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Caregiving Questions

Latest Questions and Answers
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.

My wife has had Alzheimer’s disease for over 10 years, and I can no longer understand her words. She has great difficulty speaking when she is trying to tell me something; however, she can speak more clearly when she is angry. She also becomes quite violent occasionally and demands that I leave the house. Xanax calms her down in about one hour. What stage of the disease is indicated based on the information provided? [ 12/07/09 ]

It is difficult to say just based on the above information alone, but taking into account the length of time she has had the disease and her current behaviors, a good estimate would be that your wife is in mid- to late-stage 2 of Alzheimer's disease.

My 84-year-old father was diagnosed with the beginning stages of Alzheimer’s disease. We (his daughters) have taken steps suggested by the Department of Aging to provide him with in-home care. However, he argues with us about these positive steps and thinks we are setting him up. His companion, who lives in the same apartment building, does everything for him (even his thinking) and is spouting out negative comments on what we are “doing” to my dad. How do we let his companion know in a calm manner that she needs to stick behind us concerning this transition? If she doesn't modify her behavior, what major actions do we need to take to help resolve this issue? Thank you! [ 12/04/09 ]

It is unfortunate that your father's companion is working against your good efforts, but is not uncommon for this situation to arise in the care of Alzheimer's disease patients. The confusion caused by dementia can make patients misunderstand people's intentions, and therefore they may believe that someone is trying to hurt or steal from them when in fact that person is trying to help them. Your father's companion may be playing into his fears and paranoia—fanning the flames in a way. In this respect, her presence may be hurting more so than helping your father's well-being.

The first approach you should try is to sit down with this lady (preferably with your father present) and thank her for the generous assistance she has already offered with your father's care, but explain to her the facts about his disease and why it is essential that she cooperates with you and your sisters. Tell her your plans and motives, and remind her that you are only looking out for your father's best interests. Try to keep the conversation positive and do not try to insult her or her actions. You want to get her on your “side.” To cast her in a negative light may only serve to create a further rift in your relationship with your father, fostering an “us against them” mentality. Therefore, if you go into the discussion with a combative attitude, you may be setting yourself up for failure.

Remember that you are all on the same team – emphasize that you all want what is best for your father. You will have to convince your father just as much as you will have to convince his companion. Listen to her as well. Perhaps she has some good ideas that you can take into consideration. For example, it is likely that your father tells her things about his health or in-home care that he does not feel comfortable telling you. This information could be invaluable for optimizing his caregiving requirements and should not be dismissed.

If all attempts at respectful conversation fail and if the companion still will not listen to your reasoning, you could consider the drastic measure of moving your father into an assisted living facility. Will this solve the problem? Maybe in the long run, but it could also create a whole host of other issues in the meantime. Therefore, the less drastic approach may be better for now.

I provide home care for my wife. Can I obtain tax deductions for supplies and the cost of an aide who comes to our home each week? Thanks! [ 11/20/09 ]

So long as you are paying the appropriate taxes for the aide's employment (either through an agency or directly as an employer by withholding for state, local, and federal taxes as well as for social security and Medicare), and so long as the aide is providing nursing care (such as those services associated with caring for your wife's condition) then the cost of a home health aide is deductible. The aide does not have to be a qualified nurse, just so long as his or her services are consistent with such nursing care. For example, services such as giving medications, providing assistance with bathing, grooming or feeding, or changing dressings would qualify as nursing services. Housekeeping activities would not qualify. You should keep documentation on the nursing activities performed by the aide (such as types of activities performed and approximate amounts of time spent performing these activities) as well as any medically-necessary supplies required for care of your wife.

As for supplies, if you provide meals for the aide, his or her portion of the cost of the food is deductible. Other medical supplies such as prescribed medications, bandages or other wound dressings, wheelchairs necessary for disability, and some other medically-related supplies are deductible as well.

You should consult with a tax accountant for final verification of the information presented here as well as for more detailed instructions.

My wife has Alzheimer’s disease and we have to put her in a rest home. However, we are having trouble with the nursing home manager. I tried to talk to the director, but she ran out, would not talk to me and left me in her office alone. I would appreciate if you can give any advice on how to deal with a nursing home director who will not listen to my concerns. [ 11/18/09 ]

It is unusual for the director of a nursing facility to run out of her office and leave you alone without any explanation, but it could happen. Perhaps there was an emergency and she did not have time to explain. Regardless, try scheduling another appointment with the director to discuss your wife's situation. You can inform the director that you were both confused and offended by her abrupt departure, and would greatly appreciate an explanation and an apology. Again state that you are having trouble dealing with the nursing home manager and are concerned for your wife's well-being. I would strongly suggest that you bring along a trusted family member or close friend who is aware of the whole situation and who can act as your advocate (and witness) when you speak to the director. You can also try speaking to the staff in charge of your wife's care. Perhaps they will have some insight on how to best relay your concerns to the director, or they may even be able to speak on your behalf. If your concerns continue to be disregarded by the facility, then you should consider looking for an alternative care facility for your wife.

My mother has dementia. She has started to use the phrase, "Help me" all the time. We ask her questions to see if we can figure out what she wants or needs; however, we really don't get that much of a response back from her. Within minutes she is again saying, "Help me." Why does she say this all the time? Can you provide some information on this behavior? Thank you! [ 11/18/09 ]

It is not uncommon for an Alzheimer's disease patient to repeatedly ask the same question or repeat the same phrase over and over. The repetition is a function of the disease; your mother is not purposely trying to annoy you. Alzheimer's disease impairs a patient's short-term memory, so a patient effectively forgets that the same question or request has already been asked and answered. Just remember that your mother's forgetfulness is just as confusing and frustrating to her as it is to you.

In some cases, a patient may be physically bothered by something but cannot properly communicate what is wrong. Try first to rule out all the obvious culprits: she may be too hot or too cold, she may have a wound or sore or be sitting on something uncomfortable, she may have an ache or pain that is not outwardly noticeable (a toothache, joint ache, urinary tract infection, etc.), she may have to use the toilet or have indigestion, or she may simply be hungry, thirsty or bored. Talk to her primary care physician about this. If she has not had a physical in a while, you may want to consider scheduling an exam so that physical ailments can be ruled out.

In most cases, however, repetitive requests usually stem from a particular fear or anxiety. For example, if the patient repeatedly asks you when a doctor's appointment is scheduled, it may be because she is anxious about going to see the doctor. So when you talk to her, try to address the underlying emotion in the question ("I'll be right there with you the whole time at the doctor's office.") Since your mother repeatedly requests that you help her, it may be because she feels insecure or scared, that she cannot understand what is going on and is afraid of what is happening to her. She may literally feel helpless in a sense, and does not know how else to express herself.

In this case, all you can do is reassure her that you are helping her and then try to shift her attention to a new subject or activity. When possible, try having her “help” you with some activity (naming long lost relatives in old photo albums, folding clothes, mixing dough, sorting items into piles, etc.) This can provide her with a sense of self-worth and may even reduce some of her anxiety. Because of the nature of Alzheimer's disease, your mother will require continual calm reassurance that everything is fine, that you love her, and that you will continue to care for her.

Anything you can do to help reduce your mother's anxiety and uncertainty may also help to reduce the repetitive requests. For example, you can use notes, signs, or even a written daily schedule on a wall chart to help remind her when it is time for meals, bathing, activities, bedtime, and so on. And if you are trying to get her to do something and she becomes agitated, be patient and explain what you want her to do with simple, straightforward instructions.

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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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