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Facts about
Alzheimer's and Dementia:
Here are some articles written by the "Alzheimer's Foundation Of
America" which should be of interest to you:
http://www.alzfdn.org/network.shtml
DEFINITION OF ALZHEIMER’S
Alzheimer's disease is a progressive, degenerative disorder
that attacks the brain's nerve cells, or neurons, resulting in loss of memory,
thinking and language skills, and behavioral changes.
These neurons, which produce the brain chemical, or
neurotransmitter, acetylcholine, break connections with other nerve cells and
ultimately die. For example, short-term memory fails when Alzheimer's disease
first destroys nerve cells in the hippocampus, and language skills and judgment
decline when neurons die in the cerebral cortex.
Two types of abnormal lesions clog the brains of
individuals with Alzheimer's disease: Beta-amyloid plaques—sticky clumps of
protein fragments and cellular material that form outside and around neurons;
and neurofibrillary tangles—insoluble twisted fibers composed largely of the
protein tau that build up inside nerve cells. Although these structures are
hallmarks of the disease, scientists are unclear whether they cause it or a
byproduct of it.
Alzheimer's disease is the most common cause of dementia,
or loss of intellectual function, among people aged 65 and older.
Alzheimer's disease is not a normal part of aging.
Origin of the term Alzheimer's disease dates back to 1906
when Dr. Alois Alzheimer, a German physician, presented a case history before a
medical meeting of a 51-year-old woman who suffered from a rare brain disorder.
A brain autopsy identified the plaques and tangles that today characterize
Alzheimer's disease.
DIAGNOSIS
Clinicians can now diagnose Alzheimer's disease with up to
90 percent accuracy. But it can only be confirmed by an autopsy, during which
pathologists look for the disease's characteristic plaques and tangles in brain
tissue.
Clinicians diagnose "probable" Alzheimer's disease by
taking a complete medical history and conducting lab tests, a physical exam,
brain scans and neuropsychological tests that gauge memory, attention, language
skills and problem-solving abilities.
Proper diagnosis of Alzheimer's disease is critical since
there are dozens of other causes of dementia that could exhibit the same
symptoms. Some of these dementias, such as those caused by vitamin deficiency,
thyroid problems and depression, are reversible; of those that are irreversible,
Alzheimer's disease is the most common.
The sooner an accurate diagnosis of "probable" Alzheimer's
disease is made, the easier it is to manage symptoms and plan for the future.
SYMPTOMS
Symptoms are divided into two categories: cognitive, or
intellectual, and psychiatric.
Differentiating them is important so that behavioral
problems that are caused by loss of cognitive functioning are not treated with
anti-psychotic or anti-anxiety medications.
Cognitive, or intellectual, symptoms are amnesia, aphasia,
apraxia and agnosia (the 4 As of Alzheimer's).
Amnesia is defined as loss of memory, or the inability to
remember facts or events. We have two types of memories: the short-term (recent,
new) and long-term (remote, old) memories. Short-term memory is programmed in a
part of the brain called the temporal lobe, while long-term memory is stored
throughout extensive nerve cell networks in the temporal and parietal lobes. In
Alzheimer's disease, short-term memory storage is damaged first.
Aphasia is the inability to communicate effectively. The
loss of ability to speak and write is called expressive aphasia. An individual
may forget words he has learned, and will have increasing difficulty with
communication. With receptive aphasia, an individual may be unable to understand
spoken or written words or may read and not understand a word of what is read.
Sometimes an individual pretends to understand and even nods in agreement; this
is to cover-up aphasia. Although individuals may not understand words and
grammar, they may still understand non-verbal behavior, i.e., smiling.
Apraxia is the inability to do pre-programmed motor tasks,
or to perform activities of daily living such as brushing teeth and dressing. An
individual may forget all motor skills learned during development. Sophisticated
motor skills that require extensive learning, such as job-related skills, are
the first functions that become impaired. More instinctive functions like
chewing, swallowing and walking are lost in the last stages of the disease.
Agnosia is an individual's inability to correctly interpret
signals from their five senses. Individuals with Alzheimer's disease may not
recognize familiar people and objects. A common yet often unrecognized agnosia
is the inability to appropriately perceive visceral, or internal, information
such as a full bladder or chest pain.
Major psychiatric symptoms include personality changes,
depression, hallucinations and delusions.
Personality changes can become evident in the early stages
of Alzheimer's disease. Signs include irritability, apathy, withdrawal and
isolation.
Individuals may show symptoms of depression at any stage of
the disease. Depression is treatable, even in the latter stages of Alzheimer's
disease.
Psychotic symptoms include hallucinations and delusions,
which usually occur in the middle stage. Hallucinations typically are auditory
and/or visual, and sensory impairments, such as hearing loss or poor eyesight,
tend to increase hallucinations in the elderly.
Hallucinations and delusions can be very upsetting to the
person with the disease. Common reactions are feelings of fear, anxiety and
paranoia, as well as agitation, aggression and verbal outbursts.
Individuals with psychiatric symptoms tend to exhibit more
behavioral problems than those without these symptoms. It is important to
recognize these symptoms so that appropriate medications can be prescribed and
safety precautions can be taken.
Psychotic symptoms can often be reduced through the
carefully supervised use of medications. Talk to your primary care doctor,
neurologist or geriatric psychiatrist about these symptoms because they are
treatable.
LIFE EXPECTANCY
Alzheimer's disease stretches from two to twenty years, and
individuals live on average for eight to ten years from diagnosis.
Individuals with Alzheimer's disease are likely to develop
co-existing illnesses and most commonly die from pneumonia.
Alzheimer's disease is the eighth leading cause of death in
the U.S.
TREATMENT
Currently, there is no cure for Alzheimer's disease.
Researchers are continually testing the effectiveness of
various drug therapies that will control symptoms; slow, reduce and/or reverse
mental and behavioral symptoms; and prevent or halt the disease.
The U.S. Food and Drug Administration (FDA) has so far
approved four drugs for the treatment of mild to moderate Alzheimer's disease.
They are tacrine (Cognex®), introduced in 1993; donepezil hydrochloride
(Aricept®), marketed since 1996; rivastigmine (Exelon®), available since the
spring 2000; and galantamine hydrobromide (Reminyl®), approved in February 2001.
These drugs inhibit the enzyme that breaks down the brain chemical
acetylcholine, and thereby may help slow the worsening of symptoms.
The FDA in October 2003 approved memantine HCI (NamendaTM)
for the treatment of moderate to severe Alzheimer's disease, which can slow the
decline in mental function.
The National Institute on Aging, in concert with the FDA,
tracks private- and government-sponsored clinical trials; contact the
Alzheimer's Disease Education and Referral Center (www.alzheimers.org/trials or
800-438-4380).
RESEARCH
The causes of Alzheimer's disease are still unknown.
Current research indicates that Alzheimer's disease may be
triggered by a multitude of factors, including age, genetic makeup, oxidative
damage to neurons from the overproduction of toxic free radicals, serious head
injuries, brain inflammation, and environmental factors.
