Is there an increase in mouth breathing with the advancement of Alzheimer's disease? My aunt, who has had this disease for five years, is mouth breathing more frequently. Her breathing is sometimes really loud and fast. There does not appear to be any particular situation that initiates this type of breathing; she could just be sitting and it will start. I am worried about dry mouth or other issues related to this habit, so I have tried to help her indirectly by giving her chewing gum. Can I expect this behavior to increase? [ 03/01/12 ]
It is quite common for dementia patients to sleep with open mouths, and to have their mouths agape for most of the day as well. It is nothing really to be concerned about, unless it is causing your aunt's throat to be irritated. The gum is a good idea; just make sure it is sugar-free. You can also try giving her a sugar-free candy to suck on during the day, which will help her to produce saliva as well as to be a reminder to keep her mouth closed. Additionally, if her mouth and throat become very dry as a result of this open mouth habit, you can speak to her doctor or pharmacist about using artificial saliva gel or spray.
I live in the United Kingdom, and my brother and his wife live in Tazewell, Virginia. They both have been diagnosed with early-onset Alzheimer’s disease, as well as other medical conditions. He has had to give up teaching, and because he is not an American citizen Medicaid is not an option for him. They are penniless and need help. There is a real possibility they could become homeless as they cannot pay their rent. Is there anyone who could help them with filling out forms? There appears to be no one that they can turn to for help and advice. [ 03/01/12 ]
You must feel frustrated and powerless being so far away from your brother and his plight. But there are several ways you can help.
In your brother's area, there are a few agencies that should be able to provide information, referral services, and counseling for your brother and sister-in-law. Even though it means phoning from the UK, it might be best for you to contact the agencies initially on your brother's behalf. This way, you can speak to someone directly and hopefully get some answers to specific questions you might have. If nothing else, it will help to get the ball rolling for your brother.
The agencies are:
Appalachian Agency for Senior Citizens (AASC)
P.O. Box 765
216 College Ridge Road
Cedar Bluff, VA 24609
1-800-656-2272 (toll free)
1-866-828-7723 (toll free)
Virginia Department for the Aging
1-800-552-3402 (toll free)
Also, since they live close to West Virginia, the following organization might also be helpful:
Appalachian Agency on Aging (AAAOA)
West Virginia Aging and Disability Resource Center
1460 Main Street
Princeton, WV 24740
1-800-473-1207 (toll free)
Additionally, you mentioned that your brother was a teacher. This must mean that he was employed somewhere. It is likely that he was friendly with someone at his place of employment, such as a former co-worker or supervisor, who might be able to at least check in on him. Perhaps they have other friends or neighbors who might be willing to lend a helping hand. What about your sister-in-law's family? Can you contact any of them for assistance? Does your brother or sister-in-law belong to any community organizations, social groups, or a church? Again, perhaps you can make some calls on your brother's behalf to ask people if they could help. Your brother may be too proud to ask for help on his own, but it will be essential that he and his wife accept some form of help in the time to come. The members of the church or other community group might be able to provide some immediate assistance or relief until such time that your brother's paperwork is filed.
My mom has had Alzheimer's for the last eight years, and lives in a nursing home. She fell three months ago and broke her hip. She didn't need hip replacement but has a plate and pins. Although she has been doing physical therapy since the surgery, she is not able to walk. She is no longer on Aricept; her doctor decided it wasn't helpful anymore. She can still feed herself, but in the last few weeks she started this goat-like chanting sound. Usually we have been able to distract her, but today the only time she stopped was while she was eating her lunch. Shortly therafter, she started making the sounds again. I think she is anxious because of the expression on her face, and when I ask her about it she tells me that she isn't in pain, but that she feels "nervous." The nurse called the doctor and he has prescribed Ativan to help calm her. Do you think Ativan is a good medication to calm the chanting? My mother is also taking 37.5 milligrams of Seroquel (I believe twice each day). [ 02/09/12 ]
Chanting like that can be annoying, for sure, but before trying to put an end to it, you will probably want to understand more about why she's doing it. She may be making noise to express pain, so you might see whether the chanting occurs more in particular circumstances such as walking. Constipation is another common source of discomfort, and she may have difficulty putting these issues into words. Anxiety, as you thought of, is another good reason for vocalizing. Is there anything remediable that she might be anxious about? Falling again, for example, may be a fear. Might she be able to benefit from physical therapy or a walker, or is she too cognitively impaired? And, again, see if there's a pattern to these expressions. A third common reason for making noises is the need for self-stimulation. See whether she might need some interesting activities to occupy her. Such activities sometimes work better than Ativan or Seroquel (though each medication has legitimate uses) and activities don't have the side effects that medications do. Ativan or Seroquel, when given properly and for appropriate reasons, can have legitimate treatment roles; however, these medications are associated with side effects, which include among other things, an increased risk for falling. You may want to see whether there is a nonpharmacologic way to control this problem.
