Taking care of Alzheimer's patient at home

Laishram John Singh *

Introduction

Caring for Alzheimer's disease at home is a difficult task and can become overwhelming at times. Each day brings new challenges with changing levels of ability and new patterns of behaviour.More than the medication it is important to know, how to be with the patient and feeling for the patient. The attitude of unconditional positive regard and love is the most effective tool in caring for these patients.

What is Alzheimer’s disease?

A degenerative brain disease of unknown cause that usually starts in late middle age or in old age, that results in progressive memory loss, impaired thinking, disorientation, and changes in personality and mood.

Alzheimer's disease causes the brain to shrink and brain cells to eventually die. Alzheimer's disease is the most common cause of dementia.It is a devastating disease that not only affects the person who has it but also places an enormous burden on the families and care givers.

**Areas of attention while caring Alzheimer’s at home:

I) Communication techniques/ tips for caring Alzheimer’s patient: (Things to do)

§ Try to attract and maintain your loved one’s attention before speaking.
§ Begin conversations with orienting information.
§ Minimize distractions and noise.
§ Keep communication short, simple, and clear- Give one direction or ask one question at a time.
§ Allow enough time for a response- be careful not to interrupt.
§ Find words for him as he may have problem finding words.
§ Use repetition as much as necessary.

Communication Tips- (Things Not to do)

§ Do not Point out the person’s memory difficulty.
§ Refraining from arguing or engaging in power battles
§ Instead of saying "sit there" say "sit in the blue chair."
§ Do not Use sarcasm or irony, even if meant humorously.
§ Avoid “baby talk.” not to treat live kids.
§ Do not Use slang or unfamiliar words.

II) Activities of daily living

1. Nutrition

§ Quiet, calm, mealtime atmosphere by limiting noise and other distractions. Allow plenty of time.
§ Give the person food choices.
§ Notifying what meal it is breakfast, lunch and what food you are providing.
§ Plan for several small meals rather than three large meals
§ Food serve should not be too hot or too cold.
§ Care should be taken care if patient is having medical illness which needs diet modification, such as diabetes, hypertension etc.
§ Encourage plenty of fluids throughout the day to avoid dehydration (reduce during night time).
§ Provide a well balanced diet, rich in protein, high fibre with adequate amount of calories.

2.Personal hygiene

§ Take care while brushing teeth, nails need to be check regularly. Hair care regularly.
§ Bathing/sponging every day, it gives opportunity to observe for any pressure sores.
§ Keep skin clean & dry particularly in areas prone to perspiration and assess the bony prominences and area prone for pressure soresto PREVENT BED/ PRESSURE SORES.Can use cotton rings and pillows and frequent changing of positions for bed ridden patients or those who cannot move.
§ Pressure points in supine position- back of head, shoulder, elbow, lower back and buttocks, hip, heel.
§ Pressure points in prone position- head, ear, chin, chest, breast for female, reproductive organs, knee, toes.
§ Pressure points in side lying position- ear, shoulder, elbow, hip, inner knee, ankle, heel.

3. Dressing:

§ Allow the person to choose from a limited selection of outfits, this may enhance self-esteem.
§ Encourage the person to dress himself or herself to whatever degree possible.
§ Plan to allow extra time so there is no pressure or rush.
§ Arrange the clothes in the order they are to be put on to help the person move through the process.

4. Sleep

§ Adequate sleep required, try not to sleep during day time.
§ Approaching night time may become restless and irritable, try spend time with him/ her.
§ Encourage exercise during the day and limit daytime napping.
§ Try to keep bedtime at a similar time.Sleeping pills are best to be avoided, instead a glass of milk.
§ Causes of discomfort during sleep time need to be taken care: noise, light, pain, temperature.

5. Toilet habits

§ Establish toilet habits and maintain a rigid routine.
§ Patient should be taken for urination at fixed interval.
§ Watch for signs for urge of toileting or any other issues.
§ May experience incontinence as disease progress. Diapers can be use.
§ Constipation again is one common causeof discomfort for the patient. High fibre diet to be given.
§ Plan ahead if going out- Locate restroom, wear simple easy-to-remove clothing.

6. Exercises (Active & Passive):

§ Exercise benefits both patient and the caregiver, can work out together. Choose physical activities you both enjoy.
§ Build slowly, perhaps just starting with a short walk.
§ Choose exercise programs available like laughing Yoga/meditation, this can be a socializing time.
§ Provide rest period in between.
§ Passive exercises if not able to do by self. Slowly moving the joints, rotating etc. to the limit possible.

III) Handling moods and emotions

§ Respect as a person- value his presence in the family and it need to be express.
§ Use comforting and non-controlling or commanding statements.
§ Give praise for the simplest achievements and successes
§ Participate with his emotions- when he is down lift him up, just ignore some of his action.
§ Repeat enjoyable activities- Same story allow him to tell again and again.
§ Give choices, whenever possible to enhance self-esteem or worth.
§ Soothing music may be devotional can work wonders.
§ Taking him out for a walk: Diverting the mind
§ Socialization, taking him out in family gatherings/ outing in the community.

IV) Developing day today routines

§ Try to keep consistent daily times for activities (Waking up, toileting, exercise, meals etc.)
§ Let your loved one know what to expect morning (open the curtains to let sunlight in) & Evening, put on quiet music to indicate it’s bedtime.
§ Try to include him/ her in the entire activity process in family.
§ Help get started on an activity and praise the person for each step he or she completes.
§ Orient the patient to reality - large faces clock, calendar with large writing and a separate page for each day.

V) Planning activities and visitors:

§ Start with your love ones interest, may be a morning walk/ meditation which he enjoy or use to enjoy.
§ Vary activities to stimulate different senses of sight, smell, hearing, and touch.
§ Planning time outdoors can be very therapeutic. Out for a drive, visit a park, or take a short walk.
§ Consider outside group activities like Senior citizens club, park etc.
§ Visitors can provide an opportunity for caregiver to socialize or take a break.
§ Plan visitors at a time of day when your loved one can best handle them.

Scheduling visitors time.

VI) Home safety and prevention of accidents:

Creating safe environment prevents stressful & dangerous situations.

§ Make sure knives, matches, sharp items, paints, guns are secured.
§ Protect electrical appliances, gas stoves, sockets and others that may pose a risk to the patient.
§ Adequate light inside and outside the room.
§ Label all the rooms (Common room, bed room, toilet, kitchen etc.)
§ Keep the house free from clutter/disordered things.
§ Care to avoid accidents caused by tripping over furniture.
§ Label medications and keep them locked up.
§ Take care while taking him out.

VII) Care of care givers:

§ Caregivers need outlets for dealing with their own feelings.
§ Not to neglect own physical, mental, emotional well-being.
§ Take time off or time away, do not ignore social life.
§ See your physician regularly.
§ Get screened for stress and depression.
§ Get plenty of rest whenever possible.
§ Eat well-balanced meals.
§ Exercise regularly.
§ Accept help from others.

Conclusion

Alzheimer disease is a journey never to come back, our love ones will leave us one day without recognising us, by just looking at us and receiving the care that we are providing. The disease might hide the person inside, but there is still a person in there who needs your love and attention.

There will come a time when your loved one will be gone and you will find comfort in the fact that you were his/ her caregiver or a dear one, so do the best possible from your heart.