Age is the most important known risk factor for Alzheimer's
disease.
There are two types of the disease: sporadic Alzheimer's
disease and familial Alzheimer's disease (FAD). Unlike sporadic Alzheimer's
disease, FAD follows an obvious inheritance pattern. Less than ten percent of
Alzheimer's disease cases are FAD. This rare form of Alzheimer's disease usually
occurs between the ages of 30 and 60.
On the genetic front, scientists have zeroed in on three
mutations on chromosomes 1, 14 and 21 that cause early-onset Alzheimer's
disease, which generally affects those aged 30 to 60.
Other genes boost susceptibility, but do not signal that a
person will definitely develop the disease. Multiple research studies indicate
that inheritance of a specific one of the three forms, or alleles, of the
apolipoprotein E (apoE) gene on chromosome 19 heightens the risk of late-onset
Alzheimer's disease. Those who carry one copy of the allele e4 face a higher
risk of developing Alzheimer's disease, and those with two copies of e4 confront
the greatest risk. Another relatively rare apoE allele, e2, appears linked to a
lower risk of the disease.
Several other studies suggest that a gene or genes on
chromosome 10 may also boost an individual's risk of developing late-onset
Alzheimer's disease.
STATISTICS
Alzheimer's disease currently strikes an estimated 4.2
million to 5.8 million Americans.
It is projected that the number of Americans with
Alzheimer's disease could more than triple to 16 million by mid-century.
An estimated one in ten persons over age 65 and nearly half
of those 85 or older have Alzheimer's disease.
It is estimated that one to four family members act as
caregivers for each individual with Alzheimer's disease.
Although Alzheimer's disease is not a normal part of aging,
the risk of developing the illness rises with age. Current research from the
National Institute on Aging indicates that the prevalence of Alzheimer's disease
doubles every five years beyond age 65.
As our population ages, the disease impacts a greater
percentage of Americans. The number of people age 65 and older will more than
double between 2000 and 2030 to 70.3 million or 20 percent of the U.S.
population; likewise, those 85 and older will rise two-fold, to 8.9 million,
according to the U.S. Census Bureau.
About Dementia
DEFINITION
Dementia is a general term that describes a group of
symptoms-such as loss of memory, judgment, language, complex motor skills, and
other intellectual function-caused by the permanent damage or death of the
brain's nerve cells, or neurons.
One or more of several diseases, including Alzheimer's
disease, can cause dementia.
Alzheimer's disease is the most common cause of dementia in
persons over the age of 65. It represents about 60 percent of all dementias.
The other most common causes of dementia are vascular
dementia, caused by stroke or blockage of blood supply, and dementia with Lewy
bodies. Other types include alcohol dementia, caused by sustained use of
alcohol; trauma dementia, caused by head injury; and a rare form of dementia,
frontotemporal dementia.
The clinical symptoms and the progression of dementia vary,
depending on the type of disease causing it, and the location and number of
damaged brain cells. Some types progress slowly over years, while others may
result in sudden loss of intellectual function.
Each type of dementia is characterized by different
pathologic, or structural, changes in the brain, such as an accumulation of
abnormal plaques and tangles in individuals with Alzheimer's disease, and
abnormal tau protein in individuals with frontotemporal dementia.
WARNING SIGNS
Trouble with new memories
Relying on memory helpers
Trouble finding words
Struggling to complete familiar actions
Confusion about time, place or people
Misplacing familiar objects
Onset of new depression or irritability
Making bad decisions
Personality changes
Loss of interest in important responsibilities
Seeing or hearing things
Expressing false beliefs
DIAGNOSIS
Experienced clinicians can accurately diagnose dementia 90
percent of the time.
Accurate diagnosis is critical. Some conditions that cause
symptoms of dementia, such as hormone imbalance, vitamin deficiency and
infections, can be reversed. For irreversible dementias, treatment options vary
depending on the disease.
Obtaining a proper diagnosis involves consulting with a
healthcare professional expert in dementia, communicating symptoms and
undergoing extensive testing.
Diagnostic tools include a complete medical history; blood,
urine or other medical tests; neuropsychological tests that measure memory,
problem solving, attention, and language; and brain scans.
Individuals with clinically diagnosed dementia have clear
cognitive loss in two or more intellectual domains, such as amnesia (loss of
memory) and aphasia (inability to communicate effectively), but almost all
individuals with Alzheimer's disease demonstrate short-term memory impairment.
Other types of dementia may begin with a slow loss of
memory function; however, a careful, clinical evaluation will usually provide
information that suggests dementia other than Alzheimer's disease.
SYMPTOMS
Symptoms of dementia are divided into two categories:
cognitive, or intellectual, and psychiatric.
Differentiating them is important so that behavioral
problems that are caused by loss of cognitive functioning are not treated with
anti-psychotic or anti-anxiety medications.
The clinical symptoms of dementia vary, depending on the
type of disease causing it, and the location and number of damaged brain cells.
With Alzheimer's disease, manifestation of all of these symptoms is quite
probable; with other types of dementia, it is possible to have some or all of
these symptoms.
Cognitive, or intellectual, symptoms are amnesia, aphasia,
apraxia and agnosia.
Amnesia is defined as loss of memory, or the inability to
remember facts or events. We have two types of memories: the short-term (recent,
new) and long-term (remote, old) memories. Short-term memory is programmed in a
part of the brain called the temporal lobe, while long-term memory is stored
throughout extensive nerve cell networks in the temporal and parietal lobes. In
Alzheimer's disease, short-term memory storage is damaged first.
Aphasia is the inability to communicate effectively. The
loss of ability to speak and write is called expressive aphasia. An individual
may forget words he has learned, and will have increasing difficulty with
communication. With receptive aphasia, an individual may be unable to understand
spoken or written words or may read and not understand a word of what is read.
Sometimes an individual pretends to understand and even nods in agreement; this
is to cover-up aphasia. Although individuals may not understand words and
grammar, they may still understand non-verbal behavior, i.e., smiling.
Apraxia is the inability to do pre-programmed motor tasks,
or to perform activities of daily living such as brushing teeth and dressing. An
individual may forget all motor skills learned during development. Sophisticated
motor skills that require extensive learning, such as job-related skills, are
the first functions impaired by dementia. More instinctive functions like
chewing, swallowing and walking are lost in the last stages of the disease.
Agnosia is an individual's inability to correctly interpret
signals from their five senses. Individuals with dementia may not recognize
familiar people and objects. A common yet often unrecognized agnosia is the
inability to appropriately perceive visceral, or internal, information such as a
full bladder or chest pain.
Major psychiatric symptoms include personality changes,
depression, and hallucinations and delusions.
Personality changes can become evident in the early stages
of dementia. Signs include irritability, apathy, withdrawal and isolation.
Individuals with dementia may show symptoms of depression
at any stage of the disease. Depression is treatable, even in the latter stages
of dementia.
