Alzheimer's Disease

(Complete list of Alzheimer's PDF Files)

No two people experience Alzheimer’s disease in the same way. As a result, there's no one approach to caregiving. Your caregiving responsibilities can range from making financial decisions, managing changes in behavior, to helping a loved one get dressed in the morning.

Handling these duties is hard work. But by learning caregiving skills, you can make sure that your loved one feels supported and is living a full life. You can also ensure that you are taking steps to preserve your own well-being.

Related Information: Caregiver Manual

Caregiver Stress

This section provides information on Alzheimer care strategies. Experiment to find those that work for you and the person you care for.

Tracking Symptoms
One of the most helpful tools for caregivers is keeping a diary or journal of their loved one's symptoms. This record can help you better communicate with the person's doctor changes in memory or behavior.

The journal can also help you track caregiving strategies that worked and activities the person enjoys.

For each day you are tracking, note the following:
Problems or changes in:
Memory
Behavior
Personality
Daily living skills (can the person do daily activities, such as bathing or dressing, with no, little or a lot of help?)
Caregiving strategies that worked? Strategies that did not work?
Activities the person with dementia enjoys.
Any medications the person took that day (include prescriptions, over-the-counter and herbal remedies):
Medication name
Dosage
When and how many taken daily

Daily Care
As Alzheimer's disease progresses, the abilities of a person with dementia will change. As a caregiver, you can adapt a daily routine to support these changes with some creativity, flexibility and problem solving. The information in this section will help you do just that.

Activities
For the person with Alzheimer's, activities structure the time. Activities also can enhance a person's sense of dignity and self-esteem by giving purpose and meaning to his or her life.

Planning activities should focus on the:
Person
Activity
Approach
Place

Person
Activities should be appropriate to the person and reflect his or her interests.

Keep the person's skills and abilities in mind

Pay special attention to what the person enjoys

Consider if the person begins activities without direction

Be aware of physical problems

Well-planned activities can improve the quality of life of those with dementia.

Focus on enjoyment, not achievement
Encourage involvement in daily life
Relate to past work life
Look for favorites
Change activities as needed
Consider the time of day
Adjust activities to stages of the disease

Approach
Your approach to activities can bring meaning, purpose joy and hope to the person's life.

Offer support and supervision
Concentrate on the process, not the result
Be flexible and patient
Be realistic and relaxed
Help get the activity started
Break activities into simple, easy-to-follow steps
Assist with difficult parts of the task
Let the individual know he or she is needed
Stress a sense of purpose
Don't criticize or correct the person
Encourage self-expression

Place
Create a safe, comfortable and supportive environment for activities.
Make activities safe
Change your surroundings to encourage activities
Minimize distractions that can frighten or confuse the person

Creating a daily plan

A planned day allows you to spend less time and energy trying to figure out what to do from moment to moment. To pick activities and organize the day for the person, think about:

What activities worked best and which didn't? Why?
Were there times when there was too much going on or to little to do?
Were spontaneous activities enjoyable and easily completed?
Was the person bored or distracted? Is it time to introduce a new activity?

Example of a daily plan:

Morning
Wash , brush teeth, get dressed
Prepare and eat breakfast
Discuss the newspaper or reminisce about old photos
Take a break, have some quiet time

Afternoon
Prepare and eat lunch, read mail, wash dishes
Listen to music or do a crossword puzzle
Take a walk

Evening
Prepare and eat dinner
Play cards, watch a movie or give a massage
Take a bath, get ready for bed

Communication
Alzheimer's disease can gradually diminish a person's ability to communicate. Not only do people with dementia have more difficulty expressing thoughts and emotions, they also have more trouble understanding others. Here are some tips to help you and the person with dementia understand each other better.

Changes in communication
The person with dementia may experience changes in communication such as:

Difficulty finding the right words
Using familiar words repeatedly
Inventing new words to describe familiar objects
Easily lose their train of thought
Difficulty organizing words logically
Reverting to speaking in a native language
Using curse words
Speaking less often
More often relying on gestures instead of speaking

Tips for better communication
Let the person know you are listening and trying to understand what is being said.
Keep good eye contact. Show the person that you care about what is being said.
Let the person think about and describe whatever he or she wants to. Be careful not to interrupt.

Avoid criticizing, correcting and arguing.
If the person uses the wrong word or cannot find a word, try guessing the right one.
If you don't understand what is being said, ask the person to point or gesture.

Focus on the feelings, not the facts. Sometimes the emotions being expressed are more important than what is being said. Look for the feelings behind the words.

Always approach the person from the front. Tell the person who you are.

Call the person by name. It helps orient the person and gets hid or her attention.

Use short, simple words and sentences. Talk slowly and clearly.

Ask one question at a time.

Patiently wait for a response. A person may need extra time to process your request.

