"My Husband Is Waiting for His Dinner"
Mrs. Chen, 86, has moderate Alzheimer's disease and has lived on your unit for eight months. It is 1600 on a winter afternoon; the sun is setting and the hallway is noisy during shift change. Mrs. Chen paces the corridor carrying her coat, saying, "I have to get home, my husband is waiting for his dinner." Her husband died four years ago. She refused her afternoon snack and has not sat down in two hours. When you step toward her she says loudly, "Don't touch me, I'm leaving." The alarmed exit door is 15 feet away.
1. How do you respond to the statement about her husband, and why is arguing with her the wrong move?
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Do not correct her. "Your husband died four years ago" asks her to absorb a loss she cannot hold onto; she will likely experience it as fresh grief and become more agitated, and she still will not have her need met.
Do not invent a story that creates a new problem either - "He's on his way here" sets up a promise you cannot keep and can escalate distress later.
Instead, respond to the feeling and the task:
- "You're worried about getting dinner ready. That's a lot to think about."
- Redirect to a familiar, purposeful activity that satisfies the impulse: "Could you help me set these napkins out? You're good at this."
- Walk with her rather than steering her from behind.
Look for the unmet need underneath. Refused snack, two hours on her feet, failing light, a loud hallway at shift change - hunger, fatigue, noise, a full bladder, or pain can all show up as exit-seeking. Offer a snack, a rest, a toileting stop. Many afternoon escalations improve when the trigger is addressed rather than the behavior corrected.
2. She keeps moving toward the door and refuses your arm. What may you do, what may you not do, and when do you call for help?
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May do:
- Stay with her; never leave a wandering resident alone near an exit.
- Lower your voice, slow down, give space, and offer two acceptable choices ("Would you like to sit by the window or in the dining room?").
- Call for a coworker by whatever call system the unit has, so the door is covered while you stay with her.
- Let the door alarm do its job if she reaches it; follow her at a safe distance rather than chasing.
May not do:
- Physically restrain, grab, block with your body, or corner her.
- Lock her in, or use the alarm as a threat or punishment.
- Leave her unsupervised to go finish another task.
Call for help now, not after you have tried everything alone: she is agitated, near an exit, and refusing contact. The nurse - not the aide - decides whether a care-plan change, a behavior consult, or a provider notification is needed.
Document and report: the time of day, the pattern (afternoon, at shift change, snack refused), what she said, what worked, what did not, and that the nurse was notified. Patterns reported over several days are what get a care plan revised.