Psychotic symptoms include hallucinations and delusions,
which usually occur in the middle stage of dementia. Hallucinations occur in
about 25 percent of dementia cases and are typically auditory and/or visual.
Sensory impairments, such as hearing loss or poor eyesight, tend to increase
hallucinations in the elderly with dementia. Delusions affect about 40 percent
of individuals with dementia.
Hallucinations and delusions can be very upsetting to the
person with dementia. Common reactions are feelings of fear, anxiety and
paranoia, as well as agitation, aggression and verbal outbursts.
Individuals with psychiatric symptoms tend to exhibit more
behavioral problems than those without these symptoms. It is important to
recognize these symptoms so that appropriate medications can be prescribed and
safety precautions can be taken.
Psychotic symptoms can often be reduced through the
carefully supervised use of medications. Talk to your primary care doctor,
neurologist or geriatric psychiatrist about these symptoms because they are
treatable.
DELIRIUM
Delirium is defined as a temporary confusion caused by
underlying medical problems, drug toxicity or environmental factors.
Delirium is a very common, yet often unrecognized condition
in elderly individuals with dementia.
It is marked by confusion and disorientation; fluctuating
levels of consciousness; jerking motions; disruption of sleep-wake cycles;
hallucinations, delusions and anxiety; memory impairment and altered speech;
intermittent agitated behavior; mood changes; behavioral problems such as
aggression and wandering; and changes in blood pressure and pulse.
Delirium follows a time pattern. It has an abrupt
onset—less than one month; and a short duration—not more than one month from the
time the symptoms are detected to intervention and recovery.
Medications are often the major cause of delirium in the
elderly. This results from drug interactions, failure to take medication, slow
absorption of medications, characteristics of the drug itself, or the use of
anesthesia and other medication during and after surgery.
Underlying medical problems that may cause delirium are
bladder infection, pneumonia, dehydration, metabolic disorders, oxygen
deficiency, constipation, and urinary retention.
Environmental factors may also contribute to delirium. This
ranges from sensory overload, such as too much noise, to sensory deprivation
stemming from isolation, hearing impairment and lack of environmental
stimulation.
It is important to identify the risk factors for delirium
and learn about preventative measures. For example, providing adequate hydration
and carefully managing medication are preventative approaches.
Delirium does not involve structural brain damage.
Individuals may completely improve from delirium if the
medical problem is identified and treated.
If delirium is left untreated, individuals develop
additional complications that may result in poor outcome or death.
DEPRESSION
Individuals diagnosed with dementia can present with
coexisting depression.
Several symptoms are common to both dementia and
depression: apathy, lack of interest in people or activities, poor sleep,
restlessness, memory loss, and difficulty concentrating.
Distinguishing between dementia and depression, and
determining whether each condition exists or if they co-exist is critical to
ensure proper treatment.
The frequency and severity of depression remain fairly
constant through most stages of Alzheimer's disease.
For most individuals with Alzheimer's disease who develop
depression, it tends to be mild and moderate in severity, and suicidal behavior
or completed suicide is rare.
Depression may cause or worsen memory loss and other
cognitive impairment.
It appears that Alzheimer's disease is more likely to
develop in people who have depression plus cognitive impairment, but that
depression occurring without cognitive impairment does not increase the risk of
developing the disease.
Counseling or psychotherapy may be helpful in mild to
moderate depression in the earliest stages of dementia, but systematic studies
on this issue are lacking.
Antidepressants are usually indicated for those with
Alzheimer's disease who demonstrate persistent or severe depression. However,
only half of the published research shows superiority for antidepressant
medication over placebo in the treatment of depression in those with Alzheimer's
disease or dementia in general.
If a physician prescribes antidepressant medications, it is
important to monitor the choice of medication, dosage, possible side effects,
impact on cognition and activities of daily living, and the status of the
depression.
Contributed by D.P. Devanand, M.D., a professor of clinical
psychiatry and neurology at the College of Physicians and Surgeons at Columbia
University in New York.
Education and Care
12 WAYS TO BOOST CAREGIVER SUCCESS
Educate yourself about the disease. Read books, attend
workshops and consult with healthcare professionals.
Learn caregiving techniques. Key areas are communication
skills, safety concerns, and managing behavioral challenges and activities of
daily living.
Understand the experience of your loved one. Adjust your
expectations. Be patient and kind.
Avoid caregiver burnout. Make time for yourself. Join
caregiver support groups. Pursue interests beyond your caregiving role, such as
exercise, hobbies, journaling and art.
Maintain your own physical and mental health. Exercise,
respite and other activities can reduce stress. Seek medical help if there are
signs of depression.
Discuss the situation with family and friends. Support
systems are critical.
Do cognitive stimulation activities with your loved one.
Listening to music, word puzzles and memory games can easily be done at home.
Foster communication with physicians. Be involved in your
loved one's medical care. Ask questions about the progression of the disease,
express concerns and discuss treatment options.
Take care of financial, legal and long-term care planning
issues. Try to involve your loved one in decision-making, if they are still
capable of providing input, and consider their wishes related to future care and
end-of-life issues.
Smile. Kindness, humor and creativity are essential parts
of caregiving. Hugs, hand massage and other gentle physical contact will help
your loved one feel connected and loved.
Think positive. Focus on your loved one's remaining
strengths and enjoy your relationship while you are still able to.
Reach out for care. Call the Alzheimer's Foundation of
America—866.AFA.8484, for counseling, information and referrals to local
resources nationwide.
COMMUNICATION TECHNIQUES
It's not what you say, but how you say it. This expression
holds doubly true when communicating with individuals with dementia.
Alzheimer's disease or related illnesses impair a person's
ability to understand words and to speak. However, they can still benefit from
non-verbal communication—body language, voice tone and facial expressions. As
the individual's ability to process verbal information declines, the importance
of how caregivers communicate with them, verbally and non-verbally, increases.
Here are some tips to enhance
interactions:
Remember that the individual with dementia might be feeling
confused, anxious, irritable and depressed, and suffering from low
self-esteem.
Speak in a tone that is calm and reassuring; talk slowly
and distinctly; and use simple words.
Approach the individual from the front. It may startle and
upset him if you touch him unexpectedly or draw near from behind.
Before asking the individual to do something, address him
by name to get his attention. While you are speaking, maintain eye contact to
help him focus.
Ask only one question at a time and allow time for an
answer. If he does not seem to understand, repeat the question using the same
wording. If this does not work, after a few minutes, rephrase it.
Allow the individual adequate time to respond in
conversation or when performing an activity. Rushing will increase confusion.
If the individual repeatedly asks a question, keep in mind
that he cannot remember the response you have just given him. Instead of
answering the question after a second or third repetition, reassure the
individual in some way-everything is fine, you will be with him, you will help
him.
Eliminate distractions, such as the TV or radio, when
talking to the person with dementia.
Avoid statements that sound negative. For example, instead
of "Don't go outside," say, "Stay inside." Use humor whenever possible, though
not at the individual's expense.
