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[KJW #064] The Joy In Alzheimer's Caregiving: Improving Communication and Behavior Management with Alzheimer's Patients.
As many as 600,000 people under the age of 65 have Alzheimer's disease,
and that number is expected to grow. Let's do all we can to influence a
better quality of life, better mental health and happiness.
Presented by Kathy J. Ward
National Alzheimer's Association Speakers Bureau
The Inland Northwest Chapter of the Alzheimer's Association
delivered two meaningful workshops, open to all community members,
at Alterra Clare Bridge, Spokane, WA
December 2006 and January 2007
 
Health care professionals, family members and elders attended these meaningful workshops.
Their questions and comments were helpful for everyone. We have learned once more
how much we can do to help each other achieve and nurture a better quality of life.
Some of the questions and comments from the audience with the answers:
Q = What is cognitive impairment?
A = A brain deficiency in the ability to think, perceive, reason or remember. Also, deficiency to perform daily tasks, disorientation of time and place.
Q = How can I make my mother choose what to wear easily? Having fewer options makes deciding easier. For example, provide two outfits to choose between — not a closet full of clothes. Q= I can not get my father to drink water or to finish his meals. What is going on?
First, please be a bit more flexible with your father... Please tell me, what's your father level of Alzheimer's? Early stage or middle stage?
A = I am not sure but he was diagnosed with the illness four years ago.
Q = Have you discussed your concerns with his doctor?
A = No. But I want to help my father this is why I am here tonight.
It is hard to access what could be triggering this behavior without having better cognitive impairment information about your father. However, meal-time issues are common among dementia patients. There are a number of reasons that can contribute to this. Environmental factors during meal times can include; over stimulation, noise, room temperature, clutter, colors, etc. These can affect a person with Alzheimer's making it more difficult to focus on one thing at a time and finish a meal. Reduce the number of food choices at a time and simplify routines. About color discrimination and contrast sensitivity; be mindful about the contrast between the food items and the color of the plate and tablecloth, so your father can see where the food is. Remember that vision impairment predicts deficient performance in people with Alzheimer's.
Q = My mother insist that she needs to go to work. How can I convince her that she does not longer go to work?
A = Great question. There is a misconception about "Reality Orientation, RO", that we must convince a "confused" person with dementia with the 'truth'. This therapy was used more effectively among disturbed war veterans, not in geriatric work. Among Alzheimer's patients, RO can an significantly contribute to their distress and anxiety. "Validation Therapy" on the other hand is about understanding life situations that have been expressed. The point is not to prove that the person with Alzheimer's is "wrong" and that we are "right". But rather it is about LISTENING... about nurturing trust, better communication, safety, better stimulation, life satisfaction, happiness and dignity... for the elder with Alzheimer's and for the caregivers too. The next time that your mother gets ready to go to work, go along with it... talk with her about having breakfast before she goes out and change the subject. Engage your mother in a meaningful activity in the kitchen or other... By not arguing but focusing on something else, your mother will soon forget all about going to work and both of you will enjoy a new task.
  Comments and evaluations provided by the participants were outstanding! Degree to which the program met its objective ... 94% rated Excellent. Presenter's knowledge of the material and teaching style ... 95% Excellent.
Q = What's the link between Down Syndrome and Alzheimer's?
A = Clinically Alzheimer's Disease is identified by senile plaques, made of amyloid peptides, which are derivatives of a large precursor protein, encoded by genes on chromosome 21, and tangles in the brain. Due to the presence of three copies of chromosome 21 in Down Syndrome patients, scientists are investigating whether the over expression of the precursor protein may explain the increased occurrence of Alzheimer's Disease in those afflicted with Trisomy 2.
Both brains, the brain of a person with Down Syndrome and a person with Alzheimer's are impaired. The behaviors displayed by individuals with Down Syndrome are similar to those displayed by individuals with Alzheimer's. However, they are not the same and the two diseases can be distinguished from one another. One of the main differences between the two mental diseases is that people are born with Down Syndrome, unlike Alzheimer's, which sets in late in life. One has to remember that even though a person with Down Syndrome has limitations in intellectual functioning, he or she can often function quite normally in the community and can utilize daily living skills, which often disappear with the onset of Alzheimer's.
If Down Syndrome patients already display problems with cognition, then one must wonder about how the transition from Down Syndrome to Alzheimer's can be witnessed. Because the brain is already impaired, memory loss is not always noted at first. With the onset of Alzheimer's, the retarded individual's behaviors often changes. These changes may include: the development of seizures, the changing of personality, the occurrence of long periods of inactivity or apathy, the development of hyperactive reflexes, the loss of activity and utilization of daily living skills, the visual retention deficits, the loss of speech, the onset of disorientation, the increasing of stereotyped behavior, and the appearance of abnormal neurological signs
Q = When a person with Alzheimer's should stop driving?
A = A decline in visuospatial skills, which help drivers judge distances and predict upcoming traffic problems, seems to play a larger role in making people with Alzheimer's unsafe drivers. Drivers with Alzheimer's may also have trouble prioritizing visual cues. Cognitive performance of the person with Alzheimer's needs to be discussed and monitored with health care professionals and caregivers.
