Ideas for Dealing with Cognitive Issues

Since I wrote A New Routine, I’ve been thinking about some of the strategies our family  and therapists used in dealing with cognitive issues.

From the beginning:

  1. Caregiver-handsUse normal tone of voice, staying calm and reassuring.
  2. Talk to the person as if they understand everything you’re saying. Never discuss subjects that may be upsetting in front of the person.
  3. Keep comments and questions short and simple.
  4. Let them know what you’re going to do before you do it.
  5. Allow the person extra time to respond.
  6. It’s okay if responses are inconsistent or don’t occur.
  7. Have only one person speak at a time.
  8. Tell the person who you are if you’re not sure they know.
  9. Remind the person of the day, date, name and location of where they are.

To stimulate memory:

  1. If they’re in the hospital, bring favorite belongings, pictures of family members and friends.
  2. Play their favorite music.
  3. Read familiar books and magazines to them.
  4. Watch their favorite TV shows or movies.
  5. Talk to them about family, friends and activities they previously enjoyed.
  6. Keep a notebook nearby for family and friends to sign so the person can read and remember who visited. If they can’t read, you can use it to remind them of who had been there.
  7. Write down improvements so they can read it or you can remind them of the changes.
  8. Don’t assume the person will remember what you tell them. Frequent repetition is often required.

To stimulate senses:

  1. Gently massage lotion on their arms, hands, legs, feet, face, back and stomach. It also helps prevent skin breakdown.
  2. Use a variety of soaps and lotions to stimulate smell. Talk about what they smell like.

If the person is agitated:

  1. Make sure they are getting the rest they need.
  2. Keep the room calm and quiet.
  3. Limit the number of visitors to two or three at a time.
  4. Allow them to move as much as safely possible.
  5. Moving them to a different location might help.
  6. Take them for a ride if permitted.
  7. Don’t force the person into activities.
  8. Listen to them and follow their lead if safely possible.
  9. Don’t laugh at, play into or reward inappropriate behavior.
  10. If reasoning is not successful, try redirection and distraction to stop inappropriate behavior.

If conversation is confused, unusual, insistent or bizarre:

  1. Tell them where they are and reassure them they are safe.
  2. Help the person get organized for tasks and activities.
  3. Provide a rest time.
  4. Be careful with humor, teasing, or using slang. Sometimes it works and other times it’s misunderstood.

Other useful hints:

  1. Expect the person to be unaware of their deficits and the need for increased supervision and/or rehabilitation.
  2. They may insist nothing is wrong with them and that they can resume their usual activities.
  3. Realize that redirection is not always effective and arguments can be frequent and prolonged.
  4. Encourage the person to participate in activities. Help with starting and continuing.
  5. Treat the person with respect while providing guidance and assistance in decision making.
  6. Talk through problems about the person’s thinking skills, problem solving or memory challenges without criticizing.
  7. Encourage the person to improve cognitive skills with games and/or therapy.
  8. Check with the physician regarding any restrictions such as driving, sports or drinking. Let them be the bad guy.
  9. Encourage the person to use note taking and recorders to help with memory deficits.
  10. Discuss situations where the person may have had difficulty controlling emotions.
  11. Talk with the person about yours and their feelings and offer outside support such as counseling and/or support groups.
  12. Make sure you have the help, support and respite care you need.

Resource: http://www.jhsmh.org

What ideas can you add to this list? Please share what has or hasn’t worked for you.

 

 

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The Blessing of Comfort

ambulance

April 27, 1991

“I know what you’re going through,” said the EMT at my side while the other one drove the ambulance to the hospital. “I just lost my wife three weeks ago,” he said in a somber voice.

“Mark will be okay,” I said as he placed the oxygen tube in my nose and checked my heart rate and blood pressure. He has to be okay, I thought. I can’t live without him.

“Is there anyone we can call for you?”

“Yes,” I replied and recited my parents’ phone number.

No answer confirmed my earlier fear they had already left with our two kids to pick up my 14 year-old niece, Linda. She had agreed to watch Christopher and Katie for the evening until we returned from our all day house hunting adventure in Ogden, Utah. I envisioned Mom and Dad in the front seat of their 1979 gray Chevy car with the three kids in the back seat.  Like a snapshot pictured, I saw all five of them happy, healthy, and unaware that our world had just turned upside down as they made their way to our home in Sandy, Utah. They were sixty miles away and I knew it would take at least an hour for them to get to us. They were uninformed of how much I needed them and how far away they all seemed to be. Yet in that moment, I wanted to protect all five of them from this devastating news.

