Molly’s Kilt: Another True Dementia Care Story

I came across this article through LinkedIn.

“Kilt:  A costume sometimes worn by Scotchmen in America and Americans in Scotland” – Ambrose Bierce

By , Nurse, Dementia Specialist, author, “​ Kisses for Elizabeth:Common Sense Guidelines for Dementia

May 16, 2015

Sometimes what seems like an insignificant thing can mean the most to a person with dementia. We need to understand this and respect this.

      In 1995 I began consulting with several long term care facilities in Northern Virginia, providing them with education and training in dementia care and assisting with the development of dementia units. One of the facilities was home to a patient named “Molly”, a 63 year old woman who had been diagnosed with early onset Alzheimer’s disease. When the staff told me they were having problems with Molly, it was hard to believe. Molly appeared to be friendly, cooperative and interested in her surroundings. However, ever since her admission, she had worn the same outfit refusing to consider a change to anything else. Since she had been at the facility almost 7 weeks, her clothing had become quite soiled and in need of repair.

Bathing and personal care were apparently not a problem for Molly. She happily allowed the staff to assist her in the shower and had changed into pajamas every night. On the fourth night she was there, however, the staff had taken the sweater and kilt she had been wearing from her room intending to launder and clean them. When Molly awoke in the morning they were not there.

      When people with dementia become upset, their reactions can range from simply complaining to crying or anger, and in the extreme, they can have what we call a catastrophic reaction. This is what happened to Molly. She simply could not cope with what she perceived as someone stealing her kilt and sweater. Molly was hysterical and combative. Although the nursing assistants tried to explain that her clothes were being cleaned, Molly would not calm down. Finally, the staff found it necessary to contact her doctor to get an order for a sedative. After taking the medication, Molly became lethargic and slept most of the day. In the evening her kilt and sweater were returned.

      The staff was now afraid to take Molly’s kilt and sweater away again. Even when she showered, Molly kept them nearby and had taken to sleeping in them at night. Molly had also stopped attending activities and preferred to sit quietly in her room most of the day.  However, when I stopped by for a visit, I was surprised at how articulate she was despite her memory loss and some obvious confusion. We spoke about a few things I thought would not be threatening to her. Although the conversation was a little disjointed at times, she told me about her love of cooking and a dog she had once owned. She also told me a little about her family. Molly was Irish and her parents had immigrated to the United States when Molly was 2 years old. At this point in the conversation, Molly simply got up and walked out.

I asked the staff if they had talked to Molly’s family about her attachment to her clothing but they told me that Molly had been admitted when her older sister Kate had a stroke. Kate had recently been admitted to the skilled nursing unit in the same facility for rehabilitation, but had not yet recovered enough to be involved in Molly’s care. Although the social worker had taken Molly to visit Kate twice since their admission, all the staff knew was that neither of the two women had ever married and Kate and Molly lived together for most of their lives. I suggested that the social worker visit Kate alone and see if she could get more information.

When I returned a few days later the social worker had some information for me. Kate was recovered enough to now visit Molly and wanted to attend her care plans, but she herself would also have to remain in the nursing home for extended physical therapy. The two women were down in Molly’s room which gave me the perfect opportunity to ask Kate about the kilt and sweater.

      As I approached the room, I heard both women laughing, something Molly had not enjoyed for several weeks. Kate was helping Molly recall funny stories about their childhood and both women held hands as they giggled at the memories.
Kate was more than happy to talk to me as she had been concerned that we would not understand Molly’s need to wear her kilt and matching sweater. She told me that the two women decided to celebrate Molly’s 40th birthday by visiting the town where they were born. The highlight of their trip was the time they spent with their father’s brother, “Collin,” who gave them information on their family history. As they were leaving, their uncle Collin had given each of them kilts and sweaters which represented the colors of their family’s clan. He explained that, had their parents survived, they would have been given similar outfits when they reached their teens.

      Kate returned home and hung her kilt in the closet, wondering when she would have the opportunity to wear it. Molly, however, wore her’s frequently saying that it helped bring her a little closer to the parents she could not remember.

      When Molly was diagnosed with Alzheimer’s disease, she became very depressed. The kilt and sweater seemed to comfort her and eventually she started wearing the outfit every day. Kate admitted that she had eventually replaced Molly’s kilt and sweater with her own when they became frayed. Recently she had been staying up late once a week to wash and repair the sweater and spot clean the kilt that was left, making sure to return it to Molly’s room before she awoke the next morning.

      We now knew why the kilt and sweater were so important to Molly, but the outfit was deteriorating and losing it might be a problem for her. The answer came from Kate who was able to give the social worker the addresses of their cousins who still lived in Ireland. By sending them a picture of the kilt and sweater, the social worker was able to help Kate purchase an additional two outfits that were almost identical to the set that Molly owned. When they arrived a week later the staff set up a rotating schedule for the clothing. Molly would now always have a clean set to wear.

      I had the opportunity to visit the facility again to provide some training the following year. Remembering Molly, I asked the staff about her. Once again I found both women in Molly’s room but this time, Kate was able to walk and had moved back home while Molly had declined. Molly was silent. Her dementia had progressed fairly rapidly which was not unusual for early onset Alzheimer’s disease. Kate was there to hold her hand, still telling her stories about their childhood, but there was no laughter. Instead there was perhaps a flicker of recognition in Molly’s eyes while Kate’s were full of tears.

      I sat with Kate for a while.. She was facing life without her sister and talked about how much she would miss her. They had been very close all of their lives and had no other immediate family. Kate had always watched over Molly. As I was leaving, Kate made a point of telling me how grateful she had been for the understanding way the staff treated Molly and her need to wear her kilt and matching sweater. I made a point of letting them know this before I left.

What we learned:
Most of us have something from our past that is precious to us. When people suffer from Alzheimer’s disease or other dementias, the memory loss problems can be devastating. Immediate and recent memories are affected first, and eventually only the earliest memories remain. For these individuals, specific items may become extremely important. For Molly it was her kilt and sweater. Using a common sense approach, we found a way to let Molly have her treasured kilt and sweater without having to wear soiled clothing.

Molly’s story is one of 40 that can be found in the book “Kisses for Elizabeth: Common Sense Guidelines for Alzheimer’s and Dementia Care” available on Amazon and the website: Kissesforelizabeth.com

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