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."
My mother is 72 years old and has glaring signs of dementia and mental illness (paranoia, for example). Her primary care doctor has referred her to geriatric psychologist. She went once but refused to go back again because they recommended a cognitive function evaluation and medications. She is paranoid, forgetful, aggressive, confused at times, and clearly suffering, but she won't accept any help. Most of her aggression is at my father and he had to move out after being married for 51 years. Our family is suffering greatly and don't know what to do. It's like watching a crash that you know is going to happen, but you no ability to stop it. What shall we do with her, especially under the circumstance that she is in complete denial of her situation? [ 06/16/10 ]
Get together with your family to discuss your mother's situation. If she is currently living alone, then her confusion and forgetfulness could pose a danger if she, for example, forgets that a pot has been left on a hot stove, confuses the amount or type of medication she is supposed to take, or goes wandering on her own outside of her home and becomes lost. Therefore, your family's most pressing concern should be your mother's safety and welfare. Your family needs to come to a consensus about the best course of action for your mother, even if this means you all decide, for instance, that a care facility would be the best option for her now or at some point in the future.
Once your family has reached an agreement about a plan, you all need to sit down together and calmly talk about your concerns with your mother while she still may be able to have such a conversation. Do not expect that your mother will understand or accept everything you have to tell her, particularly since she is suffering from paranoia and confusion. Denial is quite a normal response considering everything, as is the potential for becoming depressed. It is important that you all try to remain calm even if she becomes agitated and starts yelling. Try to address her underlying emotions when you speak to her. For example, she may be scared, lonely, or feeling a loss of control over her life. So continually reassure her that she is loved and that you all only want what is best for her. Work with her in devising a plan that is acceptable to everyone, but be realistic in your (and her) expectations and demands. It is clear that she should not be living alone, though she may be able to remain in her home for some time with appropriate care and providing she takes her medications and visits the doctor regularly.
You and your family should consider consulting an attorney who specializes in elder issues. If nothing else, you can prepare and organize your mother's financial and legal documents, such as a Living Will and a Durable Power of Attorney. In your mother's case, the attorney may recommend that a Power of Attorney for health care also be drawn up. This way, your father, you or another trusted family member can make decisions affecting her health on her behalf. You can identify such attorneys in your area with the help of 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.
Additionally, you should contact your mother's primary care doctor and/or the psychologist she was referred to and explain the situation to them. The medications that were prescribed to her may help in controlling her paranoia and other symptoms, but they are useless if she will not accept them. Her doctors may have some suggestions for getting her to take her medications.
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Last Review: 04/29/13