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My brother has extreme wounds on his legs that cause him excruciating pain. He will not keep the bandages on. Now the nursing home is sending him to the wound clinic. The results are amazing, but John still won't keep the wraps on. He has been in this condition for 4 years. My question is, is it appropriate to scold him? I am not sure he understands once the pain starts and he rips off the dressings and digs into the wounds. I am at a loss to help him.

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My mom broke her ankle a month ago and had to have surgery. The first night she unwrapped all her dressings and took the splint off. I have her sleeping in the recliner due to the pain and I'm sleeping on the couch so that I can hear her if she needs something. I about freaked when I saw what she did and yelled at her. She quickly informed me that I needed to stop yelling. I was relieved when I figured out she did not hurt anything and I shut my mouth. In the morning I had to re-wrap it and I told her what happened. Of course she did not remember anything but I asked for her forgiveness and we both laughed about it. I taped up the splint and wrappings with packing tape and used pink duct tape around her foot. At night she still continued to pick at it and try to take it off but it was enough of a deterrent that she would eventually give up.
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Healing wounds itch. Ask the nurse to request a doctor's order for cotton gloves or mittens "to prevent infection caused by contamination" (this will help with any concern about them being restraints) until the wounds are better healed and you can also suggest they ask for an order for ace wraps which are much harder to remove than regular dressings. I also like Grandma 1954's idea about pants that are tighter at the ankle so he can't get his hands to the bandages.
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montanacmm Dec 2018
We have tried all the suggestions. The NH has stopped him from going to the wound center because he won't comply. He actually gets the UNO (spelled wrong?)boots off!!! The nurse practitioner at the NH insisted he get them and assured me he could not get them off. I told her prior to his admittance to the NH his primary tried 3 times with the UNO boots and he managed to get them off. They stopped putting them on because he was causing more damage to the wounds. She just wasn't going for it. Guess what? He got them off in the dining room during dinner and put everything on the TABLE. They yelled at him. His reaction caused them to call me to come over and calm him down. He was crying, shaking and so upset I ended up sleeping in his recliner in his room.
I visited him today. It has been 3 weeks since he went to the wound center. His wounds look horrible. There is slough (white dead skin and blood) all around both of his legs. The wounds are about 1/4" deep. At the center they used a currett instrument to scrap everything off and they actually looked like they where healing - even without the bandages.
The NH won't let him out of his room without them or if he has blood on his fingers. So, he is room bound. No activities - no socializing - just watches TV. I try and try to get through to him, but it isn't and won't happen. Now I go visit and bring a game or craft to do in his room. I feel so horrible for him. God is good to people with dementia - they don't remember the bad stuff. :(
I do have his applications at a few other NH's that are set up for his medical and mental conditions. When he went to this one he was no where near the stage he is now. I don't think the place is a bad place, but the complexity of his medical issues is huge. Oh, did I mention his kidneys are failing and he isn't manufacturing enough blood - just had 2 pints this week....... S T R E S S S T R E S S S T R E S S S TRESS
thanks for hearing me and my gripes. xo
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You'll probably do it because you're human, but it won't help. This too will pass in time and be replaced with a different repetitive behavior. 

Make sure that you ask the doctor for help with any type of medicines to help with the pain and infection and bandages that might not be as easy to tear off.
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That’s tough. I can’t see how scolding would help. It seems like that behavior is compulsive and he probably cannot stop himself. Lots of good ideas here. I have heard family members say that Fidget Quilts can be a good distraction for loved ones with harmful behaviors. It might be worth a try. You can find fidget quilts on Amazon or Etsy.
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"Scolding" will not work with dementia patients.
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First of all, if you do NOT reprimand him, you will feel guilty for "not appearing to be interested in his welfare and care". He has Alzheimers so I doubt he will understand what you are telling him. However, I do believe you have every reason and right to 'TELL HIM OFF' and hopefully he will understand at the minimum he is doing something he should not be doing. And if you don't do this, you will hold in you your anger and frustration and this will lead to many problems for you. So, my advice is - be tough, very tough and do whatever it takes to make him stop doing what he is doing. Let's hope he gets it into his head. Also keep the medical people informed so they can figure out a way to handle this problem.
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Scolding does not work with dementia patients. They don't remember from one moment to the next what was "said" to them, so the behavior will not be changed. So, it is wasted effort - and akin to scolding a one-year-old child who does not comprehend the concept of behaviors=consequences.

The others on this list have good ideas about having adequate pain relief. Benadryl will also relieve itching, if that seems to be the issue.
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I would have him medically evaluated...to see if some medication would help him..also I would ask to see if some different kind of dsg [ wouly] would be possible..and perhaps some cover[ foe[of ]for the dsg that he would not be able to get at[ he would not be able to get at][  PERHAPS SOME KIND OG]    perhaps SOME KIND OF BOOT   sOUNDS LIKE YOU ARE BOTH SUFFERING  GET HELP QUICK.    IF  your current m.d. does not agree get a new m.d.     I hope this helps...not appropriate to scold....would not help anyway...only frustrate you.as you know this is a long term project ...get both of you aas comfortable as possible
PLEASE EXCUSE COMPUTER  ISSUES..WISH YOU THE BEST
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If they are using Unna Boot Dressings - my DH said they burned and felt like insects biting him and he made me cut them off.

