|
Understanding affects & stages of disease |
|
Creating a safe place to live |
|
Communicating with someone |
|
Helping with daily activities |
|
Coping with unusual features
|
Compiled by Rebecca Flaton, M.A., CCC-slp
Speech-Language Pathologist
PSH&TC |
| Resources: |
|
Alzheimer's Association: Family Care Guide
American Journal of Alzheimer's Care & Related Disorders & Research
Therapy Management Innovations, Inc., Dementia: Disease Overview &
Treatment Guidelines
Kansas Department on Aging: A Caregiver's Guide for Alzheimer's and Related
Disorders
U.S. Dept. of Health & Human Services: Early Alzheimer's Disease Patient
& Family Guide
|
|
UNDERSTANDING DEMENTIA |
|
There are many causes of dementia: stroke, Parkinson's
disease, & Alzheimer's disease are some of the causes. New research shows
that people with Down Syndrome may acquire Alzheimer's as they now live longer
and are growing older. Dementia affects:
|
|
short & long term memory for remembering the, names of
people and things, for remembering how to do ordinary, everyday tasks |
|
thinking & judgment to solve problems & keep self
from danger |
|
personalities: people change and may become moody, sad,
negative, fearful |
|
all aspects of life as it interferes with work, social n
activities, and relationships |
|
Alzheimer's disease is progressive and deteriorating:
|
| Stage II: |
the person is labile, suspicious & somewhat
paranoid due to the start of word-finding and memory problems. They don't
understand what is happening. |
| Stage III: |
the person is anxious, impatient for upcoming
events; there may be some negativity and anger. |
| Stage IV: |
(pre-dementia) person may be depressed, may have
verbal outbursts; think people are stealing from them fidget and pace; have
difficulty adjusting to new or changes in routine.
|
| Stage V: |
( early dementia) the person "looks just the
same"
- still has good speech, language & social skills (if
there before)
- may wander and leave, forgetting how to return *increase in
labile, suspicious, and delusional behaviors related to short term memory loss
- fear of being
alone
- routine tasks take longer
- poor judgment about safety
- still don't think they need assistance
|
| Stage VI: |
(middle dementia)
- person resists change (even their clothing)
- may develop balance & gait problems i.e. forgetting how
to walk
- may not recognize family or familiar people
- wants to be physically near someone-fear of being alone
- language comprehension problems increase
- begins repetition of questions, words, and sounds
- extreme
mood shifts with anger, paranoia, frustration
|
| Stage VII: |
(late dementia) "lost in their own
world"
- clothing worn inappropriately, fidget with them
- difficulty
recognizing & using common everyday objects
- very distracted, very inattentive to any task or event
- frequent outbursts
- unable to effectively communicate wants & needs
- will
accept interactions, but rarely initiate them
- may have trouble feeding & swallowing (forgetting how)
- may become unable to walk, incontinent, dependent
- need protection from
household hazards creating a SAFE place to live
- Check for harmful substances. Lock up medications, cleaning supplies,
insecticides, etc.
- Look for things they might trip or fall over. Check rugs, electrical cords,
clutter. Use non-skid rugs or mats. Buy non- slip shoes and slippers.
- Turn the hot water heater down to 140 degrees or lower, or use an automatic
temperature or overflow gauge.
- Use good lighting that can't be tipped over, and can be easily turned on.
They might need non-breakable touch lamps, nightlights or automatic sensors.
- Put away appliances or sharp utensils: knives, scissors, blenders,
toasters, etc. U se safety locks.
- Keep matches and lighters in your possession.
- Arrange furniture so there is a clear path from their bed to the
bathroom.
- Provide grab bars in the bathroom. You might need a bathtub
bench or a hand-held shower .
- Provide a medical alert bracelet or necklace. Place ID information in the
person's wallet, purse, or clothing. Keep a recent photograph handy.
- Put reflective material on shoes, jackets, etc. worn outside.
- Consider purchasing a wandering alarm device or door alarm.
|
| Creating a SAFE
place to live |
|
Check for harmful substances. Lock up
medications, cleaning supplies, insecticides, etc.
|
|
Look for things they might trip or fall over.
