“Christopher” had always been a very active, sporty gentleman who enjoyed his walks with his wife, “Marietta.” Just a few months before he moved into the long-term care (LTC) home where he now lives, he had a stroke. His stroke only mildly affected his ability to walk or move, but it did trigger vascular dementia which caused Christopher to get confused. He knows how to walk but his gait is not steady enough, nor can he walk for a long period of time. He has fallen a few times. This causes his family to worry that he might hurt himself more seriously should this continue to happen. 

With the family’s consent, and in an attempt to keep him safe and prevent further falls, they decided to purchase him a wheelchair with a pen-release lock. However, because Christopher remains physically strong, able to walk without the aid of a walker, and is still able to go and use the toilet on his own, he gets anxious and scared not understanding why he is now “bound” to a wheelchair with a seatbelt he cannot remove. 

Putting Ourselves in Christopher’s Shoes

For an active gentleman like Christopher, all these abrupt and drastic changes may be the equivalent of waking up to a different world and with a different “self.” He had a stroke and now, it appears his whole world changed. 

Instead of a quiet home which he shared with his loving wife, Marietta, he now has to share a “noisier” space with several people he has never seen before.

Instead of being able to sleep in a familiar bed, he now sleeps in a “crunchy” sounding bed (the thin plastic bed alarm is placed in between the mattress and fitted sheet) that makes a loud sound that hurts his ears every time it senses he is about to get out of bed. 

Instead of his underwear, he has to put on an adult diaper (i.e., “briefs”).

Instead of his loving wife, he sees different faces coming to assist in his personal care.

Christopher feels like he has lost the safety and security of his home, his independence, his sense of modesty and privacy, and his dignity. His first few days at the LTC home were understandably highly stressful.

The Reason Behind Christopher’s Behaviour

It appears that there are a few reasons for Christopher’s behaviour. One – Christopher likes to walk. When he was in the hospital, his family said that he used to pace up and down the corridors. Although he had fallen a few times, the hospital staff never restrained him to a wheelchair.

Secondly, Christopher seemed to hate having the seatbelt, particularly one he is incapable of removing himself. He felt “disempowered” as he needed a staff member to “release” him from his “restraints.”

Lastly, his exit-seeking was related to Christopher looking for his wife Marietta. When they lived together in their home, they apparently spent a lot of their time talking and just being in the same space where they could see each other, even when they were doing their own thing.

The Staff’s Creative Solution to Manage his Behaviour

Now with a little bit more understanding of Christopher’s behaviour, the staff was able to come up with solutions.

Whenever they would notice Christopher get upset and attempt to “escape” from his “restraints,” they would talk to Christopher and tentatively take off the seatbelt. He still remains in his wheelchair, but he appears to be calmer not seeing the seatbelt hooked up. They only do this whenever there is staff around to watch over Christopher should he attempt to stand on his own.

Secondly, when he starts to wander and get upset about being bound to his chair, the staff would distract him by taking him for a walk around the corridors, or if the weather is good, bring him outside. Outside walks bring a smile to Christopher’s face and always seem to get him in a great mood when he comes back. After the walk, he can calmly sit in his wheelchair with the seatbelt fastened allowing the staff to help other residents.

Lastly, when they know he is anxious about not seeing his wife, they would give him a handwritten letter from Marietta that reminds Christopher, she will be out for a few hours but is coming back. As Christopher’s short-term memory is impaired, reading this “love letter” from his wife was enough to calm him down. 

Whether it’s anxiety or loss of a sense of “freedom” and independence, there is always a reason behind the behaviour and there are several creative approaches that can be explored to manage these behaviours. However, it starts with taking the time to get to know the person, their history, and their background. Ask questions. Investigate then try out alternative solutions. It may take a lot of trial and error, but often these creative alternatives are much safer options for the person we are caring for. 

If you have concerns about a loved one or a friend and don’t know what to do, you are not alone. Reach out and ask for help. We can help by brainstorming ideas with you that will best suit your situation. Begin by contacting us through our website www.DementiaSolutions.ca to arrange your free 20-minute consultation with one of our Dementia Care Advisors.

DISCLAIMER:

The contents of this blog are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional.