Caring for Alzheimer’s Patients
All CNAs who work with the elderly will come into contact with someone who suffers from Alzheimer’s disease. However, when the elderly senior suffers from dementia – Alzheimer’s disease in particular – verbal communication can be difficult, if not impossible.
An elderly person with Alzheimer’s disease may display sudden mood changes, develop an uncooperative attitude, and may become unusually aggressive. While such behaviors are common for the person with dementia, these same behaviors can also occur when the elderly person is experiencing pain from a secondary cause – such as a pulled muscle or sore back, for example.
If the patient has lost the ability to reason and cannot verbally tell the healthcare provider what hurts and where it hurts, then how can the physician effectively treat the patient? This is why the CNA’s input is extremely important. CNAs who work closely together with the patients know, whether by observation or by instinct, if the patient is being uncooperative as a result of the disease or if the aggressive behavior is caused by an underlying problem that’s causing pain.
Repercussions of Overlooking Pain in the Alzheimer’s Patient
A physician may not get a clear picture of the elderly patient’s situation if the senior doesn’t know how to respond or responds incorrectly to questions regarding his condition. Treating an Alzheimer’s patient for disease-related behavioral problems, without first ruling out pain as a cause, can result in dangerous consequences.
Many people with dementia express pain through behavioral problems, particularly verbal or physical agitation, and are unsuccessfully treated with psychotropic medication. When high-risk psychotropics are prescribed without ruling out pain issues, the medication may be increased, due to ineffectiveness. Side effects from psychotropic medications can cause lethargy, dizziness, and increased confusion. Increasing the dosage only puts the patient in more danger. At the very least there is an increased risk for falls and serious injury.
Signs of Pain in the Elderly Person With Dementia
The elderly person’s body language may be the first sign that pain is causing a problem. The physician may consult with the caregiver and conduct a more thorough exam when pain is suspected. Sudden changes in eating habits, changes in sleep patterns, and decreased socialization may indicate the person is experiencing pain or discomfort.
Other signs of pain are obvious with careful observation:
- Groaning or moaning, especially when moving a certain way.
- Wincing or facial tension during movement or an activity.
- Sudden change in gait or mobility.
- Restlessness and agitation beyond what has been routine until now.
- Resistance to movement or decreased ability to move.
- Bruised spots, or swelling in an area.
Best Ways to Interact with Alzheimer’s Patient
The Alzheimer’s patient may become argumentative or violent, may try to get away, or may be unresponsive. Underneath maybe feelings of fear and vulnerability. The Alzheimer’s Association recommends the following, when handling Alzheimer’s patients:
- Move slowly when approaching the patient.
- Approach patients from the front where they can see you coming, so they do not get startled or surprised.
- Once you have approached the person, stand alongside him instead of face to face. Standing face to face can seem confrontational, whereas standing alongside is perceived as supportive.
- If the patient is seated, crouch low so that you are looking at her eye to eye.
- Do not grab or touch the person, this may feel threatening. Instead, offer your hand so he may take it.
- Call the person by name. Alzheimer’s patients remember their own names even very late in the disease. However their married name often disappears from memory.
How to Get the Alzheimer’s Patient to do Daily Activities
- When you want the patient to do a task, offer simple choices, (i.e “Would you like to put on your blue or your red sweater?”) instead of asking yes/no questions (i.e. “Would you like to get dressed?”)
- Ask for their help. (i.e. “Will you help me by putting your arm in this sleeve?”)
- Ask them to try. (i.e. “I know it seems hard but will you give it just one try?”)
- Break the task down into simple steps. (i.e. don’t say “Let’s go to lunch.” Instead say, “Put your foot down for me.” When they’ve done that go to the next part, i.e. “Lean forward” or “Stand up” or “Let’s walk to the kitchen.”)
- Use short, simple, sentences and give concrete information (i.e. “It’s time to eat.”)
How to Have a Conversation With the Alzheimer’s Patient
- Go slow.
- Use familiar words and phrases.
- Use objects to show what you are talking about.
- Be prepared to repeat conversations.
- Look at the person and look interested.
- Be prepared for emotional outbursts.
