In light of the Thomas Fire, our thoughts and concerns are with the countless families affected by this tragedy. We are also reminded of how California’s preparedness can play a significant role in minimizing the impact and casualties of this large fire (the largest in California’s history!).
Californians are not unfamiliar with natural disasters. Most of our households have evacuation plans and well-stocked emergency kits. In addition, there are special considerations when evacuating a patient affected with cognitive impairment, memory loss, or any form of dementia.
Here are some points that every family caregiver should consider:
Get yourself and the person with dementia to a safe place.
If the need to leave quickly is likely, do not delay. Try to leave as early as possible to minimize long delays in heavy traffic.
Alert others (family, friends, medical personnel) that you are changing locations, and give them your contact in-formation. Contact them regularly as you move.
Be sure there are people other than the primary caregiver who have copies of the person’s medical history, medications, physician in-formation and family contacts.
Purchase and pack extra medications.
If your loved one uses oxygen, be sure to obtain portable tanks.
Consider preparing an emergency kit in advance. Keep it in a watertight container and store it in an easily accessible location. Your emergency kit might include:
Easy on/off clothes (a couple of sets).
Supplies of medication (or minimally, a list of medications with dosages).
A spare pair of eyeglasses.
Extra identification items for the person, such as an ID bracelet and clothing tags.
Copies of legal documents such as a power of attorney.
Copies of medical documents that indicate the person’s condition and current medications.
Copies of insurance and Social Security cards.
Use waterproof bags to hold medications and documents.
Physician’s name, address and phone numbers (including cell phone).
Recent picture of the person with dementia.
Hand lotion or other items to provide comfort.
Favorite items or foods, liquid meals.
Pillow, toy or something else to hug.
During an evacuation
People with dementia are especially vulnerable to chaos and emotional trauma. They have a limited ability to understand what is happening, and they may forget what they have been told about the disaster. Be alert to potential reactions that may result from changes in routine, traveling or new environments.
When appropriate, inform others (hotel or shelter staff, family members, airline attendants) that your loved one has dementia and may not understand what is happening.
Changes in routine, traveling and new environments can trigger agitation, wandering, and increase in behavioral symptoms, including hallucinations, delusions and sleep disturbance. Do not leave the person alone. It only takes a few minutes to wander away and get lost. And do your best to remain calm. The person with dementia will respond to the emotional tone you set.
Tips for preventing agitation
Reassure the person. Hold hands or put your arm on his or her shoulder. Say things are going to be fine.
Find outlets for anxious energy. Take a walk together or engage the person in simple tasks.
Redirect the person’s attention if he or she becomes upset.
Move the person to a safer or quieter place, if possible. Limit stimulation.
Make sure the person takes medications as scheduled.
Try to schedule regular meals and maintain a regular sleep schedule.
Avoid elaborate or detailed explanations. Provide information using concrete terms. Follow brief explanations with reassurance.
Be prepared to provide additional assistance with all activities of daily living.
Pay attention to cues that the person may be overwhelmed (fidgeting, pacing).
Remind the person that he or she is in the right place.
The way which caregivers approach people with dementia is critical part of avoiding agitation. A gentle, supportive, simple approach will almost always be more successful than commands or rationalizing. However, it is very difficult to keep calm and collected in an emerging situation, such as the one our community experienced with the approach of the gargantuan Thomas Fire. The smoke in the air, the fire engines going by, the evacuation warnings: all signal approaching danger. Dementia patients, even if kept away from the news, will sense the danger and the caregiver’s concern or anxiety and become anxious themselves.
If your loved one has been showing signs of agitation under these unusual circumstances, here are some strategies to consider:
Gently guide the person being evacuated while speaking in a calm and reassuring voice.
Use gentle physical touch to calm person. Keep in mind that holding hands and hugging may be comforting for some dementia patients, but perceived as restraining by others.
Try these communication techniques:
As always, D.A.R.E. – Do not Argue, Reason, or Explain.
Try not to reason with the person as he/she no longer has the ability to think logically.
Evacuations are stressful for all of us. Try not to express your own anxiety verbally or with physical movements such as fast pacing, rushing through directions, talking over yourself, etc. These responses are easily sensed and likely to increase confusion and agitation.
Speak slowly and clearly. Use short simple sentences.
Be sure you have the person’s attention before speaking and touching.
Give clearly stated directions for each step. Complete one step at a time. The person no longer has the ability to think of several things at once and may be overwhelmed in trying to keep track of multiple events, statements, questions or directions.
Use repetition. Frequent, clearly stated reminders and needed to reassure the person with dementia.
Calmly acknowledge their feelings. Saying something like “I know you are concerned about what is happening,” can be helpful in reducing agitation.
Reassure him that “we are safe”.
Make sure person is comfortable – clothes are not tight, person is not too hot or too cold.
Throughout the evacuation period, keep daily routine as consistent as possible. Limit changes and surprises as much as possible. For some people with dementia, the slightest change may lead to confusion and disorientation. Try scheduling meals, bathing, and walks, for example, at the usual times.
Orient person to time by using calendars and large numeral clocks, as the person may lose a sense of time because of the disease and the novelty of being removed from their familiar environment.
Make sure the person is protected from hurting him/herself. Remove sharp utensils, tools, and objects from environment.
Distract the person with a favorite food or activity. This may reduce agitated feelings. Distraction and avoidance are often the most useful approaches to handling agitation.
Try music, massage, quiet readings as way to calm person.
Various medications including anti-anxiety, antidepressants and neuroleptics can often reduce agitated behavior. This should be done under the direct supervision of a physician. Contact the doctor and ask if a change in dosage would be helpful.
After returning to your own home and back to the regular routine, try not to remind person of incident. He/she will probably soon forget.
Take care of yourself
Take care of yourself by finding a good listener to hear your thoughts and feelings about the event. Find moments to breathe, meditate and reflect.
These tips and more are detailed in The Calm Before the Storm: Family Conversations about Disaster Planning, Caregiving, Alzheimer’s Disease and Dementia. To order a free copy of the booklet – the first comprehensive natural disaster planning guide specifically created for caregivers, families and friends of those with memory disorders – visit http://www.thehartford.com/calmbeforethestorm or you can download it at https://www.thehartford.com/sites/the_hartford/files/cmme-storm.pdf