After several rings, the EMT interrupted my thoughts, “Is there another number we can call?”

Still struggling to breathe from the blow to my shoulder and chest, I simply recited my brother’s home phone number. I was surprised by my memory of phone numbers and calmness under such horrific circumstances. I knew God was blessing me.

“Hello,” I heard my sister-in-law, Dianne’s voice over the speaker.

“This is the paramedics in Roy City. Do you know Mark and Barbara Wilson?”

“Yes,” Dianne said, sounding apprehensive.

“They have been in a very serious automobile accident and we are transporting Barbara to McKay-Dee Hospital in Ogden and another ambulance will take Mark there. We have tried her parents’ phone number, but there was no answer.”

Dianne anxiously assure the EMT she would let them know and the quick call ended.

She immediately called my oldest brother, Mick, at work. Since Dianne was home, she knew when my parents had picked up her daughter, Linda and realized they probably had time to drop the kids off at our house and were in route to their home. Mick told Dianne he wanted to go to the hospital with our parents so he called their phone number and since they didn’t have an answering machine he just left it ringing for several minutes until they returned home to answer it. As soon as they got the news, they cancelled the dinner date they had and headed for Salt Lake City to pick up Mick and the three of them drove together to McKay-Dee Hospital.

brand-canvas-hospital-mckay-dee-hospital

McKay-Dee Hospital in Ogden, Utah

After the x-rays and removing pieces of glass from shattered car windows from my ears with tweezers, a compassionate nurse asked me if there was anyone she could call for me. I knew it would be at least an hour before my family could get to the hospital. I didn’t even know who knew at this time other than Dianne. I thought of a close childhood friend who lived in Ogden. I told the nurse I did not know their phone number, but if she could look up Darlene and Dixon Pitcher’s phone number, I would appreciate it.The nurse left the room to make the call while another one fitted a patted figure eight brace which wrapped around the back of my neck, under my armpits and fastened in the back to secure my broken collarbone. Broken pieces of glass were all over my body,but not one cut. How strange, I thought as I looked at my bruised body while the nurse cleaned the glass off. Next she brought a sling for my right arm and adjusted it to my size.

“Would you like some medication for the pain.”

“No thanks, I don’t need any,” I said numbed to any feeling.

The nurse was just finishing up with me when Dixon and his friend came to the hospital. I was relieved to see a familiar face. Recalling the frightening words from the surgeon just before he took Mark into surgery, I was terrified of what laid ahead. I asked the two men to give me a Priesthood Blessing. I didn’t know Dixon very well and had never met the friend he brought with him. It was Dixon’s wife who had been my childhood friend, but he knew just what to say and his blessing brought solace. They sat with me for a while after the blessing. I was so stunned by the experience I don’t remember what was said, but I do remember the comfort these two men brought. My broken heart was full of gratitude for them.

The nurse came back in the room and handed me a large plastic bag with Mark’s belongings. Inside was his cut clothing, shoes, wallet and watch. She explained to me in the rush for Mark’s MRI and surgery, they cut the jacket, shirt and pants from his body. She told me Mark would be in surgery for a while and I was free to wait in the waiting room.

I thanked Dixon and his friend for the blessing and visit and assured them my family would be on their way. I didn’t want to keep them from their Saturday plans any longer and told them I’d be fine, so they left. I sat for a moment on the edge of the bed in the emergency room, alone and oblivious of the other crises going on in the other rooms. I wondered how I’d make my body move. I didn’t feel pain, emotion or drive. I felt dead and consumed with despair. This must be a nightmare, I thought. Surely I would awaken soon and life would go on as planned.

Divine intervention must have given me the strength to grab the plastic bag of Mark’s belongings with my left hand as I mustered up the will to get off the bed and walked aimlessly out of the  room into uncertainty, still wearing the hospital gown for my shirt. I looked down the hall and saw some swinging doors at one end. Unaware of anyone else in the hallway or in the rooms I passed, I walked devastated and all alone through the swinging doors into the main area of the hospital. To my relief, there stood my brother, Mick, at the information desk, talking to the receptionist. Mom and Dad stood behind him and noticed me. Immediate comfort came from the sight of them. Gratefully, I was no longer alone in this nightmare, but unfortunately…that also made it more real as my family poured love and life back into me.