Family Education Articles
The following articles are provided by the Alzheimer Society of Haldimand Norfolk. For more information on issues related to dementia, please call toll free 1-800-565-4614 or 519-428-7771 and speak to the Psychogeriatric Resource Consultant.
It happens to us all when we speak with those that have memory impairment, we can say the wrong things. We point out their memory loss by making comments such as, “Don’t you remember?”…”Did Aunt Mary come today?” Asking them to remember is like asking a blind person “Don’t you see?” We try to reason or convince them that they need to do a particular task when it is totally unrealistic of us to think they should understand. The person with dementia has a broken brain. They do not see the world the way we see it. They no longer have the mental ability to reason or to anticipate the outcome of their behaviour. We can go into a long drawn out story to explain why they should take a bath or why they should not strike out at the personal support worker but you are wasting your breath. The brain no longer understands these explanations. Your relative hasn’t turned into a mean person or an uncaring individual; they have a disease which is affecting their brain. Memory loss produces unpredictable emotions, thoughts and behaviours, which you can lessen peacefully. The key is not to argue, correct, contradict, confront, blame or insist!
Reminders are rarely a kind way to respond to a person with dementia. It tells them of their memory problem over and over again. Reminders of the recent past tells that person, “I remember, I’m okay; you forget, your’re not okay”. Ouch! Refer to either the present time or the future. If they are hungry don’t remind them they just ate, offer a snack or set a time to eat soon. Individuals with dementia live in a different reality and reminding them of our reality will not bring them back into ours.
Open-ended questions such as, “Where do you want to go? or “What do you want to wear?”, can be surprisingly complicated and can cause anxiety to someone with memory problems. Simply give them a choice between two items or help them decide “You would look great in this blue dress”.
Be direct when asking them a question. Do not say, “Do you want a drink?” or “Are you thirsty?” Ask them, “Would you like apple juice or orange juice?” One of the most important things to remember when communicating with someone with memory impairment is to remain calm. When you feel tensions rising, self control is one response on which you should always depend. We cannot expect a person with dementia to be able to change their response to a act on emotion, instinct and are impulsive since they cannot logically think through a situation. We, on the other hand, can think through a situation and change our response by remaining calm, accepting the blame for the situation and apologizing for upsetting them. “I’m sorry; I must have forgotten to tell you I took your dirty clothes to the laundry room. I will get them back to you as soon as they are clean”. This is a better response then reminding them they were present when you removed the clothes and you have already had this conversation with them. If they remembered that, they would not be asking you the same question over and over again. The person with dementia is not trying to push your buttons or annoy you; their brain is not functioning correctly. We would not think to get angry with someone who has dementia and asks the same question over and over again because he/she forgets. Both symptoms are directly due to the disease they have, yet we expect a person with dementia to act like they have absolutely nothing wrong with them. We are expecting the impossible.
Using Restraints in Long-Care Facilities
If your relative is in long-term care you may wonder why the use of restraints is limited and “frowned upon”. Sometimes family members feel it is important to restrain “mom or dad” as they are going to fall and hurt themselves. The Long-Term Care Homes Act, 2007 (LTCHA or the Act) came into force in Ontario on July 1, 2010. With this Act, “The minimization of restraint, where necessary, and the application of restraint in accordance with the legislation” remains in place. What does this mean? It means that the long-term care home must look into all possible solutions before deciding to use a restraint.
What is considered a restraint? A restraint is anything intentionally used to limit the movement or behaviour of a person and over which the person has no control. Restraints may be one of three main types: physical restraints – devices that prevent or limit movement; environmental restraints – locked rooms or barriers which confine a person to a specific space; and chemical restraints – drugs used to inhibit and control behaviour or movement. A Resident is restrained if he or she cannot remove a physical device, leave a specific area or refuse a chemical restraint.
This article will focus on physical restraints. Physical restraints can be considered bed rails, seat belts, a table fixed to a chair, anything that cannot be opened by the person being restrained.
A common myth about restraints is that a restraint can prevent injury. There is a growing body of research that shows the exact opposite and that injury to an individual actually increases with the use of restraint. Undesirable outcomes, including death, can result even with safe restraint practices. A person can end up getting bed sores, lose the ability to walk and can cause fear, anger and the feeling of being humiliated even if the individual is confused already. Restraining someone may increase their anxiety. If you were upset or scared would you want to be placed in a device you could not get out of? Would you not spend all your waking hours attempting to get out of the restraint?
What could be used instead of a restraint? To prevent using bed rails, the person’s bed could be lowered to 7-9 inches from the floor. A mat can also be placed at the side of the bed. To prevent falls and injuries such as a broken hip, keep their bedroom free from clutter, use walkers or canes, hip protectors or activities that keep the person busy such as music, puzzles, crafts or cards. Regular toileting, walking routines and the ability to pace can help relieve the “wandering”. You will notice some long-term care facilities use bed, chair and/or door alarms to notify them should the person get up unattended.
Nothing unfortunately is 100% perfect in protecting your loved one from injury. Falls may happen, just as they could with our children. This comparison is not to make elderly individuals sound child-like or to be disrespectful to the elderly but to remind us that the individual’s quality of life is what comes first. We could keep our children in a bubble but what type of life would that be? Could we not say the same about keeping our elderly individuals restrained?