Coming out of the fog

Pam
Pam Frampton
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Last in a two-part series

“A kind of light spread out from her. And everything changed color. And the world opened out. And a day was good to awaken to.”
—  John Steinbeck, “East of Eden”

For the past eight years, Vicki Dyer has been the program director of the dementia ward at Lakewood, a continuing care centre in Waterville, Me., a pretty little city on the west bank of the Kennebec River.

Lakewood looks welcoming — a swath of green lawn and manicured grounds with trees and park benches and a rustic fountain like an old-fashioned, hand-cranked water pump.

Take the website’s pictorial tour and you’ll see a couple of cats luxuriously stretched out on windowsills or beds, and chickens scratching outside on a gravel run.

There’s a coop made to look like a little red barn, and on fine days the elderly residents can go outside to collect the eggs and hear the chickens clucking — an activity that often triggers fond memories of simpler times.

What you won’t find at Lakewood is dementia patients lolling listlessly in chairs, lost to the world in a psychotropic haze.

They just don’t give dementia patients anti-psychotic drugs at Lakewood.

“Not on my unit,” Dyer says.

“Anti-psychotic drugs have been completely eliminated. Psychotropic medication is not meant for anyone with dementia.”

Vicki Dyer exudes warmth over the phone, but there’s a hint of steel in her voice. You get the feeling she doesn’t suffer fools gladly and is relentless in her determination to make life as good as it can get for the people in her charge.

“If you go home at the end of the day and you don’t feel good, you’ve done something wrong,” she says matter-of-factly.

Dyer and her staff have a right to feel good when they walk out the door. The transformation they have achieved at Lakewood is remarkable.

Their success story is one of many to be found south of the border, even as news reports from Canada continue to uncover the overmedication of seniors with dementia here.

Dyer says she was inspired to try a different approach more than a decade ago, when she saw dementia patients on the ward getting upset and realized there was usually  a legitimate reason.

“I was watching those patients and observing them, thinking, what’s setting them off? I put myself in their situation. Their (outbursts) are cries for help. They’re letting you know, ‘Hey! There’s something wrong with me.’”

Dementia often robs people of the ability to communicate clearly. The traditional approach to caring for them is to mute those cries for help by administering drugs.

“They’ve lost the ability to communicate through disease. It’s a huge communication problem,” Dyer said.

“We’re making the disease worse by giving medication … unnecessary drugs that could kill them. Ninety per cent of their behaviours are caused by their environment. We’re here to help them through their day, not make it worse.”

Residents at Lakewood who have been carefully weaned off meds they never should have been given have come back to life before Dyer’s eyes — every one a singular awakening.

It helps that life there is not regimented. Residents can sleep in if they like and eat when they want. There are trivia games, exercise groups, pet therapy, live music, and outings to the city.

Sometimes, they take groups of four residents at a time on camping trips to Belfast at Penobscot Bay, where the transformative experience of reconnecting with nature moves some of them to tears.

“They just want to be like they were,” Dyer says.

“Our job is to help them. … And it is so worth it. It could be us. It could be our loved ones.”

Education was key to changing the philosophy at Lakewood. Dyer says you start by getting one doctor onside to champion the new approach and then it spreads to staff, patients and families.

•••

The desire to empower family members by giving them the information they need to act as advocates for their elderly loved ones is something Dyer has in common with Dr. Leslie Kernisan, a geriatrician and clinical instructor at the University of California in San Francisco.

Kernisan writes a blog on geriatrics and technology, as well as one for caregivers of the elderly, which you can find at  http://drkernisan.net/blog/.

She offers excellent and approachable advice for anyone involved in caring for an older person, including information about the kind of medical care that should not be administered to people with certain conditions.

Defence to doctors

Kernisan acknowledges that today’s elderly tend to have a deference to doctors that is not always in their best interests; they are often unwilling to question or challenge.

“I think, partly, for people to take action (when it comes to their medical care), there has to be this loss of innocence,” she says. “Care can be risky or harmful.”

In one recent blog post, (http://drkernisan.net/choosing-wisely-healthcare-aging-adults-part-1/) she wrote about five treatments older adults and their families should question, including the use of anti-psychotic drugs for dementia patients.

“If Alzheimer’s or another dementia is causing difficult behaviors, don’t start by trying an antipsychotic medication,” she writes. “Many difficult behaviors can be reduced or managed by using non-drug approaches. This is safer and often more effective, so these approaches should always be tried first.”

Kernisan  said she chose to specialize in geriatrics because she sees it as the area of primary health care with the most room for improvement.

The idea for the blog came, she said, because she perceived a gap in the kind of practical information caregivers need.

She also offers a free monthly teleseminar, when caregivers can phone in and ask questions.

“Not everyone can be a geriatrician,” she said.

“I figured we could do a lot to train caregivers. … I thought there was relatively little support for how to be a savvy patient proxy.”

•••

Back at Lakewood, Vicki Dyer is getting ready to meet a new arrival. Her first order of business? To get him off medication that he does not need and that could actually be doing him harm.

“People that come here from the home setting, we look at their meds and ask, ‘Why are they on this?’” she says.

When residents do act out at Lakewood, there’s a standing rule for staff: follow the care plan, try to determine what triggered the outburst and try every intervention possible to soothe the person. If all else fails, they are to contact the on-call physician and ask for a strictly one-time dose of medication to calm the resident.

On Dyer’s watch?

That hasn’t happened once.

It’s better living — without chemistry.

Pam Frampton is a columnist and

The Telegram’s associate managing editor. Email pframpton@thetelegram.com.

Twitter: pam_frampton

Organizations: University of California

Geographic location: Lakewood, Waterville, Me., Canada Belfast Penobscot Bay

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Recent comments

  • Cashin Delaney
    April 27, 2014 - 09:21

    See the work of Bruce K. Alexander winning of the Sterling award for controversy on his addiction work, and Psychoanaylist and Theologian Dan Merkur on drugs and mental illness. We have some of the most excellent, but most repressed geniuses at work in our country, trying to alleviate the effects of unfortunate imprinting conditioning and dislocation. Let them be heroes to is today, not just to our wiser defendants who unearth their legacy. Acupuncture would be viewed like voodoo a couple of generations ago, and now is a staple accepted method. Sister Kenny treating Polio was absurd to vaccine pioneers, but worked and saved lives.

  • Steve
    April 26, 2014 - 21:22

    This is awesome and proves it is very much possible to take a completely drug-free approach to helping people who are distressed. I wish we would stop calling seniors and others harmed by the current medical approach "overmedicated." What we should say is that they were given drugs that were inappropriate and unhelpful, and often damaging, in lieu of more effective known approaches. Or in short language, we can say "harmed by medication" instead of "overmedicated." It is not an overuse of medication - - the problem is that we are substituting medication for compassion and creativity. And it's not just happening to the elderly in dementia wards - it is happening all over the US and Canada and spreading to the rest of the world. Drugs should ALWAYS be the last resort, and should be used at the lowest doses and as short as possible while we come up with solutions to the underlying problems. When we can't do this, we should not blame it on the patient, but on our own lack of knowledge and skill, and it should motivate us to seek more deeply for a real solution that enhances life instead of chemically muting understandable expressions of dismay. Great article! --- Steve