What is My Role in Treating Patients with Dementia and Alzheimer’s

It is estimated that more than 70 percent of nursing home residents, and many of those in long-term care facilities have dementia-related illness. Symptoms of dementia can vary greatly, but may include memory loss, trouble communicating, and an inability to focus or reason or perform everyday activities.  As dementia progresses, harsh words, angry outbursts, throwing or breaking things and even striking other people can manifest in some people with dementia.  Sadly, research shows that almost 90 percent of aggressive behaviors are directed toward certified nursing assistants¹ (CNA’s) in healthcare settings.

Staff at assistive living or memory-care facilities may wonder why dementia patients are exhibiting extreme behaviors.  Patients with dementia are not aggressive because of dementia, they are aggressive because they have a need and don’t know how to express that need.  They don’t wander because they have dementia; they wander because they are not sure where they are, where to go, or what to do. A skilled CNA must understand that these behaviors are the resident simply trying to communicate their needs, such as pain, hunger or thirst. This is important, because a CNA will need to practice both patience and compassion when assisting people with Alzheimer’s or dementia.

Many healthcare facilities will agree that CNAs need additional training about dementia and Alzheimer’s beyond standard coursework in order to correctly communicate with residents, as well as understand what doctors or nurses are ordering. This knowledge also allows CNA’s to recognize signs and symptoms of Alzheimer’s and dementia in order to insure residents receive proper treatment.

One CNA pointed out, “I received coursework about the signs and symptoms of dementia, but there was little training about how to handle difficult situations. I think this may be because people react differently, and dementia is progressive, so a patient’s behavior can change overtime.“ 

There are a number of programs providing online and classroom training for professional care providers. Some residential care facilities will also offer on-going training, which can lead to greater responsibility and salary.

One such program: CARES®² Dementia Care Online Training, provides training in:

The Basics^TM
Advanced Care^TM
Dementia-Related Behavior^TM
Activities of Daily Living^TM

The CARES® program is a 4-hour online program that focuses on the basics needed to care for patients with dementia.

This program offers the option of online certification through the essentiALZ certification³ program by the Alzheimer’s Association. Classroom training is also available through the Alzheimer’s Association. Contact your local Alzheimer’s Association⁴ to find a program in your area.

What Warming Signs of Alzheimer’s Disease Should I Look For in My Patients?

The main warning signs of Alzheimer’s disease, include:

• Disruptive memory loss
• Difficulties in problem solving or planning
• Problems in completing familiar tasks
• Time and place confusion
• Problems with visual and spatial relationships
• Problems with writing and speaking
• Having problems retracing their steps
• Losing things
• Poor judgment
• Social withdrawal
• Personality and mood changes

The dementia patient may have difficulty paying bills, keeping track of their belongings and prescriptions, planning or making meals, or remembering appointments. That’s why a CNA is so important to the over all care of a patient with dementia.

Many dementias are progressive. This means that they are mild at first and gradually worsen.  If your patient is showing evidence of memory loss or thinking skills, this should not be ignored and the nurse in charge should be contacted to find out the cause.

Stages of Alzheimer’s disease

The progression of Alzheimer’s disease covers three typical stages, which are mild, moderate, and severe.  Since the disease affects individuals in different ways, no two people will have the same symptoms in the same order.  But, knowing what to look for in your patients/clients will help you know how to handle any difficulties that arise, when to intervene as an advocate to nursing staff and families, and what to do to lessen your patient’s anxieties.

• Mild Alzheimer’s disease. Neighbors, family, or friends may be the first to notice their loved one’s problems, which include:
• Difficulty remembering names of new acquaintances
• Forgetting something they have just read
• Difficulty in finding the right name or word
• Increased difficulty in organization and planning
• Misplacing valuable objects
• Having difficult in task performance, especially in work or social settings

Moderate Alzheimer’s disease.  When the disease is moderate, Alzheimer’s patients may have problems with complex tasks, such as doing their finances. Typical symptoms of the moderate stage of Alzheimer’s disease, include: Behavioral and personality changes with the coming of delusions and suspiciousness

