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At a Loss for Words

Using your keen sense of observation to create understanding.

· Dementia Challenge,Alzheimers Disease,communication

As Joan sat at the kitchen table, wrapping silverware in paper napkins with her husband Ron, out of the corner of my eye, I noticed Ron become fidgety. He squirmed in his seat, used his hands on the armrests of the wheelchair to raise his body then began to rock back and forth.

I placed my hand on Ron’s shoulder and asked if he would like to use the bathroom. He looked at me, eyes wider now, as if in recognition but then responded, “Watermelons, 0.99 cents.”

Confused I repeated the question “Ron, do you need to go to the bathroom?”

He padded his arms down on the armrests again and then pointed to the grocery ad on the table, “Watermelons, 0.99 cents.”

“I see that watermelons are on sale,” I added, “ So are bananas and strawberries. It is fun to shop for fruit.”

Joan piped in and said, “He doesn’t need to go to the toilet. He is just looking’ at the grocery ad.”

I smiled at Joan and agreed with her, “He is doing a great job reading the ad, I just get the sense that he is uncomfortable.”

“If he needs to use the toilet, he will tell us… won’t you Ron?”

Ron looked from me to Joan and then said, “I don’t know. You tell me.”

Moments later a dripping sound emerged from Ron’s wheelchair. As I investigated further, I noticed that Ron had urinated and his pants were wet, urine dripping down the leg of his pants and onto the floor.

Joan became visibly angry and pursed her lips in frustration, “Ron, If you had to go, why didn’t you say something? You made a huge mess that we have to clean up. If I were in my right mind, I would let you sit in that and learn from what you’ve done!”

Ron looked down at his pants, used his hands to pull at the crotch of his trousers and then attempted to raise his body out of the incontinent mess by using the armrests again.

“Let’s get you cleaned up Ron”, I began. “It never feels good to be wet. A clean pair of pants will feel so much better.”

Joan pushed Ron’s wheelchair away from the table in disgust and said that she would mop the floor while I assisted Ron to the bathroom, too irritated to work with him right now.

Once in the bathroom Ron was visibly embarrassed by the accident, head tilted to the floor, eyes down-trodden. I assured Ron that accidents happen and that this was no fault of his own, “I should have gotten you to the bathroom sooner,” I started, “I could see that you were uncomfortable and I didn’t act quick enough. Please accept my apology.”

Ron lifted his gaze to mine, eyes soft and full of tears, “It’s O.K.” he stated.

As we cleaned up in the bathroom and put on clean pants we talked about the grocery ad in the kitchen, “You mentioned watermelons on sale. What other fruits do you enjoy in the summer?” I asked.

“Peaches are my favorite,” Ron added “and watermelons are 0.99 cents.”

“You are so right.” I told him.

Later that afternoon, as Ron napped, Joan and I sat folding laundry. “I am concerned that Ron may not be able to communicate his needs as effectively as he used to” I began, “... when Ron was fidgeting in his chair it reminded me of how I feel when I need to use the bathroom. That is why I asked him if he wanted to go.”

Joan looked quizzically at me, “He was talking about the ad, not the bathroom. I think he was just being obstinate.”

I chuckled as I reminisced with her about what a “hard headed” individual Ron was back in his youth. “I am sure it is frustrating to have Ron say one thing and mean something else. It can be exhausting to play detective all the time.”

She agreed and leaned back in her chair, “Do you really think he cannot say what he means anymore? How is that even possible? Everyone knows when they need to use the toilet!”

I spent a few minutes describing how the irreversible effects of Alzheimer’s disease not only affects memories but eventually creates limitations in communication, understanding and appropriate responses. I mentioned that body language is often a helpful tool to better understand Ron’s needs.

As I spoke, I noticed Joan begin shaking her foot and leg and biting her upper lip. “Do you need to use the bathroom?” I asked her.

“How could you tell.” she half smiled?

“Your body language spoke a thousand words.” I replied.

~ by Cathy Braxton, CDCS, CBDDP - Chief Education Officer

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