Caregiving for the confused elderly person who becomes easily agitated
Posted by Virginia on Wednesday, September 2, 2009 at 4:57pm

Agitation is excessive movement or rapid speech that usually has no purpose. Excessive movement or excessive talking without purpose (due to the environment or level of confusion of the elder) we usually refer to as agitation. When a confused elder is agitated, negative behaviors can contribute to more falls, increase their confusion, increased chance of injury, decrease their social life and possibly at the extreme may require medication. This agitation might be expressed in pacing, hand wringing, crying, fidgeting, insomnia, screaming, being uncooperative, being argumentative, delusions, paranoia, and hallucinations. When the agitation escalates, and the confused elder is grossly over reacting it may turn to anger or even violence. Controlling the environment the first step to controlling agitation. When the environment is controlled in a way to provide a positive atmosphere, many times agitation will not become a problem. The confused elder may not be able to manage excessive stimulation such as a loud T.V., several people visiting and talking, a crowded public area, a crying baby, traffic sounds, all the sounds we take for granted in a busy society. When the environment becomes stressful and agitation is triggered it may escalate depending on the caregiver’s response to the behavior. So the caregiver who remains calm in the face of an agitated confused elder will help reduce the behavior. Having a dementing illness makes the elder more vulnerable to stress or a highly stimulating environment. When you see symptoms of agitation-look to the environment first. Virginia Garberding R.N. Director of Education, The Wealshire Author: Please Get To Know Me – Aging with Dignity and Relevance With Cecil Murphey (For related information see also other blogs in this category) Behaviours
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Aging: 96 year old woman has third hip replacement – paid for by Medicare
Posted by Virginia on Monday, August 31, 2009 at 4:15pm

I have to ask myself – in the future would this 96 year old woman have the opportunity to have a third hip replacement? She has her hair piled up on the top of her head in a kind of bun look. She is well groomed with a lovely gray skirt, white blouse and white cardigan. She is bright, happy, engaging and wants to talk to everyone – she is also 96 years old. When asked about her recent surgery she will clearly explain that the incision is smaller than her previous two – more than 20 years ago – and is healing well. She talks about how fast and great the therapy is going and how much stronger she feels already. She says that at first “they” didn’t want to do it, just wanted to give her pain pills for the chronic hip pain, as her last hip replacement was failing. She didn’t really know why they changed their minds, but she is glad “they” did. She lives in an Assisted Living Community connected to the Nursing Home where she is now recovering. She is very much looking forward to returning to her small apartment, and now has the confidence that she will. Does it make a difference because she is not confused or have a diagnosis of a dementing disease? Should a diagnosis of Alzheimer’s disease make a difference? How old can you be to still be considered eligible for a major surgery? When do we stop trying and go to “pain pills?” Virginia Garberding R.N. Director of Education, The Wealshire Author: Please Get To Know Me – Aging with Dignity and Relevance With Cecil Murphey (For related information see also other blogs in this category) Aging
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Caregiver Tips: Alzheimer's disease, when he realizes he can't drive anymore
Posted by Virginia on Saturday, August 29, 2009 at 9:45pm

He'll never drive a car again. He's taken such good care of our cars. More than just being able to drive, giving it up symbolizes a lot of things he'll never do again. He was a skilled driver, moving efforlessly through crowded lanes while he talked or listened to the radio. A few months ago I saw how upset he became when he had to drive in heavy traffic. He forgot a turn, and a car almost hit us. Fortunately he made the transition easy for me. "You'd better drive," he said, trying to sound casual. "Downtown traffic gets on my nerves." He tried to smile, but I knew what it cost him to turn the driving over to me. Other wives have had trouble making the change. They took over when they realized that it involved human safety-theirs and others'. God, give both of us strenght to accept what we can't change. Help us make these transitions with grace and dignity. Excerpt from: Daily Encouragement - When Someone You Love Has Alzheimer's by: Cecil Murphey and Beacon Hill Press of Kansas City Virginia Garberding R.N. Director of Education, The Wealshire Author: Please Get To Know Me – Aging with Dignity and Relevance With Cecil Murphey (For related information see also other blogs in this category) Alzheimer's Disease
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Caregiver Tips: Confused elderly man is spitting all the time
Posted by Virginia on Tuesday, August 25, 2009 at 3:38pm

Elder is being ostracized because of spitting. I received a call from Larry’s nurse saying they have had an ongoing problem with Larry “spitting.” The staff is having a problem because no one wants to sit with Larry and especially have him at their table during meals. Spitting is a particularly difficult problem and caregivers find the habit revolting and something the elderly are doing on purpose. Very seldom is this purposeful behavior. Possible causes of excessive saliva and spitting: • Elder no longer able to swallow saliva. • Side effect of medication. • Possible dental problem – inflammation. • Problem with gastric reflux. • Possible food allergy causing sinus problems. • Behavior associated with Alzheimer’s disease. In meeting Larry for the first time, I noted that he holds his head so far forward that his chin is almost resting on his chest. The staff says that when they are feeding him he doesn’t spit and swallows fine. We agree to have Larry seen by the dentist as well as the speech therapist to see if there are any dental or swallowing issues. From the position that Larry is holding his head – it doesn’t appear that he can swallow his saliva, so as it accumulates he spits it out. We will be following up with evaluations by the physical therapist as well as the occupational therapist to see if we can provide strengthening exercises for his neck and shoulder area. Providing Larry with a higher backrest for his wheelchair will also support his head in a more normal position, as well as give us the option in the future of additional positioning devices. Virginia Garberding R.N. Director of Education, The Wealshire Author: Please Get To Know Me – Aging with Dignity and Relevance With Cecil Murphey (For related information see also other blogs in this category) Alzheimer's Disease
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Caregiver Tips: When caring for the confused elderly who is taking numerous medications, suggest a "drug holiday" to the doctor
Posted by Virginia on Monday, August 24, 2009 at 5:03pm

For the elderly, many times we just keep adding more drugs. Ann was in the late stage of Alzheimer’s disease. She no longer recognized her family or even herself in a mirror. She did not know her caregivers or even where she was. Over the years she had been diagnosed with a heart condition as well as having many negative behaviors. As time went by more and more medications were added to her day. Medications for her heart as well as her dementia. Medications many times have a way of building and being added to and multiplying. Until the confused elderly are taking so many medications you no longer really know how the person would function without all those pills. For Ann a defining moment came when her husband became ill and the family decided that it was just too much for him to continue going to the nursing home everyday to visit Ann. So with the blessing of her doctor and because of her end stage Alzheimer’s disease they all agreed to a “drug holiday” for Ann. “Drug Holiday” or when the doctor gives the elderly a vacation from drugs. To everyone’s surprise Ann blossomed. She was more wide awake, smiling, greeting everyone who came within ear shot of her. She now was singing all the time, very happy and responsive. She still no longer recognized anyone, but she sure enjoyed seeing you. Ann continues on her “holiday” some 3 years later. Many times the accumulation of multiple medications is just taken for granted in the elderly population. Maybe as we age, the elderly should be taking away medications instead of adding to them. Virginia Garberding R.N. Director of Education, The Wealshire Author: Please Get To Know Me – Aging with Dignity and Relevance With Cecil Murphey (For related information see also other blogs in this category) Alzheimer's Disease
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