Break down all tasks into simple steps. Tell the individual
one step at a time what to do. Giving too many directions at once or too quickly
will increase confusion. If the individual gets upset and becomes uncooperative,
stop and try again later.
Use non-verbal gestures, when appropriate, to help convey
what you want done. For example, point to objects or demonstrate an action, such
as brushing your teeth.
EATING
Weight loss is common among individuals with dementia,
regardless of whether they are cared for at home or in a long-term care
facility. Assessing why they are not eating and obtaining an accurate diagnosis
are the first steps toward maintaining adequate nutrition and body weight.
Possible problems:
Has the individual forgotten how to feed himself?
Do they have trouble chewing or swallowing?
Are they having problems with dentures or gums?
Have they lost the ability to taste?
Is the individual having coordination problems, such as
difficulty in using the silverware?
Are there co-existing medical or psychiatric problems, such
as ulcers, depression or delusions, that are causing loss of appetite?
Do they seem disinterested in eating?
Is the person fearful at meal times? For example, do they
say or think that the food is poisoned?
Are they unable to ask for food?
Do they dislike the food?
Is there too much noise or other environmental stimuli?
Do they eat only sweets, or like to eat them first?
Are they filling up on fluids?
Are other residents in a group setting eating the
individual's food?
Tips:
Consult a physician to detect any medical causes.
Seek a swallowing assessment from a speech therapist if the
person is regularly having trouble chewing and swallowing.
Have the individual sit in an upright, comfortable
position.
Try to have them eat with others to increase socialization
and make mealtimes more pleasant.
Check that their mouth is empty, especially if they hoard
food or cigarette butts.
Make sure they have their glasses, dentures, hearing aids
or any other appliances they need.
Prompt or feed those who can't feed themselves (apraxia).
Give the individual food they like and adequate snacks.
Provide nutritional supplements if there is significant
weight loss.
Present one item at a time if the person seems confused by
too much food in front of them.
Consider moving food to a different location on the tray or
table.
Serve the drink last if the individual drinks too much and
will not eat.
Serve pre cut or finger food, if using utensils becomes
difficult.
Keep stressing that the food is safe if the individual
believes it is poisoned.
Reassure the person that you will make sure they are well
fed.
Note:
If someone loses five pounds within a month or 2.5 pounds
in two consecutive weeks, aggressive intervention should be undertaken to
prevent further weight loss and to help them gain the weight back.
BATHING
The bathing habits of an individual with dementia ideally
should follow the same pattern as prior to the onset of the disease. If someone
showered every day in the morning, aim for that; if they bathed every other
evening, stick with that routine. The rule of thumb: Bathing should occur as
frequently as before unless specific hygiene needs or behavioral changes arise.
For example, adjustments may be necessary if an individual is severely agitated,
wakes up soiled in the morning, or experiences behavioral problems, or "sundowning,"
as evening approaches.
Bathing is a complex activity of daily living composed of
several phases: undressing, introduction into the shower or tub, washing, drying
and re-dressing. Recognizing a person's abilities and preparing ahead of time
can help simplify the process.
Possible Problems:
Most older individuals retain a sense of modesty and
resist undressing; this is a normal response.
Frightened, disoriented individuals may not recognize the
family or professional caregiver.
They may have forgotten how to undress, wash or dry
themselves, or redress.
Individuals, especially those who are visually or hearing
impaired, recovering from recent medical problems or on certain medications, are
at risk of falling.
Shower and bathtub surfaces can be dangerous—cold, hot or
slippery.
An individual, especially in the middle to late stages, may
forget how to pick up their legs or sit in a bathtub.
Someone can become alarmed during any part of the process
and attempt to flee.
Tips:
Give one-step instructions in short, simple terms, and go
slowly.
Communicate with non-verbal cues to help the individual
understand.
Remember to provide privacy, and ensure dignity.
Be reassuring since concern over modesty also may increase
agitation.
Approach the individual from the front whenever possible.
Make sure the room temperature is appropriate for
disrobing.
Smile, speak calmly and do not express any frustration.
Remove the bathroom door lock for safety.
Do not leave the individual unattended in the bath area.
Minimize safety risks by installing a no-skid surface and
grab bars.
Try the shower instead of the tub, or vice versa, if
someone becomes afraid of either.
Keep the individual in a bathrobe until they are in the
bathing area.
Make sure the individual uses the toilet prior to bathing
to prevent accidents during or after the bathing process.
Secure soap, towels and other bathing items in advance.
Ensure appropriate water temperature, especially to prevent
scalding.
Keep the individual in a warm room until they are
completely dry and clothed.
Lay out clothing in advance to proceed quickly from drying
to dressing.
Note:
Be flexible. Bathing does not have to occur daily. If the
regular routine stops working, try sponge baths, switch to every other day or
change the time of day.
DRESSING
Getting dressed can pose a complicated series of challenges
for individuals with dementia. Their need for assistance could range from having
someone select outfits for them to physically dressing them from head to toe.
Possible problems:
Loss of communication skills and motor coordination makes
the process difficult.
Too many choices of clothing can be confusing and
frustrating.
Clothing may be difficult to put on or remove due to
zippers, buttons, etc.
Tips:
Encourage the individual to dress himself to whatever
extent possible.
Intervene when attempts at self-dressing are not working.
Recognize the need for a sense of dignity.
Set a daily routine; try to have the individual get dressed
at the same time each day.
Do not rush the process.
Give one-step instructions if the person needs prompting.
Limit the choice of outfits to two.
Clear closets and drawers of excess clothing to reduce
confusion.
Provide loose-fitting, comfortable clothes with elastic
waistbands.
Lay out the articles of clothing in the order they are to
be put on.
Use a consistent method of helping the individual dress
each day. For example, first dress their upper body and then the lower body. If
the individual can still dress himself, hand him one article of clothing at a
time in the same order each day.
Use gestures to show the individual what to do.
Do not argue if they want to repeat the same outfit.
INCONTINENCE
Proper use of the toilet requires a complex mixture of
motivation, internal cues, visual recognition and motor skills—all of which
diminish with dementia. Therefore, as the disease progresses, many people
develop incontinence, or loss of bladder or bowel control. Typically, an
individual first develops episodic urinary incontinence that slowly progresses
over a period of years to total loss of bladder control. A similar pattern is
seen with bowel control, which becomes impaired in the latter stages of
dementia. The rapid onset of incontinence suggests a behavioral or medical
change, and should be evaluated by a physician.
Possible problems:
Medical problems, such as enlarged prostate glands and
urinary tract infection, or medication side effects.
An individual cannot remember where or what the bathroom
is.
Loss of verbal skills makes them unable to express their
needs.
Clothing is hard to remove in time.
Individuals are not able to perceive internal signals for
urination.
STRATEGIES TO HEAD OFF OR DEAL WITH BEHAVIOR
PROBLEMS
Pay attention to what the individual with dementia is
saying—both verbally and non-verbally. Caregivers also should be aware of their
communication techniques, including providing one-step instructions and speaking
in a reassuring tone.
