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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

In Search of Meaning

An Approach to Educating Long-Term Care Staff on Meeting Seniors’ Mental Health Needs

Irene Barnes, RN, BSN, GNC(C), PMHN(C)

Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp.36-37

He enjoyed the new place. The stairs were a little tricky but once he found the way it was easier. The others found them more difficult. He was doing his best to help the others but the younger ones only talked in that weird language and kept taking him back to do the stairs again.

Dementia is an acquired illness that affects the functioning of a once-normal brain. There are several causes like Alzheimer’s disease or brain attacks (strokes). The key feature is that the person has memory loss. In Alzheimer dementia, the person cannot remember after a short time frame and as a result is unable to learn anything new. With brain attacks, depending on the location of the assault, the person will experience either short-term memory loss — the inability to learn new information — or the loss of segments of past memories. The disease does not stop but goes on to affect other brain functions like speech, understanding words, inhibitions, planning, and even the loss of bladder and bowel control.

With the progression of the disease, the person requires an increasing amount of care that can be complicated by behaviours that place them or others at risk. It is usually at this time that the person will be admitted to facility care.

As a nurse with the Elderly Outreach Service, my focus is to assist staff in providing care for seniors who are presenting with challenging behaviours due to dementia as well as other mental health challenges. This is accomplished by blending formal teaching sessions with specific resident-focused care conferences. In other words, I assist the staff in finding meaning for the person’s behaviours and assist in developing other ways to respond to the underlying needs, or in adapting the environment.

To begin, it is important to gather all the facts like past occupations, medical history, past personality and coping skills, present cognitive abilities, staff reports of the behaviours and attempted interventions, and staff and family expectations for the person with dementia. Our search is for the skills that are still present rather than just the deficits. In a case in-service/conference all the information relating to understanding the disease and the person is shared. It is from this sharing that possible meanings for the challenging behaviour unfold. Once a meaning for the behaviour is discovered, a brainstorming exercise requires all partners in the person’s care to be creative and flexible in coming up with an intervention, and to be willing to try the interventions discussed.

In the scenario outlined in the opening passage, the gentleman had lost the ability to understand the spoken word, but could still read and understand what he read. As he had always been a helpful person, and since the sign over the door in red lights said “EXIT,” he would help the other residents to follow the directions. The solution to the situation? A sign on the door at his eye level that said, “Pete, do not open this door.”

Our seniors with dementia are doing the best they can. Because they physically look the same as when they were able, it is difficult for some people to see how hard they are trying. As a human, we tend to cover up for what we can no longer do, and as a result family and friends can become alienated when the person hides behind a difficult behaviour or an ineffective coping skill.

With dementia, memories unravel and the person relives previous life events. This same gentleman, who would climb into other resident’s beds with them, was not making a sexual overture, but looking for the comfort of another person. He came from a large family, where several children shared a bed, and he had been married for many years, so he had never had slept alone.

In our fast-paced society, we rely on the spoken word, but once the person has lost that skill, we tend not to stop long enough to get the message from their behaviours. If you are in a foreign place with people who do not speak your language, and you need to go the bathroom, what would you do? After you have searched the area, tried to do the needing-the-bathroom dance, and the urge continues, would you find a dark corner, wet yourself, or just pull down your pants and go wherever you are? You have just had a glimpse into the world of a person with dementia.

About the author
Irene is certified as a Gerontology Nurse and a Psychiatric Mental Health Nurse. She works with the Elderly Outreach Program in Victoria and has authored Musings From A Dementia Unit (available from the Alzheimer’s Resource Centre on Quadra Street) and several articles on dementia in facilities for the journal Canadian Nursing Home, based in White Rock

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