Adapting Activities for People with Alzheimer’s Disease

(NIH) Doing things we enjoy gives us pleasure and adds meaning to our lives. People with Alzheimer’s disease need to be active and do things they enjoy. However, don’t expect too much. It’s not easy for them to plan their days and do different tasks.

People with Alzheimer’s may have trouble deciding what to do each day, which could make them fearful and worried or quiet and withdrawn, or they may have trouble starting tasks. Remember, the person is not being lazy. He or she might need help organizing the day or doing an activity.

Activity Planning

Plan activities that the person with Alzheimer’s enjoys in your daily routine, and try to do them at a similar time each day. He or she can be a part of the activity or just watch. Here are things you can do to help the person enjoy the activity:

  • Match the activity with what the person with Alzheimer’s can do.
  • Choose activities that can be fun for everyone.
  • Help the person get started.
  • Decide if he or she can do the activity alone or needs help.
  • Watch to see if the person gets frustrated.
  • Make sure he or she feels successful and has fun.
  • Let him or her watch if that is more enjoyable.

Try These Activities

The person with Alzheimer’s disease can do different activities each day. This keeps the day interesting and fun. Here are some daily activities people with Alzheimer’s may enjoy:

  • Household chores: Wash dishes, set the table, prepare food, sweep the floor, dust, sort mail and clip coupons, sort socks and fold laundry, sort recycling materials or other things.
  • Cooking and baking: Decide what is needed to prepare the dish; measure, mix, and pour; tell someone else how to prepare a recipe; watch others prepare food.
  • Exercise: Take a walk together, watch exercise videos  or TV programs made for older people, use a stationary bike, use stretching bands, throw a soft ball or balloon back and forth, lift weights or household items such as soup cans.
  • Music and dancing: Play music, talk about the music and the singer, ask what the person with Alzheimer’s was doing when the song was popular, sing or dance to well-known songs, attend a concert or musical program.
  • Pets: Feed, groom, walk, sit and hold a pet.
  • Gardening: Take care of indoor or outdoor plants, plant flowers and vegetables, water the plants when needed, go to school events, talk about how much the plants are growing.
  • Visiting with children: Play a simple board game, read stories or books, visit family members who have small children, walk in the park or around schoolyards, go to school events, talk about fond memories from childhood.

Going Out

People in the early stages of Alzheimer’s disease may still enjoy going out to places they enjoyed in the past. For example, the person might enjoy going to a favorite restaurant, park, shopping mall, swimming pool, museum, or theater. Keep going on these outings as long as you are comfortable with them.

Plan Ahead for Outings

Here are some tips to make outings fun:

  • Plan outings for the time of day when the person with Alzheimer’s is at his or her best.
  • Keep outings from becoming too long. Take note of how tired the person gets after a certain amount of time. Bring the person home before he or she becomes overtired.
  • Use a business-size card to tell others about the person’s disease. Sharing this information with store clerks or restaurant staff can make outings more comfortable for everyone. For example, the card could say “My family member has Alzheimer’s disease. He might say or do things that are unexpected. Thank you for your understanding.”

Eating Out

Going out to eat can be a welcome change, but it can also be challenging. Planning can help. Before choosing a restaurant, think about its layout, menu, noise level, waiting times, and the helpfulness of the staff. Ask yourself:

  • Does the person with Alzheimer’s disease know the restaurant well?
  • Is it quiet or noisy most of the time?
  • Are tables easy to get to? Do you need to wait before being seated?
  • Is the service quick enough to keep the person from getting restless?
  • Does the restroom meet the person’s needs?
  • Are foods the person with Alzheimer’s likes on the menu?
  • Is the staff understanding and helpful?

Before going to the restaurant, decide if it is a good day to go. If it is, think about the best time to go. Earlier in the day may be best, so the person with Alzheimer’s is not too tired. Also, the restaurant may be less crowded, and service may be quicker. If you decide to go later, try to get the person to take a nap first.

Before you leave home, gather what you need. Helpful items may include utensils, a towel, wipes, or bathroom items.