Think ahead and plan for situations that could result in
problem behaviors.
Understand that trying to argue with someone who has
dementia only results in frustration for both them and the caregiver.
Distract and divert attention whenever possible.
Hold to the same routine.
Keep things simple to avoid frustration.
Promote a sense of security and comfort.
Use positive reinforcements, such as smiles, a gentle
touch, personal attention and praise.
Allow the individual to have some sense of control. Being
able to "save face" is important to someone who is very confused.
Maintain a calm manner even when the individual becomes
aggressive or agitated. This can defuse a tense situation and help reduce a
person's fears.
Assess the situation to protect yourself. Should an
individual's aggression become violent, be mindful of your own safety first.
Caregivers should practice ways to reduce stress when they
become angry or frustrated, since anger and frustration could aggravate a
behavior problem.
Remember that behavior problems result from the disease. Do
not take things that the person says and does personally; it is the disease
speaking.
Be creative and use common sense.
Try to keep a sense of humor even in the most difficult
situations.
POTENTIAL CAUSES OF BEHAVIOR PROBLEMS
Symptoms of dementia can cause a flood of emotions and
physical reactions, which can manifest in behavioral problems. Understanding the
cause and effect can help family and professional caregivers cope better with
situations that may arise.
Reaction to Loss:
We all rely on input from our environment to guide us in
activities and relationships. An individual with dementia has lost both the
benefit of such input and the ability to inform us of their internal world. This
absence causes fear, insecurity and frustration, which may present in the form
of aggression and agitated behavior.
Some Suggestions:
Provide reassurance.
Speak in a calm voice.
Promote a sense of security and comfort.
Inability to Meet Basic Needs:
As a result of cognitive impairment and psychiatric
symptoms, a person's basic needs might not be met. The resulting hunger,
dehydration, elimination problems and fatigue can produce behavioral changes.
Individuals with dementia may stay hungry because of, for example, their
inability to feed themselves, depression or loss of muscle coordination. They
may show their discomfort through agitated and aggressive behavior.
Likewise, they may forget how to pour water into a cup or
never ask for a drink due to their inability to communicate. Dehydration can
lead to urinary tract infection, constipation and fever—putting individuals at a
high risk for delirium and consequently more behavioral problems.
Similarly, an individual may forget where or what the
bathroom is, and eventually may not recognize the internal cues for urination or
a bowel movement. Elimination problems may manifest in the form of agitation,
aggression, wandering, pacing, and incontinence. Compounding this, they may
develop urinary tract infections or constipation which, left untreated, could
result in delirium.
Lastly, someone with dementia may get tired easily because
of wandering, pacing and disruption of the sleep-wake cycle. Fatigue often leads
to irritability and aggression.
Some Suggestions:
Offer verbal and physical assistance during meals.
Serve foods that the individual likes.
Provide adequate snacks and supplements.
Prevent distraction during meals by rearranging the
environment
Serve pre-cut or finger food if using utensils becomes
difficult.
Consult with a healthcare professional about swallowing
problems.
Schedule fluid intake to ensure six to eight glasses of
liquid per day.
Avoid coffee, tea beverages with caffeine that act as
diuretics.
Establish a routine for using the toilet, such as assisting
them to the bathroom every two hours.
A commode, obtained at any medical supply store, can be
left in the bedroom at night for easy access.
Put up signs (with illustrations) to indicate the bathroom
door.
Use easy-to-remove clothing, such as those with elastic
waistbands.
Try soothing music or a massage to induce sleep.
Reduce environmental stimuli.
Encourage short periods of napping to prevent exhaustion.
Co-Existing Medical Problems:
Pain and discomfort from a medical problem (i.e., dental
pain, urinary tract infection) or medication side effects can go unnoticed
because of the individual's inability to report it due to poor memory and/or
loss of verbal skills. In addition, caregivers may have difficulty gauging the
individual's pain because they do not respond to questions. As a result, these
individuals may not receive necessary medication or treatment. Those who are in
pain and discomfort tend to exhibit verbal and physical aggression,
restlessness, wandering and pacing behaviors.
Some Suggestions:
Become familiar with the person's medical history.
Assess their non-verbal behavior to help identify the cause
of distress.
Watch for signs of urinary tract infection and other
medical conditions.
Monitor medications for side effects.
Co-Existing Psychiatric Disorders:
Individuals with a previous diagnosis of psychiatric
disorders, such as schizophrenia, depression or mania, and those with mental
retardation are likely to exhibit more behavioral problems when they develop
dementia than other individuals without psychiatric illnesses. Those with
hallucinations or delusions and who are depressed or manic tend to exhibit more
aggressive and agitated behavior.
Consult with your physician about available medications,
such as anti-depressants, anti-psychotics and other mood stabilizers, to control
symptoms.
Provide reassurance.
Distract and redirect with other activities.
Environmental Factors:
Excessive noise, poor or glaring lighting and cold
temperature in the home or a long-term care facility, and overcrowding in a
group setting can increase agitation, screaming and aggressive behavior. Any
change in the environment or routines, such as bathing and eating, can cause
frustration and agitation. As well, boredom that results from lack of
activities, and conflicts among residents in a group setting can manifest in
behavioral changes.
Reduce excess stimuli, such as the TV or radio.
Elevate the room temperature.
Ensure adequate lighting.
Carefully and gradually introduce changes in routine or the
environment.
Provide activities that are simple and creative.
In a group setting, staff should anticipate the
characteristics of each resident and adjust the environment accordingly.
Sensory Impairment:
Individuals with hearing or visual impairments tend to be
more paranoid, hallucinate more, and feel more frightened and frustrated. For
example, those with poor eyesight may not eat their food or they may be at risk
for falls.
Some Suggestions:
Assess vision and hearing.
Ensure that individuals who wear glasses or hearing aids
have them in place.
Evaluate problems such as cataracts, glaucoma or other eye
diseases, and correct them with surgery, if feasible, or by creative
environmental changes.
Factors Related to the Caregiver:
A caregiver's attitude and knowledge of dementia affect the
care of individuals with the disease. The more one knows about dementia, the
less likely they will be to resent certain behavioral problems. Individuals
usually respond to a caregiver's mood and behavior accordingly.
Become educated about the disease.
Learn effective communication techniques and how to cope
with specific behavioral challenges.
Use a calm tone of voice combined with physical touch to
convey reassurance.
Be patient and kind.
Take care of your own physical and mental health.
COPING WITH…ANGER AND AGGRESSION
Dementia affects the parts of the brain that control mood
and behavior. An individual can become anxious and fearful, which often manifest
as anger and aggression.
Possible problems:
Seek a doctor's advice to determine if there is a medical
cause, or if medications are causing adverse side effects.
Limit outside noise, clutter or the number of persons in a
room.
Keep to the same routines.
Reduce caffeine intake.
Restrict choices to minimize confusion. Do not ask, "What
would you like for lunch-soup or a sandwich?" Instead, say, "Here's some
soup."
