Dementia vs. disobedience

Golden girlsDementia is a decrease from baseline cognition. Disobedience is willful rule-breaking. Dementia is unintentional and tragic. Disobedience rails against authority. And yet there are people in the healthcare profession who treat dementia just as they would treat disobedience in a toddler. I’d have to say, that’s one of my biggest pet peeves.

I had a lovely patient yesterday. In her 90s, sweet as could be (in the south we’d say, “bless her heart!”). She was confused in the morning, alert and oriented mid-day, and confused again in the evening. In the evening she pulled out her IV, took off her sequentials, and just as I walked in the room, pulled the dressing off her surgical site. I grabbed my supplies, smiled, and started fixing her back up, getting her comfortable. She looked at me with sad eyes and asked, “what’s wrong with me? I just can’t do anything right today.” Now, what would make her say something like that? Moments later my tech walked in, and right in front of my sweet patient started to relate to me in great detail all the “problems” this patient had caused her today. My patient sunk back into her bed, eyes downcast, and if she could have made herself disappear I’m sure she would have.

Treating patients with dementia as if they’re disobedient or child-like robs them of their dignity. They’ve been robbed plenty by the aging process – loss of control of bodily functions, teeth, the car keys, memory loss, weakness… We do not need to subtract more dignity from the equation. In fact, we should be doing all we can to restore their sense of self, warding off the depression that so often accompanies the aging process. They need to know that they still command respect, are still needed by family and friends, and are so much more than the physical body that is failing them.

And y’all. Can we please stop calling those disposable things diapers? Diapers are worn by babies. Would you want someone to walk into your room and tell you it’s time for a new diaper? Acceptable alternatives are “depends,” or “briefs.”

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