Repeat information and questions. If the person doesn't respond, wait a moment. Then ask again.

Avoid quizzing. Reminiscing can be healthy, but avoid asking, "Do you remember when...?"

Give simple explanations. Avoid using logic and reason at great length. Give a complete response in a clear and concise way.

Related information; Communication brochure (PDF)

Depression
Depression and dementia share some common symptoms. As a result, depression often goes untreated in people with Alzheimer’s disease.

Alzheimer symptoms, however, are more progressive than the symptoms of depression and include profound memory loss. While their depression can be treated through medications, the cognitive abilities of people with dementia will continue to decline.

Symptoms of depression
People with depression may lose interest or pleasure in activities, have difficulty concentrating or experience feelings of hopelessness and worthlessness. They may have physical symptoms, such as changes in appetite, weight, energy and sleeping patterns.

A person may have depression if he or she has at least four of the following symptoms over a two-week period:

Depressed or irritable mood
Feelings of worthlessness or excessive guilt
Suicidal thinking or attempts
Motor retardation or agitation
Disturbed sleep
Fatigue and loss of energy
Loss of interest or pleasure in usual activities
Difficulty thinking or concentrating
Changes in appetite and weight

Source: American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders

Treatment for depression
If the person with dementia is showing signs of depression, see a doctor to get a medical evaluation. Medications or an unrecognized disorder may cause depression.

If there are no other underlying causes, consult a psychiatrist to obtain a diagnosis. Geriatric psychiatrists specialize in recognizing and treating depression in older adults.

There is no one test to identify depression. The diagnosis involves an assessment of medical history, interviews with the individual with Alzheimer’s and family members, and a mental status examination.

Treatment for depression can include some combination of medicine, therapy, psychosocial support and activities.

Related Information: Behavioral & Psychiatric (PDF)

Hallucinations (PDF)

Early Onset (PDF)

Sleep Disorders

Dressing and Grooming
Helping the person with dementia maintain his or her appearance can promote positive self-esteem. Here are some ways you can assist the person with dressing and grooming routines.

Dressing
Choosing and putting on clothes can be frustrating for the person with dementia. The person may not remember how to dress or may be overwhelmed with the choices or the task itself.

Simplify choices. A person may panic if clothing choices become
overwhelming. Try offering just two choices of shirts and pants.

Provide direction. Lay out clothing in the order that each item should be put on. Hand the person one item at a time while giving short, simple instructions such as “Put on your shirt,” rather than “Get dressed.”

Keep the closets free of excess clothing.

Choose comfortable and simple clothing. Cardigans, shirts and blouses that button in front are easier to work than pullover tops. Substitute Velcro® for buttons, snaps or zippers, which may be too difficult to handle.

Choose comfortable shoes. Make sure the person has comfortable, non-slip shoes.

Get duplicate outfits. If the individual wants to wear the same outfit repeatedly, buy duplicates or have similar options available. It’s all right if the person wants to wear several layers of clothing, just make sure he or she doesn’t get overheated.

Offer praise, not criticism, if clothing is mismatched.

Be patient. Rushing the person can cause anxiety and frustration.

Grooming
The person with dementia may forget how to comb hair, clip fingernails or shave. He or she may forget what the purpose is for items like nail clippers or a comb.

Maintain grooming routines. If the person goes to the beauty shop or a barber, continue this activity. If the experience becomes overwhelming, ask the barber or hairstylist to come to the person's home.

Use favorite toiletries. Allow the person to use his or her favorite toothpaste, shaving cream, cologne or makeup.

Use a "show me" technique. Take a brush, comb your hair, and encourage the person to copy your motions.

Use safer, simpler grooming tools. Use cardboard nail files and electric shavers that are less threatening than clippers and razors.

Bathing
People with Alzheimer’s may perceive bathing as unpleasant, threatening or painful. In turn, they may act in disruptive ways, like screaming, resisting and hitting.

This behavior occurs because the person doesn’t remember what bathing is for or doesn’t have the patience to endure the lack of modesty or being cold. Try the following:

Prepare the bathroom in advance by gathering towels, washcloths, shampoo and soap. Check the room temperature to make sure it's not too cold.

Make the bathroom safe by installing grab bars on the wall and tub edge. Use a tub bench or bath chair that can adjust to different heights.

Help the person feel in control. Involve or coach the person through each step of bathing. Be sure the person has a role. For example, have the person hold a washcloth or shampoo bottle.

Respect the person’s dignity. Some people may be self-conscious about being naked. Ease anxiety by letting the person hold up a large bath towel as he or she gets in and out of the shower or tub.

Don’t worry about how often the person bathes. Try sponge baths in between showers or baths.

Be gentle on the skin. The person’s skin may be very sensitive. Avoid scrubbing, and pat skin dry instead of rubbing.