- How to Deal With Distress in the Alzheimer’s Patient
- Remember to approach the person from the front, then step to the side in a supportive stance and offer your hand. Be at eye level.
- Try to understand the need or the emotion behind what the person is saying. What are they feeling?
- Use “active listening” and empathy. Repeat back to them what they seem to be feeling, i.e. “It sounds like you are sad.” “It seems like you don’t like these eggs.” “It sounds like you are cold and you need a sweater.” Try to understand what they are going through, for example, “I want to go home,” means “I don’t recognize anything around me.”
- Don’t argue. Do not try to talk the patient out of their delusion. This will increase their agitation and it will not work.
- Try to distract or re-direct the person. “I know you don’t like the eggs. Let’s try some of the bread. Didn’t you tell me you used to enjoy making bread? Tell me about the bread you made.”
Other Skills for Dealing With the Alzheimer’s Patient
- Give lots of praise and positive strokes when they help you.
- Show your appreciation.
- Use humor when appropriate.
Ensuring Alzheimer Patient Safety In Home
The majority of people with Alzheimer’s live in the home with family members as caregivers. Many people are thrust into the position of caregiver with very little training or practical ideas for caring for a confused adult. Memory loss can lead to many dangerous situations in the house, such as:
- Inappropriate medication use or drug overdose
- Accidentally or intentionally locking doors
- Exposure to the weather without appropriate clothing
Making a home accident-proof can be a rather dauntless task when it seems that dangers lurk throughout a home. Fortunately, some simple and inexpensive options can quickly provide a safer environment for a loved one with Alzheimer’s while still maintaining his or her dignity and encouraging independence as much as possible. It can be helpful to identify and collect items that are the most likely to cause injury together in a limited number of places in the home and place them in a locked cabinet or drawer.
This might be accomplished with the purchase of drawer locks that are commonly found in baby sections of many stores. A combination or keyed padlock might be placed on a closet or cabinet door. Door locks found in the baby section may also be helpful, particularly if a conventional lock does not fit well with a particular knob or door. Sometimes the person with Alzheimer’s may discover the combination or “trick” to opening a lock, so it can be helpful to have a back-up plan if the first one fails.
Some red flag items with a high potential to cause injury include:
- Lighters and matches
- Cleaning supplies
- Appliances that produce heat, such as a stove, electric skillet, tabletop grill, iron, curling iron, etc. can quickly cause a fire. If it is impossible to secure the appliance, consider installing an automatic shut-off switch or unplugging a stove to help prevent potential fires. Ensure that smoke detectors are installed and regularly checked in the home.
People with Alzheimer’s may attempt to eat items such as a bar of soap or houseplant, so it is also important to evaluate items within the home that one might not expect to cause injury.
Medication Safety in the Home When Someone Has Dementia
Confusion can lead to a host of medication administration problems, such as:
- Extra doses or unintentional overdose of medications, which often results when a person takes a drug again because she forgot that she took it earlier
- Forgotten extra medications, such as a missed antibiotic prescribed for a UTI
- Forgotten changes in doses with resulting dosages that may be dangerously high or low
- Forgotten purpose of as-needed medications with resulting doses of unnecessary drugs or a lack of treatment for problems such as pain
Caregivers should always be aware of currently prescribed medications and doses and should understand the purpose and potential side effects of each medication. Store medications appropriately in a locked place with a current list of prescription and over-the-counter medications that the person is taking.
How to Keep Someone Safe Who Wanders
People with Alzheimer’s disease may tend to wander, which can lead to a variety of problems such as exposure to cold temperatures without appropriate clothing if he or she wanders outside during winter months. Many people with Alzheimer’s disease experience sundowning, in which confusion increases in the evening and at night, which is often the time when a caregiver is busy cooking dinner or may be trying to rest.
Restraining or tying someone who wanders can lead to more problems, such as pressure ulcers, loss of independence, and circulation problems. Improperly restraining a person is a form of elder abuse that should be avoided.