• Compulsive or repetitive behaviors such as hand wringing
• Increases in wandering behavior
• Sleep disturbances
• Bowel and bladder incontinence
• Needing help selecting the right clothing for the weather or the occasion
• Being confused about their location
• Being confused about what day it is
• Being unable to know their own telephone number or address
• Feeling withdrawn and moody, especially in social situations
• Forgetting the patient’s own personal history
• Forgetting events

Severe Alzheimer’s disease.  In the late stages of the disease, you may witness your patient losing the ability to carry on a conversation, control movement, or even to respond to their environment.  They may still speak certain words or phrases but can’t carry on a conversation. Typical symptoms at this stage of Alzheimer’s disease include:

• Becoming vulnerable to infections like pneumonia
• Having difficulty in communication
• Having difficulty sitting, walking, and swallowing
• Needing high levels of help with personal care and daily activities
• Losing awareness of their surroundings
• Losing awareness of recent happenings
• Needing full time, around the clock care for their daily care

Behavioral Changes of Dementia

Many CNA’s find that the behavioral changes seen in dementia are the most distressing and challenging aspects of the disease. In the early stages, you may see incereased depression, anxiety, and irritability in your patient.  In the later stages, there are other symptoms, including:

• Agitation
• Emotional distress
• Anger
• Aggression
• Sleep disturbances
• Delusions
• Hallucinations
• Restlessness
• Physical or verbal assaults

What Situations Trigger Behaviors In Patients?

It is usually the changes in the patient’s environment and events that play the biggest role in triggering behaviors in the dementia patient.  Change can be a stressor for anyone, but it is especially hard for a patient with Alzheimer’s disease or dementia.  Change can increase the patient’s fear level and may increase their ability to make sense out of even the simplest of things. Just being asked to change clothing or bathe, moving into a new place, or when a new caregiver is hired can all trigger behavioral issues in your patient. Identifying the triggers can help in choosing the best approach as to how to deal with the behavior.

Caring for the Dementia Patient

The care you give to the patient with dementia depends on the stage of their disease.  Early dementia patients may simply need reminding and redirection when their memory falters.  However, as the disease progresses, your patient will need your help in caring for themselves; including eating, bathing, and dressing.

They may need to be taught how to use assistive devices, such as a wheelchair or walker.  Dementia patients who are combative or aggressive will need to be treated carefully and with patience, and they may need redirection should they develop wandering behaviors.

[Wandering, one of the most common behaviors of dementia, has been identified as one of the primary reasons patients are admitted into nursing homes or residential care facilities, and also one of the most time-consuming behaviors for caregivers to tackle].

One CNA points out, “One of the problems we see is patients wandering.  They may leave their room and walk down the hall, or even outside. And more often than not, they have no idea where they are and they become scared, which can sometimes lead to anger. Then, we have to try to lead them back to their rooms, and this isn’t always easy.”

As a CNA, it would be far-sighted to seek additional training, or ask questions of resident nurses or doctors when you find you are unable to handle a situation. Asking patients’ questions and knowing their history will help them gain trust in you.  Take notes about behaviors or issues you witness. For instance, maybe you’ve noticed a certain resident enjoys music, which you may use to calm them in certain situations.

Other things to try:

• Ask simple questions
• Point to objects or use gestures
• Always call the person by name
• Allow time for the person to respond
• Speak slowly and in a calm, gentle voice
• Approach the person in a calm manner
• Don’t criticize, argue with, or correct the patient
• Don’t interrupt the person or rush them

Engaging the residents in daily activities can also help gain trust, and make a CNA’s job easier when considering your resident’s needs.

Promote daily exercise to help reduce wandering. This may also help the resident sleep better.

If time permits, sit and talk for a few minutes.

Walk them to meals

Help with daily hygiene and bathing.

Bring in their mail or newspapers

Make their bed, or clean up clutter from the floor.

Help them with TV or radio programming

and more…

References:

• PubMed; What CNAs taught us: lessons learned while teaching CNAs how to handle resident aggression; Autumn, 2004; Soreff S, Siddle D.
• Healthcare Interactive; Empowering Caregivers Through Education; Dementia Basics; 1997-2016.
• org; Alzheimer’s Association; 2016
• org; Alzheimer’s Association; In My Community; 2016