As medical and technological advancements continue, humans are, on average, getting older getting older – no surprise there. We’ve gotten to the point where often times the body outlasts the brain. Between Alzheimer’s, vascular dementia, TBI, and more there’s a lot that can go wrong with a person’s brain function. After 65, the incidence of dementia approximately doubles with every five years until 90, and continues thereafter.
So as a nurse, unless you work with kids, you’re likely to encounter dementia patients from time to time (if not every day). Caring for dementia patients may come naturally to some nurses, but this is an area in which I’ve seen otherwise fantastic nurses struggle. Like so many other areas of nursing, clinical knowledge will only take you so far.
One of my favorite jobs in healthcare was working as an LPN on a memory care unit at an assisted living facility. While I don’t want to regurgitate the obvious “best practice” tips on working with dementia patients, I would like to share some of the principles that really helped me to become better at, and find fulfilment in my job.
- Don’t be condescending. While you may need to simplify language in certain situations, just remember that you’re talking to someone who was probably way smarter than you before dementia set in. Unless there’s evidence that suggests a change in communication style for better results, you should start by speaking normally.
- Reorient. Depending on the patient’s baseline mental status, sometimes a gentle reminder is enough to solve a problem.
- If reorientation doesn’t work, don’t keep arguing. If your patient insists that her dead husband is coming at 2 a.m. to pick her up, then you may just have to get creative. Instead of repeating “YOUR HUSBAND IS DEAD” over and over again, try “Well if he’s coming so soon, then maybe we should start getting ready.” Then give her a comb and see if she can be distracted.
- Minimize fall hazards. I know this one was probably hammered into every nurse’s brain during nursing school, but it’s easy to forget during actual care. Getting in the habit of keeping the floor clear any time you walk into or leave the room is a whole lot better than trying to catch your patient mid-fall, or worse.
- Do they have to pee? Quite often, your patient who keeps trying to get up either needs to use the bathroom, or has just had an episode of incontinence and doesn’t want to tell you. I mean, can you blame them?
- Think about UTI’s. Seriously. Elderly dementia patients, especially women, have lots of risk factors for developing urinary tract infections. Weakened immune system, possible issues with hygiene, possible incontinence, just to name some of the most prevalent. Any time a dementia patient of mine presents with one or more of the following (even without a fever), UTI is always the first thing that comes to mind:
- Change in mental status baseline – while cognitive decline is to be expected, sudden changes are cause for concern.
- Difficulty and more frequent urination – this may present as your patient trying to get up more frequently, if he/she can’t properly verbalize urges.
- Loss of appetite
- Be kind. Again, no duh. But when caring for dementia patients who have difficulty understanding and interpreting speech, so often it’s not about what you say but how you say it. If you’re having trouble getting a patient to shower, go to bed, take their medications, etc., just shower them with kindness and see what happens. I promise you, it’ll work more often than not.
Helping people that may not be able to express what they need, and advocating for people that can’t advocate for themselves is one of the main reasons I got into nursing (it sure wasn’t the salary or the hours). It can be really rewarding working with dementia patients, even though sometimes it will frustrate you to no end. Hopefully these tips serve as a good reminder for your nursing practice!