Caregivers learn to cope with stress of dementia
Caregivers learn to cope with stress of dementia
When Judy Campbell’s research team taught families of dementia patients a model intended to curb damaging and irritating behaviors, they had mixed success.
Campbell, DNS, RN, assistant professor of nursing at Ball State University in Muncie, IN, says patients showed little or no improvement in the behaviors. But she says family caregivers showed marked improvement in how they dealt with those behaviors.
"We had a checklist of problems — memory impairment and those kinds of things — and we asked, How much does this bother you?’ Over the year, the caregivers who were taught the model reported less bothersome feelings associated with the behaviors," Campbell says.
"That was because we explained how those behaviors were related to the dementia, but we also gave them some support and some suggestions on how to deal with them. It gave them a little more control."
Sharon Ostwald, PhD, RN, director of the Center on Aging at the University of Texas-Houston, used different methods of teaching families about dementia and how to deal with it. She, too, found a noticeable lessening in caregiver burden among families.
Both say that home health nurses who teach caregivers about dementia and coping strategies can give them a feeling of greater control, even as the illness progresses.
"Part of it is just feeling that somebody’s understanding them and supporting them and trying to work through it with them," Ostwald says. "There aren’t any pat answers."
The stress threshold
Campbell’s team used the Progressively Lowered Stress Threshold model developed by G.R. Hall. It identifies six major stressors that can cause agitation in dementia patients, as well as identifying interventions that can help:
1. Fatigue. Allowing the patient to rest in the morning and again in the afternoon can help cut down on difficult behaviors. Campbell suggests using a reclining chair to reinforce the idea of a short rest.
2. Multiple stimuli. The effects of too many people or too much noise or even too many items on a patient’s plate at dinner can be overwhelming to a person with dementia. Caregivers should try to break out small pieces of a task or limit choices for patients.
3. Misleading stimuli. Photos, mirrors, and televisions all can give the patient the impression that someone is there when he or she is alone. As long as those impressions are comforting or entertaining, they are all right. But if they begin to cause confusion or agitation, they should be removed.
4. Change. Change often can’t be avoided in care — a new home health staffer or a move to a different home may be unavoidable. But caregivers should be aware that the patient will have to think harder and will need to find ways to establish new routines.
5. Physical stressors. Medications, pain, constipation or other symptoms may be causing problems even if the patient isn’t communicating them. Caregivers should look for reasons behind sudden changes in behavior to pinpoint the cause.
6. Expectations. Caregivers should look for ways to streamline activities.
In many cases, she says, family members who weren’t in the home often had no idea the patients had deteriorated to the extent that they had.
Some examples of her suggestions for real-life problems:
• Meal times. Instead of eating, patients may play with the silverware or napkins or attempt to eat a centerpiece. Ostwald suggests ridding the table of anything unnecessary — leaving one spoon or fork, or dispensing with utensils entirely and giving patients finger foods such as carrots or hot dogs or string cheese.
• Clothing. If a patient tries to put the same clothes on every day, remove dirty clothes so he can’t find them. Lay out clothing in the order it must be put on.
• Bathing. If a patient shows resistance to taking a shower, introduce her gradually to the water, perhaps with a hand-held nozzle.
• Judy Campbell, Assistant Professor, School of Nursing, Ball State University, Muncie, IN 47306. E-mail: [email protected].
• Sharon Ostwald, Director, Center on Aging, Isla Carroll Turner Chair in Gerontological Nursing, University of Texas-Houston, 7000 Fannin St., Suite 720, Houston, TX 77030. Telephone: (713) 500-37700. Fax: (713) 500-3785. E-mail: [email protected].
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