Tuesday Tidings: Phases of Disorientation

Distrust and repeated anger are often signs of a very important phase of disorientation known as malorientation.  Individuals with Alzheimer's who experience this stage, which is phase 1 of 4, tend to be unhappily oriented to life, are regularly accusatory, and typically do not maintain eye contact.  My belief is that it is our duty as caregivers to never judge situations and comfort our loved ones in the best way possible.  Naomi Feil's Workshop Handouts give basic guidance information when caregivers need extra support.  No one, patient or caregiver, should have to go down the long road of Alzheimer's disease without helpful advice from trained professionals who care.

In attempts to give Alzheimer's patients top priority over our own when it comes to emotions, we must remember this key expression: Alzheimer's is a disease of the mind that is uncontrollable.  When we as caregivers are having a bad day, we should stop to center ourselves.  As Carrie Gallahan, Certified Validation Worker and Group Practitioner expresses, close our eyes and imagine our favorite color entering our bodies each time we breathe in - all the way down to our toes.  Take a few minutes to do this until the body and mind feel relaxed.  Start off the day with a fresh slate, leave worries and everything negative at the door.  This will allow us to give our undivided attention and empathetic emotion to our dear elders.      

Has anyone tried using the Validation Technique?  How about attempting to center yourself?  Did either of these approaches provide benefits throughout the day of caregiving?

Technique Tip #5

"Did you ask Margaret where she was going?"  These were the words from one of my clients as she was waking up from her nap.  Knowing in my mind that I had not been introduced to Margaret, I simply stated, "No, I was not able to ask her."  This response might seem a bit outlandish to some individuals on the outside, but I wanted to preserve my client's feelings.  I did not want to make her feel as though she was speaking out of the blue, making her feel uncomfortable. 

When a client or loved one speaks to you in terms that you do not understand, it might be best to use ambiguity of pronouns to substitute for your not knowing.  As I stated, I wanted to spare my client's dignity.  My experience was months ago, and now that I know my client a bit more, I might respond a differently if it were to happen again.  It all depends on what kind of bond you have with your loved one.  Some individuals may feel more comfortable using the non-verbal technique of ambiguity.  Whichever technique chosen, we want to make sure our Alzheimer's patients are at the center of our reasoning and responses from the heart. 

Has anyone had someone with Alzheimer's ask them a question that made no sense?  How did you respond?    

Technique Tip #4

Charlie Barnet, Peggy Lee, Glen Miller, and Frank Sinatra are all 1940's musical artists.  Not only are these individuals from an awe-inspiring decade, these musicians are some of my client's favorites.  I found this out one Sunday afternoon when I decided to turn on the radio in my client's home.  I was cooking lunch and didn't want her to feel lonesome in the living room.  What I discovered was an astonishing and marvelous find.  She started to bop her feet up and down and hum along with the words on the radio, bringing her back to a place, in her words, "the good ol' days."  This non-verbal technique of music lead me to yet another door in which I could bond with my client.

My dear companion was a teenager during the 1940's, and the music reminded her just how wonderful of a life she has lived throughout the years.  As the songs kept coming, she then started to conversate with me about them and what she remembered most about life when listening to her favorite musicians.  She would get so excited when she heard a song that she really loved; singing aloud and smiling from cheek to cheek.

I could tell using the non-verbal technique of music was just what she needed that day to keep her spirits high.  Alzheimer's patients often times get frustrated and irritated with the world.  With the music rolling and the memories flowing, listening to melodies of the client's or loved one's choice just might be a charming redirective.  Memories from childhood are the special remembrances that do not seem to fade with Alzheimer's.  If we can rekindle the consciousness of music, why not bring back a piece of happiness to our loved one's mind?

Do you have a precious elder in your life that goes "ga ga" over music of their day?  Who are their favorite artists?   

Technique Tip #3

Slam on the breaks, deer in the headlights looking directly at you...this is what I experienced when I attempted to tell my client of the time change that has recently occurred.  She did not understand what in the world I was referring to when I told her I had changed the clock time that night in order for us to be aware of the correct time when she got up the following morning.  In her day and age, she had not had to change the clock for daylight savings time.  Only in the past several years has South Bend/Mishawaka had to do this, and she was as confused as she could be.  In order for me to clarify what I was trying to tell her, I had to rephrase my explanation.

The verbal technique of rephrasing is a beneficial route to take when an individual with Alzheimer's does not comprehend information.  Instead of me telling my client, "we have to move your clock back an hour, that is why it is reading seven o'clock when it is actually eight o'clock," I simply rephrased my wording as, "I have changed the time of your clock to read seven o'clock rather than eight o'clock."  In restating this information, I also used a shorter sentence as to keep confusion at a minimum. 

Even though my restating the material got the point of time change across to her, which she said she understood, she still stuck with her testimony that the clock was still going to be wrong in the morning. :)  I sincerely agreed with her that, "yes, the clock will be wrong in the morning."  Rephrasing helped my client understand the issue of the time change, yet there were underlying matters that she still disagreed with.  There was no harm in allowing her to think what she wants.  Besides, in the morning, the clock would show the correct time and she would then agree. 

The use of verbal techniques allows us to be resourceful and interpret the unclear.  Does anyone have a story of how rephrasing information opened another door of knowledge?  Did your client or loved one truly understand the whole picture, or were there underlying circumstances?  I would love to her your report.      

Technique Tip #2

Bathing will usually come second nature to a person when they feel sticky from sweat, or smell an odor emerging from their body.  With a patient who has Alzheimer's, this might not be the case.  In fact, these individuals might even down right refuse to cleanse themselves.  Some may insist that they have already taken a bath today, yet we as caregivers know that it has been two days since their last wash.  A method I use as a caregiver is to give the patient two options as to when they would like to get cleaned up.  You might want to ask: "would you rather take a bath now or in an hour?"  This allows them to make their own decisions, but enables us to assist them in duties that they would not think of to accomplish.  Remember to give reminders to concerns of this nature.  Tasks, such as bathing, become increasingly difficult to conduct when Alzheimer's patients progress into the middle stages of dementia.      

