I had one lady that often saw people were not there. There were times when she would have conversations with them for hours on end.
Often these conversations were very informative and entertaining.
Those with dementia often experience hallucinations
Hallucinations are common for those with Alzheimer’s and dementia.
There are a variety of reasons but the most common are the interaction of medicines and the disease.
However, I’ve also spent enough time with Alzheimer’s patients that I believe they often see things we can’t see. For some reason, they’re able to see the veil between our world and the spirit world that is hidden from the rest of us.
I’ve seen some family members and CNAs argue and try to convince the resident that no one is there. However, this often leads to more agitation.
So instead, just listen and love your new one.
Who knows what new friends your loved ones may introduce you to?
How have you dealt with hallucinations in a loved one?
Sadly, anger is prevalent at times in those that suffer from Alzheimer’s.
Sometimes this is due to their personality and life issues. Often, this is because the person knows something is wrong, but can’t find the words to express what is wrong.
Dementia leads to anger in those with the disease
Some reasons for the anger may include:
Unable to find words to express him/herself
Is bothered by something but can’t express what
Knows something isn’t right but isn’t sure what
Is confused
Is frustrated
Is irritated by limitations {physical and/or mental}
Paranoid of being talked about
Staying calm and helping the resident find ways to express him/herself is the best way to work through these bouts.
What do you do when your loved one expresses anger?
Spending my days with senior adults, many of them have Alzheimer’s.
So what have I learned from this wonderful group?
Most of it boil down to one fact that is not all that different from the rest of us. They want to be loved.
People with Alzheimer’s aren’t that different than the rest of us. They just want to feel loved.
Some examples include:
I have one lady that sighs every time a hand is placed on her shoulder.
I have another man who constantly says “I love you.”
I have a lady that claps her hands when she sees a familiar face.
I have another lady who will take your hands and kiss them.
I have a lady that is a recluse, but a hand on the shoulder and kind word will elicit a smile
These are just some of the common responses I see on a daily basis. They just want to know they are not forgotten and that someone cares.
We often think that they don’t know when family visits. However, I’ve seen time again the way a face lights up when family appears. I’ve also seen the sadness of watching a peer with his/her family. We may not think so, but they are aware of whether loved ones visit on a regular basis or not. Again, they know if they are loved and wanted or not.
No, they may not remember who you are and they may have forgotten what you’d just said, but they also know how you make them feel.
We hear the terms dementia and Alzheimer’s, but exactly what do they mean.
There are actually several types of dementia.
First let’s define the term dementia. It is a general term for a loss of memory or other mental abilities that are severe enough to interfere with day to day life.
So what are the types of dementia?
Alzhiemer’s disease—most common type of dementia.
Vascular dementia-often occurs after a stroke
Dementia with Lewy bodies—have abnormal aggregations of the protein alphasynuclein
Parkinson’s disease
Mixed dementia—linked to more than one kind of dementia
Frontotemporal dementia
Creutzfeldt-Jakob disease
Huntington’s Disease—progressive brain disorder
Normal Pressure hydrocephalus
Wernicke-Korsakoff Syndrome—caused by severe deficiency of vitamin B-1
For a more in-depth view of symptoms, causes and treatments check out Alz.org and Alzheimers.net
Are you looking for ideas for sensory stimulation with your loved one that has dementia?
Hand massages provides that personal touch and says I care
If you’re not sure what I mean, sensory stimulation uses the five senses of sight, touch, hearing, taste and feel to hopefully evoke positive emotions.
I’ve discussed numerous activities with music, but what are some others that can be completed?
Hand massage or shoulder massage—these are always a big hit when we do them in the nursing facility where I work. {touch}
Relaxation satchel—these don’t have to be fancy and if your loved one is higher functioning s/he can assist you in making them. We used clean new or clean socks and filled them about half full with rice. We then took drops of one essential oil {such as lavender}, added to the rice and mixed to spread the scent. We then tied the sock off. The sock could be used to provoke various memories or to calm an agitated loved one {especially if you use lavender}. {smell}
You can use a keyboard {or look them up online} to play various sounds and help your loved one recognize what they are. Some examples are a doorbell, train whistle, piano, car horn, etc. {listening}
Ice cream—this is a treat most people love and can evoke positive memories. Use the treat to reminisce. {taste}
Pictures—looking through pictures, reminiscing and discussing who each person in the picture is helps with memory recall {seeing}
ice cream prompts positive memories
Bubbles—many of my residents love the bubbles. They enjoy both watching them and trying to grab them and make them pop. This can be a lot of fun. {seeing, touch}
Flower arranging—the resident can look at the various flowers, sort them by color or type and smell the flowers. {seeing, touch, smell}
Herbal tea party—fix a cup of hot tea and honey, milk, or sugar as desired. Discuss the flavors found in the tea. {taste}
Shell discovery—hide shells in a small box or pail and have your loved one pick out different ones and discuss their differences. Even if it’s just how small or large they are this can be a fun activity. {touch}
Check out a DVD from the library of a place your loved one may have visited or lived in. Videos of scenery or animals are a great idea to discuss what s/he is seeing. You could also look at pictures of these places s/he has and listen to a CD of music or sounds from that place. {seeing, listening}
What are some sensory stimulation activities you have used?