Check rugs, electrical cords, clutter. Use non-skid rugs or mats.
|
|
Buy non- slip shoes and slippers.
|
|
Turn the hot water heater down to 140 degrees or lower,
or use an automatic temperature or overflow gauge.
|
|
Use good lighting that can't be tipped over, and can be
easily turned on. They might need non-breakable touch lamps, nightlights or
automatic sensors.
|
|
Put away appliances or sharp utensils: knives,
scissors, blenders, toasters, etc. Use safety locks.
|
|
Keep matches and lighters in your possession.
|
|
Arrange furniture so there is a clear path
from their bed to the bathroom.
|
|
Provide grab bars in the bathroom. You might
need a "bathtub bench" or a hand-held shower.
|
|
Provide a medical alert bracelet or necklace.
Place ID information in the person's wallet, purse, or clothing. Keep a
recent photograph handy.
|
|
Put reflective material on shoes, jackets,
etc. worn outside.
|
|
Consider purchasing a wandering alarm device
or door alarm.
|
|
COMMUNICATING WITH SOMEONE WITH DEMENTIA
People with dementia need a lot of support and understanding. They may forget
words or use the wrong words to describe things. They may forget what they were
talking about. They may not understand what you say to them or ask them to do.
Later, they may rely more & more on you to interpret their nonverbal forms
of communication to know what they want and need. Here's some things you can do
to help:
|
|
Watch Your tone, facial expression, body tension, mood. They will be
sensitive more to your nonverbal messages than the words you may be saying.
|
|
They will know if you are angry, frustrated or impatient with them.
|
|
Look at the person and get their attention before speaking.
|
|
Remind them of YOUR name, call them by their name.
|
|
use short simple sentences or questions. Pause between sentences.
|
|
Wait & give time for them to respond. Repeat by V emphasizing key words,
e.g. You need your coat .
|
|
Try another way. If they seem not to be understanding - your verbal
messages, then try gesturing, showing or demonstrating.
|
|
Show or refer to real objects or pictures of things.
|
|
Don’t talk about them or act like the person isn’t
there.
|
|
Treat them as an adult, even as they become more child-
like.
|
|
In the early stages, make a record of their likes and
dislikes 0/ before they become unable to tell you. That way you can provide or offer what they might want, when they are no
longer able to ask for them.
|
|
Offer choices by naming the options and referring to real objects. For
example "Would you like orange
juice?" rather than "What would you like to drink?"
|
|
Assist in making and keeping personal memory book 9!!1
labeled photo albums, diaries of important people and events.
|
|
Label or in some way identify or personalize an individual's belongings, so they will recognize their room and their things.
|
|
Keep clocks and calendars available to help keep them
oriented as to time, date, season and upcoming events.
|
|
Keep their room, furniture, belongings, etc. in the same place or location, if at all possible.
|
|
Maintain their former routines for getting up and going to bed, plan activities and events that will be interesting and
similar to things the person used to like to do, e.g. gardening, watching sporting events, going to concerts, etc.
|
|
Order and sequence daily living tasks so that they are
the same each time a person is to complete them. For example, lay the person's clothes out in order that they would be
putting them on.
|
|
Realize that as the disease progresses, they may become angrier, easily
frustrated, and combative. Do not take this personally! Try to approach them
calmly.
|
|
Remember the disease affects their reasoning abilities. Rationalizing or
arguing with them will not help. They will depend more and more on you to
keep them safe.
|
|
If possible, try to look for clues as to what might be wrong. Remember their
words may not match what they are really trying to say. However, they may
use some words over and over that communicate personal meaning or intention
(but not word meaning).
|
|
Check to make sure that the person is not hungry, thirsty, tired, cold, hot,
or need to use the bathroom, as first steps to figuring out what the person
might need.
|
|
If the person wears eyeglasses or a hearing aid, make sure they are wearing
them and they are in good, clean condition.
|
|
Be sensitive and aware of signs of illness. They may not be able to tell you
they are in pain, uncomfortable, or feeling the effects of medication.
|
|
Check the physical environment. Is it too crowded? too , noisy? too
cluttered? Has something been moved or changed?
|
|
Use redirection that tells the person what they CAN DO, rather than Don't or
No or what NOT to do. For example, "Come sit by me and we'll look at
photos" (rather than "No, you can't leave.") Distraction is
usually one of the best strategies.
