Day 1/10 of Geriatric Level I Fieldwork in an Alzheimer's Day Center

Cold room, chatting with highest functioning Alzheimer's participant:
Lady: Honey, aren't you cold??
Me: No I'm fine, thanks.
Lady: Wooiee!

::moves on with conversation::

Two minutes later:
::looks at me again:::
Lady: Honey, aren't you cold??
Me: No I'm fine, thanks.
Lady: Wooiee!

::moves on with conversation::
Two minutes later:
::looks at me again::
Lady: Honey, aren't you cold??
Me: No I'm fine, thanks.
Lady: Wooiee!


Helping a woman with mosaic tiling during a 30 minute session: The PCA (personal care assistant) in charge says some of them just don't do it. I like a challenge and pick a woman who has crossed arms that I know from earlier has at least basic cognition.

Her: ::sits there doing nothing::
Me: Look at all these pretty tiles. Do you like them? I like purple and green.
Her: Yeah, the colors are very nice, very subdued.
Me: Exactly! Do you want to put them in this tray? I'll start the glue part.
Her: Ok, that's fine.Sure!
Me: Ok, it's very simple. Just take the tile and put it right here, like this ::demonstrates:: Ok, now let's pick your next color.
Her: ::discusses choices for about 10 minutes, always wanting me to decide:: (finally we do)
Her: So I just put this tile here, right?
Me: Yes. Pick up the tile with your fingers, here it is for you.
Her: ::asks more questions::
Me: Yes. Here, take this tile.
Her: ::asks more questions::: (appears to be stalling each time – not that she doesn't want to do it, though)
Me: Yes. Here is that tile.
Her: ::takes tile::
Me: Ok, now place it right here. ::shows her for the tenth time::
Her: Where?
Me: :::shows her:: right here. Here, let me have your pointer finger. ::guides her finger to it:: do you see? Right on top of the last one we did.
Her: Oh ok. ::hesitates:: now what do I do? where do I put this???
Me: :::shows her again multiple ways:: Why don't you put that tile in your fingers, and I'll help guide your fingers to the right place okay? You're doing a great job.
Her: Thanks, I like doing this kind of stuff.

Now, repeat those questions on how to do it, for every single tile, and we did close to 15 tiles. I was amazed. At first, I thought maybe she had low vision and it prevented her from seeing the tiles. Then I thought maybe she was playing around for attention. Then I thought maybe she has some apraxia (still think that – she seems to have difficulty initiating the desired motion). Then I thought (rightfully, imo)maybe she had low confidence and was scared of messing up. Then I thought that something with her Alzheimer's makes it so that she clearly articulates and sees and understands the process, but as soon as she picks up the tile herself, she loses her ability to handle the situation. It was pretty interesting. It required a LOT of patience.

Today was Day 1 of 10 of my geriatric Fieldwork, I am at an Alzheimer's Day Center, where people can drop off a person with Alzheimer's anytime between 7am and 6pm, Monday-Friday. I've never been in such a place, but I was impressed. This particular place is made up of one giant room with several small rooms attached. They had a nice sunny area with birds in a cage, a nice sunny circle area with a giant fish tank to watch, several circle areas designed for exercise or singing, tables for tablework or other games, a nice little game room for playing Bingo, Jingo, cards, etc. And a nice art room. Also, a large white trail snaked around the entire place, and there were gardens outside. All the rooms were stocked with TONS of nice stuff that any OT would love. Colorful art supplies, lots of cognitive stuff including reminiscing series with old songs and old events…very neat place and very open. I was put with one of the higher-functioning patients (let's call her Gladys) and followed her around for a few hours. She kept asking me if I was cold. As we walked around, we encountered a woman who just wandered aimlessly. Gladys whispered to me, “she has problems”. Then we came across a woman who talked about something completely off the wall to Gladys. Gladys acted like she knew what she was talking about and spoke kindly to her. Then whispered to me, “she has problems”.

The first thing we did after walking the trail, was listen to one of the many PCAs (personal care assistants or attendants or whatever) read out loud from the newspaper. This was a girl who interacts wonderfully with her patients, but clearly didn't read very well. She used her finger to follow and was hesitant with almost every word. She read the weather, horoscopes, and Billy Graham. She had a large candy or gum in her mouth, and would say things like “Yous a Scorpio.” At one point she said “you will be forgived”, and one of the higher functioning patients corrected her with “forgiven”. They were all very friendly and kind to one another. I noticed that several of the patients had trouble understanding her but they're all very patient and just sit there regardless.

When I work with patients, I always tend to think I'm boring them and I want to rush around and entertain, but the more time I spend with older patients, the more time I realize that they are usually fine with things going slowly and don't require much entertainment.

