A person who is mentally healthy functions and interacts effectively with others, Deals with situations that cause anxiety, disappointment, and frustration.
Takes responsibility for decisions, feelings and actions and Controls and fulfills desires and impulses in an appropriate manner.
REMEMBER:
People who are mentally ill cannot control their illness and choose to be well. Mental illness is a disease like any physical illness
Guidelines when assisting residents with mental illness:
Do not speak to them as if they were children
Speak with respect
Maintain a normal distance from the resident
be aware of their body language
Avoid arguments
DEMENTIA
Dementia is an umbrella term for a group of signs and symptoms that describe decline in a person’s mental ability that is severe enough to interfere with his/her daily life.
There are many types of dementia, with the 2 most common being:
Alzheimer’s Disease: accounting for 60%- 80% of all cases of dementia.
Vascular dementia (also known as multi-infarct): accounting for approximately 10% of all dementias. This type of dementia is caused by blood vessel problems (low blood flow to brain).
Knowing how the different types of dementia affect the brain will help you to understand why some people with dementia behave in the ways that they do.
A resident may present with different signs and symptoms, depending on the area of the brain that is being affected.
The different signs and symptoms may include (not all- inclusive):
Trouble remembering things
Impaired communication
Poor judgment
Disorientation and Confusion
Sleep disturbances and
Difficulty with walking, speaking, and swallowing.
As with any disease process that affects the brain, there is the possibility for behavioral issues that may be due to his/her inability to communicate.
As his/her condition progresses, the resident may start to display behaviors that may be out of character. These behaviors are often the result of an unmet need such as hunger, thirst, pain, needing to use the bathroom, being comfortable, and many others.
The behaviors that may be seen include aggression, agitation, depression, hallucinations, suspicions, repetition in speech or actions, and wandering, to name a few.
Understanding these behaviors is the first step in being able to assist someone with the possible unmet needs, which could possibly decrease the behaviors or eliminate them all together.
COGNITIVE IMPAIRMENT
Cognitive impairment means impaired or damaged thinking. The main symptoms are memory loss and confusion. Cognitive impairment is not a normal part of aging and should be reported when symptoms are emerging
Delirium (known as acute dementia): is a medical condition that results in confusion and other disruptions in thinking and behavior, including changes in perception, attention, mood and activity level.
SPECIAL NEEDS OF COGNITIVELY IMPAIRED RESIDENTS:
Provide for the resident’s physical needs.
Establish a routine for care and try to adhere.
Provide direction & encourage resident to assist with care as much as possible.
Provide a safe environment to avoid risks as directed by the nurse and according to the care plan.
Always approach in a calm, respectful manner.
Recognize when the resident is becoming frustrated and offer assistance.
Limit decision making based on the resident’s ability.
Do not attempt to force the resident to think or remember.
Orient the resident to name, place and day and time.
Use positive body language as it may be the only message the resident
can receive.
Watch the resident’s body language as it may be the only message the resident can send.
Identify yourself by name and title. Always explain what you are going to do.
Give simple easy to follow instructions.
Do not validate false thinking which may result in increased confusion.
Do not correct resident with a negative message that may result in withdrawal or anger.
Remember these points about cognitive impairment:
Interferes with ability to make decisions.
Personality may change
Anger, depression, and irritability
Can be temporary or permanent
Alzheimer’s disease
a progressive, incurable disease, which eventually cause dementia.
Facts About Alzheimer’s Disease:
AD is the most common cause of dementia in the elderly.
Women are more likely than men to have AD.
AD is progressive, degenerative, and irreversible.
Cause is currently unknown and diagnosis is difficult.
Length of time from onset to death can range from three to 20 years.
Each person will show different signs at different times.
Skills a person has used over a lifetime will usually stay with the person longer through the progression of the disease.
Every person with AD progresses differently, showing different symptoms at different times.
THE DEVELOPMENTAL STAGES OF ALZHEIMER’S DISEASE:
Early: In the early stages of Alzheimer's, a resident may function independently. He or she may still be able to drive, work and be part of social activities.
Despite this, the resident may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects.
Middle: You may notice the resident with Alzheimer's confusing words, getting frustrated or angry, or acting in unexpected ways, such as refusing to bathe.
Damage to nerve cells in the brain can make it difficult to express thoughts and perform routine tasks
Late: In the final stage of this disease, residents lose the ability to respond to his/her environment, to carry on a conversation and, eventually, to control movement.
They may still say words or phrases, but communicating pain becomes difficult. As memory and cognitive skills continue to worsen, personality changes may take place and residents need extensive help with daily activities.
