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Caregiving Questions

Latest Questions and Answers
My husband, who is 75 years old, has dementia of the Alzheimer’s type and vascular disease. He has some very strange habits, such as picking up every leaf in front yard or street, and picking up everything that I lay down and placing it somewhere else. When I’m not using the dryer, he brings in the clothing off of the line, while it is still wet, and rearranges it all, even though I have requested that he not do so. He gets belligerent if I try to correct him. Are these behaviors normal and approximately how long does each stage of the disease last? Would he be better off to take Namenda and Aricept together rather than just Namenda alone, which is his current treatment regimen? [ 07/12/10 ]

Repetitive behaviors and strange habits such as your husband's are characteristic of Alzheimer's disease, particularly in the moderate stages of the disease. Unfortunately, there is no way of knowing how long this stage—or his behaviors—will last because every patient is different and follows his or her own disease course. But every time you start getting frustrated with your husband, just keep in mind that he is not doing these things to purposely upset or annoy you. If he could help himself, he would not be this way. So even if you remind your husband not to do something, chances are he will forget what you have told him—this is the nature of the disease.

Perhaps your husband feels like he needs to keep his hands busy, or he may think that he is helping you by picking up leaves or rearranging the laundry. Rather than struggle with him over these behaviors, you can try to redirect his energy toward a useful action, such as folding laundry, peeling vegetables, vacuuming, dusting, or any other simple job he might be capable of doing. Maybe the clothes will end up being folded oddly, or the potatoes won't be peeled very well, but don't let it bother you. What matters is that your husband will be kept busy and, more importantly, he will feel that he is needed.

The combination of a Namenda (generic name: memantine) and a cholinesterase inhibitor (such as Aricept) is commonly prescribed for Alzheimer's disease patients. This combination of medications is generally well tolerated, though of course, there are some common side effects associated with Aricept such as nausea, vomiting, diarrhea, and weight loss. Additionally, a few reports have indicated that this combination of agents might have a greater therapeutic effect than taking a cholinesterase inhibitor alone. However, these studies have yet to be confirmed.

My father, who is 83 years old, has recently moved in to a care facility for Alzheimer’s disease patients. In the last five weeks he has become incontinent and is wearing adult diapers; however, he has been going in the closet to urinate. We have put a sign on the washroom in his room and added a night light, but he continues to use the closet as his bathroom. Can you think of any reason why he is doing this and do you have any suggestions to help modify this behavior? Other than this particular issue, he has settled in to his new home better than we had expected. [ 07/09/10 ]

Unfortunately, urinating in inappropriate place is not uncommon in Alzheimer's patients. There are several reason why this might be happening with you father. Most often the problem lies in the patient's perception of the bathroom, toilet or both. Due to the confusion or anxiety created the patient will then seek out an alternative. Being in a care facility, it is most likely that precautions have already been taken to eliminate these issues but it is worthwhile ensuring this is the case.

Starting with the toilet itself, make sure there is a strong contrast between the toilet and the surrounding wall and floor. Due to changes in perception it can sometimes be difficult for Alzheimer's patients to perceive objects or gauge depths and distances. Handrails and anti-slip strips on the floor of the washroom will also help to make your father feel more secure, in case he is anxious about falling or not being able to lift himself from the toilet. It may also help to install a lock on the closet door that the facility can lock each night and unlock in the morning. At least this way he will not be able to use the closet as at toilet at night. Finally, even if he does not need to go, try taking your father into the washroom as much as possible and getting him comfortable with it and with using the toilet. He may just be apprehensive of the room and may need reassurance that there is nothing to fear or be anxious about.

My mother was diagnosed with Alzheimer’s disease, and does not trust me or my brother. She needs to move and thinks that we are taking all of her belongings. In addition, she no longer wants to eat. Please help! [ 07/08/10 ]

Because of the nature of the disease, Alzheimer's patients often can suffer from paranoia or suspicions that people are stealing from them. You and your brother will have to provide continual calm reassurance that her possessions are safe and have not been taken. Your mother may be anxious about the prospect of moving, which may be causing her to have some anxiety. If this is the case, you will also need to reassure your mother that the move is a good thing and that she will be loved, cared for and appreciated no matter where she lives.

If you have not already done so, now would also be a good time to speak to an attorney who specializes in elder issues to ensure that all of your mother's affairs are in order. The attorney may advise you and your brother to make an inventory of all of your mother's most important possessions and holdings. This serves three purposes. First, it provides some reassurance to your mother that her belongings are not being taken. You can go through the list with your mother each time she accuses you or your brother of stealing things and show her that all of her things are still there. Second, your mother may have relatives who are unaware of her diagnosis and therefore may believe her if she tells them that you are taking her belongings. You then have documentation that nothing has been taken. And finally, the inventory will be very handy when it does come time to move your mother, because then you can quickly assess what needs to be moved, stored, or removed, etc.

