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Caregiving Questions

Latest Questions and Answers
My mother, who is 88 years old, has advanced Alzheimer’s disease. My father, who is totally coherent and her caretaker, recently broke his hip. He is depressed and tried to take his life this week. We want to move them to an assisted living facility because we feel that the quality of his life will improve. However, my sister feels that it will kill mom to move her from her home environment. My parents cannot afford 24 x 7 live-in help and assisted living is much more economical. I would appreciate any advice concerning this issue. [ 01/05/10 ]

Considering your father's recent injury and your mother's advanced disease, an assisted living facility definitely makes sense for them. Patients in the later stages of Alzheimer's disease can become easily confused, so your sister is partially correct in that moving your mother to an assisted living facility will be a challenge. However, such a transition is certainly not impossible.

Your mother may be anxious or confused by her new surroundings initially, but with time she can be aided in accepting them as her new "home." It definitely helps that your father will be there with her, as this should make the transition easier. Try to have her visit the new home and community as many times as possible before the move, and speak enthusiastically about how nice the new place will be. Being prepared is key to a smooth transition—do not wait until the last minute to pack or plan what to do with furniture or other belongings. As the accommodations at the facility may be smaller than your parent's current home, you and your family will want to determine well ahead of time which items are to be moved and which are to be placed in storage, donated, or discarded. During the transition, try to minimize her stress as much as possible by keeping the actual move to one day. Immediately following the move, try to get your mother back on her regular schedule as soon as possible. The more things that are "familiar" to her in the new environment, the sooner she will come to accept it as home. You can also ask the director of the facility for help and advice on the best methods for transitioning your parents to their new environment.

My wife resides in an assisted living facility mainly because I cannot handle her at home any more. She seems to act normally compared to other residents and also thinks somewhat rationally. She primarily just has short-term memory problems. How do I know if she merely has dementia rather than Alzheimer's disease? [ 12/31/09 ]

Alzheimer's disease is dementia, one of the most common forms of dementia in fact. However, only after thorough physical and psychological examinations will a doctor will be able to tell whether your wife's memory problems and other behaviors are due to dementia in general or dementia of the Alzheimer's type. Knowing whether or not dementia is caused by Alzheimer's can be of value. First, as part of the examination, the doctor will test for common causes of dementia, such as hormonal imbalances, vitamin deficiencies, viral infections, strokes, etc. Some of these causes of dementia are actually treatable.

However, the doctor may find that none of these things are the cause of your wife's memory disturbances and that her condition really is due to Alzheimer's disease. If this is the case, then an Alzheimer's diagnosis may be of value because it will allow your wife to be treated with the appropriate medical therapy. Many of the Alzheimer's disease medications, when taken early on, may help to slow the progression of cognitive impairment and memory loss.

Is there any automated support system developed for people suffering from Alzheimer’s disease? Is there any device that is entirely dedicated to help people with Alzheimer’s disease lead a normal life? [ 12/24/09 ]

Some online support groups do exist for caregivers of Alzheimer's patients, such as the Virtual online support groups can be found by searching for “online support group” and “Alzheimer's.” Interestingly, one study found that caregivers given access to an automated caregiver support system were less bothered by the behaviors of their charges, less anxious, and had a lower incidence of depression than caregivers who did not have access to such a support system. While this type of automated support line is less common at the moment than online forums, the study's encouraging results will hopefully prompt others to set up such support systems. The Alzheimer's Disease Education Referral Center (ADEAR), for example, has professionals who can help with immediate caregiver questions, refer patients and caregivers to help in their area, and are available 24 hours a day, 7 days a week. ADEAR can be reached at 1-800-272-3900. Other useful agencies can also be found under “Helpful Organizations.”

However, no device, per se, exists that can keep up with the ever-changing needs of patients having the disease. Mostly, such a device is called a caregiver.

How would a certified nursing assistant care for patients who are in various stages of Alzheimer's disease? [ 12/23/09 ]

In the early stages of Alzheimer's disease (AD), the patient may still be relatively functional and may not require extensive assistance beyond someone to check in to see how they are doing every few days or every week. However, a certified nursing assistant (CNA) can help by making sure any medications are taken properly, medical check ups are scheduled and attended regularly by the patient, and by making sure the patient is otherwise in good health and spirits. A CNA should be aware of signs of depression in the patient, and alert the patient's doctor if he or she suspects that the patient has slipped into a depressed state. Additionally, a patient in the mild stages of the disease may be more accepting of a new caregiver/nursing assistant than a patient in the later stages of the disease, so it is definitely beneficial to establish a good rapport early on.

Patients having a moderate stage of AD will require more assistance with daily activities, such as bathing, grooming, toileting, and eating. Direct supervision to ensure medications and/or supplements are taken appropriately is also required at this stage. The nursing assistant can also plan and encourage some physical exercises for the patient, tailored to suit the individual needs and capacity of each patient. Simply visiting with a patient can be beneficial too, as it may help prevent boredom or depression.

In the severe stages, the patient will probably require constant care. As the patient can often be bedridden at this stage, the CNA will need to make sure the patient is comfortable, is not developing bedsores, and is not soiled, wet, too warm or too cold. As the patient gradually loses control of his or her bodily functions, the CNA's duties will continually evolve with the patient's deteriorating condition. At this point, the primary goal would be to minimize the risk of infections and other illnesses and make sure that any pain or discomfort the patient may be experiencing is treated or at least minimized.