EFFECTS OF ALZHEIMER’S DISEASE
Progressive deterioration of behavior and personality
Impaired learning
Impaired thinking
Impaired judgment
Impaired memory
Impaired impulse control
ABILITIES THAT ARE SPARED (NOT LOST) IN ALZHEIMER’S DISEASE
Emotions and feelings
Physical strength
Senses such as vision, hearing, taste, smell and touch
Helpful Attitudes for residents with AD:
Do not take things personally.
Work with symptoms and behaviors you see.
Remember the goals of the resident care plan.
These communication tips are helpful with residents with AD:
Approach from the front.
Determine how close to stand.
Identify yourself and use the residents name.
Speak slowly and calmly.
Repeat yourself, using the same words and phrases, as often as needed.
Use signs, pictures, gestures, or written words to help communicate.
Break complex tasks into smaller, simpler ones.
Four creative therapies may be used for residents with AD:
Reality orientation
Validation therapy
Reminiscence therapy
Activity therapy
Hallucinations
When a resident with dementia experiences hallucinations, he or she may see, hear, smell, taste, or feel something that isn’t there. These hallucinations are the result of changes within the brain resulting from the dementia and usually occur in the later stages of the dimentia.
If resident is depressed or lonely:
Take time one-on-one to ask how he or she is feeling. Listen the response.
Try to involve the resident in activities
Report depression to the nurse.
If the resident is verbally abusive or uses bad language:
Remember it is the dementia speaking and not the person.
Try to ignore the language. Redirect attention.
If resident has lost most of verbal skills:
Use nonverbal skills, such as gestures, smiles, and laughter.
Use signs, labels, and gestures.
If the resident has Urinary incontinence:
Make sure resident is drinking enough fluids.
Note when resident is incontinent. Check him or her every 30 minutes.
Take resident to the bathroom before and after meals and before bedtime.
Mark restroom with sign and picture.
Observe toilet patterns for two to three nights if resident is incontinent during night.
Put lids on trash cans, waste baskets or other containers if resident urinates in them.
If the resident has trouble Dressing:
Show resident what he or she is going to wear.
Encourage resident to pick out clothes to wear. Lay out clothes in order to be put on.
Break task down in to simple steps.
Do not rush the resident.
Use a friendly, calm voice when speaking.
Praise and encourage.
If the resident has trouble Bathing:
Schedule bathing when resident is least agitated
Give resident supplies before bathing to serve as visual aid
Take a walk with resident down the hall and stop at tub or shower room
Give resident washcloth to hold during bath
Check the skin for signs of irritation
If the resident has trouble Eating:
Have meals at consistent times each day
Keep noise and distractions low
Put only one item of food on plate at a time
Give simple, clear instructions on how to eat or use utensils
Guide resident through meal with simple instructions
Make mealtimes simple and relaxed
Give resident time to swallow each bite
GUIDELINES FOR ASSISTING RESIDENTS WHO WANDER
Wandering or pacing is when a resident walks aimlessly through the facility. Allow the resident to wander if it is not harmful to resident or others.
Ensure that the resident who wanders wears appropriate identification and that the appropriate doors and windows are locked and alarms are turned on.
Look for the cause(s) of wandering, which may include seeking an exit, restlessness, stress, boredom, or unmet needs.
Repetition or Perseveration
As with many of the behaviors noted in dementia, the underlying cause is due to the deterioration of the brain cells that cause the resident to not be able to make sense of the world around them.
In the case of perseveration, a resident may not remember that he or she has just asked a question or completed a task.
If a resident is displaying Disruptive behavior, gain residents attention, be calm, direct to a private area, ask about behavior, help find ways for them to cope, and focus on positive activities.
If a resident is displaying Inappropriate social behavior (fighting) Do not take it personally, stay calm, reassure, find out cause, direct to private area, and report abuse to nurse.
If a resident is displaying Inappropriate sexual behavior, be matter of fact, report behavior to nurse.
If a resident is Pillaging or hoarding, Label belongings, place a symbol on door, do not tell others that person is “stealing” prepare the family, ask family to report strange items, and provide a rummage drawer.
Sleep Issues and Sundowning:
Sleep changes in residents with dementia are somehow the result of the impact of dementia on the brain, often causing residents to have problems sleeping or an increase in behaviors that begin at dusk and last into the night.
Catastrophic Reaction:
A catastrophic reaction is an emotional outburst, which may include crying, screaming, agitation, or fighting that is out of the control of the resident.
Try to avoid stressful situations and multiple distractions or overstimulation. Give person-centered verbal and non-verbal support. Do not scold, argue, teach or reason. Leave the resident alone to calm down if you can safely do so.