As for eating, it is common for Alzheimer's patients to lose interest in food and eating. Alzheimer's disease can affect a person's sense of smell and taste, and therefore the person may no longer find their favorite foods enjoyable or even palatable. Alzheimer's disease patients also can forget to eat, or they can become confused about how eat altogether. Whatever the issue, it is best to try to eat with your mother as much as possible. She may need gentle verbal reminders, for example, about what to do or how to use the utensils. Do not rush your mother to eat, and do not expect her to eat on your schedule. She may, for instance, feel more comfortable eating several smaller meals throughout the day then eating three large meals. Keep foods simple but nutritious, and encourage her to eat just a few bites of food each time. You can also try experimenting with different flavors. Because her sense of taste may be diminished, your mother may now prefer foods with stronger or spicier flavors.

Also, make sure there are no medical reasons why your mother may be refusing to eat. Perhaps she has mouth ulcers, a tooth ache or ill-fitting dentures, or suffers from some gastrointestinal problem. A doctor's examination can help to rule out these concerns. So long as she is drinking enough fluid and is not losing an excessive amount of weight, then it should not be too much of a concern if her daily intake of food decreases slightly. However, you can also try substituting a meal a day with a liquid meal supplement (such as Ensure), which may be easier for her to consume and can provide her with necessary calories and nutrients.

Are there room colors that are particularly soothing for people who have Alzheimer’s disease? [ 07/07/10 ]

Soothing pastel shades, light blues, peaches, pinks, greens, and beige are usually recommended colors for use in homes for Alzheimer's patients. It does not appear that an Alzheimer's patient would find any color affecting them differently than anyone else. In the design of a room the goal is to create a calm peaceful atmosphere, so bright colors and patterns should be avoided. Alzheimer's disease patients may have difficulty discriminating between similar color intensities, such as light blue or light green. Therefore, if you want to want to highlight a particular feature, such as the door to the bathroom, make sure you use a contrasting color.

A few other recommendations for decorating a room include:

  • Using flat as opposed to gloss paint to reduce glare.
  • Using contrasting colors to highlight handrails, handles and door knobs.
  • Painting stairs in contrasting colors between the stair and the riser.
  • Fixtures that may prove to be obstacles such as mantles and knee walls can also be painted to contrast.

My mother-in-law has Alzheimer's disease, and she constantly ties things in bags. This includes her clothing, articles of food, etc. Is this common? Also, she routinely washes bottles and empties vegetable cans. Finally, she no longer wants to take a bath. Are these typical signs of Alzheimer’s disease? What else can I expect in the future? [ 07/06/10 ]

Both behaviors you describe are typical of an Alzheimer's patient. Issues with personal hygiene, especially bathing, are a common manifestation in early stages of Alzheimer's. Your mother-in-law may feel uncomfortable with the prospect of bathing, as she may feel a loss of a sense of privacy. She may also be confused about what to once in the bath. Vision problems can confuse patients as well, as they may have difficulty judging the depth of water or may be confused by mirrors or other reflective objects in the bathroom. You want to make sure that her bath is comfortable (adjust water temperature, make sure the room is warm, etc.), safe (make sure there are handrails, anti-slip mats and good footing), and to the best of your ability, provide her with some privacy. For more tips, please see our section on bathing.

Because Alzheimer's disease affects each person uniquely, it is impossible to predict what else your mother-in-law might do (or not do) in the future. Sometimes patients can become belligerent and argumentative, others may stay passive or even become non-communicative. Make the most of every lucid moment she may have, and appreciate the fact that she can still communicate with you.

My 88-year-old father is in stage 5 or 6 of Alzheimer's disease and he started spitting around the house about 6 months ago, which is driving my 78-year-old mother crazy. He can't help it and he is as sweet as can be, but he just doesn't remember to spit into the lined trash can we have near him. We have signs in various places where he is spitting, but of course that doesn't help. Can mucinex, sucking on a cough drop or a dietary change help with this behavior? [ 06/22/10 ]

Your father may be producing excess saliva (hypersalivation) which may be why he needs to continually spit. If this is the case, sucking on a cough drop or other hard candy will only make this problem worse, as it will encourage the production of even more saliva. Have your father evaluated by his physician to determine if his saliva production is “normal” or if he is suffering from hypersalivation. If the latter is the case, sometimes this is caused by certain medications or drug interactions. For this reason, you should discuss any new medications (even over-the-counter ones such as Mucinex) with his physician before they are added to his regimen. His doctor can review the medications he is taking and may decide to adjust them accordingly.

