By: Jennifer Beach, LSW, MA, C-SWCM
Margie has been residing in a memory care community for a little over a year. Memory care communities are considered secure units for individuals with varying stages and types of dementia. You may find some individuals with Alzheimer’s, vascular dementia, Parkinson’s- related dementia, TBI (Traumatic Brain Injury) and many other types of dementias. Memory care communities work to find a variety of ways to keep individuals engaged in purposeful routines and activities throughout the day while assisting and supporting all activities of daily living based on everyone’s unique needs. One of the challenges for memory care facilities is providing superior training, adequate resources and tools for the staff providing the day-to-day care and support for individuals with different types of dementia.
Margie is a sweet, fragile woman in her late 80s who was diagnosed with Alzheimer’s eight years ago. About a year ago, Margie moved into a memory care facility and adjusted to her new surroundings rather quickly. She is typically pleasant, participates in activities and routines, and engages with others. Her family has felt very thankful things have been working out.
But then, Margie’s daughter received a call last week from the nurse at the facility, stating Margie had hit another resident at mealtime. Her daughter, as you can imagine, was upset, and had many questions: How was her mom? What happened? Is the other person ok? What’s going to happen now?
According to the NIA (National Institute on Aging), dementia is the loss of cognitive functioning, from thinking, remembering and reasoning to such an extent, it interferes with a person’s daily life and activities. Some people with dementia have difficulties controlling their emotions, and their personalities may change. We also know dementias manifest differently in every individual and can change day to day or even at different times of the day. As dementias progress, individuals are often challenged with communication skills and can have difficulty or lose the ability to express themselves. Pain and discomfort resulting from a variety of conditions and comorbidities may be expressed in other ways. Too often, pain and discomfort are overlooked and quickly labeled as “behaviors” due to dementia.
Margie’s facility completed an investigation of the incident. It was determined the staff working with Margie was new and did not pick up on signs Margie was not her typical self that day. After Margie lashed out at the dinner table, the nurse on duty who knew Margie was able to intervene. She discovered an open wound on Margie’s buttock that was clearly causing Margie significant discomfort. Once this was addressed, Margie was back to her normal, pleasant self. As a result, a plan was put in place to ensure overall skin checks were being done routinely. The other resident was upset and confused at the time but was not injured. A trained staff member was able to quickly redirect the other resident to a quiet, calm area and play some of her favorite music; soon the incident was forgotten, and the evening routine resumed.
The memory care facility must notify both the families or (POA and/or guardian) of an any aggressive incidents, ensure the residents are safe, have a plan to address the individual causing the aggression and to protect the other individual(s). It was an unfortunate incident and thankfully, the cause was discovered and addressed. Monitoring pain and discomfort is very important for individuals with dementia.
With many dementias, communication skills are impaired and behaviors become the way to express unmet needs, discomfort or pain. Similar to a child who does not have the abilities to communicate what they are feeling or need, they will express those needs by crying, ignoring eye contact, hiding, rocking back and forth or lashing out. All behaviors are ways to communicate or express an unmet and often unidentified need. It can be anything from feeling lost, out of place, afraid, in pain, hunger, arthritis, constipation… the list goes on. The challenge is figuring out what the individual is trying to communicate and then helping meet their needs.
Dementia doesn’t cause “behaviors.” It is the changes in the brain’s abilities to identify and express the need, pain or discomfort.
The other resident’s family understood the challenges that come with dementia and were relieved their loved one was safe, comfortable and the issue was addressed. Margie continues to sit next to the same resident at meals as they enjoy each other’s company, and the staff continue to work on learning and identifying what the individuals are communicating and needing.
Decoding takes time and attention but can make all the difference in resolving relationship issues that arise from dementia.
Original Post: https://www.northeastohioboomer.com/blogs/decoding-difficult-behaviors-due-to-dementia/