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Caregiving Questions

Latest Questions and Answers
My husband has recently been diagnosed with middle-stage Alzheimer's disease. I am having a very difficult time getting him to move in the morning. When I tell him it is time to get up, wash, brush his teeth and shave, he will say, “OK,” and then either stay in bed until I rouse him again or he will get up and sit in a chair until I prod him. He frequently gets annoyed with me for urging him to get up and move. What is the best way to motivate him? [ 04/25/10 ]

Sometimes it is difficult for Alzheimer's disease patients to understand the “big picture,” so you have to break it down for them into easy-to-understand chunks. For example, telling your husband to “get up and get ready” may be completely incomprehensible to him. He may not understand what getting up and getting ready means, so he simply stays put in bed. Try to break up the tasks for him and be very clear and specific about what you ask him to do. Instead of saying “get ready,” say “here is a damp washcloth and soap. Put some soap on the washcloth and use it to wash yourself, and then rinse the washcloth and yourself.” Demonstrate it for him and offer your assistance as necessary.

In general, motivating a patient with Alzheimer's disease is more about gaining his cooperation rather than forcing him to do a task. Such techniques can include:

  • Asking him to try to do something rather than telling him to do it.
  • Keeping instructions simple and clear. Avoid lengthy explanations.
  • Offering simple choices. For example, instead of asking “What do you want to do next?” ask “Do you want to sit at the table or walk to the living room?”
  • Breaking tasks into small steps. Instead of saying “Get out of bed” say “Swing your legs over the side of the bed, put your feet on the floor, and stand up.”
  • Maintaining a pleasant and calm tone of voice. Sometimes how you say things is just as important as what you say.
  • Asking him to help you with a task. Everyone likes to feel needed, so if he thinks that he can be of assistance to you, you may find he is more willing to cooperate. Don't forget to praise him for his efforts.
  • Allowing him to make some mistakes. It does not matter if his socks do not match or if his hair isn't brushed nicely—so long as his shoes are on the correct feet and his pants aren't on backward, the other things can be ignored. Do not belittle him if he gets something wrong, just try to ignore it (if it's not very important) or suggest trying to do it another way (if it is something significant).
  • If all else fails, leave him alone and try again later using a different approach. It will give you an opportunity to calm down and reassess the situation if you are feeling frustrated. Don't continue to push him if the technique you are using is not working.

My mother is in stage 6 of Alzheimer’s disease and mainly wants to sleep most of the time. Lately, she has no real interest in eating, and no longer seems to know us when we visit her. She needs help with most of her daily activities; however, sometimes she is able to get up and walk around the facility that she lives in. Recently, she has taken several serious falls. Is she losing her ability to walk and fading into stage 7? Is there any way to tell how much longer this nasty disease will last? [ 04/23/10 ]

The rate at which Alzheimer's disease progresses and how long it lasts is unique for each and every patient, so there really is no way to predict how much longer your mother will have. She could, for example, remain at her current stage for months or even years, or she could rapidly succumb to the disease and become bedridden within the next few weeks.

On average, patients with Alzheimer's disease live for 8 to 10 years after diagnosis. However, this terminal disease can last for as long as 20 years.

I care for an 85-year-old man. He has been gritting his teeth for 2 months while awake or asleep. I worried about him developing temporomandibular joint (TMJ) syndrome or breaking a tooth. Everyone has suggested that he use a retainer; however, this will not work because he does not let me brush his teeth or shave him anymore. He takes high blood pressure medication, thyroid drugs, gabapentin and trazodone for sleep (which doesn’t always work). Please help! [ 04/21/10 ]

Everyone is right in that a retainer would be very helpful in this situation. Is it that he will not accept wearing a retainer or is it that you fear that the use of a retainer is bad if he never brushes his teeth? In the first case, you may have to keep trying to get him to accept wearing a retainer. Ask him to just try putting it in his mouth for a few minutes. If that is successful, then ask him to just try wearing it overnight one night. If he refuses, do not force the issue. Leave the retainer where he can see it and then ask him again in a few days.