If this behavior is not caused by hypersalivation or another medical condition, then chalk it up to one of those odd behaviors that just are a part of Alzheimer's disease. It sounds like you are doing your best to remind and encourage your father to spit in the appropriate locations. If this still hasn't helped, you may just have to add more trash cans around the house, particularly in those areas where he likes to spit, and accept the fact that he is doing his best to comply with your requests. It is often very difficult to change such behaviors in Alzheimer's disease patients, so anything you can do to adapt your routine to his new behavior (rather than having him adapt his behavior to your mother's house rules) is definitely a help. Remind your mother that he is not purposely trying to annoy her, and that he would not do it if he could help himself. Although it may be hard, try to find the humorous aspect in the situation. A sense of humor can go a long way in helping to deal with such difficult behaviors.

My mother has Alzheimer’s disease. When she is eating, most of the time she starts falling asleep. Is this unusual and what can be done to help with this behavior? [ 06/21/10 ]

Persons with Alzheimer's disease often lose interest in food and in eating. Patients may have a diminished sense of taste or can, for example, forget what food is or what do with it even when the food is placed directly in front of them. It can help if your mother's meals are kept small, simple, and frequent, and also if she eats her meals with others present. Have someone stay with her while she is eating and try to keep her engaged. You can also try replacing one of her meals with a liquid meal supplement, such as Ensure, which may be easier for her to consume in a short time span.

Regular exercise can also help by providing her with more energy and potentially “working up an appetite.” To the best of her ability, encourage your mother to go for walks, do stretches, or other light exercises such as arm or leg lifts. The activities do not need to be strenuous—anything that gets her moving is good. Also, if she is not already, try to get your mother on a regular schedule for eating, sleeping, bathing, and other activities, etc. Perhaps your mother would benefit from having a short daytime nap or two provided that the naps do not interfere with her nighttime sleep.

It would be helpful for you to also speak to her doctor about this behavior. It is possible that a medication she is taking (or a drug interaction between certain medications) is causing her drowsiness. Her doctor will be able to determine if this is the case and/or if there is any other underlying medical condition that could cause her to fall asleep while eating.

My wife has Alzheimer’s disease. At the present time she still eats as long as we feed her. She has a trainer to help her with routine exercises two to three times a week, but she has hard time standing up and walking. Can you tell me what this might mean? She is my life and I hope that there is something I can do. Thanks for your help! [ 06/18/10 ]

It is not uncommon for persons with Alzheimer's disease to lose interest in eating and in normal daily activities. Persons with Alzheimer's disease or dementia may not eat as they once did because they may forget about eating, for example, their sense of taste may be altered, or they may simply forget what to do when food is placed in front of them. Eating with her in an environment she feels comfortable in may help encourage her to eat on her own. You can also help by simplifying meals—provide only one plate (or bowl) and one utensil. Dispense with any formalities (napkins placed on the lap, general table manners) and allow her to eat any way she wants if she takes the initiative. Finger foods might aide in this respect because patients sometimes find the concept of using utensils confusing. Provide verbal cues to help her recognize what to do, and beyond everything, stay positive and encouraging.

Depending on the brain areas affected by Alzheimer's disease, a person may experience more difficulty with moving about or performing physical tasks that were once easy for them. So it is wonderful that your wife is working with an exercise trainer on a regular basis. If nothing else, this will help to keep her muscles and joints healthy and can benefit her psychological well-being too.

It is also possible that you dear wife may be suffering from mild depression. Please speak to her primary care physician about this at her next visit. Her doctor can evaluate her to see if this is the case and determine if prescribing antidepressant medication would help.

It sounds as though you are providing excellent care for your wife. As a caregiver, it can be very difficult to know if you are doing the right thing all the time, and therefore caregivers often doubt themselves and feel guilty for not “doing more.” Take it easy on yourself and realize that you are doing your best. Try to enjoy every moment you have with your wife while she is still capable of communicating with you. Also, consider joining a caregiver support group. There you can talk to other caregivers about your concerns and find some moral support from others who may be going through the same issues you are currently experiencing. You can search for Alzheimer's caregiver support groups in your area by visiting our "Resources" section, such as under the Caregiving and Caregiver Support heading in "Helpful Organizations."

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Disclaimer: The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for the advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product or therapy. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.

Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.

Last Review: 04/29/13

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