As a hospice chaplain, what do you recommend in dealing with Alzheimers patients?

Hi, Rev. Harriot,

I am sure in your role, you do find it difficult to minister to those in the later stages of Alzheimer's. That's such a difficult time in the progression of this disease. Based on what I saw with my mother, I'd suggest that just being present is a comfort to the patient. During the last two weeks of my mom's life, Mom was not able to have any conversations and often was unconscious or was (as I described it) looking through me and not at me. However, my father or I'd be in the room with her, often sitting where she could see us and touching her. (Because of her body position and the bed position which was against the wall, I often had to sit at the foot of her bed, so I'd hold her foot.)

I'd also check with the nursing staff to find out if there was a time when the person seemed to be more cognizant of what was going on, which might help you in minister to them.

Additionally, I am sure that your presence also is of great comfort to the patient's family and friends. And helping them during this difficult time also is helpful to the person with Alzheimer's. Based on what I saw with my own mother, I believe that the person with Alzheimer's still senses what's going on with friends and family members who are in the room, so helping them becomes equally important.

Take care and keep us posted on what you find!

Dorian

Often, sometimes most of the time, patients with dementia are not relational.  When you say that ministering to them does not seem to be helpful, there may be another way to think about helpfulness. Certainly you won't be able to assess the quality of the intervention based on how appropriate a patient's way of relating seems to be. 

So let's get to the question of "helpfulness."   Sometimes you can make eye contact.  If you get this kind of response, it may be helpful for the patient to feel that contact.  She may feel good about the fleeting connection. 

If she is able to use her "socially appropriate" verbal responses, such as "how are you - fine thank you," etc., that may feel helpful to her. Sometimes the more comfortable social conventions like this come into the consciousness of the patient with dementia.  The exchange may be reasssuring for her, and make her feel cared for.  That's the goal, I think.

You may make a helpful contact through touch, although it not might satisfy your need to see helpfulness in her response.  You may find that sensory stimulation such as music that was once significant in an earlier stage of life brings a smile of recognition - I think the smile itself is "helpful" to the patient. 

And of course, we can learn much about music therapy, music speaking to the rhythms of the body, or the simple beat of the heart.  Music  can be of soothing and reassuring, and can bring delight and joy.  That's a gift for the dementia patient.

Many chaplains have used story-telling books to read that perhaps may evoke a comfortable memory.  One publisher has a series of age-appropriate story books.

Gestures that even through the haze of dementia and/or medication, bring to the mind something once familiar and significant are helpful.  I have used simple dance gestures (imagine choreographing the concept "I give you my heart" with your hands to your heart, a gentle smile, and a reaching out and giving of your hands to touch her heart; or try choreographing the profound respect language of a bow with hands together).

Snoezelen techniques of sensory stimulation for relaxation and redirection may be helpful, if not to the caregiver, certainly to the dementia paient. 

For religious patients, some of the old familiar prayer concepts will bring comfort, for deep in the mind there often remain the earliest memories of spiritual devotion.  The caregiver must have authentic respect for patient's specific religious tradition.   Along that line, I would add that "giving the plan of salvation" is way past the point.  Teaching or preaching is a cognitive agenda that makes the proselytizer feel "helpful."  It helps to remember that deep within the patient there resides a spirit of life which cannot by definition, get old or sick, frail or diminshed - God's love starts here. 

God is present to each person at all times in ways we might not be able to discern.  As caregivers, we have the privilege of connecting even when we don't see the results of our own "helpfulness."  I think what's best is catching a little eye contact, a snippet of social exchange, a fleeting memory, a remembrance of comfort and care from the distant past, recognized now through sight, sound, touch, and tenderness.

Caring for patients with dementia helps us to remember that on our own, we really are helpless.  But within the scope of God's love, if we just touch the dementia patient by offering our kindness, respect and loving care, without seeing the effect, we can trust that our simple presence is "helpful."