[grim ambience]
Les.
[grim ambience]
Les.
Les, you’re here in your home. I'm your nurse, Chad, and I'm
here with you. Your wife is here too.
I want you to look around. Can you see the room... your wife?
We’re at your home, Les. The walls are white, your chair is
brown, and I’m checking your blood pressure.
You're safe.
Les, my blood pressure monitor is still around your arm.
May I remove it?
Yeah.
He’s been doing this a lot since your last visit.
Does it seem to happen most when looking
at the ceiling?
It’s like he’s afraid something’s gonna fall on him.
But then sometimes he just stares into the distant- like
something's out there.
And the reaction. Is it more like what happened two weeks
ago or today?
It varies, but they’re definitely more aggressive at
night. I think that’s why he wants to sleep separately.
Les, we noticed you seem uncomfortable when looking up
at the ceiling, or looking off into the distance.
Can you tell us what's happening in that moment?
The air... when it touches me... I can smell him.
Would it help if we closed the window?
Les, we closed the window. Can you still smell it?
He’s still there... I can’t see him... he’s still there.
Are you remembering something?
I can’t get away.
[tunnel ambience]
[trip wire]
[grenade pin]
[explosion]
Are you remembering a time when you were in danger?
Are you remembering Vietnam?
You survived, Les. You're safe, at home, with your wife.
We’ll do everything we can to make sure you feel safe.
NARRATOR: Symptoms of Post-Traumatic Stress Disorder, or PTSD,
may present differently in those with cognitive impairment.
Such individuals are more at risk to become disoriented by
sounds, smells, memories, and flashbacks. Some patients may
be able to verbally communicate their experiences or fears,
while others may rely on non-verbal communication, such
as looking afraid, striking out, or trying to move away.
Using techniques called “grounding” may aid in bringing
the person back to the present. Change the environment. Keep a
nightlight on. Play music. Or draw attention to the here
and now. For example, describing the room and how the
person is physically connected, such as saying: “You are
sitting in a soft chair.” A person experiencing a flashback
may have difficulty orienting themselves to present day
reality. Because of this, they may believe a person wants to
harm them, when in truth, that person wishes to help them.
It is sometimes hard to know what is causing behaviors.
Knowing someone’s trauma history can provide clues.
Can you tell me what job you had in Vietnam?
Or, Mrs Bloom, can you?
He always said he was an engineer.
Les, were you an engineer in Vietnam?
No.
Would you like to share your job with us, Les?
Tunnel Rat.
Tunnel Rat?
Did you have experiences as a tunnel rat that bother you now?
Would you feel safe talking about how those experiences
impacted you?
I understand. Would it be okay if I checked in with you at
another visit? We can take it slow and figure out together
how you can share, so you feel in control and it’s
less upsetting.
Yeah.
Les, I wasn’t able to get a good reading on your blood
pressure. Would you like me to recheck that now, or after
I listen to your chest and breathing?
After.
Great.
Can you sit up for me, please?
Perfect. If you start to feel uncomfortable, dizzy, or
anything else let me know. We can slow down, okay?
NARRATOR: Explaining what you plan to do, and offering simple
choices remains central to providing trauma informed
person-centered care, especially for individuals with
dementia. This can help a person gain a sense of control
when confused or agitated, or when memories become
overwhelming. Aggression, physical tension, and pain may
also be present, but relating it to PTSD, medical illness, or
a combination can be hard to determine. For example,
difficulty sleeping can be a symptom of PTSD, and can be
worsened by nightmares, but is also common in other medical
conditions. If you know the person’s story involves
military experience, then it may be helpful to consider
its role in contributing to, or worsening these symptoms.
As Veterans age, many carry lasting effects of trauma,
which can manifest in unique ways late in life. But, if a
person is unable to share information because they are
feeling confused, or they find it too difficult, we may need
to find alternate methods of understanding them.
You think he has PTSD.
He seems to show those symptoms.
I knew there was more to it.
I’ve been having the same thoughts over the past couple
visits. I started to notice he's been more impulsive, and
his aggressive behaviors and withdrawal were worsening.
Couple that with what seems to be flashbacks... Mrs Bloom,
I think it’s time we discuss if there are other things we need
to do to best care for your husband.
Alone. In the dark.
Knowing someone is waiting for you.
And you still go in.
Your husband’s a brave man, Mrs Bloom.
Yes.
Family members may not be aware, or are vaguely aware, of
traumatic events experienced by their loved ones. However, they
may be conscious of potential triggers. For example: A loved
one with cognitive impairment may get more agitated in a
shower if it reminds them of a foxhole collapsing during
a rain storm.
It can be helpful to ask family members when they notice
heightened agitation or anxiety. Keep in mind, family members
may feel more distress seeing their loved one in distress,
but not knowing the underlying reason.
Both patients and caregivers benefit from the support,
reassurance, and education about how early traumatic
experiences may re-emerge at the end of life.
For a healthcare provider: Understanding PTSD, how it may
affect the dying process, and how it may present differently
in patients with dementia, will help you care for patients and
their families at the end of life.