Conditions of Alzheimer’s – How to deal with them

Hey, glad to have you here. Last week we looked at the early signs of Alzheimer’s and we compared normal signs of aging with signs of Alzheimer’s. If you missed that blog, check it out here: http://niceusgeriatric.com/2022/03/13/early-signs-of-alzheimers-in-the-elderly/. This week we will have a look at specific conditions that develop due to Alzheimer’s and ways in which to counteract or deal with them.

Alzheimer’s can be very challenging to deal with; the caregiver of someone with Alzheimer’s must take a different perspective to tolerate the behavioral changes a loved one may experience. Fortunately, we can give you some tips on how to help keep your loved ones safe and free from harm, to help you cope with giving them care, and how to keep them calm in otherwise stressful situations.

Understanding that your relative is not “miserable” or doing this for “spite” is an important part of giving care. I do not think anyone would wake up wanting parts of their brain to die or wishing to forget the people they love the most in their life. Empathy and patience are critical for caring for persons with Alzheimer’s. Try to understand their pain and allow them time to express themselves as much as you can.

Now let’s look at some of the challenges encountered while caring for persons with Alzheimer’s

FALLS

Due to cognitive impairment in people suffering from Alzheimer’s, there may be an increased risk of falls. They may experience difficulty judging spatial distance or may have visual issues, among other things.

Research shows the most successful intervention against falls are those designed to care for and meet your loved one’s needs and capabilities and find out what is the main cause of their falls. To mitigate the effects of a fall, the floor material is a significant factor….carpeted and wooden. To prevent falls, you may want to use one or more of the following tips –

• Design exercise programs to improve mobility, to strength muscles, but only give exercises that they can handle
• Use of walking aides as necessary
• Remove items that they may bump into or fall on along a pathway they usually use
• Have a floor that is not hard (eg. Has carpet on it)
• Avoid shaggy carpets – these may create a tripping hazard
• Adequate monitoring or chaperone on walks and mobility exercises
• Place handle bars at strategic points along a usual pathway
• Take a training course in fall prevention so you can better protect them as their caregiver
• Keep bed rails in an up position and the bed at a low level when your loved one is on the bed

WANDERING

At times, someone who has Alzheimer’s disease may pace and wander off. They walk aimlessly in an area and then walk away. Pacing and wandering may be due to a few factors;

• they may feel overstimulated by too much talking or noise around,
• they may feel uncomfortable, anxious or disoriented,
• they may be looking for someone or something or
• they may not like what is happening where they are.

When responding to a loved one that wants to wander off, we suggest you use the following:

• Reassure them by letting them know it is safe where they are
• Listen to cues for why they behave like that
• Ask to join walking with them then guide them to where they should be
• Offer a distraction such as starting a conversation
• Offer toilet amenities – they may want to use the toilet but do not know because of their memory issues
• Try to help remove shoes – removing their shoes signifies the walk has ended, so that may deter them from wanting to walk
• Give them a ball or round object to play with – a form of distraction
• Encourage simple tasks such as folding napkins, sorting papers or decorating a wall to keep them occupied.

It may not always be possible to be there with your loved one when the urge to wander occurs. Here are some tips to discourage your loved one from wandering off:

• Place a dark matt or paint the ground black in front the door/exit – they will think it’s a hole
• Cover the bedroom door with wall paper or curtain, or place a mirror on the door; this makes the door less noticeable
• Attach an I.D. bracelet on their hand – if all else fails and there is that one unguarded moment where you cannot stop them from wandering off, at least anyone who finds them will have a name, address and phone number to contact the relatives to inform them if they get lost.

RUMMAGING AND HOARDING

Persons with Alzheimer’s may go into drawers, closets, etc, dig up and take items out then hide them in unusual places. When responding to someone who rummages and hoards, we suggest you use the following:

• Do not scold them; they may become fearful of you, especially if they cannot remember who you are and this will break their trust in you.
• Try distracting them
• Offer another activity or a snack.
• Reorient them to the location of their own personal belongings. You may have to do this several times, so patience is key.
• Take them to the bathroom. Again, they may not remember what the urge to use the washroom feels like, so they may mistake that urge for wanting to rummage and hoard.
• Learn their hiding places so that you can find lost items.
• Use your sense of fun and humor for diversion, but be careful not to laugh at their behavior.
• Put valuables and dangerous items away, keep a spare set of keys in safe place and lock these areas so they cannot access them
• Provide a rummaging drawer – you can place old items, scrap materials and clothes so that they may freely rummage this drawer while keeping the important items under lock and key.

CATASTROPHIC REACTION

This is when an Alzheimer’s person becomes verbally and physically abusive. Whenever a situation occurs that they are unable to think or react to, they instead overreact because of a lack of control of their impulses.  In a situation like this, what can you do?

• Stay calm and identify yourself. Anxiety is contagious so becoming anxious will only fuel their reaction. They may not remember who you are, so be sure to remind them frequently.
• Look for non- verbal cues – they may start pounding their fist, or their body language changes; when you see this, prepare yourself for what is about to occur.
• Do NOT take the attack personally and do not argue with them. This has nothing to do with you, the condition makes them react this way. Have empathy.
• Acknowledge the anger – give verbal reassurance that you understand they are upset and you are there to help them.
• Trying to restrain them should be a last resort.
• Ask them “do you feel pain?” or “what is wrong?” Let them know hitting is wrong.
• Try to distract them with a favourite activity

SUNDOWNING

This is a phenomenon among Alzheimer’s clients where they may get more restless and confused when the sunsets. They may have issues with the dark. Signs of Sundowning include restlessness, anxiety, worried expressions, reluctance to enter their own room, reluctance to enter brightly lit areas, crying, wringing of hands, pushing others away, gritting their teeth, or taking off clothing

These may be a real physical need, eg. needing to use the bathroom or being hungry, in pain, or feeling uncomfortable. On the other hand, they may represent the need for loved ones to be around, another human contact, or control over something

How to approach Sundowning?

• Is it pain? Hunger? Are these symptoms really sundowning? Maybe fear of the dark or fear of being alone? Try asking questions to find out how they really feel. Be patient with these questions, don’t make them feel as if its an interrogation. Pace your questions so as not to increase their anxiety.
• Provide a night light. This may give a comfort from the intimidation caused by the darkness.
• Say comforting words, use comforting touch, or soothing music
• Develop a routine for bedtime – take note at the time they start to display these changes in behaviour so you can start the routine just before that time.
• Distraction tactics – offer them something to eat, start a favourite hobby or engage in conversation
• If they start pacing, allow a safe place to pace. They may pace until they become tired, as such you can simply take them to bed.
• Do not argue with them. Remember empathy and patience is key, and again, do not take it personal.

So today, we looked at some of the conditions a person with Alzheimer’s may experience, namely Falls, Wandering, Rummaging and Hoarding, Catastrophic Reactions, and Sundowning. Important factors when dealing with an Alzheimer’s person is really having empathy for them, having patience, and ensuring that you take care of yourself as well… because you cannot pour from an empty cup. Thanks so much for reading! Share with someone who needs to see this, it may help them a lot.

Photo by Steven HWG on Unsplash