Sundowning gets everything turned around as the sun goes down
If you have a loved one with dementia/Alzheimer’s you know that often sundowning is a common issue.
Sundowning is in the later afternoon and early evening, when the sun begins to set, and the individual becomes more agitates and frustrated. Often s/he wants to go home, yells, increased hallucinations, begins undressing, has increased confusion, etc.
So how do you deal with sundowning?
Turn the lights down and calm the loved one. Often turning on soft music will also help him/her to relax.
Keeping a track of triggers and what calms agitation is a great idea
On the reverse side, sometimes turning the lights on in the room being occupied helps the loved one.
Hold your loved ones hand and gently talk with him/her. Take the time to reassure him/her.
Take a walk—staying active is good for the body. Even if it is just a few steps or down the hall and back is good for your loved one. If s/he can’t walk and has a wheel chair, put your loved one around in the chair for a change of scenery.
Calming activities—find activities that are not stressful for your loved one and will keep him/her calm. Depending on the level of functioning, some activities such as reading and watching TV are stressful because they are difficult to follow.
Eat a lighter dinner—larger meals may be heavier on the digestion system or have more caffeine and/or alcohol. Enjoy these foods at lunch and have a lighter meal or snack in the evening.
Keep a daily journal—keep a journal of the daily activities and document triggers and behaviors that create agitation. By keeping track of this information you can identify the triggers and attempt to eliminate or change them.
Limiting sleep during the day to short 20 minute catnaps—this helps the internal body clock to not become so confused
Keep active—during the day keep your loved one active and develop more activities or outings for your loved one {depending on his/her ability}.
Talk to a doctor—most importantly discuss the issue with his/her doctor. Medication{s} may be a factor or could be prescribed to help with agitation and confusion.
I’ve had some residents that would yell, become agitated, or have hallucinations. I’ve discovered I can use music to calm and minister to these residents.
Using songs that are familiar helps the loved one feel comfortable because the song is familiar
Music is theraputic
Singing hymns is often soothing
Music that is calming or played softly often helps to deal with agitation. I’ve often found that piano music is great for calming the loved one, whether in person or through a CD.
Nature sounds are a great way to calm agitation
Hymns ministers to the soul
Familiar songs can illicit happy memories
Singing is often the equivalent to “praying twice”
Music often speaks to the soul and can be used to help the loved one express themselves
Use songs that help redirect the loved one into other thoughts or memories. For instance, ask “Did Dad sing let me call you sweetheart to you when you were courting?” or “did you see Wizard of Oz as a child?” or “did you see {name artists} in concert?”
Use movement to music to help the loved one stay active. This can be done in a variety of ways from playing a small handheld instrument to dancing to hitting a ball/balloon to moving with scarves to the music.
At times it is difficult for someone with Alzheimers to know how to express themselves
I had one resident that was normally very sweet, but at times she had nightmares that caused violent outbursts.
Calming her down during one of these episodes was never easy and took a lot of time. Often it took time that others did not want to dedicate to her. There have been numerous times when I spent a good hour or more working to calm her down.
So how do you calm down an Alzheimer’s patient that has a violent outbursts?
Remember that often it is the disease and not the individual
Finding the window to help Alzheimer’s deal with their reality
Understand the history and background of the person. In this case, we knew the traumatic event from her youth that triggered these outbursts.
Redirect the individual as much as possible
Don’t argue with the person
Allow the individual to talk about the incident if possible and necessary. You don’t want to agitate him/her more.
Beware of triggers. Keep a record of events before these outbursts. Is there a certain person, incident, time of day, etc. that triggers these outbursts? By tracking any triggers you can work to eliminate them.
If nothing else works and the person is in a safe place and not a danger to his/her self, sometimes the best thing is to leave him/her alone {even if you watch over him/her from another room} to come down
Pray and quote scripture together or over the person.
I used all of these techniques and in time I was able to calm this sweet lady back and see her return to her normal self. What works with one person may not always work with another, but in my personal experience I found that singing and then praying together were the most calming tools I could use.
Of course, I had to talk with her until she was calm enough to sing and pray with.
How do you calm an individual that has violent outbursts?
Recently a dear friend of mine with Alzheimer’s mourned the loss of his wife. He would often twists his wedding ring when thinking about her and asks questions. There were times when he was quiet and other times when he had bursts of anger. All of this is a natural part of the mourning process.