At the Restaurant

  • Tell the waiter or waitress about any special needs, such as extra spoons, bowls, or napkins.
  • Ask for a table near the restroom and in a quiet area. Seat the person with his or her back to busy areas.
  • Help the person choose a meal, if needed. Suggest food you know the person likes. Read parts of the menu or show the person pictures of the food. Limit the number of choices.
  • Ask the server to fill glasses half full or leave the drinks for you to serve.
  • Order finger food or snacks to hold the attention of the person with Alzheimer’s.
  • Go with the person to the restroom. Go into the stall if the person needs help.

Participating in Spiritual Activities

Like you, the person with Alzheimer’s may have spiritual needs. If so, you can help the person stay part of his or her faith community. This can help the person feel connected to others and remember pleasant times. Here are some tips for helping a person with Alzheimer’s disease who has spiritual needs:

  • Involve the person in spiritual activities that he or she has known well. These might include worship, religious or other readings, sacred music, prayer, and holiday rituals.
  • Tell people in your faith community that the person has Alzheimer’s disease. Encourage them to talk with the person and show him or her that they still care.
  • Play religious or other music that is important to the person. It may bring back old memories. Even if the person with Alzheimer’s has a problem finding the right words to speak, he or she still may be able to sing songs or hymns from the past.

Traveling Overnight

Taking a person with Alzheimer’s disease on an overnight trip is a challenge. Traveling can make the person more worried and confused, so it’s important to think ahead. Here are some tips.

Plan Ahead

  • Talk with the person’s doctor about medicines to calm someone who gets upset while traveling.
  • Find someone to help you at the airport, train station, or bus station.
  • Keep important documents with you in a safe place. These include health insurance cards, passports, doctors’ names and phone numbers, a list of medicines, and a copy of the person’s medical records.
  • Pack items the person enjoys looking at or holding for comfort.
  • Travel with another family member or friend.
  • Take an extra set of clothing in a carry-on bag.

People with memory problems may wander around a place they don’t know well. In case someone with Alzheimer’s disease gets lost:

  • Make sure the person wears an ID bracelet or something else that tells others who he or she is.
  • Carry a recent photo of the person with you on the trip.

After You Arrive

  • Allow lots of time for each thing you want to do. Don’t plan too many activities.
  • Plan rest periods.
  • Follow a routine like the one you use at home. For example, try to have the person eat, rest, and go to bed at the same time he or she does at home.
  • Keep a well-lighted path to the toilet, and leave the bathroom light on at night.
  • Be prepared to cut your visit short if necessary.

Visiting Family and Friends

Spending time with family and friends is important to people with Alzheimer’s disease. They may not always remember who people are, but they often enjoy the company. Here are some tips to share with people you plan to visit:

  • Be calm and quiet. Don’t use a loud voice or talk to the person with Alzheimer’s as if he or she were a child.
  • Respect the person’s personal space, and don’t get too close.
  • Make eye contact and call the person by name to get his or her attention.
  • Remind the person who you are if he or she doesn’t seem to know you. Try not to say, “Don’t you remember?”
  • Don’t argue if the person is confused. Respond to the feelings that he or she expresses. Try to distract the person by talking about something different.
  • Remember not to take it personally if the person doesn’t recognize you, is unkind, or gets angry. He or she is acting out of confusion.
  • Have ready some kind of activity, such as a familiar book or photo album to look at. This can help if the person with Alzheimer’s is bored or confused and needs to be distracted. But be prepared to skip the activity if it is not needed.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Adapting Activities for People with Alzheimer’s

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
1-800-438-4380 (toll-free)
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimer’s Association
1-800-272-3900 (toll-free, 24/7)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

Alzheimer’s Foundation of America
1-866-232-8484 (toll-free)
info@alzfdn.org
www.alzfdn.org

Family Caregiver Alliance
1-800-445-8106 (toll-free)
info@caregiver.org
www.caregiver.org

Citation

https://www.nia.nih.gov/health/adapting-activities-people-alzheimers-disease

Content reviewed: May 18, 2017

National Institutes of Health

 

Alzheimer’s Disease: Common Medical Problems

(NIA) In addition to the symptoms of Alzheimer’s disease, a person with Alzheimer’s may have other medical problems over time, as all older adults do. These problems can cause more confusion and behavior changes. The person may not be able to tell you what is wrong. As a caregiver, you need to watch for signs of illness and tell the doctor about what you see. Here are some common medical problems to watch for.