My mother-in-law is in the 5th or 6th stage of Alzheimer's disease, is very combative, and refuses to take her medications. She puts her fingers in her ears and says she doesn't want to hear what we say. This is becoming a control issue and we are not sure what to do. Her health is generally good otherwise, except for having high cholesteral all of her life. We appreciate any suggestions. [ 02/08/12 ]
Her resistance to taking the medications is not so tough to appreciate! You probably wouldn't want to take so many pills yourself, and especially if you (like a person in stage 5 or 6 of Alzheimer's) didn't understand why they are considered necessary. Assuming you are her health care proxy and can make these decisions, here are some suggestions:
- Simplify the number of pills. Her primary care physician, if asked, may agree that some of these (for example the aspirin or pravastatin) are no longer necessary;
- Simplify the schedule. If she can take pills only once or twice daily, that is better than taking them more times each day;
- Simplify the administration. After talking with her physician, determine the pills that can be mixed with an easily swallowed food like apple sauce or banana. This can sometimes make them more palatable;
- Verify your success. Watch her swallow the pills, if possible, so that it's more of a challenge to hide them!
My 81-year-old mother is in stage five of Alzheimer’s disease. Today she woke up totally lucid, very agitated, and paranoid. She was able to remember conversations we had one week ago, but normally her retention span is less than five minutes. She asked for her cell phone, address book, and car keys and is driving herself back to Florida. We are in shock and are anxious to see what happens tomorrow. Is this normal for an Alzheimer's patient? [ 01/03/12 ]
Temporary episodes of lucidity can sometimes occur in Alzheimer's disease. Because of the nature of Alzheimer's disease, a patient may have brief moments of clarity interspersed amongst long periods of confusion and forgetfulness. Agitation and paranoia are also commonly seen in the mid-stages of the disease, which is consistent with the stage your mother is currently in. Alzheimer's disease is a day-by-day disease, because every day can bring something new to the table. Your mother's memory and agitation may be increased today (or even this week), but may be gone in a day or two.
However, if her agitation and paranoia seem to persist, you should consider contacting her physician for an evaluation. She may, for example, be suffering from an infection or have a pain that she cannot relay to you; the discomfort or pain may be disturbing enough to affect her behavior. A doctor's examination could therefore help to rule out medical causes for her change in behavior.
If no medical condition is found to be the culprit, then anti-anxiety medications might be of help to reduce her agitation. You can also try to determine if there is an environmental reason for her change in behavior. Is there someone new living with you? Have there been any significant changes to her daily routine, such as when/where/what she eats, where she sleeps, where she goes, who she visits, etc.? Sometimes seemingly insignificant changes to the routine of a person suffering from Alzheimer's disease can greatly impact his or her behavior. If the agitation continues, try to do a little detective work to determine whether something in her general environment may be disturbing her. Then, if possible, try to remove or limit these factors.
My elderly mother-in-law lives with me and my husband, and she has been on Aricept for about six months now. She has exhibited signs of dementia for several years, which is the reason that she came to live with us. I work full time and wonder how I will know when not to leave her alone. She still climbs stairs to get to her bedroom, and I come home to check on her at lunch every day. Also, I can get home in an emergency within seven minutes. Is there checklist for me to use as a guideline so that I can know when she shouldn't be left alone anymore? [ 01/03/12 ]
You and your husband will have to continually re-evaluate your mother-in-law's condition as to whether or not it is safe to leave her alone. She could easily have an accident (or cause an accident) and may not have the wherewithal to contact you at work in case there is an emergency. You cannot assume that she will remember how to use a phone and dial your work number. Simple tasks such as this can be overwhelmingly confusing for a person with dementia, even if they have successfully performed the task in the past.
Consider the following when trying to decide whether or not she should be left alone:
- Does she seem agitated or depressed when you leave her alone?
- Can she recognize an emergency situation? Would she be able to phone for help?
- Does she wander or leave the house? Does she become confused when she leaves the home?
- Does she try to do things she used to do, but are now unsafe for her to do alone (use the oven or other appliances) or at all (drive a car)?
In the meantime, make sure you safeguard the home:
- Install locks on doors of rooms and cabinets that your mother-in-law has no need to access.
- Install sturdy handgrip bars by toilets and tubs.
