Expert: Michalene Peticca - 7/15/2008

Question
Hi, I am a director on an Alzheimer unit and have a lady that myself and staff believes is acting out behaviorally but my DNS doesn't think so. If you look directly at the resident she will act like she is falling or will get on her knees and lay on the floor. She uses a walker (with constant reminding), and will lean over it and bend down and feign fainting. I am really afraid she will lose her balance, fall and get hurt. As of today, we are now monitoring and charting each episode (8 hrs. over 30 episodes) and doing orthostatic BP x 3 days, BP q day x 2 weeks and another UA (UA done in June, positive). When this resident is ambulating and thinks no one is watching, she gets along just fine, actually walks up and down hall with another resident and outside on her own, no problems. We are all bewildered and really don't know what to do. I have instructed the CNA's not to give direct eye contact, but now she is doing it when some of the other residents are talking to her. I believe it is attention seeking, her spouse lives on the step down unit of LTC and is in very poor condition. She goes out to visit him, my understanding is he has always been very devoted and doting. Hope I have given you enough info.

Thank you for your time,
Linda

Answer
Hello Linda,

My apologies for the tardy reply.  I enjoyed your question as i was "reminicsing" about my own days as an Alzheimer's unit director.

I believe you are right on track with your resident's behavior.  Don't forget, most Alzheimer's individuals Magnify a specific personality trait that was common in their past that previously they had "control" over.  Thus, when the dementia became more prevelent, they lost the inhibition to "control" this behavior and it is now going to manifest itself more until she declines in the dementia process.

You may have thought of this...but i would strongly reward the behavior that you want to see.  For example...if she "swoons" when she is around staff...have 1 (NO more than 1) staff member calmly go to her and ask her to join an activity, go for a walk, read a story to her, etc.  and PRAISE her during that activity for her attention and tell her how much you enjoy being with her while she is like this.   

You want to set more structured time with 1:1 time with her..daily. CAn her husband still visit?  Are there volunteers that can?  Can you have staff rotate a daily visit with her?

What you Don't want to do is have 2 or 3 staff members running to her b/c they are afraid she is going to fall and make a "big fuss" over the situation.  You don't want staff to talk about her outloud or even discuss her situation where she may hear.  You want staff to just non-chalantly help her during these fall times, not say much at all...No scolding, No re-directing, etc.  NOTHING....and just go on.

Although an Alzheimer's person doesn't have the "file cabinet" to store memory any longer...they are very good at picking up on Routines, Emotions and Directions.   Getting "good emotions from good behaviors" just might help the situation.

Keep me posted!

Best Regards,

Michalene Peticca, MA