Keep objects and furniture in the same places.
Help orient the confused person with calendars and
clocks.
Dot the environment with familiar objects and photographs
to provide a sense of security and promote pleasant memories.
Try gentle touch, soothing music, reading or walks.
Speak in a reassuring voice.
Distract the person with a snack or an activity.
Learn to recognize certain behaviors. An agitated state or
pulling at clothing, for example, could indicate a need to use the bathroom.
Do not try to restrain the person during a catastrophic
reaction.
Keep dangerous objects out of reach.
If agitation increases at night, a nightlight may reduce
confusion.
In severe cases, doctors can prescribe medication to calm
an individual.
Acknowledge the person's anger over the loss of control in
their life.
COPING WITH…PARANOIA
Individuals with dementia may become paranoid as a result
of false beliefs, or delusions, which are a symptom of the disease. Examples of
paranoia are accusations that someone is poisoning their food or stealing their
money, or statements such as, "My spouse is an imposter."
Possible problems:
Discuss paranoid behaviors with the individual's doctor.
Medications may need to be adjusted.
Explain to other family members and caregivers that
suspicious accusations are a part of the illness.
Respond to the feeling behind the accusation. If the
accusation involves hurting someone who has passed away, you might suggest, "You
really miss your mother; tell me about her."
Try non-verbal reassurances like a gentle touch or hug.
If the individual suspects money is "missing," allow them
to keep small amounts of money in a pocket or pocketbook for easy inspection.
Assist the person in looking for a missing object. Try to
learn where their favorite hiding places are for storing objects that are
frequently "lost."
Avoid arguing.
COPING WITH…TRAVELING
A change in routine or environment can be upsetting and
confusing to an individual with dementia. New and different surroundings can
produce anxiety and disorientation.
Tips:
Do not "negotiate" an outing. Do not ask, "Are you ready to
go out?" Instead, use statements, such as, "Here's your coat" and "We're getting
into the car now."
Reassure the person.
Plan your route as carefully as possible, with attention to
parking, elevators and other details.
Leave plenty of time so you do not have to rush.
Consider taking along another adult to assist you.
Bring items, such as snacks or books, to occupy the person
if you must wait somewhere.
COPING WITH…SUNDOWNING
Sundowning is a dementia-related symptom that refers to
increased agitation, confusion and hyperactivity that begins in the late
afternoon and builds throughout the evening. Most sundowning emerges in
mid-stage dementia and slowly worsens as the disease progresses. What causes it?
Dementia may damage the body's internal clock, causing a disruption of
sleep-wake cycles. Secondly, individuals with dementia become fatigued by their
inability to process information; the more hours spent on this process, the more
exhausted—and irritable—they may become.
Tips:
Plan activities or outings in the morning.
Do only simple, calming activities in the afternoon.
Keep individuals awake during the day.
Increase indoor lighting before dusk.
Ensure that the individual is not suffering from hunger,
thirst, pain or fear.
Correct potential causes with basic interventions such as
hydration and snacks.
Remove excess stimuli and clutter.
Watch for sundowning in early-stage dementia or rapidly
worsening symptoms, both of which may suggest delirium.
Consult your doctor to see if medications may help.
Be twice as patient and kind during these hours.
COPING WITH….WANDERING
One-quarter to one-half of all individuals with dementia
will wander, most commonly during the middle stage of the disease. This behavior
includes attempting to leave, roaming, visiting and rummaging. To assure safety,
individuals should be assessed to determine possible causes of these episodes,
and treated with behavioral, medical or pharmacological interventions.
Tips:
Do not leave a person with dementia home alone.
Monitor and record the individual's wandering
patterns—frequency, duration, time of day, etc. For example, if wandering occurs
first thing in the morning, they might be hungry; in the late afternoon or early
evening, they might be experiencing "sundowning"; and during the night, they
might need to use the bathroom.
Consult with a physician to see if medications can help.
Individuals who wander as a result of delusions or hallucinations may require
psychotropic medications.
Provide recreational activities—music therapy, physical
exercise or movies, for example—to reduce boredom, under-stimulation or lack of
socialization that prompts wandering.
Ensure that the individual is well fed, well hydrated and
using the bathroom since individuals may wander to fulfill these basic needs.
Consider setting a schedule.
Reduce environmental stimuli like loud music, screaming or
overcrowding that might spark this behavior.
Outfit the individual with an identification bracelet, and
put some form of identification in every jacket, pocketbook or other article.
Obtain a wristband transmitter, such as those used by
Project Lifesaver, to more easily track wanderers.
Have a current photo readily available and find out about
leaving one on file at the police department.
Secure doors in a way that are difficult to open.
Add electronic chimes or doorbells so a caregiver is
alerted if the individual attempts to exit.
Identify bathrooms and other rooms with colorful signs to
re-orient individuals.
Post a large sign that says "stop" or "do not enter" on
exits.
Mask exit doors with a curtain.
Place a black mat or paint a black space by an exit, which
may appear to be an impassable hole to those with dementia. Likewise, a large
line, strip of tape or VelcroTM may act as a barrier.
Provide familiar objects, such as family photographs,
slippers and a quilt, to an individual living in a long-term care facility to
make it feel like home.
Put away essential items, such as the person's coat, shoes,
pocketbook or glasses, since some individuals will not go out without certain
articles.
Tell neighbors about the person's wandering behavior and
make sure they have your phone number.
Look for changes in patterns. For example, those who begin
to wander after a prolonged period in a facility may suffer from a new medical,
psychiatric or cognitive complication. For instance, delirium may produce the
abrupt onset of wandering.
THERAPPIES -- STORYTELLING
Creative storytelling is catching on as a therapeutic tool
for individuals with Alzheimer's disease—and their families. It is increasingly
being used in adult day programs and other group settings. Pleased with the
results, experts say families can adapt this technique for use in their home
environments as well.
Storytelling sparks memories, encourages verbalization and
promotes self-esteem among those with dementia, according to healthcare
professionals. "Inevitably, storytelling is about memories, but it opens the
rules to include imagination and to create something new that accepts who they
are and where they are in the moment. That's a great thing for families," noted
Anne Basting, founder of the Milwaukee-based National TimeSlips Project.
Renya Larson, a TimeSlips facilitator and the associate
director of the National Center for Creative Aging, Brooklyn, NY, calls
TimeSlips a "potent" tool designed for individuals in the middle to late stages
of Alzheimer's disease who can no longer communicate through conventional
methods. Participants can comfortably incorporate gestures, sounds and facial
expressions into the story.
For individuals still in the earlier stages, Larson
suggested, "Creativity may be threatening. They want to hold on to the true
stories they still have." However, it may be possible to adjust the program by
including more reminiscence and current events.
How-to of creative storytelling:
Create the right scene. Eliminate background noise, like TV
and radio, and set up in a dedicated space. Prepare a sketchpad, brightly
colored markers and an image. Do storytelling during the "magic hour" for higher
cognitive functioning—9:30 am to 11:30 am or right after lunch. Maintain eye
contact.