|
|
Helping with Daily Activities
|
|
Dressing Problems: they may forget how to dress and undress;
they may not recognize seasonal changes; may not be able to concentrate; the
task may be too difficult; too many choices
|
|
-
Offer fewer choices
-
Purchase easy-on styles or easy to use fasteners
-
Pre-select clothes for hot or cold weather
-
Arrange order or present one item at a time
-
Allow time to "wake-up" before dressing
-
Dress in a quiet, private area
-
Help only if needed, offer encouragement
|
|
Eating Problems: may not know when hungry; may forget how to
use fork and spoon; may forget how to chew and swallow; may not recognize foods;
task may be too difficult; too many distractions; at risk for aspiration
-
Schedule meals
-
Eat in the same quiet place
-
Set table with contrasting plate and place setting
-
Use bowls and plates with rims or adaptive utensils
-
Serve familiar foods you know the person used to like
-
Get the person started eating
-
Gently rub the person's throat with finger
-
Avoid foods that may result in choking
|
|
Sleeping problems: may have disrupted patterns; may be
overtired or under-tired; too many distractions; fearful or anxious
|
|
Bathing problems: too many steps; anxiety over removing clothing; forgot how
and reasons why it's important
- Choose a time when person is calm and relaxed
- Continue former habits of showering vs. taking a bath
- Monitor water temperature and overflow
- Simplify task with partial baths; separate hair washing from bathing
- Offer encouragement and support
- Set-up bath with grab bars, hand-held showers, bath chairs as needed
|
|
Toileting problems: incontinence; doesn't recognize urge; constipation;
dehydration; forgot where bathroom is; forgot steps involved
- Establish regular toileting schedule
- Watch for non-verbal clues: restlessness, facial changes, pulling at
clothes
- Monitor fluid intake
- Check for medication side-effects
- Keep bathroom door open, use nightlights
- Keep toilet lid up, put rug around toilet, close shower curtain
|
|
Coping With Dementia
|
|
Continual Pacing: seem to have excess energy; pacing can be annoying to
others
- Provide safe pathway or enclosed backyard
- Allow them to pace
- Find other outlets for energy: exercise, activities
|
|
Wandering: leave the safety of their home; may be looking, for bathroom,
someone, or something
- Have proper ID on the person (bracelet, in clothing)
- Notify police department, neighbors of potential wanderer
- Have recent photograph
- Place reflective material on shoes, jackets, etc.
- Have locks out of reach or hard to open
- Purchase a wandering alarm device
- Look for person's usual route or place they wander to
|
|
Rummaging: handle things, search for things, take other's things, hoard
things.
- See if they can tell you what they are looking for
- Limit hiding places
- See if you can "live with it"
- Allow collections of items that the person is interested in
|
|
Paranoia and Suspicion: disease results in loss of memory so they may not
understand what another is doing or saying.
- May accuse another of wrongdoing. May not be able to separate dreams or
imagination from reality.
- Do not become defensive or argumentative
- Do not try to reason or explain
- Respond to their fear, anxiety, feeling out of control
- Try distracting them to another topic or activity
|
|
Sundowning: increased agitation & restlessness during the late afternoon and early evening hours.
- A daily schedule or routine gives structure & helps
provide that "sense of security" they need when daily life is
predictable
- Include exercise & activities as part of a daily routine
to help reduce stress and restlessness
- Some may want a "short" nap in the afternoon
- Plan quieter or calming activities during this time, e.g.
listening to music, folding laundry, being read to, looking at photo albums
& memorabilia
- Reduce the noise level and use maximum lighting during the
twilight hours
|
|
Combative Behavior: outbursts of anger or extreme agitation which may include shouting and physical attacks
- May occur in some phases (usually middle) of the disease
- Usually the person is "overloaded" with too much
noise, activity, people, or requests
- Person may startle and over react if you touch them
- Do not
challenge or argue with person
- Keep your voice calm and reassuring
- Get out of their way, even leaving the room, if you can do
so safely
- Offer distraction to a favorite item, food, activity
- Check
medication side-effects
- Review episodes to look for patterns: time of day, physical
factors, changes in the environment, etc.
|
|
Sexual Behavior: may undress or masturbate in public, may use
obscenities, may make unreasonable sexual demands
- Memory of sexual pleasure may still remain
- Remove or
distract to a private place
- Offer other forms of touch (back & shoulder rubs )
- Check need to use
the bathroom
|
