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Caregiving Questions

Latest Questions and Answers
My husband has had Alzheimer’s disease at least since early 2006. I had to put him in a home specializing in Alzheimer's disease patients in late 2007 because I could not handle him anymore. He cannot go to the bathroom by himself, always has tremors and now has problems feeding himself or recognizing food. The facility will not feed him; they try to let him feed himself and he is not doing well. He was a very big man (over 200 pounds) and now he only weighs between 148 and 150 pounds. He just keeps his head down and eyes closed all the time; however, he is not asleep. Even though he can talk, he rarely speaks at all. I visit him every day and he is declining. What stage of Alzheimer's disease do you suppose he is in? Sometimes I try to help him, but he is not interested. Thank you! [ 06/07/10 ]

Based on the details you have provided, your husband would appear to be in late stage 2 or early stage 3 of Alzheimer's disease. Your husband's physician can provide you with a definitive answer. Detailed information about the symptoms and stages of Alzheimer's disease is available. You can read more about the different symptoms and stages of Alzheimer's disease in the 'About Alzheimer's Disease' section of our website.

Is it typical for a person with early-stage Alzheimer's to "see" and yet "not see"? For example, my husband will often ask where his razor is, even when it is right in front of him on the bathroom counter. How can he not see it? Similar scenarios could apply to his eyeglasses or wallet. I would like to be more patient with him if I understood that, indeed, this is a symptom of Alzheimer's disease. [ 06/04/10 ]

Alzheimer's disease affects short term memory, so it is not uncommon for persons with this disease to completely forget, for example, why they walked into a particular room or what they were about to do with the checkbook they just retrieved. Similarly, Alzheimer's patients can experience a disconnect between the name of an object and the actual physical object, or what the object is supposed to be used for. For instance, your husband may recognize that he needs to do something in the bathroom involving the razor, but he can't remember what it is. Sometimes patients get “stuck” in the middle of performing a task (or have difficulty starting the task altogether), and need a little help to remind them what to do or how to do it. In these cases, a simple prompt such as “your razor and your shaving cream for shaving your face are on the bathroom sink” could be used to aide your husband. If he still seems “stuck,” then break the task into smaller steps such as: “Lather up a small amount of shaving cream to put on your face, and use the razor to shave the stubble.” Then tell him that you'll be in the next room if he needs any further assistance. Some gentle reminders such as these can greatly help your husband in his daily activities.

I read some time ago that one of the early signs of Alzheimer's disease is an out-of-control temper. My 68-year-old husband definitely has this behavior, but his dad also behaved like this until he died at age 87. Do you think that Alzheimer's disease is causing the temper issues, or is it just related to genetics? My husband’s 70-year-old brother has been diagnosed with some form of dementia and is taking medications daily. Please help! [ 06/03/10 ]

A sudden change in behavior along with memory lapses, confusion, and difficulty with decision making can be early indicators of dementia, but there are many other conditions that cause similar problems. For example, head injuries, infections of the brain or central nervous system, thyroid hormone imbalances, depression, drug interactions, alcoholism, and even certain vitamin deficiencies can all cause symptoms similar to the early stages of dementia. Also, if your husband's angry temper is something that has always been present instead of something that has started recently, then his temper may not be a symptom per se, but rather just his “normal” behavior. Only a thorough examination by his doctor will be able to determine if this behavior is the result of a medical condition such as dementia.

It may be difficult, but try to persuade your husband to go see his physician, perhaps by scheduling annual physicals for both of you during the same visit. Rather than telling your husband that you want the doctor to assess his behavior (which very well may anger your husband), you can say that with advancing age it is a good idea to get regular medical check-ups, and therefore both of you are going to the doctor. He may feel less threatened if you are having a physical as well. Prior to his examination, you can discuss your concerns with his doctor and/or your doctor.

Regardless, you may also benefit from talking to a counselor about your husband and his angry outbursts. The Alzheimer's Disease Education Referral Center (ADEAR), for example, has professionals who can help with issues such as this, as well as generally providing advice on immediate caregiver questions, referring patients and caregivers to help in their area. ADEAR is available 24 hours a day, 7 days a week, and can be reached at 1-800-272-3900. Other useful agencies can also be found under “Helpful Organizations.”

My mother-in-law is in the moderate stages of Alzheimer’s disease. If she needs to move to an assisted living facility in another state, but closer to her family, should she be told about this change ahead of time or wait until the day before the move takes place? [ 05/28/10 ]

Alzheimer's patients generally do not like surprises or unexpected changes, and may become frightened, stressed or agitated if their routines are suddenly altered without warning. So by all means prepare your mother-in-law for the move to the new facility by describing what will happen before, during and after the move. Mark the date of the move on a calendar that she can see, and be sure to talk about the moving process frequently beforehand.