Fever

Having a fever means that the person’s temperature is 2 degrees or more above his or her normal temperature.

A fever may be a sign of:

Don’t use a glass thermometer because the person might bite down on the glass. Use a digital thermometer, which you can buy at a grocery store or drugstore. Call the doctor right away if the person with Alzheimer’s disease has a fever.

Flu and Pneumonia

These diseases spread quickly from one person to another, and people with Alzheimer’s are more likely to get them. Make sure that the person gets a flu shot each year and a pneumonia shot once after age 65. Some older people need to get more than one pneumonia vaccine. The shots lower the chances that the person will get the flu or pneumonia. For more information on pneumonia, visit the Centers for Disease Control and Prevention (CDC). For more information on the flu, visit the CDC or the National Institute of Allergy and Infectious Diseases.

Flu and pneumonia may cause:

  • Fever (Not everyone with pneumonia has a fever.)
  • Chills
  • Aches and pains
  • Vomiting
  • Coughing
  • Trouble breathing

Falls

As Alzheimer’s disease gets worse, the person may have trouble walking and keeping his or her balance. He or she also may have changes in depth perception, which is the ability to understand distances. For example, someone with Alzheimer’s may try to step down when walking from a carpeted to a tile floor. This puts him or her at risk for falls.

To reduce the chance of a fall:

  • Clean up clutter.
  • Remove throw rugs.
  • Use chairs with arms.
  • Put grab bars in the bathroom.
  • Use good lighting.
  • Make sure the person wears sturdy shoes with good traction.

Dehydration

Our bodies must have a certain amount of water to work well. If a person is sick or doesn’t drink enough fluid, he or she may become dehydrated.

Signs of dehydration to look for include:

  • Dry mouth
  • Dizziness
  • Hallucinations (Don’t forget that hallucinations may be caused by Alzheimer’s itself.)
  • Rapid heart rate

Be aware of how much fluid the person is drinking. This is even more important during hot weather or in homes without air conditioning. Also, look for signs of dehydration during the winter months when heat in your home can create a lot of dry air.

Constipation

People can have constipation—trouble having a bowel movement—when they:

  • Change what they eat
  • Take certain medicines, including Namenda®
  • Get less exercise than usual
  • Drink less fluid than usual

Try to get the person to drink at least 6 glasses of liquid a day.

Besides water, other good sources of liquid include:

  • Juice, especially prune juice
  • Gelatin, such as Jell-O®
  • Soup
  • Milk or melted ice cream
  • Decaffeinated coffee and tea
  • Liquid cereal, such as Cream of Wheat®

Have the person eat foods high in fiber. Foods like dried apricots, raisins, or prunes; some dry cereals; or soybeans might help ease constipation.

If possible, make sure that the person gets some exercise each day, such as walking. Call the doctor if you notice a change in the person’s bowel habits.

Diarrhea

Some medicines, including Alzheimer’s medications, may cause diarrhea—loose bowel movements. Certain medical problems also may cause diarrhea. Make sure the person takes in lots of fluids when he or she has diarrhea. Also, be sure to let the doctor knowabout this problem.

Incontinence

Incontinence means a person can’t control his or her bladder and/or bowels. This may happen at any stage of Alzheimer’s disease, but it is more often a problem in the later stages. Signs of this problem are leaking urine, problems emptying the bladder, and soiled underwear and bed sheets. Be sure to let the doctor know if this happens. He or she may be able to treat the cause of the problem.

Here are some examples of things that can be treated:

When you talk to the doctor, be ready to answer the following questions:

  • What medicines is the person taking?
  • Does the person leak urine when he or she laughs, coughs, or lifts something?
  • Does the person urinate often?
  • Can the person get to the bathroom in time?
  • Is the person urinating in places other than the bathroom?
  • Is the person soiling his or her clothes or bed sheets each night?
  • Do these problems happen each day or once in a while?

