Alzheimer Training vs. Psychotropic Drugs

Recently there has been much discussion of psychotropic drugs being prescribed to those with Alzheimer’s disease in both hospital and long-term care environments.  Many times these drugs are used to control a dementia patient when appropriate care of the individual is all that is needed.  The example below illustrates how important caregiver approach is to the Alzheimer’s patient.

A nursing assistant walks in a room and advises the patient that it is time for a shower.  He responds negatively stating that he just took a shower and doesn’t need another one.  She advises him that he has not had a shower this week and he must shower now.  She approaches the patient, taking his arm to guide him to the wheelchair.  The patient strikes out hitting her in the face.  The nursing assistant leaves the room and returns with reinforcements. Three people enter the room and advise the patient that he must take a shower.  The patient sees three individuals approaching and unsteadily turns to flee, falls and fractures his ankle...he would receive no shower today.

Utilizing the knowledge of how Alzheimer’s disease affects an individual’s thought process:   

1)      The Alzheimer’s patient does not have short term memory.  Reasoning with a patient with Alzheimer’s is not effective.  Cognitively, they are not able to participate in this high level skill.

2)      All individuals, but especially Alzheimer’s patients become fearful when approached by a group of individuals that he perceives as a threat to his safety.

 

Alternative scenarios: 

A nursing assistant walks into a room and advises the patient that is time for a shower.  He responds negatively stating that he just took a shower and doesn’t need another.  The nursing assistant notes that the patient his acting rather defiant this am and suggests that they take a walk together to look at the beautiful sunshine coming in the windows.  The patient and the nursing assistant take a short stroll which seems to calm the patient.  The nursing assistant then asks the patient if he would like to for another short walk to take a shower.  Having forgotten that he told the nursing assistant no a few minutes ago he willingly goes with her to the shower room.

 A nursing assistant walks into a room and advises the patient that it is time for a shower.  He responds negatively stating that he just took a shower and doesn’t need another.  The nursing assistant states “ok” and advises the patient that he looks tired and suggests that he may enjoy sitting in the recliner in the other room to relax.  He agrees and follows her to sit in his favorite chair.  A short time later the nursing assistant returns to the patient with his shower supplies in hand.  She approaches him and states that he looks like he is more rested and suggests that he get cleaned up for lunch.  The patient is assisted from the chair and makes the short walk to the shower room where he willingly participates in his shower.

There are many other ways to handle this situation keeping in mind that a person with an altered memory does not respond to attempts to convince them to act.  Alzheimer’s patients are programmed to fight or flee when threatened.  These individuals are often influenced by how they feel at the moment.  By changing how they feel, cooperation in daily tasks will follow.