Caretaker Archives

The last two months I’ve talked about a lecture that I attended, “Understanding the Person with Dementia: How to Communicate Effectively.” It was presented by Susan Stone who is with the Alzheimer’s Family Day Center (AFDC) in Fairfax, Virginia and does outreach and education. Communicating with a person with Alzheimer’s disease (AD) is a challenge which takes patience and understanding. This is a continuation of her lecture and the final in the series of three articles.

To communicate with a person with Alzheimer’s disease (AD), we need to understand their world. There is no point in arguing or correcting. The patient’s reality is not your reality so join the individual where he is. Simply acknowledge the statement and emotion behind it even though you know that it’s incorrect. Avoid asking questions that they cannot answer. Allow them to reminisce.

Make positive statements. Try going through the day without saying “no.” Difficult? Avoid pronouns like it, he, she. And use very simple explanations. Details often overwhelm them and can cause increased anxiety.

Here are some strategies to consider.

  • Offer guided choices. They are losing their right to make choices so say something like “chocolate or vanilla” and they will likely remember the last word.  The speaker humorously added that if there are only two choices and you want the chocolate one, offer the chocolate one first followed by vanilla since they will probably choose vanilla.
  • Write it down and use labels. During the late stages, labels won’t help, but during earlier stages of AD, they will help.
  • Validate emotions rather than facts.
  • Avoid overstimulation.
  • Model appropriate behavior.
  • Fill in lost words, although this depends on the person.
  • Turn your questions into answers.
  • Use events to measure time.

Listening is extremely important. Learn to read body language to figure out what the person is trying to communicate. Is it pain, frustration, fear, pleasure, boredom? Survey the environment as well to see what’s going on. Focus on the person and listen. One AD patient said,

I have taken time to put words together and I may be unable to repeat it.

Another AD patient said, I’m doing the best I can. They may overhear you talking about them so be careful. The ability to understand what is being said outlasts the ability to speak effectively.

The understanding the person has might come from body language and tone of voice more than from the words that you use. Use humor gently and never at the expense of the individual. But humor is everywhere; just keep looking for it.

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Last month I talked about a lecture that I attended, “Understanding the Person with Dementia: How to Communicate Effectively.” It was presented by Susan Stone who is with the Alzheimer’s Family Day Center (AFDC) in Fairfax, Virginia and does outreach and education. Communicating with a person with Alzheimer’s disease (AD) is a challenge which takes patience and understanding. This is a continuation of her lecture.

As we age, we all experience age-related brain changes, but for Alzheimer’s disease (AD) patients, the changes may be a lot more pronounced. They include:

  • Impaired hearing – especially higher frequencies
  • Lessened ability to determine the location of sound
  • Decreased vision
  • Slower thought processing
  • Slower in adjusting to light changes. (She suggested going into their bedroom earlier and opening the blinds).

Along with age-related brain changes, there are definite communication changes in dementia. They include the following:

  • Word finding problems (initially nouns and pronouns)
  • Frontal lobe damage
  • Word salads (stringing a lot of words together that don’t make sense)
  • Perseveration (repeating words over and over)
  • Mis-naming (but getting close) (An example she gave was someone trying to say Dairy Queen and used the word “king”).
  • Returning to original language (first to learn and last to lose)
  • Loss of ability to recognize and understand words

When approaching a person with dementia, use the person’s name and casually introduce yourself. Approach the person from the front and make sure you have eye contact. Touching the person also helps them to maintain attention. There’s less human touch as a person gets older so touching is important.

Finally, here are tips for initiating conversation.

  1. Speak slowly and clearly. Use e-x-p-a-n-d-e-d speech, but by all means treat them with dignity and not as though they are a child.
  2. Pause at the end of thoughts to give them time to process.
  3. State one request at a time.
  4. Always explain what you are going to do.
  5. Use lots of hand gestures.
  6. Watch the person closely for their reaction. Anxiety leads to anxiousness to regression.

Next month I will continue with more tips.

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A couple of years ago, I wrote about a wonderful Alzheimer’s disease (AD) resource in Fairfax County, Virginia located about 15 miles south of Washington, DC, the Alzheimer’s Family Day Center (AFDC). Not only are they a day care center for AD patients, but they have excellent programs for caregivers. I recently attended one such program on communicating with Alzheimer’s patients.

Titled “Understanding the Person with Dementia: How to Communicate Effectively,” it was presented by Susan Stone who is with AFDC and does outreach and education. Susan is an excellent communicator herself and interacts with the audience extremely well. I want to share some of her thoughts in this article and I will continue next month.

Because communication is only 7% verbal and the rest nonverbal, it is important to not limit your communication to just words. People with Alzheimer’s prefer not to talk on the phone and initiating phone calls is difficult. They have difficulty keeping up with conversation and may not understand your words. Their attention span is limited and they may have trouble finding the correct word. Furthermore, they may pick up only every three to four words.

For example, the conversation may sound like this:

___ WANT ___  ___  ___ GET ___  ___  ___ TAKE ___  ___  ___ . WE ___  ___  ___ APPOINTMENT ___  ___  ___  ___ WE ___  ___  ___ BEFORE ___  ___  ___ HOME.

