Dementia, Part IV Attachment #1

A BEARABLE SOLUTIONResponding Creatively to Dementia

By: Denise Perlaky, RN, BSN

The last thing this agitated patient needed to hear was that the flying polar bears in his room weren’t real.

I drove down the dirt lane slowly, wondering what new adventure awaited me. I’m a home health care nurse who specializes in Alzheimer’s patients, so every day brings a new challenge.

This patient’s clapboard house stood alone in the distance, save for a few nearby trees. It looked like the set for The Little House on the Prairie, except that the grounds were cluttered with shovels, rakes, rusty metal rods, an uprooted water pump, and other discarded material.

As I pulled into the driveway, the steering wheel jerked back and forth and the car dipped, scraping bottom. After I’d navigated about 100 feet of bumps and puddles, I found a dry spot behind the house, parked, and took a moment to catch my breath. Someone was watching from the back door - a woman with long, dark hair and alert, brown eyes.

She smiled and I smiled back. Good, I thought, grabbing my nursing bag from the floor. She looks like she’ll be a help.

I’d visited literally hundreds of Alzheimer’s patients before this visit - in circumstances so diverse that now nothing could be called unusual. But this time was different, and that’s why I want to tell you about it. This woman was more than just a help, you see. She changed the way I care for my patients.

Warmth and Caring

Her name was Tina, the patient’s granddaughter-in-law. She welcomed me into a warm, inviting kitchen. After we’d finished introducing ourselves, she went to find Roland, my 81-year-old patient.

Roland walked slowly into the kitchen, using a cane. He was a wiry, broad-shouldered man with muscular arms, exposed to the elbows by the rolled-up sleeves of an old gray work shirt.

"He’s worked hard all his life," said Tina. "That’s all his stuff outside. We cleared everything out of the barn for him. He still likes to go through his tools and things." Roland was staring across the room, seemingly unaware of our presence.

"Hello, Roland, I’m Denise." "He probably doesn’t hear you." Tina said. "It’s not only the Alzheimer’s, he’s almost deaf, and he can’t see too well either."

I watched him stand there impassively as Tina talked. She explained how she, her electrician husband, and their four young children had moved in with Roland when his dementia got worse a year earlier. "We try to be one, big happy family here," she said, smiling. "Grandpa, us, the cat, and the eight rabbits."

Tina was obviously a compassionate person, and I could see that she was taking meticulous care of her grandfather-in-law. His chart had said he was occasionally incontinent and had difficulty eating, but you wouldn’t have known it to look at him. He looked well fed and very clean, with no telltale odors coming from his clothes or lingering in the house.

As we discussed his case, Tina revealed that Roland could get angry and swing his cane at times. But usually he was calm. She noted with pride that her children played a key role on the care team - as I could see when one of the little girls gave her great-grandfather a pat as she passed through the kitchen.

Continued ...

Dementia, Part IV Attachment #2

A BEARABLE SOLUTION, page 2

Flying polar bears

As we talked more about Roland’s behavior, I asked Tina if he’s ever had any hallucinations. "I should say so," she said. "He had flying polar bears bothering him last week." "Flying polar bears?" "Yep, all over the bedroom. He was taking his stick to them." She sounded as if she’d seen them too.

"What did you do?" "Well, I knew this was really serious business for Roland. He was very frightened, and I had to come up with something really fast. So this called for Flying Polar Bear Spray." "What’s that?" She smiled. "My invention. I just grabbed one of those air freshener cans and put a wrapper around it. Drew some flying polar bears there and wrote Flying Polar Bear Spray on it. Then I went into Roland’s room with it and took care of all those polar bears."

"Can I ask how you did that?" "Sure, I yelled that I was saving him from those lousy flying polar bears. Just sprayed and made like I was chasing them, then sprayed some more. Then I told Roland I’d gotten rid of every one of them."

"How did Roland respond?" "He went to sleep. Hasn’t seen a polar bear since."

Undocumented "cure"

What do you know about that? I’ve had four years of nursing education, read hundreds of articles, and attended countless seminars, workshops, and presentations, and I can say that this cure for hallucinations was never mentioned once.

Since that day in Tina’s kitchen, I’ve come to realize that sometimes as professionals we overlook the creative solutions that work for the families of our patients. Tina, with only a degree in the school of hard knocks, solved a problem that might have stumped even the best-educated nurse or doctor.

Now I know better than to ignore my common sense. Sometimes you have to forget the textbooks and respond intuitively to a patient like Roland. You may have to suspend rational thought and ease up on the reality orientation. Think about what Tina did - affirming Roland’s fear, supporting him, and producing a positive outcome. Can you think of a better way to describe good nursing care? May all of us pay more attention to the other Tinas and their simple, direct methods for coping with health care problems.

Hurrah for Tina and her "bearable solution."

Nursing94, January. Coauthored by Edith S. Dorang. MEd, CAS, LCSW, Administrative Supervisor, Hospice of Pioneer Valley, Inc., Springfield, Mass.

Dementia, Part IV Attachment #3

S H E L L SBy: Phyllis S. Yingling

One day while walking on the beach, I found a fragment of what must have been a magnificent conch shell . . . a remnant of a masterpiece, an exquisite shard.

I tried to imagine the part as the whole when it was at its best, before it was broken by the churning sea . . . and Time. The shell must have been an elegant ecto-skeleton, a prime example of its species.

Now, all that remained was a chunk of pink and white shell, its scalloped edge chipped and scratched. Its complex shape, intricate design, and brilliant colors had vanished as the crashing surf took its toll.

I thought of my mother, a victim of Alzheimer’s disease for the past five years. At 78, wheelchair-bound, unable to walk or speak coherently, she resides in a nursing wing of a retirement home.

In recent years, she has become an exquisite shard of a magnificent person she once was, before she was broken by degenerative disease . . . and Time. She is the remnant of a masterpiece.

Those of us who knew and loved her in her prime still see her as the loving mother, warm-hearted wife, and fun-loving sister she used to be. We know her as the gifted teacher, the outstanding church and community leader, the confidante friend.

We still know her as the lover of laughter and music, and the wearer of beautiful hats, that she was for most of her years.

We love her all the more for the change in herself that she has had to endure.

Those of you who know her now see only the shell of a once vital person, a lovely fragment of a magnificent individual.

As caregivers for the elderly, it must be difficult to imagine the people you work with as the young people they once were. As you feed them, walk with them, change their clothes, endure angry outbursts, bathe them, and tuck them in at night, please know that families and friends . . . and the individuals themselves . . . are grateful when you show respect and kindness, and handle them as gently as a once-exquisite shell.