Choose pictures carefully. The more unrealistic the
picture, the better. Large, colorful pictures that are odd or include animals
mimicking what people do spark creativity. While you might be inclined to use
family photos, they raise the possibility of right and wrong answers, and a
sense of failure. Instead, try a picture that triggers something from the past,
but that is not too close so that it prompts the person to focus on
remembering.
Learn questioning techniques. The wording of the questions
is even more critical than the images. Questions that elicit yes and no, or
direct answers will not work. Inquiries like "Who is this?" or "What is this?"
are outlawed. These create a pressure cooker for an individual with dementia,
and set them up for a wrong answer. Only open-ended questions are encouraged,
such as: "What should we call the person?" "Where are they going?" "What could
this be?" "What is going on here?"
Be persistent. If the method does not click one day, try
again another day. It might take a lot of cajoling to get the person to respond.
Engaging other family members in storytelling can stimulate more responses from
the person with dementia, bringing the process closer to a group experience.
Keep a stiff upper lip. The whole idea is to open up the
thought process. Responses may be negative, incorrect or resurrect family
baggage. Individuals often voice their contrariness or use sexual or bathroom
language. Still, echo whatever is said and make that the story. Otherwise, if
you frown upon their answers, they will be afraid to participate. It is
important to validate comments-however shocking, and move on.
Integrate music. Sometimes music will prompt responses even
among individuals who are no longer verbal. Bring in music by asking open-ended
questions, such as, "What might she be singing?" or "What music does the
character like?"
Go with the flow. You do not have to write the story down
if you feel it will distract from enjoying the moment. Consider using a tape
recorder or involving a youngster as the scribe.
Redefine "story." Creative storytelling does not have to
have a beginning, middle and end, nor does it have to make sense. For example, a
character can have three names and words can be nonsensical. Most of all,
remember this is creative storytelling. Noted Basting: "It can be scary for
people to let go of literal language. But if you can follow to where the person
is, you can find a whole new way to connect to your loved one."
Note:
Experts caution that creative storytelling can be more
challenging one-on-one than in a group setting. Families will need to jump over
some hurdles, but, with that done, this technique can be successfully adapted to
the home—and can be very rewarding all-around.
SAFEPROOFING YOUR SURROUNDINGS
Turning a home into one that is dementia-friendly can help
minimize accidents and maximize well-being. It can also give peace of mind and
reduce stress for at-home and long-distance caregivers.
Act before a crisis. In safeproofing surroundings, it is
best to take preventative steps, rather than scramble around to solve an
immediate crisis. This way, options can be more carefully weighed. The challenge
is balancing a desire to keep individuals with dementia as functional as
possible against the hazards posed by cognitive decline, including poor
judgment, difficulty with spatial perception and inability to react
appropriately. Observing an individual's patterns and how they navigate their
environment, looking for red flags, and pinpointing causes and effects are all
very telling.
Professionals or caregivers themselves should survey a home
three times, progressing in security at each inspection. Look for safe, safer
and safest.
Safe involves detecting basic dangers and fixing or
removing those items, such as movable furniture that people wrongly rely on for
support, chairs that blend in with the walls behind them, and loose extension
cords and telephone wires;
Safer means locating ways to minimize injury in the event
of accidents, like replacing glass tables with furniture that has blunt edges,
and locating a soft rubber mat by the bed in case of a fall; and
Safest is maximizing access to help in an emergency, such
as installing a monitoring device.
Look at critical areas. Since those with dementia need a
quiet, orderly environment, it is critical to address factors such as noise,
color and lighting. Modifying kitchens and bathrooms, and taking steps to deter
wandering are primary concerns. The key is to pay special attention to lighting,
furnishings, textures, changes in elevation, handrails, and types of flooring,
and to remove hazardous clutter from floors, stairways, etc. Often, small
changes can make big differences. For example, reducing the level of light
during meals can prompt better eating habits; camouflaging an exit door with a
curtain can prevent wandering; and removing clutter and unnecessary furniture
can reduce confusion.
Be creative. Products do not have to be taken at face
value; rather, consider a person's specific condition and further adapt products
for an even greater sense of security. And always keep in mind that, with this
progressive disease, what works one day may not the next.
Consider redundant strategies for life-threatening
situations. For example, to prevent wandering, install multiple locks on a door,
each at varying heights out of direct sight and requiring different skill sets
to open, and supplement them with an alarm. Or when buying a personal response
system that uses pendants with a call button to alert a central monitoring
station, spring for extras. Use one as a pendant, and cut off the strings from
the others and use double-sided tape to install the help buttons to base
moldings in key spots. This way, if the individual falls while not wearing the
pendant, he could crawl to an emergency button in, say, the foyer or shower.
Walk gently. While many changes sound easy enough,
convincing the at-home caregiver and/or their loved one to alter their
environment can be the hard part. Often, their reluctance boils down to a sense
of shame or the feeling that many assistive devices are unattractive.
Look for designs and assistive devices that give people
independent functioning while maintaining privacy and dignity. One example of a
perfect solution: grab bars so individuals can get on and off the toilet by
themselves. Manufacturers are increasingly designing products without a
medical-type appearance, addressing the "shame" issue for both caregivers and
those with dementia. Products are nicer looking, boasting decorative colors and
style.
In presenting home safety features to those with dementia,
be delicate. Since most people do not welcome change, caregivers may need to
broach the subject on several occasions and make gentle suggestions. Also, try
to include the person with dementia in the decision-making process. And use
language that empowers the person to agree to the safety features for someone
else's sake, such as, "It's not for you; it's for me so I don't worry so much."
Another effective strategy is to call solutions by another name—gifts.
CHECKLIST
Clear all passageways.
Remove unnecessary furniture, knickknacks, clutter and
items that may cause confusion.
Fix loose or uneven steps, and loose or broken handrails.
Put gates at the top of stairways.
Install safety latches on cabinets that store dangerous
items, such as knives, firearms, medications and cleaning products.
Place guards around radiators and other heaters.
Install secure locks that are higher or lower than eye
level on outside doors and windows.
Eliminate poisonous houseplants.
Keep small objects that may be swallowed out of sight.
Make sure electrical wires and phone cords are secured and
cannot be tripped over, and that lamps cannot fall over.
Remove or fasten down scatter rugs to prevent slipping.
Put nightlights in bathrooms, hallways and bedrooms.
Make sure light fixtures are easy to turn on, such as
switches near doorways and glow-switches.
Use maximum wattage allowed by fixtures.
Reduce glare with frosted bulbs.
Ensure adequate lighting by stairways and passageways.
Remove stove and oven knobs when not in use.
Install an automatic shut-off switch on the stove.
Put away kitchen appliances such as blenders and
toasters.
Use non-slip decals or mats in the tub and shower.
Install grab bars around the tub, shower and toilet.
Try a bathtub bench or a hand-held shower.
Keep the temperature gauge on the hot water heater at 120
degrees or lower to prevent scalding.
