What is Alzheimer’s Disease?
Alzheimer’s disease is the most common form of dementia among the elderly and affects more than four and a half million people in the United States alone. More than five percent of seniors between 65 and 74 years of age have Alzheimer’s, and nearly half of seniors over 85 are afflicted with the illness.
Dementia is a brain condition that seriously impairs a person’s ability to carry out the activities of daily living. Symptoms of dementia may include repeatedly asking the same questions, disorientation about time, people, places, or getting lost in familiar places, inability to follow directions, or neglecting personal hygiene, safety, and nutrition.
Alzheimer’s is a slowly progressive disease that begins with mild memory problems and ends with severe brain damage. The average Alzheimer’s disease patient lives 8-10 years after they are diagnosed, however the rate at which the disease progresses varies with each individual, and some patients have lived with the disease for 20 years or more.
Alzheimer’s initially affects the parts of the brain that control thought, language, and memory. Doctors have found certain changes in the brain tissue of those who have died from Alzheimer’s disease. These changes include abnormal clumps called amyloid plaques and tangled bundles of fibers called neurofibrillary tangles. These are considered the characteristic signs of the disease. Scientists have also found that nerve cells die and connections between nerve cells are disrupted in areas of the brain that control memory and other mental functions, and there are also lower levels of certain neurotransmitters, which are chemicals that carry messages back and forth between nerve cells. These changes may be responsible for the mental impairments seen in Alzheimer’s disease.
Although much research is underway to find the cause of Alzheimer’s, and to develop effective treatments for it, scientists still do not know what causes it, and currently there is no cure for the disease.
Coping with Alzheimer’s Disease
Alzheimer’s disease presents daily challenges both for the patient and for their caregivers. Although nothing will make having or caring for someone with Alzheimer’s disease easy, there are some simple measures that you can take that can help to alleviate some of the difficulty and frustration that this disease can cause.
Communication
You should try to minimize unnecessary distractions and noises when talking, by turning off radios and televisions, for example. When you start talking, first, call the patient by their name, in order to make sure that you have their attention before speaking further. Then, speak gently, with a calm tone of voice using simple words and sentences. However, you should not talk to the person with Alzheimer’s disease like a baby or talk about the person as if he or she were not there. Always give the patient enough time to understand and respond to what you are saying. Be careful not to interrupt, but if the patient is having trouble finding a word, you can try to suggest a word.
Eating
You should try to maintain a consistent mealtime routine, while being flexible and adapting to the patient’s changing needs and abilities. Maintain a calm atmosphere at mealtime, free of unnecessary noises and distractions. Remain patient and calm, and avoiding rushing or pressuring the person with Alzheimer’s, and allow the patient to do as much as he can for himself.
Make sure that the patient is drinking plenty of fluids throughout the day to prevent dehydration. If the patient is having difficulty holding or using silverware, try using utensils with enlarged handles. Drinking cups with lids are available if the patient has trouble with regular cups and glasses.
Offer the patient a choice of foods, but limit the number of choices to avoid creating confusion. Serve nutritious and appealing meals with different flavors and textures. Try serving several smaller meals throughout the day and having nutritious snacks available between. As dementia progresses, swallowing problems can develop, which pose a risk of choking. Be alert to this potential danger, and be sure that you know how to perform the Heimlich maneuver. Be sure to maintain oral hygiene and make sure that the patient is receiving routine dental care.
Bathing
Bathing can be frightening or confusing for some people with Alzheimer’s, but you can minimize the stress by planning and preparing in advance, and establishing a consistent routine. Try to schedule the bath for the time of day when the patient is most calm and cooperative. When preparing the bath or shower, make sure that the air temperature and water temperature are comfortable. Have towels and a bath robe ready in advance. To help make bathing safer, use a flexible shower hose, shower bench, grab bars on the shower and tub, and nonskid pads and bath mats. And NEVER leave the patient alone while they are bathing. Always respect the patient’s dignity, and tell him what you are going to do before each step, and allow him to do as much as he can for himself. Always remain calm, patient, and considerate. You may find that it is not necessary to bathe every day. A sponge bath can be effective and refreshing in between regular baths or showers.
Exercise
Regular exercise is important for maintaining and improving both physical and emotional well being. Exercise benefits the whole body, and makes us feel more energetic during the day, and can help us fall asleep more easily at night. It can also be a pleasant shared activity for both the person with Alzheimer’s and their caregiver.
Before starting any exercise routine, talk to the patient’s doctor to find out what types of exercise are appropriate in their particular situation. Based on what the doctor tells you, choose an exercise that both of you enjoy doing. It could be gardening, dancing, or maybe walking in the park. Whatever exercise you choose, be realistic in your expectations, and start off slowly at first, while allowing the patient as much independence as possible. For example, the patient may only be able to walk a few minutes inside their home for the first few weeks. As their strength and endurance improve, you can gradually increase the exercise level to match their ability. But beware of signs of over exertion or discomfort, and talk to the patient’s doctor if such signs appear.
Your local senior center may have group exercise programs. This may be a good option if the patient enjoys group activities. Also, some malls have mall walking clubs that offer the opportunity to walk indoors, even in bad weather.
