Resident with dementia, Aranlaw House

Mr B has dementia of the vascular type. Mr B is married and is 86 years of age; he came to Aranlaw House 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.

Initially Mr B showed many of the behaviours that are consistent with being fearful and feeling lost at stage 2; he was constantly looking for his wife, even if she left him for a few moments he would frantically search for her. He frequently got lost and was unable to find his own room. Mr B became very angry with staff if they tried to stop him following his wife when she left the building, he would repeatedly come to the office and ask how he was going to pay for his care worrying about having no money. When he left his room he would gather up personal items that he recognised like his glasses, comb and toothbrush and take them with him wherever he went, often putting them down and then becoming anxious that he could not find them.

Staff encouraged Mr B to sit down and talk to them, asking him to tell us more about what he does at work; when he mentioned people by name we asked about their role at work and made sure that we didn’t correct Mr B when he told us that he was late for a meeting or had a train to catch shortly. We asked his advice on financial matters as this was his area of expertise. When Mr B was worried about not being able to get in touch with his colleagues we offered to help him write to them. When he was angry we acknowledged this and gave him the opportunity to tell us what had upset him. We found that he was much more relaxed if he was given a daily newspaper. Mr B responded well to eye contact and to a gentle touch on his arm when he was upset.

Gradually Mr B could be seen to be much more settled and less fearful about what was happening to him, he was much happier to engage with routines within the home; he had favourite places to sit and was much happier to spend time with staff when his wife was not at Aranlaw. He would tease staff and was always there with a compliment for the ladies! We did not have to increase his sedation again as he slept well for the first part of the night only getting up if he was worried about something he believed needed doing at work; as he now trusted us we were able to talk to him about his concerns and together agree that we would deal with things first thing in the morning or if he was really worried he would dictate a letter to staff and we agreed to get it typed up the next day.

Mr B continues to live at Aranlaw, on some days he will tell us that he is thinking of retiring and taking things a bit more slowly and on other days he will seek out one of the managers for us to go over figures that he believes relate to mergers he is involved in. We schedule meeting times with him and then go to his room at the agreed time to take notes.