Here are some ways you can deal with incontinence:

  • Remind the person to go to the bathroom every 2 to 3 hours.
  • Show him or her the way to the bathroom, or take him or her.
  • Make sure that the person wears loose, comfortable clothing that is easy to remove.
  • Limit fluids after 6 p.m. if problems happen at night. Do not give the person fluids with caffeine, such as coffee or tea.
  • Give the person fresh fruit before bedtime instead of fluids if he or she is thirsty.
  • Mark the bathroom door with a big sign that reads “Toilet” or “Bathroom.”
  • Use a stable toilet seat that is at a good height. Using a colorful toilet seat may help the person identify the toilet. You can buy raised toilet seats at medical supply stores.
  • Help the person when he or she needs to use a public bathroom. This may mean going into the stall with the person or using a family or private bathroom.

Accidents happen. Be understanding when they occur. Stay calm and reassure the person if he or she is upset.

Incontinence supplies, such as adult disposable briefs or underwear, bed protectors, and waterproof mattress covers, may be helpful. You can buy these items at drugstores and medical supply stores. A drainable pouch may be useful for the person who can’t control his or her bowel movements. Talk to a nurse about how to use this product.

Some people find it helpful to keep a record of how much food and fluid the person takes in and how often he or she goes to the bathroom. You can use this information to make a schedule of when he or she needs to go to the bathroom.

Dental Problems

As Alzheimer’s disease gets worse, people need help taking care of their teeth or dentures.

Check the person’s mouth for any problems such as:

  • Sores
  • Decayed teeth
  • Food “pocketed” in the cheek or on the roof of the mouth
  • Lumps

Be sure to take the person for dental checkups. Some people need medicine to calm them before they can see the dentist.

Other Medical Problems

People with Alzheimer’s can have the same medical problems as many older adults. Research suggests that some of these medical problems may be related to Alzheimer’s disease.

For example, some heart and blood circulation problems, stroke, and diabetes are more common in people who have Alzheimer’s than in the general population. Diseases caused by infections also are common.

Visiting the Doctor

It’s important that the person with Alzheimer’s gets regular medical care. Make sure the person sees a health professional on a regular basis. This is the best thing you can do to help prevent medical problems.

Here are some tips to help you get ready for a visit to the doctor’s office:

  • Make an appointment during the person’s best time of day and when the office is not very crowded.
  • Let the office staff know before the visit about the person’s Alzheimer’s disease. Ask them for help to make the visit go smoothly.
  • Don’t tell the person with Alzheimer’s about the visit until the day of the visit or even right before it is time to go if visiting the doctor makes the person nervous. Be positive and matter of fact.
  • Take something he or she likes to eat or drink and any materials or activities the person enjoys.

For more information on preparing for hospital and emergency room visits, read Going to the Hospital: Tips for Dementia Caregivers.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Alzheimer’s and Common Medical Problems

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
1-800-438-4380 (toll-free)
adear@nia.nih.gov 
www.nia.nih.gov/alzheimers

The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimer’s Association
1-800-272-3900 (toll-free, 24/7)
1-866-403-3073 (TTY/toll-free)
info@alz.org 
www.alz.org

American Academy of Family Physicians
1-800-274-2237
aafp@aafp.org 
www.familydoctor.org

Citation

https://www.nia.nih.gov/health/alzheimers-disease-common-medical-problems

Content reviewed: May 18, 2017

 

Healthy Eating and Alzheimer’s Disease

(National Institute on Aging) Eating healthy foods helps everyone stay well. It’s even more important for people with Alzheimer’s disease. Here are some tips for healthy eating.

Buying and Preparing Food

When the person with Alzheimer’s disease lives with you:

  • Buy healthy foods such as vegetables, fruits, and whole-grain products. Be sure to buy foods that the person likes and can eat.
  • Give the person choices about what to eat—for example, “Would you like green beans or salad?”
  • Buy food that is easy to prepare, such as premade salads and single food portions.

It may be helpful to have someone else make meals or use a service such as Meals on Wheels, which brings meals right to your home. For more information, contact the Meals on Wheels organization at 1-888-998-6325 or w ww.mealsonwheelsamerica.org .

