Clint Maun, CSP
Deciding on care arrangements for a loved one with Alzheimer's is one of the most difficult decisions a family can face. Often they may feel guilt and anxiety about taking their loved one away from their home and placing them in a professional care setting. Many family members feel ashamed of themselves for seeking professional help and may feel disappointed that they were not able to "do it all" for their loved one. However, as healthcare professionals, it's important that we ease family members' fears and assure them that seeking help does not make them a failure-professional care helps not only the caregiver, but the Alzheimer's sufferer as well.
When individuals with Alzheimer's reach stage three and beyond, everyday tasks such as cooking, cleaning and taking care of their own personal hygiene becomes increasingly difficult. It is generally at this stage that the nursing home or long-term healthcare facility option becomes a recommended alternative for the safety and well-being of the loved one.
While family members and loved ones may feel apprehensive about placing an individual in a nursing home, you can point out the many benefits including:
- Around-the-clock care and supervision
- An opportunity for one-on-one attention and a fresh approach from healthcare professionals (this may have been difficult for the family caregiver to provide with all of the other daily responsibilities he/she maintained)
- An opportunity for the patient to be around others who are facing the same challenges
- A safe environment with structured activities and care
Indeed, caring for an Alzheimer's patient is challenging as the disease affects the person both physically and mentally. When an Alzheimer's sufferer is making the transition from home care to professional care, your organization will want to make some additional inquiries that you wouldn't necessarily make with other residents. For example, have the family members and/or former caregivers share techniques that worked for them in the past. Perhaps this could include specific routines the patient likes to follow or special methods of communication. Also, ask for a written personal history of the Alzheimer's patient. Have them bring photos, share stories and memories. All of this will help your organization gain an understanding of the patient's personal traits and ultimately help you and your colleagues connect with the Alzheimer's patient. Family members will certainly recognize and appreciate this level of detail.
Addressing Specific Issues
Aside from the general, daily care you provide, family members may be concerned with how your healthcare facility handles specific issues tied to Alzheimer's disease. For example, it's common for many Alzheimer's suffers to experience problems with sleep, communication and their own behavior. Below are strategies to help you prepare and deal with all three of these issues.
Targeting Sleep Problems
Alzheimer's patients often have trouble achieving consistent, restful sleep. To improve sleep in these individuals, the U.S. National Institutes of Health has encouraged use of the non-drug measures described below rather than medication therapy (unless the sleep disturbance is clearly related to a treatable medical condition).
To create an inviting sleeping environment and promote rest for a person with Alzheimer's:
- Maintain regular times for going to bed and arising.
- Establish a comfortable, secure sleeping environment-provide nightlights, maintain a comfortable temperature and lock the door if the patient is prone to wandering.
- Discourage staying in bed while awake.
- Establish regular meal times.
- Avoid excessive evening fluid intake and empty the bladder before retiring.
- Avoid daytime naps if the person is having trouble sleeping at night.
- Expose the patient to morning sunlight.
- Have the patient engage in regular daily exercise (i.e. small walks
and light stretching), but no later than four hours before bedtime.
Achieving Clear Communication
Communication with an Alzheimer's patient can be quite difficult and frustrating at times. However, there are several strategies you can use to improve communication with a patient who has Alzheimer's disease.
Engage the patient before you speak. Gain the listener's attention before you begin talking. You can do this by approaching the person from the front, identifying yourself, and calling him or her by name. Also, try to achieve eye contact with the patient, in efforts to discern if they are alert and coherent.
Cut the clutter. Try to reduce background noise, such as from the TV or radio, when speaking. In addition to making it harder to hear, the TV or radio can compete with you for the listener's attention.
Pay attention. While you may feel that the patient isn't listening or can't comprehend what's being said, it's still very important that you show you are listening. Nod your head as they speak and use friendly facial expressions.
Stay simple. Try and keep conversations clear and to the point. Give one-step directions. Ask only one question at a time.
Be kind and remind. When/if an Alzheimer's patient is having trouble conveying a message, you may have to gently remind them of certain things. Without being condescending or appearing frustrated, simply remind them of things such as the date, time, and names of the people with whom he or she has contact.
Make Adjustments. It's very difficult for later-staged Alzheimer's patients to learn or understand something new. With that in mind, adapt to his or her way of communicating as opposed to forcing the patient to understand your way of communicating. Make adjustments on your part and try to make sense of the words and gestures the patient is using to communicate. It may also be helpful to keep a journal. Jot down the words and methods patients are using to communicate with you-it can serve as a good reference guide.
Be persistent. If a patient feels as though you don't care as to whether they speak or not, they will eventually stop trying to communicate altogether-which is obviously very unhealthy. So, make sure you encourage the person to continue to express his or her thoughts, even if he or she is having difficulty. Just be careful not to interrupt or put words in their mouth.
Above all, remember that the poor communication is not the person's fault, rather the disease. Don't ever speak down to the person or speak to others as if he or she is a child or isn't present. Treat the patient with dignity and respect.
Controlling Unpredictable Behavior
As most healthcare professionals know, the changes in the brain that are associated with Alzheimer's disease can lead to unusual and unpredictable behavior. The person with Alzheimer's disease may become paranoid, begin to withdraw from social interaction, wander, become aggressive, and/or become angry and irritable.
Below are what you don't want to do when dealing with unpredictable behavior that accompanies Alzheimer's disease.
Don't stray from the path. Try to minimize any changes in the surroundings or to the patient's daily routine. Also, avoid situations that require the person with Alzheimer's to make decisions. Having to make choices can be very frustrating and cause anxiety for a person with Alzheimer's disease.
Don't be a broken record. Hearing the same word or phrase repeated time and time again can make anyone want to act out in anger. When a patient doesn't seem to understand what you're saying and is becoming frustrated, it may help to simplify, or re-word your statements as opposed to saying the same thing over and over.
Don't write anyone off. It's important for healthcare professionals to keep a positive attitude. Reassure patients that they are in good care, even if he or she does not respond-this can help ease their own fears and reduce the chance of them acting out.
Don't "sweep it under the rug." If an Alzheimer's patient has an outburst or is acting odd, make sure to document episodes of such behavior so you can try and prevent it in the future. Try to identify any actions, words or situations that may "trigger" inappropriate or dangerous behavior. Ask the patient what has made them angry or what is troubling them. You may not always get a logical answer, but it never hurts to ask.
Don't overlook their environment. To minimize confusion and anxiety, adjust the patient's environment to his or her capabilities. For example, if the Alzheimer patient can no longer brush his/her own teeth, it may be best to keep toiletry items out of sight and reach.
While there is no current cure for Alzheimer's, there is more we find out about the disease everyday. Furthermore, by focusing on the positive-how to best treat patients-healthcare professionals can ease suffers' and family members' worries and help them live out life the best they can.
Sources: Web MD & The Alzheimer's Association