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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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,
  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.

The American Journal of Alzheimer’s Disease and Other Dementias recently reported in an open-label pilot study that apple juice improved behavioral, but not cognitive symptoms in moderate-to-late Alzheimer’s disease patients. Although this was a very small study of only 21 institutionalized patients who drank two 4-ounce glasses of apple juice twice a day for a month, the study suggests that apple juice may be a useful nutritional supplement since, as Alzheimer’s disease (AD)  progresses, the mood of AD patients may decline as well. It may help ease the burden for caregivers.

The study said, “Caregivers reported an approximate 27% (P < .01) improvement in behavioral and psychotic symptoms associated with dementia as quantified by the Neuropsychiatric Inventory, with the largest changes in anxiety, agitation, and delusion.”

Exactly how apple juice might help remains unclear. It’s possible that the antioxidant nutrients in the apple juice reduces the oxidative damage to the brain tissue.

Since this was a very small study funded by the apple industry with no placebo, the conclusions need to be viewed with caution. However, given that apple juice is a healthy and inexpensive beverage, it would seem a positive thing for caregivers to try.

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According to the Alzheimer’s Association, there are seven stages of Alzheimer’s disease. In stage 5, there is moderately severe cognitive decline. This is the moderate or mid-stage Alzheimer’s disease. The Alzheimer’s Association says:

Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:

  • Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated

  • Become confused about where they are or about the date, day of the week or season

  • Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s

  • Need help choosing proper clothing for the season or the occasion

  • Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children

  • Usually require no assistance with eating or using the toilet

Life becomes quite a challenge for the primary caretaker at this point. I was not the primary caregiver; my mom was, but my sister and her family lived in the same house so she was always available to assist. Mom never had a break, but each summer I would go to assist when my sister and her family went on vacation.

I do remember dad being frustrated with his situation at this point and he voiced his frustration. It is such a helpless situation. He definitely recognized me at this point and I remember the big smile he had to see me, although he wondered how I had gotten there.


Alzheimer’s Disease: Caregiver Stress

In my previous post, I wrote about focusing on the caregiver. If you’re not physically and mentally healthy, finding the strength to take care of an Alzheimer’s disease (AD) patient is a monumental challenge. Even if you are in the best of health, I know it’s still difficult, but at least you’re healthy and can think more clearly. Recently, the Alzheimer’s Association in my area sent me a request to renew my 2010 Champion membership — i.e., please send more money.  Attached to this request was a list — 10 Symptoms of Caregiver Stress. I was happy to see the focus on the caregiver. Here are the symptoms of caregiver stress.

  1. DENIAL about the disease and its effects on the person who has been diagnosed. “I know Mom’s going to get better.”
  2. ANGER at the person with Alzheimer’s or others that no effective treatments or cures currently exist and that people don’t understand what’s going on. “If he asks me that question one more time, I’ll scream.”
  3. SOCIAL WITHDRAWAL from friends and activities that once brought pleasure. “I don’t care about getting together with the neighbors anymore.”
  4. ANXIETY about facing another day and what the future holds. “What happens when he needs more care than I can provide?”
  5. DEPRESSION begins to affect the ability to cope. “I don’t care anymore.”
  6. EXHAUSTION makes it nearly impossible to complete necessary daily tasks. “I’m too tired for this.”
  7. SLEEPLESSNESS caused by a never-ending list of concerns. “What if she wanders out of the house or falls and hurts herself?”
  8. IRRITABILITY leads to moodiness and triggers negative responses and reactions. “Leave me alone!”
  9. LACK OF CONCENTRATION makes it difficult to perform familiar tasks. “I was so busy, I forgot we had an appointment.”
  10. HEALTH PROBLEMS begin to take their toll, both mentally and physically. “I can’t remember the last time I felt good.”

The Alzheimer’s Association offers a brochure that tells you how to manage caregiver stress and how to be a healthy caregiver. Click here to obtain the brochure. The Alzheimer’s Association has a toll-free number should you wish to speak with someone. 1.800.272.3900. I wish you the best. Please take care.