When a person with early-stage Alzheimer’s disease lives alone, you can buy foods that the person doesn’t need to cook. Call to remind him or her to eat.

Maintain Familiar Routines

Change can be difficult for a person with Alzheimer’s disease. Maintaining familiar routines and serving favorite foods can make mealtimes easier. They can help the person know what to expect and feel more relaxed. If a home health aide or other professional provides care, family members should tell this caregiver about the person’s preferences.

Try these tips:

  • View mealtimes as opportunities for social interaction. A warm and happy tone of voice can set the mood.
  • Be patient and give the person enough time to finish the meal.
  • Respect personal, cultural, and religious food preferences, such as eating tortillas instead of bread or avoiding pork.
  • If the person has always eaten meals at specific times, continue to serve meals at those times.
  • Serve meals in a consistent, familiar place and way whenever possible.
  • Avoid new routines, such as serving breakfast to a person who has never routinely eaten breakfast.

As Alzheimer’s progresses, familiar routines and food choices may need to be adapted to meet the person’s changing needs. For example, a family custom of serving appetizers before dinner can be preserved, but higher-calorie items might be offered to help maintain the person’s weight.

Stay Safe

In the early stage of Alzheimer’s, people’s eating habits usually do not change. When changes do occur, living alone may not be safe anymore. Look for these signs to see if living alone is no longer safe for the person with Alzheimer’s:

  • The person forgets to eat.
  • Food has burned because it was left on the stove.
  • The oven isn’t turned off.

Other difficulties, such as not sitting down long enough for meals and refusing to eat, can arise in the middle and late stages of the disease. These changes can lead to poor nourishment, dehydration, abnormally low blood pressure, and other problems.

Caregivers should monitor the person’s weight and eating habits to make sure he or she is not eating too little or too much. Other things to look for include appetite changes, the person’s level of physical activity, and problems with chewing or swallowing. Talk with the person’s doctor about changes in eating habits.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Healthy Eating for a Person with Alzheimer’s

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
1-800-438-4380 (toll-free)
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimer’s Association
1-800-272-3900 (toll-free, 24/7)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

Alzheimer’s Foundation of America
1-866-232-8484 (toll-free)
info@alzfdn.org
www.alzfdn.org

Choose My Plate
www.choosemyplate.gov

Family Caregiver Alliance
1-800-445-8106 (toll-free)
info@caregiver.org
www.caregiver.org

Meals on Wheels America
1-888-998-6325 (toll-free)
info@mealsonwheelsamerica.org
www.mealsonwheelsamerica.org

Citation

https://www.nia.nih.gov/health/healthy-eating-and-alzheimers-disease

 

Managing Medicines for a Person with Alzheimer’s

(National Institutes of Health) People with Alzheimer’s disease may take medicines to treat the disease itself, mood or behavior changes, and other medical conditions. Caregivers can ensure that medicines are taken safely and correctly. Here are some tips to help you manage medications for someone with Alzheimer’s disease.

Learn the Basics

Know each medicine (prescription and over-the-counter) the person with Alzheimer’s disease takes. Ask the doctor or pharmacist:

  • Why is this medicine being used?
  • What positive effects should I look for, and when?
  • How long will the person need to take it?
  • How much should he or she take each day?
  • When does the person need to take the medicine?
  • What if the person misses a dose?
  • What are the side effects, and what can I do about them?
  • Can this medicine cause problems if taken with other medicines?

Managing medications is easier if you have a complete list of them. The list should show the name of the medicine, the doctor who prescribed it, how much the person with Alzheimer’s takes, and how often. Visit Tracking Your Medications: Worksheet for a template. Keep the list in a safe place at home, and make a copy to keep in your purse or wallet. Bring it with you when you visit the person’s doctor or pharmacist.

People with Alzheimer’s should be monitored when they start taking a new drug. Follow the doctor’s instructions and report any unusual symptoms right away. Also, let the doctor know before adding or changing any medications.

Use Medicines Safely

People with Alzheimer’s disease often need help taking their medicine. If the person lives alone, you may need to call and remind him or her or leave notes around the home. A pillbox allows you to put pills for each day in one place. Some pillboxes come with alarms that remind a person to take the medicine.