Fortunately, options to restraints are available, such as:
- Maintaining a regular and predictable routine as much as reasonably possible
- Offering regular toileting assistance as needed
- Encouraging daily physical activity such as walking
- Placing alarms that will alert a caregiver if the person rises from the chair or bed if the caregiver cannot visualize the person
- Labeling doors and posting signs that say “Keep Out” in key areas
- Offering a rummaging drawer with items that are likely to hold the person’s attention
- Place a mural or large picture on the wall that resembles the outdoors
- Ensure that furniture is comfortable and safe
- Utilizing available resources, such as elder care options, adult day care, home care, respite care, etc.
It is also likely that someone with Alzheimer’s may accidentally lock himself within a room, such as a bathroom, and be unable to get out. Ensure that keys for these rooms are protected and readily available to caregivers or change the doorknobs to ones that do not lock. Keeping other keys, such as car keys, in secure and safe places is also important. Keep a house key outside in a secure but readily accessible in case the person with Alzheimer’s decides to lock all the inside doors once a caregiver walks outside.
Someone who wanders or who needs assistance walking but attempts to move or care for oneself without assistance can be at risk for falls in the home due to slipping or balance issues. One fall can have devastating effects for a senior.
Practical examples for preventing falls include:
- Ensure that assistive devices such as walkers or canes are available when needed.
- Items on the floor should be secure.
- Remove throw rugs that slip.
- Remove any clutter on the floor, on handrails, etc.
- Consider securing bookshelves to the wall.
Adapting Parties and Other Family Functions For Alzheimer Patients
Alzheimer’s disease affects a person’s ability to process stimulating, unfamiliar activities, so patients generally do better when they have a calm daily routine. This, of course, is the opposite of what occurs at the typical holiday party. Holiday get-togethers often include adults having several loud conversations in the same room, bright or blinking lights on the Christmas tree and excited children running around the house. Also, party food may vary from the usual meals, and be served at a different time. An Alzheimer’s patient – even one who once was the life of the party – will probably be overwhelmed in this kind of environment, and can feel more confused, anxious or irritable. Instead of courting failure, the family can follow a few strategies to tone down some holiday events, and increase the chances of the patient doing well at parties and other festive activities.
- When planning a party that includes the patient, it’s crucial for the family to remember that a lot of noise and confusion can upset an Alzheimer’s patient, and aggravate symptoms. If a party is bound to include hours of non-stop noise and activity, the caregiver can make sure the patient, accompanied by a companion, can have a quiet, low lit place to go to at the first sign he or she is acting anxious or irritable. The family can also decide, guilt free, to keep the party as usual, and plan for the patient to have an alternate, quiet activity.
- Once at a holiday event, an Alzheimer’s patient should be settled into a comfortable seating area that is away from the main hustle and bustle of the party. Patients can have a lot of trouble trying to focus when several people are talking back and forth to each other. It’s easier for the patient to talk to one person at a time, so friends and relatives can take turns visiting with the patient.
- Holiday activities that include the Alzheimer’s patient and young grandchildren can be structured to minimize chaos and noise. A patient might enjoy decorating Christmas cookies or making a Thanksgiving decoration with a few grandchildren, rather than trying to sustain a conversation or have open-ended play. If a patient starts to become anxious or agitated during a visit, the caregiver can intervene and direct the children to another activity, or guide the patient to a quiet place.
- Depending on the day or hour, the patient may or may not remember certain relatives and friends. When making introductions, the caregiver can say something like, “Mom, your grandson Matthew wants to wish you Happy Holidays. Say hello to your grandson Matthew.”
- Partygoers can help the patient by bringing up past events, rather than talking about the present and future. Patients often still maintain good long-term memory, so will be able to enjoy the reminiscing. Scrapbooks with clearly labeled photographs can also be shared, and may bring much pleasure to both the patient and the visitor.
Alzheimer’s Association Provides More Support
So long as there is no Alzheimer’s cure, caregivers need to find a way to release the stress of caregiving. Check out the Alzheimer’s Association regional chapters near you.
Often what happens when caregivers share their stories, they learn from others about other ways to help strengthen their loved ones’ memories. It is no secret that by providing stimulating and nurturing activities for an Alzheimer’s patient, one can actually see the love and build a connection, which is so vital and critical as the loved one progresses from one stage to another.