Dementia Care: Making a Difference in Minnesota Continued

Even in the Mid and Late Stages of Alzheimer’s and Related Dementia, Professional and Family Caregivers Can Still Make a Difference

Sadly, Alzheimer’s disease is a progressive disease.  There may be some noticeable ups and down, but over time, it will worsen.  As the loss of cognitive ability worsens, there comes a time when it is nolonger useful to try to help someone remember.  It only reinforces their fears and anxiety.  Many people will respond either with anger (they may feel you are putting them on the spot,) or they will pull in because they feel embarrassed about not be able to respond appropriately.

*  Keep learning as much as possible about the disease and its progression, so you can recognize changes in the person’s behavior and understand that it is the disease, not the person.

*  Validate feelings.  Persons with Alzheimer’s disease continue to have the same feelings we all do right through to death.  The difference is, they lose the ability to communicate their feelings.  Fear is a common emotion, because people whose brain cells are being destroyed don’t understand what’s happening to them.  They become frustrated and sometimes act out when those who care for them seem unable to understand them.  When they exhibit combative or other unwanted behaviors, there is almost always some need, feeling or fear that they have be unable to communicate.  Caregivers need to become detectives in order to discover the need behind the behavior.

*  “Does this really matter?” becomes a question the caregivers should ask them selves on a regular basis.  This is another version of “pick your battles.”  If the patient doesn’t want to do what you ask, in most cases it really won’t matter to just let it go and try again later.  No one ever died of not bathing eating or sleeping on a specific schedule.  Give some latitude where a delay is not a dangerous thing.

*  Don’t ask questions that put people on the spot.  Instead of asking do you remember the names of your grandchildren, say, ” Let’s talk about the little ones.”  Showing some pictures may help.  Don’t ask a person what they had for lunch or breakfast, instead, gives some clues to make it easier.  “Let’s see, we had eggs for breakfast, let’s have some chicken soup for lunch.”

*  Be aware that before dementia, the person had a daily routine.  Trying to continue that as much as possible with some adaptation toward simplifying can be helpful and give a feeling of security and success.  People with Alzheimer’s disease tend to tire easily (my theory is that they need to work very hard to just understand what’s going on in their day,) so alternate activities during the day with active (mild exercise, going for walks, help with simple household tasks) and more restful (naps, listening to music, reading short pieces to the person) tasks.

The bottom line is as the disease progresses, simplify, simplify, simplify.  If music, especially singing is enjoyable, just singing one verse and repeating the same verse a couple times is probably better than trying to get through all 4 verses of a favorite hymn.

 

Minnesota Care Givers Know How to Make a Difference

Monthly Newsletter Helps Seniors’ Choice Employees With Senior Care

Every month I write a newsletter for Seniors’ Choice at Home employees.  I tried to include some fun things like recipes and jokes, some recognition for successes with clients and some pointers for working with clients who have memory loss.  The Alzheimer’s Association (www.alz.org) is always a great resource for me.

Memory Loss

*   Accept the memory loss; don’t think that if the person tried harder, she or he would remember.

*  Answer questions each time as if it was the first time they were asked.  If you run out of patience answering questions over and over, write the answer on a recipe card (a black, felt tip  pen works well for this, ) hand the card to the person, and direct him or her back to it when s/he repeats the same question.

Planning, Organizing and Carrying out Complex Tasks

*  Know that what may seem simple to you (brushing teeth) becomes complex to the person as dementia progresses.  Break directions down into simple steps and offer only one step at a time.

*  Use simple and direct language–the more advanced the disease, the fewer words.  If you want someone to stay seated, say, “Please sit,” rather than “Don’t get up.”  With limited memory, the person may forget the “don’t” and actually get up, because that’s the last thing he/she heard.

*  Be sensitive to emotions–frustration, fear of falling–and offer support and encouragement.

*  Because judgement is sometimes a problem, keep the person’s safety in mind.

Disorientation

*  Use reality orientation carefully.  It may be helpful for some people, especially in the earlier stages, but in some cases, it can be confusing and even hurtful.  Commonly, patients ask for “mother” even though she has been dead for years.  Rather than say, “Oh, your mother has been dead for 20 years,” you might say something like, “Do you miss your mother?”  I bet she was a wonderful person.  Was she a good cook?”

*  Pick your battles.  If she says the sky is green, don’t bother arguing about it; just say, “Wow!  that sure is an interesting color?”  If they ask for the salt for their cereal, and you know they mean sugar, don’t bother correcting them; just pass the sugar.

Go with the flow; meet the person in the reality where he or she is living.   Don’t argue; you will just upset both you and the care recipient.  Remember that “therapeutic fibbing” is OK, and that this disease is different for every person.  It helps to acquire a “bag of tricks”, so that that you can pull one out and try it when needed.  It may not work, so be ready to try another.  It may not work today, but it may be just the thing at another time. 

Seniors’ Choice at Home care givers amaze me every week with their patience and creativity when they work with clients with memory loss.  One care giver made a daily schedule on white paper with a felt tip pen for a gentleman who was continually agitated.  She had the schedule laminated (a plastic cover would work well too,) so he could carry it with him throughout the day.  It seemed to provide him with the sense of security and calmness he needed to know what was happyening next, so he could go through the day with less anxiety.

For more information about Seniors’ Choice at Home in the seven counties in and round dthe Twin Cities of Minnesota, call 763-546-1599, or check out our website at www.seniorschoicemn.com.