Thursday, March 25, 2010

Para bailar LA BAMBA

Spent my morning researching dementia, MTx and dementia, how to talk to people who have dementia, how dementia affects these people...

I suppose it would be rather difficult to research a topic such as dementia... although it affects hundreds of thousands of people, it is so patient-specific, and even varies in severity and symptoms within a specific patient. Also, it is difficult for a mentally healthy person to fully understand dementia without experiencing it first-hand. There's been a fair share of conflicting advice when it comes to interacting with pts who have dementia. If there is apparent short-term memory loss, I am currently in support of the tactic to just go with whatever the pt says, rather than fight it. If a pt says their husband should be coming home soon from work, even though her husband has been dead for 10 years, I'd rather say something like, "Okay, hopefully he doesn't hit too much traffic" rather than get the pt all worked up and upset by trying to convince her that her husband is dead and not coming home soon. Either way, sooner or later the pt will most likely forget the conversation ever happened, so why bother upsetting the pt and arguing? By appeasing the pt and going along with the reality the pt creates, a more peaceful here and now can be instilled and maintained, which is of all-importance.

Should you do this with anybody who is disoriented or creating an alternate reality to live within? No. Take that episode of House for instance. He saw the medical director at the psych hospital try to tell one of the patients that he wasn't a really a superhero, nor had superhero powers. The patient became extremely depressed that no one believed in his powers. House thought it would be nice to help make the patient's alternate world a true reality. So, the next day, he took the patient to a county fair where they had a wind machine. They gave it a go, and the patient was a new man. He was experiencing first hand what it felt like to fly and be suspended in mid-air. Thanks to House, his superhero reality was given a rebirth. But, on their way back to the car, parked on an upper level of a parking garage, the patient scaled the wall, and, with a big smile on his face and one last thank you to House, he jumped, believing that he could actually fly.

One must always assess the situation as to whether someone's alternate reality holds any potential danger to the person or to society. An elderly woman living by herself who wants to set the dinner table for her family, even though nobody is coming over for dinner, is yearning for the time in her life when she felt purposeful and just wants to somehow contribute. This situation is very different than a 30yr old man with PTSD who covers up his past trauma with a superhero alternate reality, which can cause harm to him or others.

Despite how blatantly different these scenarios might seem, not every situation is this black and white. One of the facilities we have pts at has a pt with dementia who has physically harmed the other pts. If you recall me saying, she pulled out one of our pt's hair a while back, and was then allowed to return to the facility unrestricted. She roams around, asking where her son is, and mumbling sentences unrelated to anything going on. She has highly progressed dementia. This past visit, she tried stealing my bag of music. For pts like this, buying into their reality may not be the best way for someone to interact with them, or in the least, buying into their reality in order to lead them to a safer place.

But anyway, enough of that. I visited with our lovely Russian patient around noon. She had just woken up, and was sitting in her wheelchair in the living room, slowly eating her breakfast. I played songs from many different decades for her, since she did not grow up in America and therefore does not recognize the songs from the 20's and 30's like our other elderly pts do. As long as I played the songs slowly, she was happy. Every song, she closed her eyes and let her mind wander.

Her nurse had become concerned around the time of our last MT visit because the pt had become disoriented, becoming preoccupied by thoughts of visitors coming over for dinner, such as her brother and sister, who are deceased. I was able to note today that the pt was able to tell me with no hesitation that her sister has passed away many years ago. Like I said, dementia can come and go, and differs from person to person, and within each person, from day to day, hour to hour, minute to minute...

The middle portion of my day was meetings, so I will not bore you those details :)

Our last pt of the day was a new admission. He is a very kind Mexican man, who speaks enough English for the MT and I to interact with him without needing someone to interpret. We played Spanish and country songs for him, like La Bamba and Shania Twain. He and his family played their little shakers happily with us. It was a lovely and fun visit. Again, so sad that the pt's grandson is so cute! The whole family was as wonderful as the pt, and it's so unfortunate that we always have to meet these wonderful people under such circumstances. If only I could meet all these people for a reason other than their loved one is dying...

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