NOW ___  ___ HURRY.

Here is the entire message:

I WANT you to GET up now and TAKE a good shower. WE have a doctor’s APPOINTMENT at 11:00 and WE can have LUNCH before we go HOME.

NOW please just HURRY!

Getting angry and adding a sharp tone of voice is not going to make this message any easier for the AD person to decipher. Here are some suggestions Susan offered:

  • Restating key words will help.
  • Give one direction at a time.
  • No rushing – time does not mean anything to an AD person.

Here are further suggestions repeating just the key words.

  • Get up. (Offer your hand).
  • Shower.

This is all the person needs to know at this point. They don’t really need to know about the appointment and having lunch is too far in the future to mention it now. You want them to take a shower and all they might remember is having lunch.

More suggestions will be coming next month. I hope this gives some understanding as to why communication is so challenging for those with dementia.

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Memory and Focus

Many people have problems with memory and focus as they age.  Whether the problems are the beginning stages of dementia or just a lack of focus, the following exercise can help to ensure that aging has less power to rob you of precious memories.  In addition, this exercise provides a possible solution for insomnia.

1.  Focus on the events of the day in order from arising in the morning until you go to sleep. The good news is that you will fall asleep long before you reach the end of the day.

2.  During the process, visualize each step of the day.  The process should include all activities, conversations, thoughts and individuals met during the day.  It might be seen as a video recording of the day played back only in your brain.  Focus on details.

3.  Initially, the mind video will be playing in fast forward.  It will be difficult to pick out the small details such as thinking over your today list or looking in the mirror while brushing one’s teeth.  In addition, scenes may jump out of sequence from morning to afternoon and then back to getting out of bed.  However, your goal is to play the video in sequence.

4.  As you continue the exercise several days in a row, you should begin to see some differences.  That which was once a just big chunk of time will begin to develop into fully visualized scenes, which include people, conversations, room decor, signs and thoughts.  Details will become clearer.

5.  It should become a daily challenge to remember more of the day.  You will become more aware of the things you normally would have done without much thought.  Since you know you must recall, your focus changes.  You are using brain cells not previously harnessed.  While the nighttime exercises may be a cure for insomnia, the daytime exercises help you to focus, improve your memory, and lower the chances of developing dementia.

By improving one’s daytime focus and recalling events of the day, it is possible for people to avoid memory loss and dementia.  Additionally, these activities can help with insomnia.

The ideas in this article are adapted from a blog on how to become a better chess player, but certainly seem appropriate for anyone concerned with dementia and having problems with memory and focus.

http://www.mychessblog.com/one-simple-mental-exercise-to-improve-your-mind-power/

 

Facebook Light for Dementia Patients

According to Medical News Today, there is a version of Facebook called Facebook Light being developed by SINTEF, the largest research organization in Scandinavia. This will enable the elderly and those with dementia to maintain important social contact. This will enable them to maintain their level of functioning longer, according to research and experience.

According to Tone Oderud, a research scientist at SINTEF, the elderly are being excluded from social media today. The user interface is too advanced for many of them. Oderud is working in a multidisciplinary research team to develop a web-based communications application which is simple enough to enable even people with dementia to use it. The goal is to create a simpler and more secure everyday life for elderly and senile people, their relatives and personnel in the community care services.

Furthermore, research scientists believe that contact through social media can improve the quality of health and life for the great numbers of elderly and those with dementia in our society. At the same time, this can ease the burden on therapists and caregivers.

Testing of other web-based communications systems have already been started. They include a “digital diary” and “scrapbook” with personal photos, newspaper cuttings, and other online information. Oderud says that both of these improved communication between both relatives and the community care services in an informal but valuable way.

The article states that the tests showed that constant, simple contact between relatives and the support services improved everybody’s security and at the same time it reduced the time the caregivers needed to follow up concerned relatives. This holds great potential in all fields of caregiving.

A prototype is currently being tested in the city of Drammen in southern Norway.

Caregivers of Alzheimer’s disease patients have one of the toughest jobs in the world and yet sometimes one of the most rewarding. Stephanie Jewett, RN, MBA, in an article in ezinearticles.com, offers the following tips for caregivers in a home setting.

  • Find something they love to do and keep that favorite thing going everyday, i.e. take a walk in the park, watch their favorite television show or read articles in a magazine. Go to the Internet and learn more about their favorite subject.
  • Keep life simple; follow a schedule everyday. Eat at particular times, keep hair appointments to one specific day a week, and enjoy a meal out once a week, on the same day.
  • Get lots of rest – take a nap if one feels tired, but don’t sleep the day away. Get up at the same time each day, bathe and then have a nutritious breakfast each and every day!
  • Go through scrapbooks and old pictures, reminding them of family members — their names, ages, etc.
  • Get a dog or a cat so that the patient has some responsibility and company in the home. Pet therapy is one of the best methods known to keep a person happy and healthy.

As a caregiver, your top priority is to take care of yourself so that you will have the strength and stamina to take care of your loved one. So the tips for your Alzheimer’s disease patient apply to you as well. Take good care!