In order to make her transition less stressful, try to make her feel welcome at the new facility. Have some of her possessions or personal effects already waiting for her in the new facility. Do not leave anything to the last minute for the move – try to have all the necessary paperwork and provisions in place. Also, Alzheimer's disease patients can get stressed if they feel as though they are being rushed, so be sure to leave plenty of extra time for the journey to the new facility. Finally, immediately following the move, try to get your mother-in-law back on her regular schedule as soon as possible.

My father placed my mother in a nursing home because she has Alzheimer’s disease. He no longer wanted the responsibility of taking care of her. Her short-term memory is poor; however; she still knows where her home is and recognizes her family. She has been in the nursing home for 6 months and begs to go home where she is familiar with her surroundings. She is confused and scared because she doesn't understand what is happening to her. What can I do or say to help her? I just tell her everyday that she'll get to go back home in a couple of days. What can I do to make her adjustment less frightening for her? [ 05/27/10 ]

Your mother is still anxious and confused by her new surroundings, but with time she can be aided in accepting them as her new "home." Try to visit your mother frequently, and speak enthusiastically about how nice the new place is. The more things that are "familiar" to her in the facility, the sooner she will come to accept it as home. Perhaps the facility will allow some of her personal effects (pictures, a favorite blanket, etc.) to be used in her room. Be sure that the items are not valuable, in case they should become lost or damaged.

Also, when you speak to her, continually reassure her that you are trying to provide the best possible care you can for her. She may feel as if she was rejected by your father in some way, so you must assure her that no matter what, she is loved by both you and your father and she will be cared for. Finally, try redirecting her attention to a more enjoyable topic or activity.

We have an Alzheimer's patient who is 96 years old. He gets up several times each night and roams with his walker. We get no sleep; however, he can sleep throughout the day. His doctor has changed his medications several times but nothing is helping him. We have tried Ambien CR, Depakote and Benadryl. Do you have any suggestions? [ 05/26/10 ]

For reasons not fully understood, Alzheimer's disease frequently disrupts a patient's circadian rhythm (our internal clock that helps regulate day-night awareness/activity), which then results in patients being awake at night and sleeping during the day. Regular exposure to sunlight can help to improve an Alzheimer's patient's overall mood and – when combined with calming, dim lighting in the evening – can help to keep a patient's circadian clock on track.

Several studies also seem to indicate that the use of bright lighting in the patient's home environment (or care facility) improves sleep quality in dementia patients, presumably by normalizing the day-night cycle. For example, bright lighting improved facility patients' sleep patterns (longer nighttime sleep with fewer nocturnal sleep interruptions), reduced patients' agitation, and lessened the incidence of depression.

Additionally, physical activity during the day can help to improve or regulate nighttime sleep. So try to encourage the patient to participate in some sort of physical exercise every day.

If someone has Alzheimer’s disease, should they be informed of their medical condition? Also, should I tell this person about events that they participated in years ago? [ 05/13/10 ]

It can be very difficult to speak openly with someone who is suffering from Alzheimer's disease. However, if this diagnosis has been confirmed by a doctor—rather than just something you suspect—then I believe you have a moral obligation to tell the person. If you prefer not to be the bearer of bad news, ask his or her doctor to do it. The patient will have to come to terms with this information in his or her own time, and it will undoubtedly be difficult. You can be there to give the patient the support he or she will need. Our organization provides information on the progression of Alzheimer's disease, such as “Alzheimer's Symptoms and Stages" which may be useful in talking with this person.

Unless it is a subject that clearly upsets or agitates the patient, there should be no harm in talking about past events. In fact, Alzheimer's disease often attacks short-term memory and spares a patient's long term memory, such that they can remember the distant past but have trouble remembering what was done just 5 minutes beforehand. So the patient may be able to more easily engage in conversations about the past than in current topics.

My siblings and I need to care for our mom, but she has a spouse. Could you tell me who has the right to make decisions for her? [ 05/12/10 ]

In most circumstances, the spouse takes precedence over other relatives (children, siblings, etc.) in the right to make medical decisions should the patient become incapacitated. Depending on the state, however, this does not always hold true for same-sex marriages.

Unless her spouse strongly objects, it is possible that you or one of your siblings could obtain a durable power of attorney for health care of your mother, which would give you the legal right to make medical decisions on your mother's behalf. Please consult an attorney specializing in elder issues for more information. For example, you might consider the following sources:

ElderLawAnswers.com: This organization supports seniors, their families and their attorneys in achieving their goals by providing information concerning crucial legal issues facing seniors and a network of highly qualified elder law attorneys nationwide. You can access their website at: www.ElderLawAnswers.com.

Administration on Aging: This agency, part of the U.S. Department of Health and Human Services, is one of the nation's largest providers of home- and community-based care for older persons and their caregivers. AoA also provides some legal assistance. Their phone number is (202) 619-0724. You can access their website at: www.aoa.gov/. The AoA website can also lead you to state agencies.

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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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