Tennessee Commission on Aging and Disability
Jim Shulman, Executive Director

Communication

Minimize or eliminate distractions. It's best not to have anything else going on when you are trying to talk to the person. Turn off the tv or the radio. Keep their attention by holding their hand while you talk to them and maintaining eye contact. Slow your speech and keep your vocabulary simple and positive. Instead of saying "don't do such and such," give them options for what they can do. Coax them into talking about things that are still familiar to them. Do not talk down to the person. Instead, be encouraging and uplifting.

Persons with Alzheimer's Disease may be prone to wander. They may feel they have to find a family member or some other familiar situation. Secure doors and windows with locks that they cannot open easily. You may have to be creative to come up with ways to keep the person from slipping away. Regular exercise can help reduce restlessness.

Keep a current photo on hand in case your loved one should come up missing, and have the person wear an ID bracelet with their name, address, and phone number. Let your neighbors and the local police know about your loved one's condition and provide them with a way to reach you.

Incontinence

Establish a regular routine for visits to the toilet. You may have to remind them to go, or you may have to assist them. Eliminating fluids that have a diuretic effect (like coffee, tea, cola, or beer) and stopping fluid intake before bedtime may help. You might also consider getting a commode from a medical supply store to set by the bed. Undergarments should be easy to remove and easy to clean. A urologist might be able to prescribe medications to control frequency of voiding.

Anger and Depression

"In the elderly, depression and dementia have similar symptoms, including withdrawal, confusion and disorientation, and loss of desire to do usually enjoyable activities. Additionally, depression is often present in individuals with dementia, especially in the early stages, and it is helpful to seek and obtain proper treatment for both the depression and the dementia. Proper treatment for the depression sometimes alleviates later behavioral issues as well." ( Source - Mental Health Association)

The Alzheimer's patient may exhibit a good deal of angry behavior. No doubt they are reacting to the unfamiliar changes going through their minds. Imagine being aware of your mental powers slipping away and not being able to stop it. It's frustrating, to say the least. At no point, however, should you avoid telling the person the truth about their condition. Denial on your part will not benefit him or her at all. Tell the truth, just keep it simple.

Find activities that might distract the person if you notice depression. Companionship, a short shopping trip,

or a favorite activity can help to ease depression. If anger is a problem, try talking to the person in calm, soothing tones and giving them a chance to settle down. Remove them from the source of agitation. Don't argue with the person.

Often, Alzheimer's patients may experience higher levels of agitation and restlessness in the evening hours. This tendency is called "sundowning." You might be able to manage this condition by providing a quiet, well

-lit environment. Try turning on lamps and soft music at dusk to soothe the patient into the evening. Cut back on naps to increase the likelihood of sleepiness at night. And if the patient has a tendency to pace, provide a safe place to do it.

Both the Alzheimer's patient and the caregiver risk not getting enough sleep, which can cause health problems. Seek assistance from family members or community agencies to help with watching the person

at night. If the person tends to pace while you are sleeping, then designate a safe section of the home for

the two of you. Make sure the person's physical needs have been met (i.e. hunger, thirst, room temperature, etc.). And again, it cannot be emphasized enough: exercise is crucial. It helps both of you by relieving

tension, regulating appetite and digestion, and improving strength and coordination.

The first thing to do is to check with the doctor to rule out medical or medication-related causes. A neurologist might prescribe medication to calm the person. Reduce caffeine; maintain a routine; don't move furniture or other objects around unnecessarily. Keeping something familiar and pleasant around, like favorite photographs or a special keepsake, can help to reduce tension. Try not to increase the person's agitation by confronting them. Maintain a soothing, emphathetic tone. Offer a snack or activity.

Alzheimer's patients may repeat their words or actions, and this requires patience on your part. Reminding them that they just said or did a certain thing does not help. Sometimes ignoring the repetitions can help, as long as you've determined that there is no harm in doing so. Try using signs that have the time for meals written on them, or simple directions to the bathroom. Avoid discussing plans for an event too far in advance.

Careful observation on your part will help you learn what certain actions mean. For example, does your loved one perform a certain activity before having to go to the bathroom, like tugging on his or her clothing?

Again, you will need to rule out any medical problems by discussing this symptom with the doctor.

In the first and middle stages of Alzheimer's disease, you may witness the person rummaging around or hoarding things. They may even take things that do not belong to them. They may not even know what they are looking for, or the thing may not even exist. To reduce their frustration, you can "help" them look for items for which they are searching. A special drawer, closet, or box just for them may be just the thing for satisfying the urge to rummage. If you find misplaced items, return them to their proper location, but do it later. Lock rooms or closets that are off limits.

Traveling with an Alzheimer's patient can be challenging. Always be direct. Say things like, "We're leaving now, here's your coat," instead of "Are you ready to go?" Plan ahead as much as possible so that you can control or reduce the occurence of too many unfamiliar settings. Where will you park? Where are the elevators? You will find it very helpful if you know these types of things in advance.

One caregiver reported the difficulty she experienced traveling by airplane with her mother. At one point her mother had to go to the restroom, but because the restroom was unfamiliar, she resisted using it. They

ended up spending most of the flight at the door of the restroom. The mother never used it, but more importantly, she did not have any accidents. Whenver possible, especially for longer trips or vacations, try to bring an extra person with you. Bring something like a picture book or cards to keep the person distracted if you have to wait a long period.

Brain disfunction may make it difficult for an Alzheimer's sufferer to distinquish hot from cold. You may have

to have some type of regulator to control the temperature and prevent the person from being burned by hot water. Provide assistance during showers and baths, especially if the person easily looses their balance. Keep in mind that the desire for privacy may increase the person's agitation. And if bathing today is problematic, then skip today and try again tomorrow.

Try not to argue with the person if they are determined to wear the same thing. Getting dressed can be a bit overwhelming for them. Choose similar clothing items that are comfortable and easy to get on and off. Keep the wardrobe simple by removing unused clothing from the closet. Lay out clothing in the order in which it should be put on. Remove dirty clothes from the room.

The wrong behavior at the wrong time may become a problem as time goes on. The person may use the bathroom on him or herself and in the most unlikely places. They may take off their clothes in public or do things of a sexual nature. You can try talking them into appropriate behavior, having them wear disposable underwear, providing a stuffed animal, or a warm hand for them to hold. At all times, you have to remember that the person is not deliberately doing these things to aggravate you, it's the disease.