Wednesday, July 8, 2015

Old Lady Moviestar

It was 6AM, and the dog was right on schedule signaling the need to take a walk. Anyone thinking of changing the patterned schedule of  "when" "where," and "how," to begin the day would be left to deal with canine hostility and the sighting of a doggie do surprise on the floor!  The sound of jingling metal tags around the dog's neck could be translated into, "I need to go outside now," "I'm hungry," or "Wake up, Grandma is wandering around the house again!"  Patterns, a predictable schedule and a structured environment means everything to our dog.  She likes to know that her toys are kept to the right of the living room chair, that her water dish is under the clock in the kitchen,  and that her daily walking and feeding schedule never changes. And if, by chance there is a change in our dog's scheduled activities - she will pant and pace with agitation and angst. Her behavior will reflect the activity changes.

 People are not dogs, that is obvious. However, patterns that dogs adhere to, and need in order to feel secure in their,  "day to day lives,"  are very similar to human needs, especially people experiencing dementia.  Tangles and neural patterns in the brain have been interrupted at the synaptic junctions. So, with the internal presence of disconnect,  there comes the need to keep predictable patterns of structured connection to outward external environments. Clutter  of any kind,  even a little bit of clutter, can lead to more and more confusion and agitation. And agitation in a person experiencing dementia, can be brought about in many different ways, as seen in the exchanges below.

  Lori had been busy with her stay at home business, and normally, on a daily basis, she would straighten up her mother's room. But after missing 4 days of de- cluttering the night stand,  her mother's room started to look, less organized. And the cluttering was very minimal, only with 6 magazines stacked on the nightstand with word search puzzles, and opened junk mail that hadn't been thrown away.  (Lori's mother was a secretary for over 30 years, so opening mail and sorting through things to organize paperwork was her passion. Knowing this, Lori very excitedly would present the junk mail, ALL of it addressed to the entire household, for her mother to open, and Lori's mother was DELIGHTED to have this task to do. However, with the cognitive challenges clouding her mother's judgement, she would wander at night, searching for and collecting all of the mail in the house.  (Bills, personal mail not addressed to her, etc).  Then at times, to organize the clutter, Lori's mother would put the mail, ALL of it in an empty shoulder bag hidden away with her laundry, which she would stuff in plastic bags,  and then forget it was there. So, Lori had to always check on the cluttering in her mother's  room, and the overstuffed shoulder bag).

Lori took the cue from the dog to go outside at 6AM, and then after they both returned from the walk, Lori's mother with no teeth, messy hair, a robe,  and no socks wearing New Balance running shoes, said, "Golly, we have our work cut out for us, we really do. Do you have any more bags?"  Lori said, Bags?"  "Yes, bags, BAGS Lori!"  Lori's mother was agitated.  Her environment was cluttered and the cluttering left her in a state of confusion, agitation and in a heightened state of anxiety. "How are we going to do it? I just don't know!"  As Lori walked into the bedroom, she noticed that her mother had bags and bags full of clothes, toiletries, towels, pictures, curling irons, etc. neatly packed away in a very orderly fashion in garbage bags. It was clear to see that Lori's mother had been up for hours packing up her room.  Her entire non-made bed was FULL of packed bags which in her attempt to organize the clutter on one night stand, left the room looking like an episode from hoarders! "You need a maid, Lori!  Look at this mess, just look at it.  How are we ever going to pack this up in time for the movers!!"

Lori didn't react, She stepped back and quietly (secretly, I might add), did some deep breathing to activate her brain. Thoughts like, "How am I going to redirect her this time?  She is really in a state.  How can I learn from this to help her in the future? This is all my fault for not cleaning off the end table.  Yikes, I screwed up, but can't beat myself up over this." So, Lori validated her mother's frustration saying, "Mom, I'm here for you. We can tackle this together, okay?" Lori's mother was still stuck on being and feeling overwhelmed. "We need to do this now, Lori.  The men will be here any minute!" Well Mom, do you want the men to see you in your robe?  Do you want to move things on a truck as an almost 85 year old without breakfast?  Because mother,  I was just planning on making you a fabulous breakfast but if you choose to work through breakfast, and not eat, you may not have the energy to work so hard. "  "What were you going to make me for breakfast?"  Lori's mother completely calmed down and her ears perked up at the thought of food. "Well, mother - we can have gluten free pancakes, or mushroom, cheese omlets. How does that sound to you?"  "I like that Lori, I like that a lot!"

Lori was feeling really good. So happy that her mother took the bait, and then her mother got back on the roller coaster. "Where do you keep your bags, we need bags!" Lori's mother was back to the moving men scenario. "I need to go home, they are waiting for me." Lori's mother appeared to be on a timeline trying to make a deadline.  "Who is waiting for you, mother?" "My family, Lori. I haven't seen them and I need to see them again.  It has been way too long and I need to go home because they are expecting me."  "Okay Mom.  Then we will give you a good breakfast so that you can go.  And where are you going?" Lori's mother suddenly looked up with an annoyed look on her face. "What do you mean where am I going? You know where I am going.  I am going to see my mother.  And after that, I will go to see the crew at Aunt Hilda's. Uncle Dean and Aunt Lil, too!!"  They are expecting me, so I must go."

 Lori was almost in tears, because all of the people mentioned have been gone for many years, however Lori also remembered reading somewhere that before elderly people move on, they literally see (in their minds), and interact with their departed loved ones. Some people even say that loved ones help them to cross over!!

 Lori knew she needed to help her mother to not feel so frustrated, and to help her to live more in the "now" rather than the "then."  So, Lori decided to do a pattern interrupt on her.(A technique she used to use on her two year old to assist him through his frustrations during a tantrum.) She would shift the focus through something ridiculous to hopefully change the thought pattern. Then her mother started again.  "Lori, we are going to have to pack up the entire house. The refrigerator, the cupboards, under the sink and all of the rooms upstairs."  Her mother then grabbed some paper bags and packed up everything on the kitchen table. "There we go, and now I'm going to take a look at the garage and the laundry room."  "Wow, Lori thought.  This roller coaster has just sped up, and it isn't even 7:30AM!!!"

"Mother, you are the old lady!" Lori said. Her mother said, "What are you talking about?" "Mother we are in a movie and YOU are the old lady. We are playing roles in a movie, and you are an old lady movie star!"  Her mother then burst into laughter. "Oh really, I am , am I?"  "Yes, and I just called the movers in the movie, and they are going to do everything, EVERYTHING Mom.  So, you are done with your work. You are finished with the tough stuff and you can now just sit back, and have fun today.  You don't have to think about moving.  And in this movie, we can plan our day.  And today you get to water the plants, take a bath, get your hair done, make your favoite salad and go to a potluck!!!  Now how does that sound to you?"  Her mother then completely relaxed her shoulders.  "I like that, I like that Lori!"  "So, mother dear said Lori,  "How would you like your eggs?"

Lori and her mother watered the plants, her mother took a bath and then said, "I think I need to take a nap."  

Positive Communication methods for people living with dementia:  We recommend seminars by Teepa Snow,M.S., OTR/L.FAOTA, Naomi Feil, MSW,, and her books, all of them. And the life changing, ground breaking book, "Contented Dementia," by Dr. Oliver James

Copyright 2015 Caregivers Get Fit! Mama  Nicey

The information in this blog is information. It is not meant to be a replacement for getting medical advice from your own health professional regarding your own individual health challenge or condition. Dr. Denise will not diagnose, treat, or give direct personal consultations/advice to you on this blog for any medical condition, but will give general examples, and scientific research on many different health topics.  How you decide to use the information is between you and your own medical/ health professional.

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