My father was just diagnosed with mild Alzheimer's disease and is not on medication yet. My mother finds that he can remember when his disability check will come in, but does not remember the plant that she has had for some time now, nor does he notice the new curtains in the house. My mother and I sometimes believe he is “forgetting” just for attention; however, we have found that it is hard to talk to him about this. I would like to know if these memory issues are normal for the first stage of this disease. [ 12/22/09 ]

Your father's forgetfulness is completely normal for early stage Alzheimer's disease (AD). AD initially and most noticeably affects a person's short-term memory. As the disease progresses, so do the memory impairments. Recent events, even those from the last few months or years, can be forgotten while older memories, such as those from a patient's childhood, may remain intact.

In your father's case, the disability checks he receives are clearly important to him, and have therefore become a part of his normal routine. While the houseplant (or other such items) may be a long-time fixture in the home, it may not be very relevant to him and therefore has not acquired a secure place in his memory.

Help your father where you can by writing reminder notes or lists for him. Because at this stage your father is probably still aware when he forgets things, he may be embarrassed by his memory impairments. So there really is no need to draw attention to every small memory lapse. Though if you do want to discuss the issue with him, it can help to keep a sense of humor about you, such as casually joking that no one would remember the unimposing houseplant. He needs to be assured that you are not being judgmental or accusatory, but rather sympathetic, understanding and supportive. Remind him that you are there for him and will love and care for him no matter what happens. So unless the something he's forgotten is something important like a doctor's appointment or taking medicine, then it might be best just to let the small stuff slide.

Is there any research concerning Alzheimer’s disease and doll therapy? [ 12/17/09 ]

There has only been one formal study so far on the effects of doll therapy in dementia patients, which was reported in 2006 by a team of doctors from Scotland. Doll therapy involves giving a doll baby or teddy bear to a dementia patient and allowing them to interact with the doll. In general, the study observed that patients given dolls to “care for” tended to be more communicative with caregivers and staff and less prone to negative behaviors, such as agitation or anxiety. Doll therapy seems to bring out the nurturing instinct in many dementia patients, particularly females, who may be reliving memories of being a mother (or father) of an infant, a time in their lives when they were very much needed and useful.

Non-formal observations by caregivers recommend that the doll be as lifelike as possible, and be introduced to the patient while he or she is still in the early stages of the disease to allow time for bonding with the doll. Given in the later stages, the doll may be less effective.

If someone repeats the same question over and over again in a period of 15 minutes, does this indicate Alzheimer’s disease or some other type of dementia? What symptoms should one expect after this "phase"? [ 12/09/09 ]

Repeating the same question over and over again in a short period of time indicates that the person has impaired short-term memory. Dementia, such as Alzheimer's dementia, can affect memory, particularly short-term memory, but it is not the only possible diagnosis. Memory impairments can also be caused by infections in the brain or central nervous system (CNS), head trauma or injury, drug interactions, alcoholism, hormonal imbalances, and even severe vitamin deficiencies. Therefore, it is important that the patient be thoroughly examined by his or her physician in order to determine the cause of the memory problem. Because at this point it is not known what may be causing the repetitive questioning behavior, it is impossible to say what “phase” may come next. This patient could, for example, have a viral infection in the brain, which could be entirely treatable.

My husband, who was diagnosed with early stages of Alzheimer’s disease about 6 months ago, has become frantic if he doesn't know where his keys, wallet, and eyeglasses are. They have to be always together, or he gets very upset and keeps searching until they can be right under his nose. Is this a common situation? How should we handle this without causing him embarrassment? [ 12/08/09 ]

Alzheimer's disease (AD) patients can get easily upset over changes to a particular routine, and can become agitated over unpredictable events. Because of the nature of the disease, AD patients can easily forget what they are doing or where they are from one minute to the next. All of this can be very disorientating and frightening, and it is no wonder why they can quickly become distressed very over “unpredictable” events that seem ordinary or unimportant to you or me. In other words, your husband's behavior is not uncommon for AD. He clearly prefers to have these three items in a recognizable and defined location, and this goes along with AD patients preferring routine and predictability in their lives.

This being said, you may want to try designating one spot in your home for your husband to keep his important items. Get him into a routine that whenever he comes home and/or before he goes to bed at night, he places these items in a defined location. A men's valet station would be perfect for this job, and would make a great gift “for organizing his personal items” without causing him hurt feelings.

If he prefers to always have the items on hand (or for when you have to leave the house), then try designating one carrier for the items. The carrier can be a specific item such as a bag (perhaps a small pouch worn around the neck or a fanny pack), or a specific location on his clothing, such as a particular coat pocket or trouser pocket. You will probably have to help him initially to get him in the practice of always placing his keys, wallet and glasses in the defined spot, and you will also have to repeatedly remind him that his items are there, but it should help to decrease some of his anxiety in the long run.

If or when he does start becoming agitated when he cannot find his personal items, then just remember to keep calm and try not to raise your voice or shout at him. This will only make matters worse. If possible, while you are helping him search for the items, try to relax his mind by nonchalantly changing the topic of conversation to a more calming subject, such as something he enjoys talking about or some other neutral topic, for instance. This can serve to reduce some of his agitation and may help to diffuse a tricky situation if you are in public.

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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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