Remove locks on bathroom doors.
Outfit the individual with an ID bracelet or some other
form of identification.
Obtain a wristband transmitter or other tracking device to
locate wanderers.
Post emergency telephone numbers in large print near
phones.
Prepare and practice an emergency exit plan.
Note:
Don't leave someone home alone—even for a few minutes—if
they cannot respond to an emergency situation.
HOME SUPERVISION
A person's right to dignity and need for independence
complicate the decisions surrounding home safety and supervision. Individuals
with Alzheimer's disease and other dementias are likely to be convinced that it
is safe to be alone long after it has clearly become unsafe-even after several
accidents or injuries have occurred.
Always ask yourself: Is it still harmless for my loved one
to be alone? If it is, these steps can help:
Provide reassurance before you leave the house, since being
alone can cause anxiety and fear for those with dementia.
Explain that you are only running out for a minute, and
remind your loved one that he can call you or another family member if he feels
concerned.
Put important telephone numbers and step-by-step
instructions at each phone.
Make some simple activities, like a favorite movie or
puzzle, readily available to provide distraction.
Ask a friend or another family member to call to chat while
you are out, and to reorient your loved one and provide reassurances.
Leave large, simple notes around the home, such as "Joan is
at the store and will be home soon" or "Joan will be home when this clock says
4:30."
To ward off wandering, put up visual cues on the exits,
like "Stop" or "Do Not Leave."
Make sure that your loved one has some type of
identification bracelet, such as those available from local Alzheimer's
agencies.
Consider enrolling in Project Lifesaver, which uses
state-of-the-art radio technology to quickly locate wanderers.
Heightened anxiety can indicate that it is no longer okay
for your loved one to be home alone. Then, consider making other arrangements,
such as:
Ask a neighbor or family friend to visit in your absence.
Invite a friend to accompany you and your loved one
outdoors, running errands together as a group.
Hire a trustworthy individual from the community—a high
school student or member of your congregation, for example—to come in for a few
hours.
Bring in trained dementia care professionals.
Note:
As a caregiver, you must assess when to change routines to
assure adequate supervision. The last thing that a well-intended caregiver needs
is a crisis situation that could have been prevented. These crises can also be
construed as neglectful, possibly leading to a Protective Services
investigation. It is the caregiver's legal and ethical responsibility to
intervene when supervision is needed.
LONG TERM CARE -- EASING THE TRANSITION
Transitioning from home to a residential care setting, such
as an assisted living facility or nursing home, can be challenging for both
caregivers and care recipients.
Here's how to make the move easier:
Do due diligence. Caregivers need to have a high degree of
comfort in their selection. The quality of these settings varies greatly. Your
decision should be based on three important factors: Is there a dementia care
unit staffed by professionals with specific dementia training? Is the facility
close enough to your home and/or work to allow for visitation at a level that is
best for your family? Does the facility meet the specific medical, social,
therapeutic and emotional needs of your loved one?
Understand the emotions at play. An individual with
dementia may not be able to fully appreciate the nature of the event or the
long-term implications of placement. He may react to your emotional state during
the move. Also, the new surroundings can be overwhelming and confusing, but this
will subside in a few days or a week. Give him time to acclimate and to get used
to the staff.
Provide input. Share your extensive knowledge of your loved
one with the staff, including the unit nurse, social worker and nutritionist
prior to admission. Employees need time to learn about your loved one's medical
condition, temperament, behavior patterns, likes and dislikes, etc.
Talk about it. The level of disclosure to your loved one
about the upcoming move is a decision you must make based on your knowledge of
his ability to understand this information. If you think it will help to talk
about it each day for a couple of weeks prior to the move, be sure that he has a
chance to express his concerns and fears. Be patient and understanding. Offer
reassurance of your ongoing commitment and plans for regular visitation.
Prepare the room. Plan to have the room set up before your
loved one moves in. Put in familiar objects, but nothing of value that could be
misplaced or damaged. Label his clothing and personal items as well.
Be by his side. Accompany your loved to the facility for
the actual move, and repeatedly explain that he will be okay and that you are
there to help. You may want to stay for the day and have dinner together at the
residence. When it is time to go, explain that you have to leave for a while,
but will return as soon as you can. Assure him that he will be fine.
Ask for extra attention. Introduce your loved one to the
employee who will be available during the first shift that he is there alone.
Ask the staff to tell each subsequent shift that he is new to the facility and
needs some special consideration, kindness and reassurance.
Check in regularly. Monitor the care of your loved one on a
regular basis, and advocate on his behalf with the staff and administration.
Think about yourself. Tap your network of family and
friends for emotional comfort. And seek support from others who have been
through this situation. The facility may host a support group on site, or look
for a caregiver s
Brain Health
IMPORTANCE OF MEMORY SCREENINGS
Memory screenings are a first step toward finding out if
you have Alzheimer's disease or a related dementia, or another type of condition
that is causing memory loss.
Memory screenings can also let you know that you are okay.
The screenings could turn out normal and put your fears to rest.
A memory screening is not used to diagnose any particular
illness and does not replace consultation with a qualified physician or other
healthcare professional. However, it is very helpful. A screening can test your
memory, language skills, thinking ability, and other intellectual functions. It
can indicate whether you might benefit from more testing. If the screening
raises concern, see your doctor or other healthcare professional and get a
complete examination.
It is very important to identify the disease or problem
that is causing memory loss. That is why you should follow up with a complete
checkup by your doctor or another qualified healthcare professional.
Memory can be affected by a number of factors, ranging from
stress and lack of sleep, to such illnesses as Alzheimer's disease and vascular
dementia.
Some conditions that cause memory loss, such as vitamin
deficiencies, depression or thyroid problems, are reversible. In general, the
earlier the diagnosis, the easier it is to treat one of these conditions.
Early recognition of mild cognitive impairment (MCI)—mild
intellectual loss that may develop into dementia—provides an opportunity for
healthcare professionals to treat this condition, and possibly slow the decline
in memory and other functions.
For irreversible illnesses, such as Alzheimer's disease,
early diagnosis could improve your future health. Although there currently is no
cure for Alzheimer's disease, available and emerging medical treatments may slow
the progression of symptoms. These medications have been proven to work best the
earlier they are given.
Early diagnosis can improve quality of life. Individuals
can learn more about the disease; get counseling and other social services
support; address legal and financial issues; and have more of a say about their
care.
Caregivers and other family members can take advantage of
community services, such as support groups, which will make them feel
better—physically and emotionally. They can discuss treatment, future care and
other issues with their loved ones, rather than having to make decisions for
them.
For persons with a normal screen, memory screenings provide
a valuable opportunity to learn more about how to keep their brains healthy and
age successfully.
www.nationalmemoryscreening.org
424
Hwy. A-12, Grenada, CA 96038
P.O. Box 339, Grenada, CA. 96038
Tel: (530) 436-2514 Fax: (530) 436-2379
Email: ct@shepherdofgod.com
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