If the problem is that your feel it is unhygienic to wear the retainer when his teeth are not brushed, then you may have to find an alternative means of cleaning his teeth. Is he capable of using mouthwash or does he have difficulty gargling and spitting? Perhaps he does not like the flavor of the toothpaste. You can try using training toothpaste with him (such as for toddlers), which is designed to be swallowed instead of spit out. This may be easier for him than spitting and rinsing.

In lieu of a retainer, during the day you can try giving him sugar-free gum to chew on, which will keep his mouth active and prevent him from gritting his teeth. Unfortunately, this clearly is not an option for the night. Teeth grinding is a behavior that can be brought on by stress or anxiety. Has he seemed more anxious lately or has something dramatic changed in his life within the past few months? Talk to his doctor about this behavior. Perhaps this man could benefit from reducing anxiety or stress. However, because he is on so many medications at the moment, adding another drug to the mix may not be a good idea. Besides the use of anti-anxiety medication to reduce stress/anxiety, you can try getting him involved in more physical activity, such as by doing simple stretching exercises (in a standing or seated position) or taking regular walks outside. Fresh air and exercise are very beneficial to a patient's mood. You can also help to relieve some stress by giving him a simple head and neck massage, or even a back massage if he allows you to do so.

My 89-year-old mother has become forgetful, and has become great at covering memory lapses. Of late, she insists that she has received phone calls, for example. She is sure these things are happening, but her aide says that she is either dreaming or is having side effects from the medications (she takes Aricept and Namenda). I would appreciate your input. [ 04/12/10 ]

The medications your mother is taking should help to reduce memory loss as well as reduce many of the unusual behaviors associated with Alzheimer's disease (such as imagining conversations that never took place). It may take a while for the medications to work effectively, so you should not necessarily expect immediate results. You can also speak to your mother's physician about these behaviors. It is possible that her medications may need to be adjusted.

Alternatively, your mother may feel anxious because she realizes that her memory is deteriorating, or she may feel sad because she feels lonely, useless, or powerless to stop what is happening to her. Therefore, she may imagine that she receives phone calls from various people as a means of feeling more important or valued. So the next time she tells you about one of her phone calls, ask her who called and what they discussed. This may shed some light on what she may currently be feeling. You may discover, for example, that she misses her old job or a deceased relative, or she may be depressed because she feels as if she has become a burden. Regardless of the emotions behind these imaginary phone calls, be sure to reassure your mother that she is loved, that she is not a burden, and that she will be well-cared for no matter what happens.

Can a 76-year-old man in the last stages of Alzheimer’s disease still know his immediate family members? Can he think clearly one minute and then experience hallucinations? I can’t stop thinking about this. I am so confused and just need answers. [ 04/09/10 ]

Because of the nature of Alzheimer's disease, it is certainly possible for a patient to have brief moments of clarity interspersed among long periods of confusion and forgetfulness. Depending on the areas of the brain damaged by the disease, it is also possible for a patient to retain certain memories (recognition of specific people, for example) up through the final disease stages.

Additionally, it is not uncommon for Alzheimer's patients to experience hallucinations. Reports indicate that just under half of patients diagnosed with Alzheimer's develop some hallucinations that are either visual and/or auditory in nature, and which generally occur in the later stages of the disease. Hallucinations can be caused by dementia itself, by drug interactions, or by a combination of both damage to the brain (such as is found with Alzheimer's dementia) and an adverse reaction to a drug or to combinations of drugs.

Even though this behavior is confusing and frustrating (to both you and him), it is considered "normal" for Alzheimer's disease. While Alzheimer's disease in general follows a progressively degenerative course, the specific symptoms of the disease and their severity are typically unique for each patient.

