in the afternoons she puts on her coat, holds her purse, and waits at the "bus stop". It is more humane and functional to think about dementia this way.
I would say this nurse wasn't listening in class when brain disorders were discussed. Yes, behaviors are changed when one has dementia, and cognition is one of those behaviors. Don't get mixed up with the fact dementia is a terminal illness regardless of how an individual presents with the disease. Not all patients have identical behaviors and cognition abilities.
I think it's amazing how many people have dementia and how many healthcare workers know little to anything about it. I discovered this when accompanying my cousin to doctor appointments.
My cousin, who as Vascular Dementia, has had quite a few visits to various medical facilities. She is in a wheelchair and has obvious signs of dementia, PLUS, they are informed of this fact. She has had her Primary visits, but also, Neurologist, radiologists, orthopedics, surgeon (had cyst removed), ER visits, etc. It's just amazing how little if anything they know. I started to give them some info. (Goodness knows they need it.) With all the dementia patients they treat, why are so many of them so ill informed? This includes MD's and nurses. It boggles the mind.
Venn diagrams can come in handy for that kind of situation - let Dementia be the set, with Alzheimers (and the rest) being subsets. Even true that sometimes the subsets will intersect, sigh...
Beats me. Did you ask her? Most kinds of dementia include both cognitive and behavioral symptoms (some kinds more than others). Was she making that distinction? For example, Lewy Body Dementia is said to have a high caregiver burden because the behavioral symptoms can be severe and also come early in the dementia, before anyone has had a chance to adjust to the new "normal."
Does that explanation fit the context of the remark?
In the 'good old days" there was no such thing as dementia. People just became "senile" and some were more difficult than others to manage. Anyone over the age of 65 was classified as generiatric and not placed in an acute setting more suited to their current condition and therefor did not always receive the treatment needed. Those placed in a geriatric ward even if cognitively sound on admission frequently sank to the "norm" of the population they found themselves in. they exhibited signs of dementia or simply with drew probably due to depression. Few had anyone to advocate for them because if they did families were more able to care for them at home as most families stayed intact and the wife did not have to work. She was a "housewife" and had the time to care for the elder. Because dementia has only recently been recognized there was zero teaching about it in nursing schools. Those who could not be managed in a conventional hospital ended up in mental hospitals. Education and knowledge in this area has been slow to evolve and still may be playing "catch up" as far as education is concerned and interest by the medical professionals. Nursing school and acute care for me is over 50 years ago so I don't know how much is taught to current dy nurses. I did however take the RN NYCLEX (and passed) 18 years ago and do not remember any questions related to dementia but maybe there were because the exam is based on a pool of 250 questions and your level of expertise determines the type of questions you are asked. The minimum pass level makes you answer 75 questions and I got through with 85 mainly I believe because I had had a lot of supervisory experience and the exam is aimed at new graduates. Fifty years ago in the UK the only experience offered was 6 weeks in a mental hospital and of 60 in my class only 6 who were judged suitable were selected. I did apply but was not deemed suitable. I am sure training is very different these days as nurse education is now college based and not an apprentice style experience with only had a few weeks each year in the classroom. Just my 2 cents. The nurse who made that comment was either not educated or simply had no interest in that area terest in the area and clearly believed patients had the ability to control their "bad" behavior
Both my DIL and SIL are physicians. They don't know squat all about dementia. Well, maybe my SIL who is currently finishing his residency and has had more contact with "mental patients"...but still. My mother is showing obvious signs of age related dementia. She only sees my SIL once a year, if that. He saw her last month and said "She's not nearly as bad as you say she is". Well, talking to her for 10 minutes at church hardly constitutes a dx. He doesn't deal with her on a day to day, as I do. My DIL is completely off board and since it's not her grandma, she doesn't care one bit about my mother. Her one and only comment about mom's increasing decline is that she wouldn't take her as a patient for surgery. (DIL is an anesthesiologist). Pam is right, depression can lead to dementia. Most people will develop some level of it, if they live long enough. That's just my experience. And kudos to the sweet caregivers who find ways to incorporate "dignified" methods of dealing with their patients' dementia.
