guideline 6
Learn to use “feel-goods.”
Today I’d like to sit and sip,
Forget the world a little bit,
Ignore the things I have to do
And just enjoy a cup or two.
Anonymous
Working with people who have dementia often means approaching a person who is experiencing fear, anger, agitation, or any number of other emotions. A resident who is cooperative one day can easily be moody and unapproachable the next. Gaining her cooperation often means having to come back at a later time or risk causing an incident of combative behavior.
Dementia patients lack the ability to control their negative feelings or to realize that they are causing problems. They feel the same emotions we do, but don’t understand them or why they are happening. The resident who gets up in a bad mood because of poor sleep, or flashes back to a bad memory that makes him angry, won’t be able to do anything about it.
However, the caregiver can.
Elizabeth
In 1990 I took a job in a small assisted-living facility in Virginia. My assignment was to coordinate care, assess the patients’ needs, work with the physicians, and supervise the nursing assistants. After settling in, I held a meeting with the staff. Elizabeth was the first patient they wanted to discuss. Living in the facility for less than three months, she had managed to intimidate the staff to the point that some of them refused to have her on their assignments. The main problem they were having was how to wake Elizabeth and provide morning care without getting injured by her.
Elizabeth had mid-stage dementia. Her communication skills were poor, but she let the staff know she did not want to get up in the morning by striking out at the person who had the responsibility of waking her. Unfortunately for the staff, Elizabeth still had fairly good reflexes and a surprisingly good aim. Showing me their bruises, several nursing assistants complained, saying they could not care for her any longer.
Obviously frustrated, the staff related many of the things they had tried to gain Elizabeth’s cooperation. These included letting her sleep as long as she liked (Elizabeth slept most of the day), altering the light in the room (this did not help), changing caregivers, waking her to music, and simply moving out of the way when she started swinging. Usually, no matter what method was used, Elizabeth awoke out of sorts and her disposition rarely improved during the day.
I congratulated the staff on the measures they had already taken to solve the problem, and tried to put myself in Elizabeth’s place. Why was she so upset in the morning? I knew we had to resolve this quickly. If we could not, Elizabeth might have had to be medicated to change her behaviors or transferred to the state facility. This was something I wanted to avoid since the side effects of psychotropics often bring about a decrease in functioning and quality of life. Unfortunately, although I spent quite some time trying to figure out what was bothering her, I never did.
Elizabeth was lucky to have an understanding and loving son. Robert visited twice a week to take her out for a car ride and a late lunch despite her sometimes bizarre behaviors. After returning from one of these outings, he came to me with a little paper bag full of chocolate kisses.
“Please give my mother one or two a day. They are her favorite. She used to tell me how much she loved them as a child,” he said. “If I leave them in her room, she’ll eat them all as soon as she finds them. Mother loves chocolate, and I’d like her to have a few at a time each day.”
Since Elizabeth was not a diabetic, I agreed. After he left, I thought about a way we could help Elizabeth change her morning attitude.
The next day, I gave the nursing assistant some instructions and peered around the door to watch. As she approached Elizabeth, the aide gently touched her shoulder, hoping she could carry out our plan before Elizabeth attacked. The room was quiet except for the ticking of the small clock on her bedside.
“Elizabeth, look what I have for you,” the aide said, getting ready to duck.
As Elizabeth opened her eyes, the first thing she saw was the chocolate kiss. Watching intently as the aide unwrapped the treat, I saw the beginnings of a grin at the corners of her mouth. As soon as the cover was off, Elizabeth snatched it up and popped it in her mouth.
Unbelievably while I watched, our efforts were rewarded with a big smile. Elizabeth sat up without fuss. Since she had no teeth and the staff could not get her to wear her dentures, she had the chocolate in her mouth for quite a while, happily gumming it until it was gone. During this time, the nursing assistant was able to get her up, toilet her, wash her hands and face, and bring her to the breakfast table. I was more than pleased when Elizabeth allowed all of this without striking out even once, and as an added bonus for us, was in a fairly good mood for the rest of the day.
Since people with Alzheimer’s disease have short-term memory loss, we decided to surprise Elizabeth the next day as well. And again, she was all smiles, and we were able to repeat this scenario every day.
Most caregivers do not realize they have the ability to alter the mood of the person with dementia by using “feel-goods.” Simply defined, feel-goods are the same things we do for ourselves when we are down, tired, angry, and sad, or simply need a mood change.
Common feel-goods include such things as a hot bath, a cup of coffee, going to a movie, or even having a piece of chocolate. We do something nice for ourselves and it distracts us from our problems. It puts us in a better mood. The same would hold true for the person with dementia if they were able to use these distractions themselves.
To help nursing assistants work more efficiently with residents on the memory care unit, one facility tried giving them fanny packs filled with items to distract the residents and make them feel good. They included things like mini chocolate chip cookies and manipulatives like small wind-up toys or balls that squeaked. The staff was also taught the words and music to a number of “oldies,” which the residents often enjoyed singing or listening to. These things were used to help the residents relax and distract them while personal care was done. After a 1-month trial with the “feel goods,” the facility decided to make them part of their dementia training inservices.
The emotions of the person with dementia should not be ignored. Caregivers may not always be able to find the cause for anger or aggression, but they do need to recognize feel-goods as one of the tools that are available to change it.