Be flexible when washing hair. Wash the person's hair in the sink. Use a washcloth to reduce the amount of water on the person’s face.

Related information; Personal care brochure (PDF)

Dressing fact sheet (PDF)

Bathing (PDF)

Using the bathroom/incontinence
Many people with dementia have loss of bladder or bowel control (incontinence). Causes include inability to recognize when they need to go to the bathroom, forgetting where the bathroom is or side effects from medicine. Have the doctor rule out medical problems as the cause.

Try the following to assist the person in using the bathroom:

Remove obstacles. Make sure clothing is easy to remove. Clear the
path to the bathroom by moving furniture.

Create visible reminders. Post a sign or picture of a toilet on the bathroom door. Use colored rugs on the bathroom floor and colored toilet lids to help the toilet stand out.

Provide reminders. Encourage the person to go regularly. Look for facial expressions or pacing that may indicate the person needs to use the bathroom.

Monitor incontinence. Identify when accidents occur, then plan for them. If they happen every two hours, get the person to the bathroom before that time. Consider using incontinence products, such as rubber sheets on the bed or adult briefs.

Be supportive. Help the person retain a sense of dignity. Reassure the person to reduce feelings of embarrassment.

Incontinence (PDF)

Dental care

Proper dental care can help prevent eating difficulties, digestive problems and extensive dental procedures down the road. However, brushing is sometimes difficult because a person with dementia may forget how or why it’s important to take care of his or her teeth.

To help the individual with dental care:

Provide short, simple instructions. Break down each step by saying: “Hold your toothbrush.” “Put paste on the brush.” Then, “Brush your teeth.”

Use a “watch me” technique. Hold a toothbrush, and show the person how to brush his or her teeth. Or, put your hand over the person’s hand, gently guiding the brush.

Monitor daily oral care. Brush teeth or dentures after each meal, and make sure teeth are flossed daily. Remove and clean dentures every night.

Keep up with regular dental visits for as long as possible. Seeing a dentist regularly is essential for healthy teeth. Ask the dentist for suggestions or items that may help make dental care easier.

Eating
Mealtimes can present many challenges. A person with dementia may have a poor appetite, loss of interest in food, may forget to eat or that he or she has already eaten. Here are some ways to assist the person to eat a nutritious meal.

Make mealtimes easier
Set up a regular mealtime and stick to it.

Limit distractions. Serve meals in a quiet place so that the person can focus on eating. Turn off the television, radio or telephone ringer.

Keep the table setting simple. Take off flowers, centerpieces and condiments. Use only the utensils needed for the meal.

Distinguish food from the plate or bowl. Changes in your loved one's visual and spatial abilities may make it tough to distinguish food from the plate. Avoid patterned dishes, tablecloths and placemats that might confuse the person.

Check the food temperature. The person might not be able to tell if a food or beverage is too hot to eat or drink.

Serve only one or two foods at a time. For example, serve mashed potatoes followed by chicken tenders.

Be flexible to food preferences. The person may suddenly develop new food preferences or reject foods he or she may have liked in the past.

Give the person plenty of time to eat. Remind him or her to chew and swallow carefully.

Avoid nuts, popcorn and raw carrots. These foods can get caught in the throat. Learn how to perform the Heimlich maneuver, just in case the person chokes.

Eat together. Make meals an enjoyable social event so that your loved one looks forward to the experience.

Encourage independence
Make the most of the person's abilities. Allow the person to eat from a bowl instead of a plate, with a spoon instead of a fork even with his or her hands if it's easier.

Serve finger foods. Chicken fingers, potato wedges, cheese cubes cherry tomatoes, etc. are easier to pick up with the hands and eat.

Use a "watch me" technique. For example, hold a spoon, and show the person how to eat a bowl of cereal.

Don't worry about neatness. Let the person feed himself of herself as much as possible. Consider getting plates with suction cups and no-spill glasses.

Related Inforamation; Eating (PDF)

Web Sites

Eating difficulties and dementia.
Alzheimer's Disease and Related Disorders Association of NSW, Inc.
This Web site provides a chart of more than 30 eating problems in the middle and late stages of dementia and their solutions.
http://www.mydr.com.au/default.asp?article=3179

Skill builder: eating and nutrition.
Eldercare On-line's Alzheimer and Dementia Care Channel.
An in-depth article on the causes of eating problems and techniques for preparing meals and feeding someone who is bed-bound.
http://www.ec-online.net/Knowledge/SB/SBeatnutr.html

Swallowing disorders.
eMedicine.com.
eMedicine.com provides a comprehensive article for healthcare professionals on the anatomy of normal and abnormal swallowing, diagnosis, treatment, and strategies for compensation.
http://www.emedicine.com/pmr/topic152.htm

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