My father is 86 years old and has been dealing with Alzheimer’s disease for about 8 years. His behavior has changed drastically over the past couple of months. He can repeat words that you say to him but his conversations are gibberish. He has not wanted anything to eat for the past several days and he sleeps much more frequently. At this stage of the disease, is it possible to know how much more time he has left? It seems as though he has already left but is sitting in front of me! It is breaking my heart and I am scared. [ 04/07/10 ]

Patients in the end stages of Alzheimer's disease often decrease their food intake, lose weight, decrease (or stop) physical activity and become bedridden, and generally become non-communicative. How long a person continues in this stage really depends on whether they continue to eat and drink. Once your father reaches a point that he refuses all food and drink, then unless measures are taken to ensure he is obtaining nutrients and fluid (such as by hand-feeding if possible or—if it is his previously-stated wish or your family's decision—a feeding tube), it would not take long before dehydration would cause eventual death.

My mother-in-law has Alzheimer’s disease, and she says that imaginary children are with her all the time. When she speaks of them, I either try to change the subject or let her believe what she is saying. Is this wrong? Should I correct her when she talks about these children or about her brothers who have been dead now for 5 years or more? Is it best to let them live in their own reality? [ 04/05/10 ]

Your approach to your mother-in-law's behavior is perfectly fine, and if it helps to make her happy, then you should continue what you are doing. Although you may feel that it is inappropriate to speak with Alzheimer's patients in this way, you have to remember that Alzheimer's disease patients lose the ability to think rationally over time and begin to live in their own reality. So long as what they are being told is not malicious, going along with the world as they see it should not harm them and even may help to reduce their anxieties.

Oftentimes, when Alzheimer's patients ask about a deceased relative or friend, it is because they feel lonely or they may miss the person. So, when you mother-in-law asks about her brothers, say something like, “You miss your brothers, don't you? Why don't you tell me about them and what you all liked to do together for fun?” By doing this, you are validating her feelings as well as refocusing her attention to a happier memory or topic.

Along these lines, the imaginary children may represent an unfulfilled wish in her life, or possibly a desire to feel needed and useful. Therefore, you can use a similar approach to understand the underlying emotion that may be making her “see” these children. If you feel uncomfortable talking about the imaginary children, then just do as you have been doing by changing the subject or redirecting her attention to a new, more pleasurable activity.

I am a full-time caregiver for my grandmother. She has had Alzheimer’s disease for about 10 years and is slowly progressing. She is now at the stage where she talks non-stop all day in her own language and is also very violent when getting dressed. I would like to know what to expect next. Will the violent outbursts calm down or get much worse? [ 03/30/10 ]

Alzheimer's disease (AD) is a progressive neurodegenerative disease, meaning that over time symptoms worsen and impairments increase. Your grandmother will probably have some good days and some bad days, but in general, her condition will unfortunately tend to worsen over successive months and years. However, how the disease affects any one patient is just as unique as the patient herself, and therefore it is impossible to say which behaviors your grandmother will or will not develop in the future.

Alzheimer's patients tend to have a short attention span, and boredom can translate into restlessness, agitation, wandering, and even violent behavior. Aggressive or argumentative behavior (verbal or physical) is one of the more disturbing and difficult behaviors in Alzheimer's disease. It is not advisable to argue or fight with an Alzheimer's patient because she could cause injury to you or herself.

Aggression can be lessened or prevented if you take some time to understand what may be causing your grandmother to become agitated, and then working to reduce these triggers. Aggressive behavior can result from a patient feeling anxious or fearful of something in their environment, such as something new or unknown or if the patient feels discomfort and cannot verbalize it. For example, your grandmother may have an infection, an ache or a sore, she may be hungry or thirsty, or she may have soiled herself and needs to be cleaned.

Your grandmother's physician should be consulted about the behavior to rule out possible physical ailments. There are some medications that may reduce aggressive behaviors, which may be recommended by her physician. A patient's environment—such as constant background TV or radio sound, outside traffic noise, household noise, etc.—can also have a significant impact on a patient's comfort. Eliminating or reducing such disturbances can sometimes help to reduce agitation as well as aggressive behavior. Finally, when your grandmother becomes angry or argumentative, try your best to redirect her attention to a new subject or activity.

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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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