Try asking your brother why he is removing the wraps. A lot of people are sensitive to them and yes, they will remove them. Ask the Wound Center to use Sterile Gauze Wraps instead. There is also a gauze sleeve that can be used - my DH never minded any gauze and left his wounds alone.
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I see many reccomendations to properly medicate his pain and while that is a good idea today it's easier to play scrabble with a dementia patient then get pain meds.
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I'm guilty of it. It doesn't work and doesn't do anything but raise your stroke level.
You can reward when they do something right, but don't expect them to remember anything.
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As a nurse and caregiver it is was demonstrated that one should not scold a person with Dementia. If the person is in pain the pain must be tested. If they itch and scratch the sensation is driving them to dig.
A few ideas.
1. keep pain adequately medicated. All pain is pain.
2. Keep nails short and filed smooth. Hands need to be cleaned thoroughly as digging spreads infection.
3. If Digging is happening at night. Soft gloves - mittens can be introduced as this will can decrease scratches.

that is a few
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It is absolutely NOT appropriate to scold someone with Alzheimer's Disease.

But it is also absolutely pointless.

Even if the scolding were to frighten him into compliance one moment, the very next moment he'd be at it again. You can't stop his doing this any more than you can stop him blinking. It's a reflex response to a source of discomfort.

Ask the wound clinic about techniques and (possibly, depending on all kinds of approvals) appliances that will help to prevent further harm.

I'm sorry, and I well remember how frustrating it is when someone you're responsible for does this (post cataract surgery, lip picking and hand scratching, in our case); but even if it worked scolding would not be justifiable. Please don't!
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You can not scold someone that does not understand.
Can you scold an infant for spitting out food, or for letting their nose run, or not using the toilet?
You need to prevent the reaction he has to feeling the pain.
How often do you scratch a mosquito bite or scratch poison ivy when you itch even though you know you should not scratch. And often when you begin to scratch that releases feelings that make what you are doing feel even better so you scratch more. Same thing is going on in your brothers head. Difference is you realize what is going on he doesn't.
If there is a way to apply a numbing agent to the area so he will not have the urge to scratch that might work.
If there is a medication he can be given to possibly suppress the OCD feelings that he may have this might stem the urge to scratch. Once the wounds are healed the medication could be cut back or discontinued.
Possibly changing the type of pants he wears to ones that have a tighter cuff at the ankle (like sweat pants with the cuffed ankle)
Last resort there are mittens that he could be fitted with that would prevent this but not sure if this would be considered a "restraint" and it would have to be approved by a Doctor and he would have t be supervised and I am sure that there are a lot of other regulations that go with something like this.
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Pain control seems key. Maybe there is some numbing cream and/or other way they can keep the area desensitized so he can focus on other things. Distraction is really important. Sounds tough but know you’re not at fault for his disease and its effects. You can just do the best you can. Glad he has a wound clinic to help.
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Is he able to wear soft athletic pants with knit cuffs at the ankles? Then perhaps a sock over the ankle cuff to reduce or prevent contact with the wounds?

How about distractions- are there any table activities that he could do that could keep him from reaching the wounds at least part of the time? Jig saw puzzles, modeling clay, painting, bead stringing, a ukulele or other simple musical instrument?

If you have access to a CERTIFIED music therapist, amazing things are now being done with OCD type conditions AND pain relief, using music as a tool. A therapeutic musician (a DIFFERENT DISCIPLINE) might also be helpful.

Finally, have any specific, structured rewards been tried? Your mention of his outings with you being a reinforcer is a VERY positive sign. Can you think of any more things that he LOVES and would potentially want to EARN by keeping his hands away from his legs?

”Scolding” is usually a pretty poor reinforcer, but “treats”, praise, and pleasant experiences usually have a better result. If you could get your brother to actually select some things HE might enjoy, so much the better.

It sounds as though you’re really an asset to your brother and he enjoys being with you, and that’s a positive reinforcer already!

I think you’re on the right track. Please post if any of these ideas work!
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See if they have "sleeves" that go over the bandages. We used these with Mom to keep the bandages on when she slept.
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Thank you for the feedback. My brother is on methadone and other pain medications, anti depression and diuretics. I did ask the wound clinic doctor if they could put a plaster cast or sedate him until they heal and I was told no. I tried a new tactic yesterday and with the support of the wound clinic, nursing home staff it appears to be working. They are also monitoring him elevating his legs. I didn't mention that he picks and digs at the wounds too. I told him that I won't be able to take him out in the wheelchair once it starts to snow and ice - so - please don't take the uno boots off. We are on day 2. He did get some of the dressing off one leg, but the compression part is intact. I am so thankful that he has been able to comply this long. I know the healing will be amazing if he does.
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Take a look at Teepa Snow videos on the web. She teaches posituve techniques for working with folks with dementia.
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I doubt if scolding will help at all. Talk to the wound clinic. They may be able to cover the dressings with plaster casts that he can’t remove. Ask about pain control, too. Find out how long the wounds should take to heal – it may be possible to medicate him for the duration. How distressing, for him and for you!
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