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Last week the Alzheimer’s Association released its new 2011 Alzheimer’s Disease Facts and Figures report. The statistics are grim. It is the sixth leading cause of death and of the top 10, it’s the only one where we do not know exactly how it can be prevented, cured, or slowed. Yes, we do have many research studies going on, but there has not been anything definitive. Most of the studies are just the tip of the iceberg and require further research. Some have produced disappointments. Highlights from the report include the following:

  • An estimated 5.4 million American’s have Alzheimer’s disease. Another American develops Alzheimer’s disease every 69 seconds.
  • In 2010, 14.9 million family and friends provided 17 billion hours of unpaid care to those with Alzheimer’s and other dementias.
  • The cost of caring for those with Alzheimer’s to American society will total $183 billion in 2011.
  • Deaths from Alzheimer’s increased 66 percent between 2000 and 2008, and Alzheimer’s is the only cause of death among the top 10 in America without a way to prevent, cure, or even slow its progression.

The complete 2011 Alzheimer’s Disease Facts and Figures report allows you to get information specific to your state. Let’s hope we will have a major breakthrough this year and the 2012 report will be a lot more promising.

The Alzheimer’s Association produced a video capturing these statistics.

Hope for Alzheimer’s Disease

I know it’s difficult for families with an Alzheimer’s disease patient. What looks like so much promise for those of us who are candidates down the road, will not be a solution for those currently experiencing this dreadful disease. What’s available today are only five medications discussed previously here. These may slow down the progression of the disease, but they also have side effects (like most prescription medications) and are not permanent solutions. There are also many clinical trials going on. The Alzheimer’s Association is an excellent place to start your research.

This year there has also been a greater focus on caregivers because of organizations like the Alzheimer’s Foundation of America and celebrity involvement. Earlier this month, Al Roker of the Today show, hosted the first telethon, Together for Care, for the foundation. See video below.

Occasionally, we hear good news such as “New Piece of Alzheimer’s Puzzle Identified” which is very encouraging. Sometimes encouraging news turns out to be disappointing, but there’s always hope. In this new study, researchers from the Mayo Clinic in Rochester, Minnesota found that endothelial dysfunction increases production of proteins that provide the raw material for the amyloid plaques seen in the brains of people with Alzheimer’s disease. Simply put, endothelial dysfunction is a problem with the lining of the blood vessels. Read the full news release here.

So, as we turn the page to a new calendar year, let us keep the hope in our hearts. I wish all of you and your families a heart-warming new year.

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Now that the holiday season is in full swing, what should be a joyous time for all can be an especially challenging for a person with Alzheimer’s disease (AD) and their families. According to Dr. Stephen Moelter, associate professor of psychology at University of the Sciences, family members may not know how to react to a person who often repeats the same thing, is confused, or does not recognize the family member.

In order to engage a person with Alzheimer’s disease, he makes the following suggestions:

  1. Family members need to educate themselves about AD and the importance of supporting their loved ones and keeping them safe. There are many resources at the Alzheimer’s Association’s Web site, www.alz.org.
  2. Engaging the person in conversation and keeping them involved in activities is paramount to their health. It should be at their level and it is preferable to let them lead. Keep your tone positive and it is preferable not to challenge a person with AD. That my lead to increased anxiety and confusion. A memory test will not help the situation.
  3. Ask questions about the distant past such as how they spent their holidays as a child  rather than how they spent their holidays as an adult. Encourage reminiscing.
  4. Parents can help their children by giving suggestions to their children of topics to talk about such as hobbies, jobs, or family events. Younger children should be given permission to keep the conversations brief. It is very difficult for children to comprehend Alzheimer’s disease.

You can read the entire article at Medical News Today. Click here. Here’s wishing you and your loved ones a memorable holiday season.

Last spring the International Journal of Geriatric Psychiatry reported that for males, by delaying retirement, the age of onset of Alzheimer’s disease (AD) was also delayed. On average, each additional year of work staved off Alzheimer’s disease by seven weeks.

Not known are questions such as:

  • Did retirement somehow bring on the disease?
  • Are people who are at risk for Alzheimer’s unlikely to keep working?

The researchers speculate that employment challenges may help to keep the mind healthy and agile as one ages. For many people, it’s a financial necessity to keep working, but it might prove to be a great benefit to the brain. Click here to read the abstract of the study.

According to the Alzheimer’s Association, Alzheimer’s disease is:

  • responsible for $172 billion in annual costs in the United States
  • the seventh leading cause of death in America
  • not limited to the elderly, with people in their 30s, 40s, and 50s developing the disease
  • currently affecting more than 5 million Americans, resulting in 11 million Alzheimer and dementia caregivers who provide $144 billion in unpaid care for their loved ones
  • a disease someone in America develops every 70 seconds and by mid-century someone will develop Alzheimer’s every 33 seconds.

The statistics are staggering. If a person enjoys work, then by all means it might be a good way to delay the onset of Alzheimer’s disease. On the other hand, if one does not enjoy working or if it is too stressful, then delaying retirement would not be a good option. There are so many things that one can do in retirement to continue to stimulate the brain.

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