Wednesday, 26 July 2017

Care Partner Wednesday--The Crippling Force of Anxiety

We often associate anxiety with dementia, and that's legitimate. There's nothing like an impaired memory to cause fear, especially if everything and everyone is new to you every day--that's scary.

But that's a topic for another day. Elders who don't suffer from cognitive decline, but have an anxiety disorder, have an especially poignant struggle. I am care partner for one such elder, and I've worked with others in the past. They live a special kind of hell, and their care partner's challenge is to bring both peace and well-being into each troubled day.

Each person with an anxiety disorder has triggers. Small events can escalate into a full blown attack in minutes. An unfamiliar environment, some small medical issue (like a rash or a cough) an unfamiliar person giving care--these are just a few examples. An event which seems minuscule to us has huge, unresolvable implications for them.

When an attack occurs, there are several aspects:

  • Speech may become slurred, and the ability to express themselves is hampered by hundreds of conflicting thoughts, running through their brain. Picture a Pacman game, where the little creatures are constantly colliding. 
  • Reasoning is missing. Don't even try to explain or reason with the person, as they aren't listening.
  • Conversation is cyclical. You will go around in circles. Over and over again.
  • They might become short of breath and dizzy. They are definitely a fall risk.
  • There is no sense of humour present. You may be able to joke this same person out of mild anxiety, but it won't work during an attack.
  • Distraction seldom works during a full blown attack. They know something terrible is about to happen, and they won't be distracted.
For the care partner, special grace is needed. Patience, wisdom, love, compassion and a sense of humour. (Keep the sense of humour to yourself during a full-blown attack, but it will help you get through.) 

Sometimes, attacks come out of the blue, and you will shake your head, wondering where that came from. There are times when you can identify triggers and head them off. Sometimes, you just have to go through it with the person, because there is no way around it.

I am facing such a circumstance. On Monday, I have to tell someone with high anxiety that she needs to move from the room she is in, to another one down the hall. It's an unusual circumstance, but it's necessary.  Here are some of the steps I have taken to make this go as smoothly as possible.
  • I will tell her Monday afternoon. The move will happen Tuesday morning. This gives her the respect of knowing ahead of time but minimizes the stress time.
  • I have a whole team of people ready to swoop in as soon as she goes to breakfast. We should be totally finished (including pictures hung) by lunch.
  • Someone is taking her out for the morning after breakfast. Someone else is coming to have lunch with her.
  • Her new room will be set up as closely as possible to the way the old room is set up. The bed she is used to is being moved.
  • All staff are aware and are supportive.
  • Staffing assignments are being changed so that she will have familiar staff in her new room.
  • She has an (as needed) order for anti-anxiety medication, and it will be needed those few days.
With all this preparation, will it be seamless, and without anxiety? No, it won't. But we've made a plan, and it will be as good as it can. In a few days, we will be over this challenge, and on to the next.

Living with chronic anxiety is a burden. Care partners need to offer both strength and grace, through a filter of wisdom. 

And don't forget the sense of humour!

CLICK TO TWEET--Care Partner Wednesday--The Crippling Force of Anxiety Partner Wednesday--The Crippling Force of Anxiety

Wednesday, 19 July 2017

Care Partner Wednesday--It's All About Approach

Imagine you're snuggled in bed having a great sleep, and at about 7:00 a.m., a stranger walks in your bedroom, turns on the light, and begins rifling through your clothes. As you cower under the sheets, she  grabs the covers out of your hand, ripping them off you, and starts to perform some extremely personal acts on your body.

How would you feel?

Frightened? Disrespected? Violated? Angry? Would you scream? Hit someone?

Yet in places where elders are receiving care, this happens every morning.

"Now wait a minute. I say, 'Good morning, and I'm not a stranger. I'm helping her every morning.'"

But if someone has dementia, they may not recognize you. Even if you go in every morning. Even if you are related. And the natural reaction is fear, leading to aggression.

Try this scenario instead. (Knocking on the door) "Jean, can I come in?" (no answer, enters the room and quietly rubs Jean's arm until her eyes open.) Smiling, speaking softly, "Good morning, Jean, it's Judy. I've come to help you get ready for breakfast. Are you ready to get up?" If the answer is "No," Judy leaves and comes back later.

Approach is key elder care, but especially with people with dementia. We refer to "behaviours" that occur at times when people have dementia. When we say this, we mean actions like aggression, crying, hitting and punching, screaming and sometimes loud, inappropriate laughter. There is a nasty cycle where elders exhibit one or more of these behaviours over a period of time, and the solution is often to medicate them. Problem solved. No more behaviour--they are asleep.

Let's look at approach. It's not magic. Sometimes there is still agitation, and there are times when medication is needed. However, many times, the right approach can change the entire atmosphere, and bring calm, pleasure and even humour. Here are some tips:

1. Slow down. Rushing increases agitation and sends the clear message, "I don't have time for you."

2. Smile.  A genuine smile is hard to disregard.

3. Watch your body language. Did you know most people with dementia can read body language perfectly, even if they can no longer read words, or even speak? Check your attitude at the door. One of my co-workers impressed me with the way she greeted people. She made it sound like meeting them was the best part of her day. I'm sure they picked up on that.

