Dementia

I'm studying intro to psych on my own as one of the pre-reqs I'll need for nursing school, and read this paragraph today:
"Impaired memory, particularly for very recent events, typically is one of the first symptoms to appear. Poor judgment, language problems, and disorientation may appear [...] and episodes of distress because they feel confused. Their behavior may become uninhibited, they may lose the ability to perform familiar tasks, and they may experience significant physical decline in addition to cognitive impairments. [...] being a caregiver for a spouse or one's elderly parent who has developed dementia often is a stressful and psychologically painful experience. Over half of the people diagnosed with senile dementia show combinations of depression, anxiety, agitation, paranoid reactions, and disordered thinking that may resemble schizophrenia. Ultimately, they may not even be able to walk, talk, or recognize close friends or family members."

Sigh.

Betty has had us think of all the terms we can in class for bowel movement and urination, so that we'll recognize when patients or residents are telling us they need to go. Hospitals and long-term care facilities should actually have a copy, on each floor, of a notebook that catalogs all such terms. This is necessary in part because of the loss of inhibitions that accompanies Alzheimer's, in particular: people who had been gentle and discreet before its onset can become potty-mouths.

She told us about a 3-level Alzheimer's facility nearby, where the least-impaired, sweet, mildly forgetful Mrs. Smiths are on the first floor, and hostile and foul-mouthed residents occupy the second, and the third is for residents who mostly can't do anything for themselves any more. They're all on their way to the 3rd floor eventually--there's no cure, and they all go through the emotional, physical, and mental decline. Our job, she says, is to respond to even unkindness in a therapeutic manner. To figure out how to find connection and fulfillment in meeting the needs of even the most difficult residents. And to know our own limits, and ask our nursing supervisor occasionally to transfer to a less emotionally trying section of a facility if such a spot is available. I wonder, especially in light of Hazel's comments, whether such a transfer is realistically possible in most workplaces. It seems incredibly trying to respond to aggression gently. But I've learned to do it with my daughter, because I have a different set of expectations about what a 2-year-old is capable of and "means" by her actions. She is not yet herself. I suppose I can try to adjust my expectations consciously when I work with people who are no longer themselves.

Betty has occasionally calmed a distraught patient by putting a pile of clean washcloths on her overbed table and asking her to help fold them. I find this poignant; I suppose such a task can ground a woman who has spent a lifetime doing laundry for others, and who is now feeling lost and helpless. Betty says "it'll take her an hour." She is a no-nonsense instructor, but her tone of voice as she relates these things to us, imitating herself in such situations with vulnerable and confused patients or residents, is incredibly kind and non-patronizing.

She emphasizes that in a healthcare situation, as healthcare providers we are _always_ in a position of power, and patients/residents are vulnerable, and often perceive themselves to be, so they can be fearful of us as well, that we might withhold care, and let them suffer. Funny--I'm guessing most NACs don't have good enough health care insurance to afford the kind of care they themselves provide to others, but I suppose it is true that the balance of power between the p/r or the NAC is in the NAC's "favor," for the little that is worth. :/