Maybe the nurse was trying to explain that the person's cognition was out of order.Therefore, behaviors do not make sense to us. To the patient,the behavior has something to do with the past. 'The past' is often the present to the patient. My observation: Time just collapses . My personal observation over 8 years of caring for my husband withLewy Body Dementia. For example,at 11 pm he would want to go to a very important meeting at the office. (He had gone over 15 years ago to these types of meetings.) I hope this idea helps you.
All types of dementia affect the brain and the functions it performs. Thus, memory loss, inability to control one;s body, weight loss, speech and language impairment and behavioral are common symptoms of dementia.
Glad you asked because the medical world needs to understand dementia more fully than it does.
A person with dementia is. Because of research, and the beginning of understanding dementia as "brain failure" the new language has been simplified. Thinking about dementia in terms of behaviors empowers staff to think of strategies on how to address behaviors. When someone with dementia wanders, for example, that is a behavior that can be observed, described; when, where, how often,etc
And a treatment strategy devised- behaviorally, environmentally or with medication. For example one woman would pace the halls and try to leave in the afternoon. When she told the staff she needed to meet her children at the bus stop, they put a chair opposite the nurses station with a sign over it: Bus stop and now in the afternoons she puts on her coat, holds her purse, and waits at the "bus stop". It is more humane and functional to think about dementia this way.
My cousin, who as Vascular Dementia, has had quite a few visits to various medical facilities. She is in a wheelchair and has obvious signs of dementia, PLUS, they are informed of this fact. She has had her Primary visits, but also, Neurologist, radiologists, orthopedics, surgeon (had cyst removed), ER visits, etc. It's just amazing how little if anything they know. I started to give them some info. (Goodness knows they need it.) With all the dementia patients they treat, why are so many of them so ill informed? This includes MD's and nurses. It boggles the mind.
Does that explanation fit the context of the remark?
Those placed in a geriatric ward even if cognitively sound on admission frequently sank to the "norm" of the population they found themselves in. they exhibited signs of dementia or simply with drew probably due to depression. Few had anyone to advocate for them because if they did families were more able to care for them at home as most families stayed intact and the wife did not have to work. She was a "housewife" and had the time to care for the elder.
Because dementia has only recently been recognized there was zero teaching about it in nursing schools. Those who could not be managed in a conventional hospital ended up in mental hospitals. Education and knowledge in this area has been slow to evolve and still may be playing "catch up" as far as education is concerned and interest by the medical professionals. Nursing school and acute care for me is over 50 years ago so I don't know how much is taught to current dy nurses. I did however take the RN NYCLEX (and passed) 18 years ago and do not remember any questions related to dementia but maybe there were because the exam is based on a pool of 250 questions and your level of expertise determines the type of questions you are asked. The minimum pass level makes you answer 75 questions and I got through with 85 mainly I believe because I had had a lot of supervisory experience and the exam is aimed at new graduates.
Fifty years ago in the UK the only experience offered was 6 weeks in a mental hospital and of 60 in my class only 6 who were judged suitable were selected. I did apply but was not deemed suitable.
I am sure training is very different these days as nurse education is now college based and not an apprentice style experience with only had a few weeks each year in the classroom. Just my 2 cents.
The nurse who made that comment was either not educated or simply had no
interest in that area
terest in the area and clearly believed patients had the ability to control their "bad" behavior
Pam is right, depression can lead to dementia. Most people will develop some level of it, if they live long enough. That's just my experience.
And kudos to the sweet caregivers who find ways to incorporate "dignified" methods of dealing with their patients' dementia.
My observation: Time just collapses . My personal observation over 8 years of caring for my husband withLewy Body Dementia. For example,at 11 pm he would want to go to a very important meeting at the office. (He had gone over 15 years ago to these types of meetings.) I hope this idea helps you.
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