Maintaining Composure When Treating and Caring for Patients With Dementia

In this video from on-site at the 2024 NP Institute in San Diego, California, Tardive Dyskinesia Section Editor Amber Hoberg, APRN, PMHNP-BC, of Med Management Associates, and Brooke Kempf, MSN, PMHNP-BC, psychiatric mental health nurse practitioner and adjunct faculty member for Indiana and Purdue Universities, discuss their session "Meeting Mental Health Needs in a Growing Elderly Population: Strategies for Geriatric Depression, Dementia, and Medication Management." Nurses Hoberg and Kempf delve into the complexities of caring for individuals with dementia for clinicians and caregivers alike and discuss managing agitation, behavioral challenges, and maintaining independence for dementia patients. 

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Read the Transcript: 

Amber Hoberg, PMHNP-BC: So with clinicians taking care of patients with dementia, it can get really frustrating sometimes, especially if they're having agitation or they're having behavioral issues or they're seeing things that aren't really there. It sometimes feels like you want to argue with them and tell them, "No, that's not actually happening." But what I can tell you with dementia is you're no longer dealing with that person, per se. You're dealing with the disease. 

A lot of times what happens with dementia is it progresses, and it starts to take over the frontal cortex of the brain. It's going to start shutting that down. I always say their stop sign goes away. They now don't know what's right and wrong or what is true or not true. Arguing with these people is not going to get you anywhere.

I always say you don't win with a dementia patient. What you want to do is compromise. If they're asking to do something if it's safe, compromise with them and maybe say, "Okay, we can do that, but then we have to do this." Or give them choices. “Maybe that's an unsafe thing to do. So we're going to give you 2 choices and you can choose from those 2 choices. There are two things I want you to do, but they're choices,” so at least they get to keep some of their independence.

That's what I find a lot with dementia is even as the disease progresses, they still want to maintain their independence. They still want to cling on to as much as possible because they don't want to rely on others. The more we can foster that, the less you're going to probably sometimes see in the behavioral aspects. What about caregivers? 

Brooke Kempf, PMHNP-BC: Yes, I think as clinicians when we're trying to deal with that and it's a long disease process and so sometimes that burden that we feel as clinicians of “I don't see the progression, I don't know if I'm doing well.” Imagine what those caregivers feel. We've been dealing with them since they've had dementia. They know their whole life story. “This was my loving mother, this was grandma, we had such a great relationship.”

It's a loss for them. It's like that loved one has passed away to them. They're not there anymore and it's hard for them to understand.

So with caregivers, when they've tried to care for an individual that becomes aggressive and they're dealing with this loss, very important for them to find a support group. Very important for them to take care of themselves in every other healthy way that we encourage people to care for themselves. And that's what we encourage them to do.

We had talked before about how you have to take care of yourself before you can take care of others. I used the analogy of the airplane when the masks come down, you have to put your own mask on before you put it on someone else.

So ensuring they're taking care of themselves, providing the education. You mentioned we're dealing with the disease here. For loved ones, “let's find the days that are good and appreciate those good days.”

But on a bad day, take it with a grain of salt and go,” you know, take care of yourself and know that there'll be another good day for you to look forward to. We're just going to deal with it in the moment.” And yeah, just finding that good support system and self care.

Nurse Hoberg: Absolutely. And it's almost like they're grieving, you know, this loss and I let caregivers know it's okay to grieve. It's okay to grieve this loss because it is like a loss. You've lost the person you know and now you're dealing with something different. And so it's okay to do that and to grieve and to find people that can support you along the journey so that you don't feel alone.

Nurse Kempf: And then when you're the clinician and they're getting that support from you, that trust comes in and okay, “this person has my family member's best interest at heart” and that can make them feel better at night when they're laying their head down, they're in good hands.

Amber Hoberg, MSN, APRN, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner from the University of Texas Health Science Center, San Antonio. She has been working for the past 12 years with the adult and geriatric populations treating all types of psychiatric conditions. Her background, as a psychiatric advanced practice nurse, includes outpatient, inpatient, group home, and nursing home/ALF settings. She currently works for Med Management Associates and Morning Star Family Medicine PLLC treating the chronically mentally ill in both inpatient and outpatient settings.

Brooke Kempf, MSN, PMHNP-BC, has worked as a psychiatric nurse at Hamilton Center in Terre Haute, Indiana, since she graduated from Indiana State University with an associate degree in 1994. Her passion for mental health was sparked as she worked as a charge nurse on the Inpatient Unit and continued to grow as she served in their outpatient setting while obtaining her Bachelor’s degree from ISU in 1996. Nurse Kempf was then able to obtain her Master’s degree from the State University at Stony Brook of New York and is board-certified by the ANCC as a Psychiatric Mental Health Nurse Practitioner. She currently practices as the Hospitalist for the Inpatient Psychiatric Unit of Hamilton Center Community Mental Health Center in Terre Haute, Indiana.