AlzheimersNotes.com

SUNDOWNING

Sundowning refers to the agitation and wandering that occurs with Alzheimer’s patients in late afternoon, about the time the sun goes down. For some reason that researchers don’t completely understand, Alzheimer’s patients frequently tend to become agitated about this time of day.

Some have a greater tendency to wander in late afternoon, too.  So they have to be watched more carefully at these times for their safety.

Have you experienced sundowning with your Alzheimer’s patient?

(Here’s an abstract about sundowning from the Journal of Nursing Scholarship, 9/22/07.)

(c)2008 Mary Emma Allen

AlzhemersNotes.com

 (My piece  about restraints for Alzhemer’s patients , to keep them from opening a door and escaping or otherwise injuring themselves, drew many comments.  I’m using some of these as guest posts or in collections of comments.  I thought Bob Matthews had a very insightful comment, based on his experiences while caring for his dad. I’m posting it below.)

It’s a hard thing to do, and you are bound to get many negative comments from people who have never had to deal with an Alzheimer’s patient, but there comes a time when there is no choice.

The only option is to carefully choose the minimum practical method of restraint. The less visible the restraint the better. Alzheimer’s patients can injure themselves struggling with restraints.

It’s better if they can’t see what is holding them back. A locked door should not look like a door if possible, but a doorknob or elevator button on a blank wall can keep the patient occupied for hours.

The type of seatbelt that usually comes with a wheelchair is too obvious but discreetly attaching the patients own belt to the chair is less likely to result in a struggle. A patch of black on the floor (tape, a small rug, etc.) was all I needed to keep my Father away from a door.

My response to Bob’s comment:

Thanks, Bob, for stopping by Alzheimer’s Notes and leaving these suggestions for choosing restraints carefully. It is a difficult situation, but one that needs to be addressed for the patient’s safety and caregiver’s sanity. Sometimes in order to “appear” humane to the general public (manhy of whom have never had to care for an Alzheimer’s patient day in, day out), the patient’s safety gets pushed into the background.

The nursing home where Mother resided also had buzzers that would go off when the patient tried to get up from a chair, open a door, etc. I like that idea of a door knob or elevator button on a blank wall. I can see that this would occupy some residents for a considerable time.

Do you have thoughts to share about this topic?

(c)2008

AlzheimersNotes.com

The use of restraints, to keep Alzheimer’s patients from wandering, getting into unsafe areas, escaping out-of-doors, raises much controversy, especially when connected with nursing home residents.  There’s a balance with a fine line that separates safety from abuse in most people’s eyes.

More nursing homes and elder care agencies continually research ways to keep patients safe without severe restraints.

*The use of alarms that go off when a patient tries to get out of a wheel chair.

*Alarms that signal the opening of a door into an area where the patient may be unsafe.

*The use of a tray across a chair that might latch in place but not deter normal movement.

*The use of a half rail on the bed so the patient doesn’t roll out.  I was informed, that in some cases, a full rail was considered a danger because the patient might try to climb over, whereas with a half rail they would be stopped from rolling but not restrained.

Restrain for safety, yet allowing enough freedom has become an issue in many situations.  Perhaps when you see that someone in a care facility or a private home appears to be restrained more than you consider appropriate, inquire first about the reasoning before  jumping to conclusions.  What is safety and what is not?  

What are your thoughts on this issue?

(c)2008 Mary Emma Allen

AlzheimersNotes.com 

  Falls are the leading cause of death by accidental injury among people who are older than 65, according to an article, Home visits can help keep elders on their feet, in the DailyPress.com, by Fredrick Kunkle.  Here we learn some of the statistics about falls and the elderly and how home aides can educate about keeping homes safer.   

 Falling is of great concern as one ages and becomes more unsteady on the feet.  The elderly also aren’t so resilient if they do fall. 

My aunt’s family moved her to a nursing home when she became too unsteady to stay alone when the family was away during the day at school or at work.  She also would walk around at night and had fallen once.

My mom, who had Alzheimer’s, fell at the nursing home  She was simply turning around as she got out of bed.  Her feet apparently tangled or “got in the way of each other.”  With her fragile bones, at age 83, she broke her hip.  Although many falls seem to lead to death, Mother lived 8 more years after her fall. 

My grandfather, was in his 70s when he fell and broke his hip.  That occurred when I was a child and treatment was to stay in bed at home until the hip healed.  Grandpa developed pneumonia and died before he got well.

Although we can’t eliminate entirely the incidence of falling, there are measures we can take to make our homes and a patient’s room safer, as the home nurse demonstrates in the above article.

Also, you may want to refer to The Complete Guide to Alzheimer’s-Proofing Your Home at The Alzheimer’s Store. 

(c)2008 Mary Emma Allen