Each person's needs and medical condition are different. Some aspects of a person's day-to-day behavior can indicate whether they have lost the skills needed to drive safely. These include difficulties in coordination, judging distance and space, handling multiple tasks, forgetting how to locate familiar places, becoming angry or confused while driving, etc.
Make the transition gradual and enjoyable. Discuss the issue with the doctor and your relatives, and if possible, get a note from the doctor about not driving. Having something in writing can be a useful reminder.
Arrange for alternative transportation. Many items such as groceries, meals or medications can be home delivered.
Arrange for outings to give the Alzheimer's patients opportunities to change scenery.
Q = I want to install an alarm at the door to prevent my father from leaving the house when he wanders away at night.
Wandering in dementia is really a concern for caregivers. First let me tell you about the Alzheimer's Association Safe Return, program which is a nationwide identification, support and enrollment program that provides assistance when a person with Alzheimer's or a related dementia wanders and becomes lost locally or far from home. If an enrollee is missing, one call immediately activates a community support network to help reunite the lost person with his or her caregiver. Safe Return faxes the enrolled person's information and photo (if provided) to local law enforcement. When the person is found, a citizen or law official calls the 800-number on the identification products and Safe Return notifies listed contacts. The nearest Alzheimer's Association office provides information and support during the search and rescue efforts. The enrollment is easy, please call the Alzheimer's Association helpline 1.888.572.8566 between 7 a.m. -11:30 p.m. (CST). Representatives are available Monday through Friday.
If the person with dementia starts 'wandering', the first step is to look at the reasons behind their behavior. Once you identify what the person is trying to achieve, you can start to find other ways to meet their needs, reducing their desire to walk alone.
| What caregivers can we do to help?
The first thing to consider is why the person might be doing this, so that you can find ways to deal with the situation. Think about why people generally choose to go for a walk: Walking helps us to keep fit and to sleep better at night. Consider taking your father for a walk before or after dinner and have fun together. It is a good way to relieve tension and stop us feeling ‘cooped up’ inside the house. It can be an enjoyable way to see what is going on in the outside world. Remember if walking has been a lifelong habit for your father, especially after dinner.
At times it is inevitable for a person with Alzheimer's to feel disoriented or uncertain about the environment where they are at. They might be trying to look for ways to go back to 'their home' or a familiar place. It is important to incorporate familiar objects or favorite objects in their bedroom to help recognize where he is at.
Remember that a person with Alzheimer's needs reassurance and calmness. Try to find ways to keep your father physically and mentally and spiritually active during the day. Enjoying activities that are nurturing and fun for him. For example, play an exercise video for elders at home and start doing some of the exercises with your father during the day. Visit a local park, feed the birds with him, play his favorite music, etc...
People often walk when they are in pain or anxious, in an attempt to ease their discomfort. In the case of arthritic or rheumatic pain, walking can actually help. Alternatively, people may be trying to ‘escape’ from the pain. If you think this might be the case, ask your GP (general practitioner) to examine the person.
Some people walk about if they are very agitated or anxious. They may also be responding to hallucinations, which are a common symptom of some types of dementia. Rest and relaxation is very important to ease this behavior. Talk to your father and if this is the case let your doctor know about it.
The person with dementia may walk because they feel they need to carry out a certain activity. It may be a task that they have carried out in the past – for example, they may think they have to collect their children from school, or that they have to go to work. This may be a sign that they are feeling unfulfilled. Try to help them find an activity that gives them a sense of purpose, such as helping out around the home with small tasks during the day.
Consider a warm bath or shower before your father goes to bed. Also, practice with your father some deep breathing exercises. Limit over stimulation like noise, fluorescent lights, TV showing violence or arguments... before bedtime.
A healthy message for caregivers... Please take care of yourself too. Ask others, friends or family members, for specific help. i.e., I need help to sort out medical bills. Please sit in for me for a couple of hours while I take some time for myself... etc.
Please remember to attend your local Alzheimer's Association Support Group for more information or ways to handle some of these issues. Please call the Alzheimer's Association Helpline: 1.800. 272.39.00.
Also join a Yoga class, work on nurturing your energy levels, work on your wellness of the mind, body and spirit, follow a good nutrition plan, remember that you are important too... You are not alone, be blessed!
To view more meaningful events, workshops and programs with the Alzheimer's Association in the Spokane area please visit the website, click here: www.inwalza.org
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We are here to help you. Please send inquiries, requests for programs, speaker and consulting services with WEL, World Elder Land to connection@kathyjward.com
Peace be with you!
Kathy J. Ward, MA, CTRS, ADC, CGP, CALA
Universal Peace Ambassador,
Cercle Universel des Ambassadeurs de la Paix - Geneva Switzerland
President of WEL, World Elder Land
President of ERT, Elder Recreation Therapy
Therapeutic Recreation Consultant
National Assisted Living Administrator Certified
Board Member, Activities, Adaptation and Aging Journal
Author
National Alzheimer's Association Speakers Bureau
Love Ambassador - Florida, USA
Member of the World Poet Society - Greece
Ambassador of Happiness For Elders - Connecticut, USA
Cell: (240) 393-5456
E-mail: connection@KathyJWard.com
WEL@WorldElderLand.com
WEL Blog: www.kathyjward.com/blog
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