Day 4/10 of Geriatric Level I Fieldwork in an Alzheimer's Day Center
Today was Day 4/10 of my Level I geriatric fieldwork at an Alzheimers Day Center. It was awesome. I helped feed a woman this morning who hardly ever opens her eyes or responds, and I said crazy enough things that she once or twice looked at me and even briefly smiled. Until this week I've never fed a grown-up. It's a strangely intimate experience. I did a lot of wandering around with different groups, just observing how they were run and how participants respond to the PCAs as well as each other. I experimented by taking the nonstop-talker, let's call him Bob, to the small room that is almost like a mini Snoezelen room. Lately there has been this trend for really interesting glowy lights and such and I don't know why they are referred to as Snoezelen rooms. But anyway this room has this huge horsetail like thing of green glowing fiber optics, plus this bubble lamp thing that has moving bubbles and changes colors. I wanted to A) see if Bob would calm down some and not talk as much, and B) just keep him out of the general big area, because his talking is so disruptive to everyone else.
I had him sit down in the rocking chair, and then handed him the fake sleeping puppy. He was so startled by it that he said “What is this?!” which made me laugh. He basically can only say something appropriate if you startle him enough, (and only keep it up for about one sentence), so I thought it was funny the puppy was so startling. He prefers to just rock and hold his hands and do his talking and singing so we just sat in there a long-time. I'd try to startle him and get his attention in various ways and he would occasionally say appropriate things. I feel like all these patients have fragments of their old selves inside, and it's just a matter of finding those rare fragments. I also tried to get the wandering anguished lady in there, to see how she would respond to the Snoezelen sensory experiences, but she didn't want to.
Then I decided to take FixxyLady (the one who loves to talk but makes no sense), back in there, to hold the dolls again. We sat in there a long time with the baby dolls and stuffed puppy. She had all three dolls and puppy on her because that's how she wanted it, and when she seemed to express concern that I had nothing to hold onto, I assured her the pillow was enough for me. She seemed like she was trying to tell me a rather tragic story, and while there was no way to fully grasp the details, it appears obvious something bad happened involving children.
For both Bob and FixxyLady, my motives were mixed. I wanted to get them alone to give everyone else some peace, and also see how calming environments do, so I could try and get more “realness” out of them.
Let's see. I got to look at a few more charts – truly there is usually only one interesting line in the entire chart, which is what their previous hobbies/occupations were. And I thought it was hilarious that one of the responses to “What does she do during the day?” in one of the charts was “Aggravate the hell out of me”. AHAHAHAHAA
One of the questions that the center asks caregivers is about what the caregiver has told them about the center. Most caregivers tell them it's just a place to socialize and have something to do. Those with higher functions don't realize they have dementia, they just know there's an awful lot of interesting people around.
In the afternoon, after chart reviews, I took Bob to the art room to see if I could get anything out of him based on his previous hobbies/interests. I pulled out some butcher paper and crayons, and when I drew a few things that he had knowledge of, he might make a single appropriate comment, but would always lapse into his incoherent talk within a few seconds. The art room has a great view of the outside garden, and Bob would occasionally have his moments of clarity and say things like, Why that sure is the prettiest site I've ever seen. He would talk about dirt and stuff and finally I decided taking him out there was a good idea since he wasn't showing any interest in writing or coloring or anything.
We got outside and walked around some. He mostly did his gumbles but did occasionally break through and say things about clean up, bags, things like that. Now y'all may think I'm stupid, but he is so difficult to understand/grasp, that I really wasn't sure if he was talking about wood, or the garden, and what kind of bags. Eventually he just grabbed a pile of leaves and a Dorito wrapper and I realized he really did mean a trash bag to clean up the garden. I quickly ran to the door to ask someone to bring us a trash bag. We got one and although he needed a little bit of help, he started stooping over and picking up trash and leaves enthusiastically. We filled up a small trash bag. During this time, we had quite a bit of clarity talk, where he was actually making sense a LOT because he was discussing the cleaning up. It's not to say he was miraculously cured for 10 minutes because he still did a lot of his incoherent talking, but he showed more knowledge of reality in one small period than he has in a long time. The fact he was doing ANYTHING was miraculous though since normally he just sits and rocks with his hands together, and does not participate in any activities. I was really, really, really proud that we had used a meaningful occupation to him – cleaning up the garden – and he actually DID something and made some SENSE. I think tomorrow, if weather cooperates, I'll get him out there with some potting soil and stuff and see what else he can do. Granted, when picking up leaves, he had a tendency to not be able to let go – I'd have to wrap the bag around his wrist and then kind of tap on his wrist and pull at his fingers and remind him to let the leaves go. So I'm not sure how much higher-level things he can handle. Anyway.
I crouched down near three people around a table and was chatting with them, and one of them asked me if I was cold due to my long sleeves. I said no, and asked this one woman, let's call her Kelly, if she was hot with all her layers on. She is in her 90s and usually dozing. She said, “Honey, I'm not hot, I'm just crazy.” I LOVED that.
At the end of the day, I ended up taking Kelly to the art room to see if she'd do anything with me. She ended up looking at a coloring book which had a story line, but didn't actually do any coloring. At one point she said “Do you know if my dog is outside? Because she'll die if she is outside.” I assured her her dog was fine. While she was looking at the coloring book, I was cutting out shapes from construction paper. I cut out a bunch of green stems and then various colors of different colors, as well as some hot-air balloon shapes. Tomorrow, I'm going to take the 3 highest functioning participants to the art room, and have them decorate the hot air balloon shapes as well as design flowers for all the colored circles. Then we'll glue the stems and flowers together and tape the hot air balloons and flowers to the very sunny window in the art room. It sounds very simple, but after what I've seen the last few days, very simple is actually pretty hard.
Over the weekend I'm going to kind of formally make up my list of things I've seen or not seen that I think could be altered, as well as work on SOAP notes on my chosen participant, and come up with more OT ideas.
My mom and I talked tonight and she asked me if we could touch the participants. I told her yes, and that in fact everyone is very touchy-feely. There is a LOT of hand-holding and hugs.
Finally, my little bragging moment. The development director was out in the front lobby when I was getting something, and she told me she saw me out there in the garden picking up trash with Bob, and how she was really enjoying watching that and wished she could keep me. She also said FixxyLady has been in a much better mood this week, and I'v
e spent a ton of time with her this week, so I was really pleased to know she recognized that I was working hard to use meaningful activities (occupations) to help the participants.
Anyway….the vast majority of participants and ALL the pca's are amazing and wonderful and sweet…I really enjoy it there and my only wish is that I could have access to the caregivers in order to interview them. I plan to keep seeing Bob and FixxyLady, TRY to interact more with Anguished Wanderer Lady (I'd like to bring her some poetry tomorrow, she loves reading), see what AlwaysHungryYetTinyLady can do, and do some mini group sessions with the higher functioning participants, as well as helping out with normal group sessions and coming up with more ideas for group projects.
Probably the best tools though? A big smile and some gentle sincere attention goes a long way.