Thursday, November 3, 2011


Back to my blog home page:

Remember my first post about the "new place?" There was a lady with dementia who repeated over and over and over....

"What do I do?   What do I do?   What do I do?"'s time to deal with it.

I overhear a conversation by the nurses talking about how Nadine's adaptive clothing needs to be replaced, so I figure that is my cue to step in. "I can help you with that, guys."
They are so busy, they are happy to turn it over. I let Nadine's family know I can address not only the clothing issue, but I would like to determine her cognitive level and identify some activities appropriate to her current cognitive level that  that may help reduce her behaviors.

Adaptive Clothing
So, first, adaptive clothing - what the heck is that?  Clothing that is modified to take care of a person's special needs. Here are simple examples:  cutting a seam on a pair of jeans to make room for a leg cast. Putting velcro closures instead of buttons if someone is unable to manipulate buttons any longer.

Nadine needs all her clothing to open/close behind her back. She has a problem that is common to more older adults with dementia than one would think. She puts her hands in her brief (aka diaper) and occasionally gets her hands and fingernails really dirty.

Sorry!! But it's reality.

You take care of that nasty little problem with clothing that secures down the back. I go online and print a few options off for Nadine's daughters. I will discuss this with them when they visit next.

Next step is the hard part.

How do I connect with Nadine? How do I actively engage her and keep her attention?

Nadine has a designated parking spot at the nurses' station. From there, she partakes in a constant line of questioning, over and over,

"What do I do?
"What?"(she can't hear well)...
(and again...) "What do I do?"
and when the nurse answers,

I meet her where she is most comfortable, at the nurses' s station. I slowly put a tray over the frame of her merry walker. Merry walkers are used for people who are dangerous to walk solo, but who need the support of holding on to something or a seat when they feel like resting. It's for people who are stable going from sitting to standing or standing to sitting, but not someone who needs help standing up. Got it? Let me know if it doesn't make sense!
I must start with a very simple task. I bring a package of sugar and sweetner packets with me. My mission is to get her to separate the pink from the white. That's all.

 The pink from the white.

I put a handful on her tray.

"Nadine, pick out the pink."

Rule #1 with dementia patients, esp. hard of hearing ones: SHORT SENTENCES

I demonstrate.

She doesn't register my slow demonstrations until about 15 minutes in. She occasionally watches what is happening around the nurses' station. I continue to clearly articulate short verbal cues while I lift the pink packets and slowly lift them into a container that I hold straight in front of her. She follows my calculated movements.

...and I see it click.... after 15 minutes!

"The pink?" she says.

I demonstrate again and put the packet in her hand.
She holds it a while, then puts it in the container.


I continue to move slowly, and for the next 5-7 minutes, she puts three pink packets in the container. Then, a turning point. She picks up a packet and holds it to her face.

"Sweet N Low," she reads,

and she proceeds to discipher the small print on the packet!

I tuck that away for the next treatment two days later. I print out Robert Frost's lovely poem, The Road Not Taken.

  The Road Not Taken

TWO roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;       
Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,       
And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.       
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.

I hand it to Nadine. She picks up the paper, and starts to read.


She has obviously recited poetry in the distant past. WOW.

A nurse walks in and sits down shocked. She starts to cry. Nadine keeps reading Frost. I print off Elizabeth Barrett Browning. EE Cummings. Amy Lowell. Louisa May Alcott. Others.

She continues to read....recite...and read some more.

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