What is the best way to handle Alzheimer's patients when they are restless?

1 answer | Last updated: Sep 14, 2017
Janey54 asked...

I am a Long Term Care Nurse. I was just transfered to the Alzheimers Unit. Now that I've been nursing for 38 years I find it difficult to keep redirecting the ambulatory pts that get at my med cart, constantly grabbing anything they can, and there restlessness, even when their needs have been met. I want to have more patience!

Expert Answers

Jytte Lokvig, PhD, coaches families and professional caregivers and designs life-enrichment programs and activities for patients with Alzheimer's disease and related dementia. Her workshops and seminars help caregivers and families create a healthy environment based on dignity and humor. She is the author of Alzheimer's A to Z: A Quick-Reference Guide.

When we think of the needs of our residents, most of us think of nourishment, cleanliness, and environmental safety. Our care facilities are generally very good at meeting these physical requirements. The one need that's often neglected is everyone's need for something purposeful to do. With nothing to do, people with Alzheimer's are likely to be restless or even agitated. It's pretty obvious to the residents that your med cart is the center of important activity, so they are drawn to it.

Numerous studies have shown the importance to our good health and wellbeing of a purposeful life. We're used to finding purpose in our work, charitable causes, or other responsibilities. When we're inflicted with Alzheimer's or a related dementia, it becomes increasingly more difficult for us to engage on our own; we need others to assist us to initiate activities.

As staff in facilities, we are typically overworked (and underpaid) and in our minds it's all we can do to meet the basic needs of our residents. It would surely be unfair to expect us to come up with meaningful diversions for them as well. However, by taking a few minutes to get a resident involved in simple activities, we actually save time and also help everyone have a better day, including ourselves.

The most effective distractions and activities offer a sense of purpose for the person. I keep a supply of "fiddle boxes" or similar projects for just such occasions. A "fiddle box" is a container with things to finger, count, or organize.

When a person with Alzheimer's is restless or agitated, show him a messy fiddle box and ask him if he would mind helping you. (You can make your request even more authentic by first asking him if he has time.) It's important that he believes that this is a serious task that you need help with. When you sense that he feels that he's finished, you'll want to thank him for a job well done, no matter how much or how little he did.

Fiddle boxes can be created from any carton or plastic container, i.e. shoeboxes, either cartons or plastic. It doesn't have to be a box, you can also use a handbag or a wicker basket. A fiddle box can hold a hodgepodge of items or be devoted to one type of item. You can create a box with first aid items, i.e. bandages, cotton balls, rubber gloves, etc.

More fiddle box ideas:

Fabric swatches of different colors and textures.

Ribbons and laces in short lengths.

Baking and cooking stuff: small wooden spoons, measuring cups and spoons, cookie cutters, etc.

Jewelry: long strands of beads in different colors and clip-on earrings (no loose beads, rings or pins.

Baby things, including baby clothes.

Art supplies: dried tubes of paint with their caps super glued shut, crayons, brushes

PVC pipe connections and safe small tools.

Packets of seeds and plastic gardening tools.

Individual paint sample cards.

Office supplies.

You can augment your "emergency activity program" with catalogs and books of special interest, also thematic portfolios of magazine cutouts. Some of your residents may also enjoy participation in household chores: helping with laundry, table setting, dusting and sweeping.

Example: A male resident in the advanced stage of Alzheimer's used to get very restless, but he was unable to participate in our regular activities. When we learned that his business supplied builders with windows and doors, we created a box especially for him with pictures of windows and doors cut out of decorator magazines. He would then spend an hour or two sorting and studying the images.

Another resident was fond of the fiddle box with fabric swatches, which she would carefully stack according to texture or color; yet another would lay out strands of plastic pearls in swirling patterns.

At one point we had a situation similar to yours involving one very persistent resident, who would not leave the med cart alone. Our fiddle boxes were of no help. It turned out that she had been a nurse most of her life; no use trying to explain to her that she was retired and no longer had control over the med cart. Instead we "hired" her and made a name tag for her with: "Assistant Nurse." We gave her an old stethoscope along with a clipboard to take notes for the "charts." She "worked" vigorously for a couple of weeks before proclaiming that it was unfair that she had to work much harder than anyone else, so she "quit." Interestingly she never returned to her old behavior of obsessing over the med cart.

Communication is crucial to the success of these projects. Our residents must believe that our intentions are sincere; that the projects are real and their efforts are valuable. When we ask for help, we're moving out of the normal staff"“resident relationship and becoming two adults interacting. It gives our resident a sense of self-determination and contribution.