Sleep Problems
As nighttime approaches, usually around dinnertime, many people with Alzheimer’s become irritable, agitated and restless. Getting them to fall asleep and remain in bed all night may be difficult. But there are some things that can help.
Establish a regular daily routine, that includes sufficient exercise during the day, and limited naps. Activities that are the most physically demanding should be scheduled for the earlier part of the day. Also, you should be careful to avoid fatigue, because fatigue can worsen evening restlessness. Drinks containing caffeine should be avoided in the late afternoon, because they can also cause restlessness.
Try to create a relaxed and peaceful atmosphere in the evening, avoiding excessive noise and bright lights. Playing soft music, if the patient likes it, can help create a relaxed atmosphere, and having the patient go to bed at the same time every night is helpful.
Some people find darkness frightening or disorienting. Placing night lights in the bedroom, hallways, and bathroom may help them to feel more secure and less anxious.
Hallucinations and Delusions
Many people with Alzheimer’s disease experience hallucinations or delusions, as the disease progresses.
Hallucinations are when a person sees, hears, tastes, smells or feels things that are not there.
Delusions are false beliefs that the person continues to believe even when presented with strong evidence that their belief is false.
Hallucinations and delusions can be signs of another illness. You should keep a record of the patient’s symptoms and discuss them with their doctor.
Instead of arguing with the patient about what he or she sees or hears, respond to the feelings that the patient is expressing, with comfort and reassurance. Changing the subject, going into a different room, or going outside for a few minutes can help.
Some people with Alzheimer’s disease have trouble separating reality from what they see or hear on television. Turning off the television when there are violent images and programs can help in such cases.
Make sure that the patient does not have access to anything that they could use to hurt themselves or someone else.
Incontinence
As the disease progresses, many people with Alzheimer’s lose the ability to control their bowels and/or bladder. The inability to control their own basic and essential bodily functions can be very upsetting and humiliating for the person with the disease, and difficult for their caregiver. Fortunately, incontinence can be managed to minimize its impact on the patient’s quality of life.
Going to the bathroom according to a schedule can help. Take the patient to the bathroom every 3 hours during the day, without waiting for them to ask.
Watch for signs that the patient needs to go to the bathroom, such as restlessness, or fidgeting with clothes, and take them quickly.
To help reduce the risk of night time accidents, limit the consumption of beverages containing caffeine during the evening.
When going out with the patient, find out where the restrooms are located, as soon as you can, well before they are needed. Dress the patient in easily changed clothing, and carry a spare change of clothing with you in case of an accident.
If the patient has an accident, be calm and patient, and reassure them if they are upset. Keep a record of when accidents happen. This can help you discover what conditions tend to cause accidents, so that you can prevent them from happening in the future.
Incontinence can be a sign of other illnesses besides Alzheimer’s disease. You should always talk to the doctor about incontinence and any other health problems or symptoms that appear.
Wandering
Some people with Alzheimer’s have a dangerous tendency to go wandering away from home. Keeping the patient safe is the main priority. Make sure that the patient carries identification at all times. Having the patient wear a medical ID tag that includes their identifying information and which identifies them as an Alzheimer’s patient will help communicate their condition to others even if they cannot do it themselves.
Keep doors and windows locked, and consider installing additional locks on the doors. An alarm can also be installed on doors that will trigger a siren if the door is opened. This can help prevent the patient from wandering off in the middle of the night while their caregiver is sleeping.
You should keep recent photographs and/or videos of the patient available to give to the police and the media, in the event that the patient wanders off.
Driving
For many people, driving is a symbol of personal independence and freedom, and they are therefore very reluctant to stop driving, even when they no longer have the ability to drive safely. However, when safe driving is no longer possible, the caregiver must put safety first, and stop the patient from driving.
Be alert to signs that the patient is no longer able to drive safely, such as:
- Driving too fast or too slow for traffic
- Getting lost in familiar places
- Disregarding traffic signs or signals
- Getting confused or angry
If the patient can no longer drive safely, be firm and consistent in your request that they no longer drive. Do not let them drive on “good days”. If they will not comply with your request, talk to their doctor and ask him or her for help. Sometimes the patient will follow their doctor’s advice and stop driving. If necessary, the doctor may be able to notify the state that the patient is no longer fit to drive, and have their Driver’s License re-evaluated. If necessary to prevent immediate danger, take away the patient’s car keys.
Home Safety
Patients with Alzheimer’s disease must be protected from safety hazards in the home. Taking a few simple precautions can help keep them safe.
Install secure locks on all outside doors and windows, especially if the patient is prone to wandering off. Remove locks from bathroom doors to prevent them from locking themselves in accidentally.
Install child proof latches on cabinets where cleaning supplies or chemicals are stored. All dangerous items should be locked up and stored securely.
Make sure that all medications are labeled and securely stored.
Eliminate tripping hazards, remove scatter rugs, and get rid of clutter. Make sure that lighting is good in all areas.
Be alert to dangers in the kitchen, such as the patient leaving the stove or oven on after cooking. Consider installing an automatic shutoff device on cooking appliances to reduce the risk of fire or burns.