Alzheimer’s does not stop our loved ones from grieving when they lose a loved one, whether it is a sibling, spouse, or child.
So how do we deal with this grief?
DO NOT keep reminding them if they don’t remember.
Allow them to talk about the loved one and share memories.
Realize that any anger or showing out may be due to the grief.
Try to redirect them if they become too agitated.
Celebrate the life of the loved one.
Understand that they will feel your loved one needs to grieve and will express the same steps in the grief process {denial, anger, guilt, sadness, acceptance}.
Recognize signs, times of day or situations that may trigger the grieving process {especially anger and guilt steps}.
Understand that some bonds and intuitions are strong that even without telling your loved one s/he may “know.”
Remember that you are grieving also {most likely} and grieving together may be good for both of you.
Grief takes time for everyone to experience. We’ve got to remember that the same is true for our loved ones with Alzheimer’s. However, if they don’t remember, don’t keep bringing it back up. Doing so will be like hearing the news for the first time each time.
Time and time again I’m amazed at the power of music. I’ve shared many times how I believe this is the universal language and that still rings true.
So why do I believe this?
music soothes
Well, let’s visit the Alzheimer’s unit and take a look:
Resident #1 has terrible flashbacks from a traumatic event as a child. Talking only agitates her more in these moments. However, as soon as I begin to sing she calms down. Before the end of the song she is singing a-long. After we finish the sing a-long, she sits quietly and is able to carry on a conversation.
Resident #2 is depressed. As soon as I begin to sing, I see her eyes light up. By the time we finish singing, she is clapping her hands and singing along.
Resident #3 ask me to sing or motions towards the piano every time I walk into the room. Piano music and sing a-longs calms his agitation.
Resident #4 cannot speak, however every time I sing a certain song she has tears in her eyes. Once again I’m reminded how this song touches her heart.
Resident #5 repeats the same phrases from a hymn over and over every time you speak with him. That’s okay, because this song has struck a chord with him and we will continue to sing the song with each sing a-long.
Resident #6 does not speak, but when we begin to sing “You are My Sunshine” or “Jesus Loves Me” she can sing every word.
There are numerous ways to enjoy music. Dancing is one such way.
Resident #7 easily grows confused and frustrated in trying to recall the information she is seeking. However, when we begin to sing she can sing the words to every hymn and oldies song. Her husband is so amazed he ask her to sing every time he visits.
Resident #8 doesn’t enjoy singing, but brightens up when we use the hand bells and wants to play the bells.
Resident #9 also isn’t a singer, but enjoys moving to music when we toss a balloon, move with scarves or dance to music. She is proof, that there are other ways to implement music other than just through singing and playing.
Resident #10 is easily agitated and does not enjoy a lot of music. She will call out and disrupt her peers. However, putting on a CD of soothing music calms her down and she quickly quietens down.
In what ways have you used the power of music to help someone that has dementia?
often Alzheimer’s patients suffer from hallucinations and paranoia
For a while, GG had hallucinations, until her medicines were changed. We tried to explain to her that although we believed her, we could not see the children she saw. She would look at us like we’d lost our minds. In time, we discovered sometimes the best thing was to go along and talk with the children and tell them to leave. This seemed to suit her much better.
Alzheimer’s is a very difficult disease on everyone involved. Hallucinations, past memory regression, and an alternate reality will often appear to the patient. As caregivers we often want to reason with them, but this often causes our loved one to become more agitated, frustrated and even explosive at times.
One thing I learned in my training as a caregiving is telling “Therapeutic lies.” The term is defined as the practice of deliberately deceiving patients for reasons considered in their best interest.” {from PsychiatricTimes.com]
So how do we reason with Alzheimer’s?
Finding the window to help Alzheimer’s deal with their reality
Pick your battles—is this really worth fighting over?
There is no need upsetting the patient—if they think a parent or sibling is still alive go along with it. Maybe use generic answers such as “we’ll see them later, they are working, etc.”
If telling the truth is going to be more detrimental or traumatic to the individual
Try redirecting the individual and getting their mind on something more positive {or different}
Understanding when the patient may need to talk about an issue and listening, such as when they are grieving.
Try to use methods that will relieve anxiety and stress
Ask questions to gain more information. For example if the individual thinks she is 21 and single, ask questions about her life at that time {what does she enjoy doing, is she dating anyone, what year is it, who does she live with, where does she work/go to school, etc.}. This gives a glimpse into her lives back then and you’ll be amazed at what you may discover.
How can you handle a situation without demeaning, hurting or embarrassing the patient?
We have to find a new normal
Remember, that often it takes trial and error to discover what works. When dealing with this disease you have to think fast on your feet. What works one time may not work the next. I’ve even discovered that what works for one individual may not work for another.
The main thing to remember is that when reasoning with Alzheimer’s strive to calm the patient and help him/her deal with the stress and frustration that is being felt.