Unforeseen behaviors can arise with Alzheimer's disease that an individual in their earlier years would have never been known to possess.  This occurs throughout all of the stages, though may become more pronounced and identifiable in middle stages of the disease.  We as caregivers must know what to expect and be prepared for the unthinkable to come our way.  In doing so, we can somewhat ready our minds, or at least lessen the blow of the emotional exhaustion we may experience.

Would anyone be inclined to share an experience of their loved one's behavior that has changed since their development of Alzheimer's disease?  This does not have to be a negative experience, for dementia can open doors to different varieties in practices of bonding.  How did this actuality make you feel? 

Technique Tip

Patients with Alzheimer's sometimes feel they are not in control of their lives anymore. In an effort to regain that control, they may refuse to do what you ask of them. These individuals know that they have certain tasks to carry out to in order to stay healthy; they've been doing them their entire lives. Though, somehow, they want to do these things in their own time or feel they know best.

One evening I came across a challenge with one of my clients. She did not want to take her medication, stating that the doctor did not know what he was doing giving her so many pills to take. (While that seems highly unlikely, there are some physicians who over medicate individuals.) My client had a valid point, but her medications consisted of blood pressure, urinary control, antibiotics, and pain medicine for her degenerative disk disease in her back. This sweet lady was convinced that she was not taking these pills as I asked her, "what do you think you happen if you did not take these medications, don't you think things might be worse?"  She replied, "well, that might be true."  My client then proceeded to take her dosages for the night.

This technique I used to help me work through the difficult area that evening is known as a verbal technique of extremes. After hearing the alternative, dealing with her horrible pain, she gave in and took her medicine. If we as caregivers present the information in ways that it sheds light on the situation at hand, we might be able to persuade our clients, to what we feel, are the best options for them in order to live life in optimization. We know that is what we want for our loved ones, but at times they are just not interested. If this happens, I personally do what I can to keep my client smiling.

Has anyone ever had an experience that is similar?  Or maybe you've attempted to use this technique and it did not work. Share your story, you possibly could use another technique to keep your loved one healthy and safe.

Suggested Methods of Coping

Reaching out for support and effective coping methods to aide an individual with Alzheimer's disease can be a challenge within itself.  Proud to say, I have geriatric clinical training from Southwestern Michigan College and Home Instead Senior Care.  Many hours of case studies and lectures have provided me with extensive and meaningful instruction that I'd love to share.  Here, I am ecstatic to share essential tips in upholding an exuberant relationship between you and your loved ones:

• Agree

Even if you have a different opinion, allow an individual with Alzheimer's to dominate.  Alzheimer's patients tend to have mood swings at times of which they cannot control; wouldn't it be better to keep things calm instead of causing a commotion?

• Back Down

When the detrimental workings of Alzheimer's takes over, these dear people believe they know best.  They are, as a whole, unaware that they have a disease that is affecting their brain and memory.  Give them the pride they have accumulated throughout the years; you, as a caregiver, do not always have to be right in every or any situation.

• Forgive

As stated earlier, Alzheimer's disease causes our loved ones to experience attitudes and emotions that might not normally be a part of their character.  Do not take things to heart, let it go and forgive.

• Involve Them

It is possible that an individual with Alzheimer's can feel stripped of their decision making and freedom.  At any time viable, involve them and allow them to feel in control.

• Redirect

A person's brain with Alzheimer's is being eroded in a progressive process.  They might out of the blue speak of someone who has long ago past, or get angry about something that they feel happened two minutes ago, but in reality happened two years ago.  What us as caregivers have a responsibility to do, I believe, is to redirect them.  Flow the conversation into another more pleasant subject.

• Compassionate Lies

Caregivers who are just beginning may feel that telling a compassionate lie to a person with a disease is shameful.  On the contrary, sometimes it can pave the way for a brighter day.  I've known an individual suffering from Alzheimer's, and she absolutely despises all of the medication she has been ordered to take.  When I bring her the medication, she gets angry and demands that, "this has got to stop."  I agree with her and tell the compassionate lie of, "I will call the doctor on Monday to arrange some of the medications to be cancelled."  She needs these medications to allow her to function in a more natural state throughout the day, and if she does not take them, it could cost her, her health.  In this instance, telling a compassionate lie benefits the client.

• Small Amounts

Alzheimer's patients tend to be overwhelmed with too many stimuli going on at once, or choices to choose from.  Our society today is comfortable with having the television on while listening to the radio, and having a conversation.  This is too much and overwhelms a person with Alzheimer's disease.  Try having one type of entertainment going at once, or only give two options for them to choose from for dinner.  This makes decisions easier to handle, or perhaps able to be done.

• Task Participation

Allow them to do as much for themselves as possible; such as dressing or bathing.  Give your loved one small tasks to keep them occupied throughout the day as well.  When it is time to fold the laundry, give them one item at a time as to not smother their thoughts or actions.


For the Caregivers:

• Arrange breaks and outings for yourself in order to avoid the feeling of drowning

• Cherish the time you have together with your loved ones

• Take proper precautions; such as setting alarms on doors, or taking away car keys when necessary ~ Alzheimer's patients tend to wander and can find themselves lost

• Keep schedules consistent, as our treasured individuals tend to be more relaxed this way

Does anyone have an experience that they'd like to share?  Have you tried one of these methods and it did not work? Perhaps tweaking it a bit is all that's needed.