HAPPY DEMENTIA PATIENTS

About twenty years ago, Margaret was taken on as a nurse at an institution for female dementia patents in England.. She began her duties mid morning and was puzzled when she walked into the main hall where the patients were kept to see the distressed bunch of patients on assorted chairs in the middle of the room and a small group of contented nurses drinking coffee at the side. She joined the group of nurses and was welcomed. As she watched the patients, fidgeting and talking mostly nonsense she asked what was happening. The nurse in charge said; "They're just waiting for toilet time." Margaret looked puzzled and the nurse laughed and explained that there were set times for bodily needs.
Soon after, the nurses fetched several very large rubber sheets and they were spread over quite a big area of the floor and the patients quickly moved to the area and squatted down and began to carry out their bodily functions.
Margaret was horrified,at the complete loss of dignity and the way that people were being treated, but she was just a junior nurse so there was nothing that she could do about it. She was equally horrified at the endless confrontations between staff and patients who were all in the middle to late stages of Alzheimer's. The theory that the hospital system followed in those days in dealing with dementia patients was called 'Reality Orientation'. This meant that when a patient said something that was obviously incorrect she was corrected as to the reality of the situation. Thus, if an elderly lady claimed that she must go and visit her mother, she was bluntly told that her mother was dead and had been for many years. The reaction from the patient was great distress, because in her long term memory she had seen her mother only yesterday. This was the cause of almost endless friction and arguments between patients and staff.
It took many years before it was recognized that the system of trying to force dementia patients away from their delusions and into a sense of reality was completely wrong and caused stress to caregivers and great distress to patients. It is now understood that it is mainly short term memory that fades with dementia, and in many cases almost disappears as Alzheimer's advances. However, much long term memory remains and most Alzheimer's patients in fact retain their intelligence for a considerable number of years and sometimes to the very end.
Many caregivers are driven to distraction by patients endlessly asking the same question. The reason for the question is that the patient has forgotten the answer. If a patient complains that he has not been fed, when he obviously has, it is because he has forgotten. It is now known that the way to deal with most of the problems caused by short term memory loss is to divert the patient in another direction. Thus,to the patient wanting to go and visit her long deceased mother, the caregiver might say; "Tell me about her." She may then suggest that they chose a different dress or change a shirt and then suggest a walk.
It is now widely recognized that this method of dealing with dementia sufferers, enables them to live a contented life, with minimum confrontations.
It is difficult at first to visualize quick answers that will divert patients into different directions of thinking and it does indeed call for imagination. Although in the beginning it does take more effort, it will become second nature and will dramatically ease the caregiver's challenges in the longer term.
Sometimes odd behaviour from patients is caused by long term memory that triggers a reaction.This is not easy to understand or deal with, but knowledge of a patient's history may help.Thus, an old soldier might dive under a table because he heard a noise that reminded him of a war time experience. Even though, most of the time the caregiver will not know the cause of the odd behaviour, the solution  to calm them and bring them back to normal is to be comforting and try and divert attention to something different.
Perhaps the most important thing that caregivers need to remember is to never argue with the patient.Divert wherever possible; calm and re-assure.

My own dementia has not worsened and I am beginning to be encouraged by the coconut oil added to my diet. It is rather difficult to judge ones own level of dementia and so I rely on Julian's opinion as much as my own experiences. She sees the situation as static and is encouraged by the coconut oil as I am. My big memory lapse was the name of an old friend, which Julian had to remind me of, but as she says this is old memory damage from before the lifestyle change and therefore is not a sign of deterioration.
The weather here in Paarl is now seasonally cooler and we have had some welcome rain. We are still getting quite a lot of sunshine, so it is really the best of everything.
Our menagerie of Bobby the parrot and the three dogs continue to amuse and entertain. The squirrels have disappeared and we think that they are now hibernating in our gigantic avocado tree.
Keep taking the tablets.
David Barnato.
Paarl. South Africa
barnatod@blogspot.com