Mr B also has dementia of the vascular type. Mr B is married and is 86 years of age; he came to Aranlaw from hospital where he was admitted following a fall in another care home. The home had been unable to manage his level of night time wakefulness and desire to walk about, sometimes for several hours at a time and so they had increased his night sedation hoping that this would help him to sleep. The sedation did make him very sleepy; however it increased his disorientation and did nothing to reduce Mr B’s determination to get out of bed and look for his wife.
Mr B’s wife was highly anxious about how we would cope with his wakefulness at night; she had arranged the previous admission to a care home when her own health problems forced her to reconsider her resolve to care for her husband at home. Mrs B was able to give us a full life history for her husband and we were immediately able to see that many of Mr B’s behaviours were the result of him believing that he was still working.
On arrival at Aranlaw it was immediately clear that Mr B did not understand where he was or why he was here; we used the life history information we had been given by his wife to try and engage him. Mr B’s mobility was quite poor and I was concerned that it might get worse if he was administered the night sedation he had been prescribed since being admitted to respite care. After consulting with Mrs B and Mr B’s GP and Community Mental Health Nurse I agreed we would not sedate him at night but would instead monitor him closely and use a pressure mat by his bed to alert staff when he got up; this was not so that we could prevent him getting up but so that we were aware of him being out of bed and could monitor him discreetly whilst he walked freely around the home.
Mr B has dementia at stage 2; at this stage the person’s factual memory is very poor and they rely heavily on emotional memories to make sense of their situation, the person with dementia at stage 2 is disorientated in time, often by several decades and in place, perhaps believing they are at work or in a hotel. When talking the person will often find it difficult to remember nouns and they will lose the thread of thoughts and sentences. The person no longer has the thinking ability to try and cover up their memory difficulties.