- Make sure walkways and stairways are clear and have no tripping hazards.
- Unplug stoves or microwaves when you leave.
- Make sure there are no open flames in the home.
- Put up signs on exit doors that will discourage your mother-in-law from leaving (Stop, Do Not Enter, etc.)
You also might consider installing locks on the doors that require a key (or keypad) from both directions (to enter and exit the home). Finally, you may want to consider purchasing a medical I.D. bracelet for your mother-in-law.
How is a person with Alzheimer's affected by showing them old family photos of people or friends they cannot remember, or talking about old times, family gatherings, and holidays? Do you think it is upsetting for the person with Alzheimer's if you tell them that you are their child, spouse, or old friend, for example? [ 01/03/12 ]
Looking through old photo albums is always a good activity to do with someone who has Alzheimer's disease. He or she may not remember all the faces or stories in the pictures, but that is fine. You can help by just narrating the photos and not quizzing the person. For instance, constantly asking “do you remember so-and-so?” or “do you remember this trip to the lake?” can be frustrating to a person with Alzheimer's disease and can make him feel ashamed if he cannot recall the persons or places in the photos. It is better to just casually narrate the photos.
Examples might include:
- This is Susie and her crazy dog that once tore up mom's favorite slippers.
- I like the hairstyle on this lady.
- These people look like they are having a fun time at the party.
- Look at the snow on that house!
This allows the person to participate in the discussion without actually having to remember who or what they are looking at. The patient may surprise you and be able to tell you a story or two about the photos. Especially if the photos are old, it is not unheard of for a person with Alzheimer's disease to clearly remember a past event but forget what happened to him or her just that morning.
You can do the same when talking to the person by asking open-ended questions instead of questions that require a specific answer. For example, instead of asking “do you remember the Christmas when “X' happened,” ask “what do you like most about Christmas?” or even “what is your favorite holiday?” In general, you will have to gauge the response of the person to determine if your topic of conversation is in any way distressing him. If you sense he is becoming agitated, simply change the topic to something more agreeable—the weather, sports, anything mundane—until the patient calms down.
If you occasionally visit a person with Alzheimer's disease, it is certainly very helpful to reintroduce yourself each time you visit or else have a caregiver give the introduction. A good introduction will not only include a name and relationship to the patient, but also a brief description or story to hopefully engage a memory. For instance, you can say “this is Brian, your son-in-law. He and your daughter Lucy just celebrated their 20th wedding anniversary. When they were engaged, you went fishing with Brian to 'see what he was made of,' which was pretty funny because you were the one who got seasick.” This gives the patient a little something to go on in case they cannot immediately pull the name “Brian” out of their memory. And even if the patient still does not recognize the person being introduced, the introductory story can provide an opening for a conversation on a related topic.
My mother has Alzheimer’s disease and I care for her full time. She has been with my husband and me for 11 years, and is often confused and frightened. My siblings, who do not completely understand my mother’s illness, call very frequently and mention things to my mother that upset her terribly, which bothers me greatly. I don't want to cut off the phone conversations to my mother because she very rarely gets to see her children; however, it has become so bad that at night when she goes to sleep she has nightmares and wakes up screaming. I have communicated my concerns to my siblings time and time again. Please help me to figure this out. [ 01/03/12 ]
First, you might want to consider asking your siblings to visit your mother in person, especially if it has been awhile since their last in-person visit. Sometimes an Alzheimer's disease patient can sound perfectly fine on the phone and can give the impression that they are not as badly affected by the disease as they really are. When the family of an Alzheimer's disease patient does not see the patient's day-to-day behavior or symptoms, the family may get lulled into a false sense that “everything is okay” and that the caregiver is just exaggerating how bad the patient's condition is to get sympathy or attention from the other family members. If your siblings come to visit, they may then witness first-hand what you are talking about.
If an in-person visit is not an option, you need to stay resolved for your mother's sake. Because your siblings have ignored your requests to not upset your mother, you will have to take more drastic measures. Lay down some new rules. Give them a list of topics that are “safe” and those that should be avoided. Let your siblings know that from now on when they call to speak to your mother, they will be placed on speakerphone and you will moderate the conversation. You will help to guide the conversation to “safe” topics, but if they persist in talking about distressing topics, let them know that the phone call will be ended immediately. You need to be your mother's advocate when she cannot say that something is disturbing to her. Ask that your siblings work with you in making your mother feel safe and happy instead of distressed and agitated. Remind your siblings that you all want the same thing: to make your mother as happy and comfortable as possible. So asking that they simply limit the topics of conversation with your mother should be a perfectly reasonable request on your part.