We then moved on to playing Jingo, which is apparently a popular form of Bingo where instead of numbers it has to do with answers. We played Bible Jingo, so for example a question might be, Where did Noah place all the animals, and then the answer would be a picture of the ark, on answer sheets, to cover with a chip. I noticed several things. 1) The chips were many different colors, and this really confused most people, and they wanted to know which color to use. It would probably be helpful if they used only one color chip. 2) The PCAs wandering around have a lot of people to take care of and can't take the time to really “help” so they will just point out the answers to lower-functioning people instead of trying to help with “it's in this row, do you see it?” kind of stuff. I guess I would too if I were in charge of a whole room at a time! I only mention it since I'm trying to look at everything critically so that I can try to use OT skills to figure out things that could be changed, or should be changed, or gaps to be filled, or whatever (I'm not saying like tell the boss necessarily, just for my own education).

Then it was time to watch some video of an overly enthusiastic older woman sitting on a chair with blackness behind her, talking VERY animatedly about making food and how you need an apron and blah blah. She was like Barney reincarnated. It was frankly probably insulting and condescending to ANYONE – it was the kind of thing you'd see for 3 year olds but clearly aimed at dementia patients. Yet the higher functioning patients have no need, the moderate functioning patients aren't going to sit in a random room and watch a lady talk about the basic steps of making food, and the lower functioning patients could care less.

I kinda wandered at this point – I observed exercise groups, a group playing with a parachute with balls, groups playing basic trivia, groups singing old popular songs, and more. There were plenty of PCAs to run each activity, AND plenty of PCAs to kind of wander and deal with the lowest functioning patients who required a lot of hand-holding, quite literally. These patients mostly wandered aimlessly and if they talked, it was incomprehensible/made no sense. I get uncomfortable when patients talk to me and I don't understand, but these PCAs are very good at what they do. They are loving and patient and kind of placate the person, then hold their hands and walk around some. Eventually I ended up holding
the hand and walking with a woman who kept wanting to go check to see if her husband was there yet. Most of them fretted about being picked up. It was neat to see how they had camouflaged the main doors by painting it with scenery that matched other parts, so you can't see the doors well. In fact, one woman was talking about her husband always coming from “over there” and vaguely referring to that area but not quite sure where. To get out you have to punch in a code that is actually right there, you just have to punch it in backwards, which is beyond the ability of all the patients. All the doors to offices had half doors where it prevented a wanderer from getting in but allowed everyone to see what was going on. They also had special chairs for some of the wanderers to be “restrained” in as needed.

Between all the activities I discussed and lunch + snack, it filled up 9pm to 4pm and it was a very pleasant day. I was truly impressed with how kind and patient EVERY employee was. I was also impressed that almost all of the patients were ambulatory – a few required canes or walkers, but I didn't see any in a wheelchair and most of the people were quite spry, and dressed nicely. I got to wear a giant volunteer smock, woot woot lol.

I was impressed with the place, and here are my Yays for the Day:

1) I was the least scared to start this fieldwork.
2) The place is well-equipped for OT-like work.
3) I came with an idea to have the patients paint pre-cut-out individual fish, to put on a blue cardboard and donate to a children's hospital or classroom or something.
4) I showed several women how to unwrap their peppermints by pulling on the outside ends and letting it untwist itself, because they had a devil of a time opening them due to not doing that step.
5) I got at least one woman who wouldn't normally participate, to do the mosaic…which led me to helping another woman who wouldn't normally do it…which lead to two others looking at me with curiosity and honestly probably would have done it too had I sat with them. I think when the PCAs say “They never participate”, what is more realistic is that the patients WOULD participate if they had someone with them individually every step of the way…which is obviously unrealistic. Because they don't have the ability to do it without much help, they just don't even try.
6) All employees are patient and great with the individuals and I can learn a lot about interactions by watching them.

I know this is ridiculously long but since I have to journal it, well, now I've done so, and now I've gotten my mind clear and can try and finish the last 5 group protocols for my Well Elderly project, and perhaps make 10 postcards to go along with my flyers, as well. And make my budget. Then later this week I can do research to back it all up, and then I am DONE with that gigantic project. Which is great because I need to get a communications proposal put together this week, and also really need to start to focus on just Tai Chi.

On Wednesday I am meeting a student from my undergrad college, who is considering going into OT and was given my name by the health sciences advisor. On Thursday I am also going back to my undergrad collage to attend a Networking Career session for Alumni, to talk to people about what we are doing and such. So a very heavy OT week!

I got a really long and great e-mail from someone interested in mobility and assistive devices that I may share tomorrow since I don't know all the answers! LOL.And a few other things. Ok, off to work on Well Elderly.

Mar 25, 2008 | Category: Occupational Therapy | Comments: none

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