Sunday, April 14, 2013 CJ asks

Q: Suggestions for preventing nail-biting by an Alzheimer's person?

My mother has been an intermittent nail-biter her entire life, going some years without biting her nails but more years than not as a nail-biter. Recently, she has begun to make her fingers bleed, because she can't seem to stop herself from biting her fingernails. It almost seems as if she no longer feels or understands what she is doing, and yet, once she makes her finger bleed and it is finally sore, she complains about the pain when I put on or take off the bandaid made necessary because she has prompted bleeding.

It is getting out of hand. Her caregivers and I can remind her about this when we are with her, but this morning, she seems to have gotten herself bleeding during the wee hours of the morning, before I arrived on the scene.

Any suggestions for polite and sweet-seeming reminders about nail-biting? I'm considering getting one of those "play" pillows with buttonholes and buttons and snaps and other devices that she can fuss with while sitting. These are available through the Alzheimer's store, and I believe I could make one, as well. In the meantime, other than putting bandaids on all her fingers or asking her to wear gloves, does anyone have any suggestions about how to prevent this unconscious nail-biting?

I should probably add that my mother is otherwise a cheerful, happy person, not morose or self-absorbed (any more than an Alzheimer's person would normally be). She is not frustrated or unhappy. This is a terrible habit that has gotten out of hand, and I'm concerned about the safety of her hands at this point.

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Answers (2)

Christine Kennard, Health Pro

4/15/13 10:41am

HI CJ

There can be a number of reasons why your mother has returned to biting her nails. The first one, as you recognise, is related to her returning to an old, well established habit. There are a number of other causes that you should also consider;

It may be a symptom of anxiety. This can be from one cause or may be multi causal (sorry not to have a simple answer). It could be changes in routine, in her environment, a side effect of reduction or increase in medication or a side effect of a new drug, pain, from a physical symptom of another disease. It could be understimulation or boredom, or separation anxiety, hunger, thirst, constipation. Sorry for such a long list!

The way forward may be to consult her doctor. If you feel it is non urgent then a period of observing her behavior may be the most productive. Is there a anticedent to the behavior? Does it occur at a certain time of day? etc.etc. Record your findings for a number of days. Then you will be armed with good information before you see her doctor or change her routine, diet, medication etc.

As your mother has Alzheimers the solution may be to get her to wear cotton gloves to break the habit, allow time for her skin and nails to heal.

Christine

4/15/13 8:47pm

Thank you for your reply, Christine. I agree with you that it is likely a mix of anxiety and boredom. It's also such a long habit that it is very difficult for her to stop. Yet, because of the bleeding the other day, she is now focused on leaving her hands in her lap and agrees that it would be best if she could stop biting her nails. Thus far, we seem to be on a better path. Her caregiver got her to do some chair exercises this morning, and they talked about the difficulty of breaking old habits. Because she seems to be working to control the situation, it seems non-urgent. Soon we will be able to get her out for walks with her "walkabout" (a rollator) both outside and in the local mall. We have waited for the weather to change, and it finally has begun to do so!

I was thinking maybe a life-size small stuffed dog might help her, but I think she is still too lucid to have this work. We have two dogs, and we are letting them roam again in her room, which seems to give her pleasure.

Thank you again for your reply.

Carol Bradley Bursack, Health Guide

4/16/13 10:02am

Hi CJ,

My mother-in-law picked her skin. We had to take away her watch because she picked the skin raw under it and the skin wouldn't heal. But she'd pick other areas until they bled, as well.There was a constant battle to keep her from getting infections.

I agree that both anxiety and boredom may start this behavior, but also an OCD thing may kick in and they just can't stop. I would try the buttons/snaps idea - something to keep her fingers busy. I'd also check with the doctor for ideas. It's not a rational behavior she can be talked out of (obviously), and you're really creative in your thinking. Hopefully, between you and the doctor, you'll come up with something.

My mother-in-law eventually got over it for the most part when she it a more serious stage in her health, though if there was any hint of a snag or an itch she would start up again in a flash.

Let us know how it goes,

Carol

4/17/13 10:20am

Thank you for your reponse, Carol. Like your mother-in-law, my mother goes through periodic bouts with skin, but in her case, it is incessant scratching which, like the nails, has led to bleeding. The caregivers (or I) rub her well with a ph-building body lotion every day, so her skin remains supple and not dry, but she'll take to scratching her limbs if she has no clothing on them. We can talk with her about that, fortunately, when she is awake.

Now that she knows that we have heightened awareness about this (we had to change her sheets three days in a row, to get the bloodied ones off), she is being careful not to bite them. I hope that if/when they do grow in, we can make such a fuss about grooming her nails during manicures that she will really like that attention so much more than the bitten nails. That will be several weeks from now, but it's already in my mind to make it a great experience for her.

Thank you for the insight about your family. Sometimes it's just hard to know what to do when it is, more often than not, a situation where one can't reason with the person.

Thanks again,

Carol Bradley Bursack, Health Guide

4/17/13 10:29am

Hi CJ,

Great idea about making a fuss about grooming her nails. If she is still able to take in this attention and what it's all about, she'll feel pampered at the least, and it may be a deterrent.

Blessings,

Carol

4/16/13 3:03pm

CJ,

I am glad i works out for your Mom as she is a gentle soul.

Frankly I don't really know how my late FIL coped with all these things. He didn't bite his nails at all, but he did scratch his bug's bites on his waist at least twice and he ended up in the hospital once for getting it infected. He had severe nosebleeding once or twice but he refused the gloves and threw them away. He ended up pulling out the dressing in the nose and went to the ER again. Basically, it was the caregiver who was with him 24/7 that did all the hard work. We really just coped until he let go or got well. Not very clever but it was the only way as we didn't want to drug him yet.

I think the worst possibility is to take anti-psychotic drug. My late FIL in severe stage refused the memory unit's toilet help so they gave him antipsychotic drug and he cooled down. That was all we had done. The drug is the last resort. However, in severe stage, it is natural to take such drug since he stopped walking in May, 2011.

Hope your Mom continues to be calm and can listen to you.

Take care,

Nina

4/17/13 10:26am

Dear Nina,

Thank you for your reply to my inquiry about dealing with obsessive/compulsive behavior. My mother is still sufficiently aware that she prefers to please us, most of the time - a good thing. We call me "big Momma," and that seems to give her some verbal leeway to get her annoyances out when she is being coached not to do certain things. The caregivers know it's useful to say "Well, we'd have to tell CJ, and you know what big momma might say about that." It gives them someone to chuckle about while it enables them to correct the negative behavior she is engaging in. So far, it works. Ours was always a family where gentle (and sometimes not-so-gentle) ribbing took place, so this method works well for her. It's awkward when the child has to become the parent like this, but for us, it's so much better than having her in a location where I could not direct the events surrounding her care.

Like you, I am not inclined to employ drugs with my mother, beyond those she needs for her dementia and other specific health issues. Having seen what the psychotropic drugs did to my father (who absolutely needed them, due to his agitation 100% of the time), I really do not look forward to the time we might have to go this route with my mother.

Thank you again for your insights, and best wishes,

AFA Social Services, Health Guide

4/17/13 2:02pm

Individuals usually bite their nails due to being anxious. Others do it out of habit with no emotions connected. Since your mother’s habit is causing bleeding, I would seek medical consultation to rule out if this behavior is due to a medical condition. First, have her evaluated by her primary physician, and that doctor can refer her to a dermatologist if this is deemed a skin issue. Your mother’s condition can be serious and extends beyond the aesthetic. If your mother has open wounds on her fingers, she can introduce an infection into her body, which can be hazardous to her health. You should also consider behavioral interventions to distract her with in the meanwhile. If she is kept busy, and she is allowed to expend her energy in a safe, healthy manner, she may not spend her time nail-biting. The “play” pillow is a good idea. As well, find other activities that you think she may like, which will require the use of her hands. Folding, gardening, mixing cooking ingredients, and coloring are good examples. Another wonderful idea would be to make her a rummage bag; all items included in this bag should have significance. For example, a doll may remind your mother of her first born. Velvet cloth may be reassuring to her if she enjoyed clothing or sewed. Pictures can bring back family memories. You can be creative: just think of things your mother loved, and which will be safe for her to handle. In addition, although you are hesitant, it is ok to put soft hand mittens on her hands as well as to keep her nails short to decrease this behavior. Combining medical and behavioral interventions will hopefully decrease or stop her nail-biting altogether.

4/17/13 5:36pm

Thank you for the reply.

While in some instances medical attention might be deemed necessary, it is unnecessary in this case. Taking my mother to the doctor for this situation, which probably sounds much worse than it is in actuality, would be a needless waste of the physician's time, not to mention a very off-putting embarassment to my mother. It would also be an unnecessary medical cost to medicare and her secondary coverage. Her finger has nearly healed. Her finger's condition is healthy, and now that she is working to get her behaviors improved, she is on a good path. (I do not have an MD but a PhD, and I have significant experience in medical matters [unfortunately].)

Distractions seem to be the key to the situation. I was looking for suggestions for distractions. We now have some new films that involve animals. She is currently into animal shows. When she gets farther along in her dementia, I think the little bag of goodies (a "rummage bag") you recommend will be very helpful. She still does word games (the daily jumble, with help), and we have some jigsaw puzzles for dementia people. We also have a DVD of chair exercises for the elderly that her physician approved.

Getting the caregivers to just pull some of these things out (rather than asking her what she would like to do, which is polite but not sufficient to get her out of a rut) seems to be the trick that needed to be used here.

Thank you for taking the time to reply. I imagine in some circumstances, medical intervention might be necessary, but this is not one of those circumstances. The distractions seem to be crucial to her sense of personal satisfaction.

Q: Suggestions for preventing nail-biting by an Alzheimer's person?

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