Alzheimer’s Disease

HLTH1168

Professor Gloria Morris

By the end of today’s lecture, you should be able to…
1.1 Identify verbal and nonverbal communication strategies that are appropriate for use in client and family
interactions

3.4 Describe the physical, emotional, cognitive, and behavioural changes associated with the four stages of
Alzheimer’s disease

4.1 Explain the legal rights of the client with a mental illness and/or cognitive disorder

4.2 Identify the criteria necessary to utilize restraints including secured units

4.3 Evaluate restraints in terms of client safety and level of restriction

4.4 Evaluate ethical dilemmas in the care of clients with mental illness and/or cognitive disorders
Challenging Behaviours

Recognize that all Meaning may not fit

behaviour has meaning context of PSW reality

PSW’s role to determine

Meaning DOES fit meaning and intervene
context of client’s constructively
reality • Do NOT just REACT
Things to Consider…
Physical
• Are basic needs met?
• Discomfort or pain?
• Changes to physical
condition?
Capabilities
• Can they do more than you
realize?
• Do they understand they
they need help?
Intellectual
• Recent changes in memory?
• Impulsive behaviour?
• Speech patterns?
• Sequenced tasks?
Environment
• Noise or crowds?
• Adequate lighting?
• Enough stimulation?
Actions of Others
• What am I doing or not
doing that may contribute to
the client’s behaviour?
Emotional
•  Tearfulness or anxiety?
• Seem lonely?
• New unusual behaviour?
Social
• Childhood, early adulthood
& employment – offer
insight?
Responsive Behaviours

You are having dinner with your father in the residents’

dining room. You watch your father struggle to cut his
meat and get the food to his mouth. You offer to help
and begin to cut his food. He lets you for a minute, but
then grabs your wrist and threatens to “smack you if
you try that again!” Your father has never laid a hand on
you and you are horrified that this just happened.
Wandering
Contributing factors
• Pain
• Medication
• Disorientation
• Stress, restlessness, anxiety
• Triggers (e.g., coat and boots)
• Searching for someone/something
Responses to Wandering
Photos, ID bracelet

Allow wandering if safe to do so

Provide distraction with conversation, food, drink

Involve client in activities to channel energy

Remove items that trigger desire to leave

New behaviour? Assessment required to rule out infection or other change

If other interventions fail to reduce wandering and maintain safety  secure unit – environment
restraint
Responsive Behaviours

During a visit with his wife, Jim

fidgets, picks at his clothes and
seems restless. He can’t sit still and
his wife is getting upset with his
behaviour.
 Sundowning Confusion Restlessness

Anxiety Agitation

Increased dementia
behaviours associated
with onset of evening
Aggressiveness Panic

and overnight Increased motor

Resistance to
activity like pacing
redirection
or wandering

Increased verbal
activity like yelling
Sundowning

• Disturbance to circadian rhythm

• Increased anxiety due to end-of-day fatigue
• Fewer distractions/activities during evening
Contributing and night
• Decreased light
factors: • decreased vision
• increased perceptual disturbances
• increased anxiety and restlessness
Source: Wallhage, M.I., Pettengill, E., Whiteside, M. (2006). Sensory Impairment in Older Adults Part 1: Vision Loss. AJN, American
Journal of Nursing, 106(10), 40-48. http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=670561
Response to Sundowning
• Regular exercise
• Napping during day?
• Medical management
• Reduce caffeine in diet
• Maintain adequate light
• Provide calm environment with fewer
stimuli/activities?
Socially Inappropriate Sexual Behaviour

Person no longer able to

recognize appropriate PSW provides personal care
context for intimate contact
• Place • client mistakes PSW for
• Time intimate partner
• Person
Response to Sexual Behaviour

Encourage affection Recognize that touching,

Protect client’s
between client and scratching, and rubbing
privacy and dignity
partner can also result from
• Hand holding • Guide to own • Wet/soiled clothing or
• Hugging room if client brief
• Kissing begins • Inadequate personal
masturbating in hygiene
public • Infection (record and
report)
Catastrophic Reactions

Extreme responses when Reactions include:

client perceives: • Screaming
• Disaster • Crying
• Tragedy • Agitation
• Extreme danger • Combativeness
Response to Catastrophic Reactions
Prevention Avoid:
• Usually result from over-stimulation • Impatience
• Multiple instructions or choices
Maintain calm, quiet environment
• Reduce back-ground stimulation
Ensure adequate:
• Comfort
Approach non-confrontationally • Rest
• From side, in full view • Nutrition
• Address client calmly • Hydration
• Toileting
Rummaging and Hoarding

Rummaging Hoarding
• Searching through own • Collecting and hiding
and others’ belongings things
• Confusion  searching • Specific or non-specific
for cues to relieve
confusion
Responses to Rummaging and Hoarding
• Provide rummaging drawer
• Watch for patterns in hoarding
• Is there something specific that the client is seeking?
• Distract client with other activity
• Ensure safety by preventing long-term hoarding of
“spoilable”
Environmental Restraints

Definition:
• Barriers, furniture, or devices that prevent client from
moving freely
• Not attached to client’s body
• Includes secure units
• Completely secured unit
• Activated secured unit
Study – Berzlanovich, Schopfer, Keil (2012)
26 cases of death
while the individual 3 cases – natural
27,353 autopsies
was physically causes
restrained.

22 – in nursing
care; not
One – suicide
continuously
observed
Causes

11 cases – 8 cases – chest

strangulation compression

In 19 out of 22 – incorrectly
3 cases – dangling in fastened
the head down • 2 cases = non standard restraints used
• 1 case = abdominal restraint death even though it
position was correctly applied. Mobile enough to slip
through the restraint until it compressed her neck
Criteria for Secure-Unit Admission

Significant risk that client

Alternatives have been MD or RN(EC) has
or other would be
considered but wouldn’t recommended admission
harmed if client not
resolve risk to secure unit
admitted

Admitting client to secure Admission of client to

unit is reasonable, in light secure unit has been
of client’s physical and consented to by client or
mental condition and his/her substitute-
personal history decision-maker
False Imprisonment

• For punishment
• For staff convenience
Restraints • Without physician order
•
used Without informed consent of
client or substitute-decision-
maker