Alzheimer`s Disease/Alzheimers and injury

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Question
I work with a client who recently chewed off the tip of her index finger which resulted in surgical amputation at the dip joint.  I am being consulted to prevent this from happening again.  Other than making hand splints, or restraining her I am perplexed.  Is it possible that this could be a reaction to a medication (toxicity) or a sensory overload response?  Would using strong aroma therapy (on her fingers) be beneficial?  Would a low dose of oral Baclifin relax her tone and decrease the need for the oral sensation?  Someone asked me if she should have a mouthgard, or have all her teeth pulled.  I am not comfortable with the latter but she can't keep biting off her fingers. Do you have any insight on this situation?

Answer
Hello V:
This is really a heavy responsibility for you!  It made me think of my father, who had Lewy Body dementia.  He was adamant one day that his thumb was something he wanted to eat and took a big bite.  He stopped when the pain hit, but in your client's situation, something is blocking that realization.  I would guess it's the damage in the brain.  I would hope that the need to chew like that will go away like any other distressing behavior once the dementia progresses.  
My first thought would be an oversized "pacifier" that she could keep in her mouth.  You may wish to also put some type of splints on fingers she's targeting at the same time as using something to keep her mouth busy.  I don't think a low dose of something to relax her would be out of line, but I would not resort to having her teeth pulled because I feel it's likely this behavior will go away as the dementia progresses.  By all means, try everything that is not invasive.  My guess is the aroma therapy won't work since the olfactory senses are affected, and if she can't make the connection between the biting and the pain, then the smell and the pain probably won't be connected either.  Be sure the environment is not so stimulating that it's upsetting her and this is an anxiety response.  Music therapy, sensory stimulation that you know will relax her, and trying to keep her calm may help.  Possibly changing her environment would help--for instance, if she's always sitting in a geri-chair in the same hallway, or room, try to mix things up for her to see if it's distracting enough to keep her from chewing on her hands.  
I wish I had more ideas for you, but it's really going to come down to keeping a close eye on her and providing something for her to chew or suck on while you wait for the behavior to pass.  I wish you lots of luck as you continue to try to help this dear lady, and I commend you for seeking answers.  If you can, some day let me know what helped with her.  Cindy

Alzheimer`s Disease

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Cindy Keith, RN, BS, Certified Dementia Practitioner

Expertise

As a nurse and dementia consultant, I can answer most questions on all types of dementia. If I cannot answer your question, I will attempt to find someone who can. My passion is to help caregivers of people with dementia, which in turn helps all those wonderful elders with dementia live better lives. When caregivers are better educated, they are able to better care for themselves and their loved ones, so education is key to decreased stress levels and healthier, happier families.

Experience

I have worked as a nurse in various disciplines of nursing for over 20 years, most of which was with the elderly. I was a health care coordinator in a dementia dedicated assisted living facility for 4 years before I started my own business (M.I.N.D. in Memory Care) as a dementia consultant six years ago. As a dementia consultant, I help families nationwide through phone conference calls as they struggle to care for their loved ones with dementia.

Organizations
Alzheimer's Foundation of America Geriatric Interest Network Sigma Theta Tau International

Publications
Published "Love, Laughter, & Mayhem - Caregiver Survival Manual For Living With A Person With Dementia" which is a collection of stories about people with dementia I have known, loved and worked with. Every story has a lesson to teach and this book gently teaches family caregivers lessons about how to better care for their loved one, as well as themselves during their caregiving journey. Published "Love, Laughter, & Mayhem In Eldercare Facilities: The Master Key For Dementia Training" Created "Bringing Nurturing To Memory Care" staff dementia training video Created Ebook: "Hair Stylist's Helpful Tips For Working With People With Alzheimer's & Other Dementias"

Education/Credentials
Registered Nurse with Bachelor's degree in Nursing; Certified Dementia Practitioner; Author of 2 books and an ebook

Awards and Honors
Sigma Theta Tau National Honor Society of Nursing

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