Working with elderly confused people

Abstract

This progressive loss of contact with reality, highlighted by intellectual, emotional and memory disturbances, is a manifestation of‘dementia’. The following describes the symptoms and gives examples of behaviour illustrating them.

Mrs Garland’s admission was the culmination of several months’ gradual deterioration in her behaviour. Her family had coped quite well up to now, but recently Mrs Garland had been wandering about at night, turning the gas on without lighting it or cooking things and leaving them to burn. What seemed to be the last straw for her daughter, who had been caring for her, was when her mother squatted in a corner of the kitchen and defecated. This resulted in the daughter approaching the doctor with pleas for help. Mrs Garland had been on the waiting list to come into the elderly assessment unit, but this increase in deterioration had warranted immediate admission, as her daughter could no longer cope and Mrs Garland was a risk to herself and others.

On admission, Mrs Garland was accompanied by her daughter and son-in-law. They were taken to the reception lounge and offered a cup of tea. It was usual for the nurse in charge and another to introduce themselves and record essential information and to give the relatives and the client information they would need. Mrs Garland was sitting next to her daughter. She seemed nervous and was continually fidgeting with her dress, pulling it up to her face.

‘Do you take sugar Mrs Garland?’ She looked towards the nurse with a vacant gaze.‘Go away.’ She got up and walked towards the window.‘What is this place?’

‘I’ve told you, Mum, it’s a place where you can rest and get better.’

There’s nothing wrong with me, take me home.’

The nurse intervened,‘Come and sit down, Mrs Garland and have a cup of tea and then we’ll explain everything.’

‘Where’s my Billy?’

She started to cry. Billy was her husband, who had died four years ago. By this time her daughter was becoming distressed. In an effort to distract Mrs Garland, the nurse took her hand.

‘Come on, Mrs Garland, I’ll show you our garden, it’s lovely out there.’

Her mood changed quickly and she seemed to go with the nurse quite willingly. The remaining nurse then spent a considerable time with the daughter helping her explore a whole range of feelings, varying from frustration and anger to guilt and sadness, until she could accept the situation sufficiently in order to leave her mother in the unit with some sense of personal relief and reassurance.