4. Communicate. Ask permission if you want to do something that involves touching them. "Could I just push your glasses up for you, Mary?" I've seen people come up from behind  and hike an elder's pants up or move their wheelchair without saying anything. Next time you see a teenager on the street with his pants hanging around his bottom, come up from behind, don't say anything, and hike them up. Then send me a note, and let me know how it went.

5. Focus. Don't have a conversation with someone else, or interrupt what you are doing to greet another person. When you are with an elder, they are the most important person.

6. What is the unmet need? Often, if you can find this and meet it, the problem dissipates. I observed an elder just this morning who often comes to the breakfast table angry. She talks loudly, accusing others of lying. When she begins to eat her breakfast, the anger disappears. She's hungry. (Later in the day, the same behaviour occurs, and it's not hunger. The same person may have several unmet needs.)

Approach is all about respect. No matter what they do or don't understand, each elder is a person. Give them the gift of respect, approach them with gentleness and joy, and many times behavioural problems will vanish.

Care Partner Wednesday--It's All About Approach Partner Wednesday--It's All About Approach

Wednesday, 12 July 2017

The Small Miracle of the Broken

                            A Shattered Hallelujah

A shattered hallelujah is now my song of praise
Its notes are all the sweeter when my voice can barely raise.

Arms outflung, He calls to me to walk among the waves
To trust beyond what's in my heart, to find my inner brave.

I sob and stumble, gasp and fall
"This journey is too hard!" I call.
"They say I'm strong, but they can't see
the endless, wrenching pain in me."

His loving eyes stretch to my heart, 
He listens to my song.
His hands reach out to grasp my pain,
"I've been here all along.
I'm holding you, each frightening day,
I'm Peace to sleep at night.
I'm the order in your chaos,
the joy that finds the light.
I'm the hazy future you can't see,
 I hold those painful memories.
Your broken song is beautiful. 
I know it's precious cost.
I'm here with you, I'll bring you through.
You're never, never lost."

My shattered hallelujah is still my only song.
The waves are unrelenting and my world still feels so wrong.
Yet I am moving forward with my hands stretched to my Friend, 
Because I know He'll hold me, and some day, my heart will mend.

Ann Peachman Stewart

The Small Miracle of the Broken Small Miracle of the Broken

Wednesday, 5 July 2017

Care Partner Wednesday--"I have no choice"

It wasn't the best of mornings.

I had ten minutes to blow dry my hair, change my shoes and get out the door. At that precise moment, my puppy discovered the enticing, dangling toilet paper, and ran with it in his mouth through the house. The other end was still attached to the roll. I scolded him, salvaged what I could and threw the rest away. Watching the clock, I returned to my blow drying.

He did it again. He responds well to loud noises, and normally I would clap my hands, but I had a blow dryer in one hand and a brush in another. So I banged my brush on the side of the sink.

Wrong move. The entire porcelain corner broke off and fell to the floor, shattering into a million pieces. Stunned, I looked at my ugly sink. Bathroom vanity replacement wasn't in the budget, so I determined to live with it until the day it made it to the top of my "urgent needs" list.

A few months later, that happened. I was cleaning the ugly sink when I noticed copious amounts of water on the floor. Further examination showed that the pipe was no longer connected to the sink because the piece that connected the two had broken off. Any running of water brought floods on the floor. Suddenly my bathroom vanity was at the top of the "urgent needs" list. I could live with an ugly sink, but I couldn't live with no sink. I had no choice.

Then there's my basement. In January, I had a sewer backup. Conversations back and forth with the insurance company, the condominium and the contracted construction company took months, but eventually, they gutted my basement in preparation for renovations. Then, everything stopped. They found mould. Four small spots that aren't related to the sewer backup or each other. Now I am told I have to have an environmental company do an assessment before anything more happens in my basement. The cost of the assessment is astronomical, and I have to pay it. I have no choice.

No choice feels like restrictive clothing. It feels bleak and hopeless and empty. Someone else is in charge of my life.

I make hundreds of choices in a day. But these two instances where I have no choice rankle me. How much worse must our elders feel as their world and their choices shrink as their disabilities increase?

Why does this happen?

Many reasons. Particularly with dementia, it's easy to assume that the elder is no longer able to make choices. The truth is, there are certain choices that are beyond their scope, and many others which aren't. An elder may no longer be able to make or even comprehend financial decisions but can decide what they would prefer to eat, wear, and events they would like to attend. Often, we take choices from elders without thinking about it. We feel we know what is best. We forget to offer choices. We get used to being in charge.

Try wearing a piece of clothing that is too tight for a day. Part-way through, you feel like you can't breathe. You just want to get out of it, to feel comfortable.  Lack of choice feels like that. If an elder can't express how they feel, it can manifest in angry behaviour or resignation. Either way, it's a desolate way to live.

Honouring elder's choices is the essence of person-directed care.

Care Partner Wednesday--"I have no choice" Partner Wednesday--"I have no choice"