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Caregiving Questions

Latest Questions and Answers
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.


We are currently caring for my 87-year-old father who is suffering from Alzheimer’s disease. Recently, his 14-year-old dog died, and we just keep telling him that she is at the veterinarian for fear that he might be devastated by the truth. He has only asked a few times concerning when his dog will come back home. What should we tell him? I am afraid that if we tell him the truth, he will re-live the pain repeatedly because he cannot remember much of what he is told. Any advice would be greatly appreciated. [ 03/28/10 ]

In this case, it might be best to tell him that his dog is gone, otherwise he will continually ask about her and you will have to continue a false story. You could try telling your father that his dog has passed on. If he presses you, keep the details of her death simple: an unfortunate accident, old age, etc. Emphasize that the dog died quickly and peacefully, that it was very sudden and unexpected to everyone, and that nothing could be done to prevent it. You may not want to say anything about the dog being put down, as this might imply that there was suffering or pain involved, which might cause him to feel guilt that he could not be there for the dog.

Whatever you decide to tell him, it is important to be aware of the possibility that your father may associate himself with the dog. This is one reason why inventing a story about the dog being given away, left at the veterinarian's office, or put down may not be appropriate. He may feel anxious or fearful that his own progressing disease may burden you and that you might decide to dispose of him (or forget about him) like the dog. Therefore, it is essential to reassure your father that he is loved, that he is not a burden, and that you will continue to provide him with good care no matter what.


My mother has dementia. She keeps crying and asking why she can't remember anything. How do we explain this to her? She was hospitalized recently and the trauma from this experience has made the dementia much worse. [ 03/26/10 ]

The best approach is usually the truth, or at least a simplified version of it. Often, what you tell a dementia patient about his or her condition depends on how far advanced the disease may be and their ultimate level of comprehension. If you do not feel that telling your mother she has dementia will help with the situation (or if you believe that she is too far advanced to fully comprehend what that means), then simply tell her that she has a memory impairment, that you are aware of the condition, and that you and her doctors are doing everything possible to help her and make sure she is taken care of properly. If she is still capable of writing, you can try giving her a notepad so that she can jot down things she wants to remember on a day-to-day basis. If it is people, places, and events that she is forgetting, you can try assembling a photo album containing labeled photographs of important people and things in her life. Go through the album with—several times if necessary. If she enjoys it or seems to benefit from seeing the pictures, let her keep it with her as an instant visual reminder—sort of like a security blanket.

Also, anxiety and depression are very common in dementia patients. Therefore, you may want to discuss this with her primary care physician to see if anti-depressant medications could be of any use in your mother's case.


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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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