As Alzheimer’s gets worse, you will need to keep track of the person’s medicines. You also will need to make sure the person takes the medicines or give the medicines to him or her.

Some people with Alzheimer’s take medicines to treat behavior problems such as restlessness, anxiety, depression, trouble sleeping, and aggression. Experts agree that medicines to treat behavior problems should be used only after other strategies that don’t use medicine have been tried. Talk with the person’s doctor about which medicines are safest and most effective. With these types of medicines, it is important to:

  • Use the lowest dose possible
  • Watch for side effects such as confusion and falls
  • Allow the medicine a few weeks to take effect

People with Alzheimer’s should NOT take anticholinergic drugs. These drugs are used to treat many medical problems such as sleeping problems, stomach cramps, incontinence, asthma, motion sickness, and muscle spasms. Side effects, such as confusion, can be serious for a person with Alzheimer’s. These drugs should NOT be given to a person with Alzheimer’s disease. You might talk with the person’s doctor about other options. Examples of these drugs include:

  • Atrovent® (ipratropium)
  • Dramamine® (dimenhydrinate)
  • Diphenhydramine—includes brand names such as Benadryl® and Nytol®

Some people, especially those with late-stage Alzheimer’s, may have trouble swallowing pills. In this case, ask the pharmacist if the medicine can be crushed or taken in liquid form. Other ways to make sure medicines are taken safely:

  • Keep all medications locked up.
  • Check that the label on each prescription bottle has the drug name and dose, patient’s name, dosage frequency, and expiration date.
  • Call the doctor or pharmacist if you have questions about any medicine.

 

Medicines to Treat Alzheimer’s Disease

There are five medicines available to treat Alzheimer’s disease. It’s important to understand that none of these medicines can cure or stop the disease. What they can do, for some people, is help slow down certain problems, such as memory loss. Slowing down memory loss can allow many people with Alzheimer’s disease to be more comfortable and independent for a longer time.

Visit How Is Alzheimer’s Disease Treated? for more information on medicines to treat Alzheimer’s and behavior symptoms.

Medicines to Treat Other Medical Conditions

Many people with Alzheimer’s disease also have other medical conditions such as diabetes, high blood pressure, or heart disease. They may take different medicines for these conditions. It’s important to track all the medicines they take and take the list with you to every visit to a doctor.

For information about paying for medications, see Saving Money on Medicines.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Managing Medicines and Alzheimer’s

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
1-800-438-4380 (toll-free)
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Eldercare Locator
1-800-677-1116 (toll-free)
www.eldercare.gov

Alzheimer’s Association
1-800-272-3900 (toll-free, 24/7)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

U.S. Food and Drug Administration
1-888-463-6332 (toll-free)
druginfo@fda.hhs.gov
www.fda.gov

Citation

https://www.nia.nih.gov/health/managing-medicines-person-alzheimers

National Institutes of Health

 

Alzheimer’s Quick Tips: Making Mealtimes Easier

(Mayo Clinic) Alzheimer’s disease and eating challenges often go hand in hand. As Alzheimer’s progresses, poor nutrition can aggravate confusion and lead to physical weakness, as well as increase the risk of infection and other health concerns.

If you’re caring for a loved one who has Alzheimer’s, understand what causes eating problems and how you can encourage good nutrition.

Consider Underlying Conditions

If your loved one is having trouble eating, check for underlying problems, such as:

  • Oral problems. Make sure dentures fit properly and are being used. Check for mouth sores or other oral or dental issues.
  • Medication effects. Many medications decrease appetite, including some drugs used to treat Alzheimer’s. If you think medications are contributing to eating problems, ask your loved one’s doctor about substitutions.
  • Chronic conditions. Diabetes, heart disease, digestive problems and depression can dampen interest in eating. Constipation can have the same effect. Treating these or other underlying conditions might improve your loved one’s appetite.  Also, consider talking to your loved one’s doctor about removing dietary restrictions.

Acknowledge Declining Skills and Senses

In the early stages of Alzheimer’s, your loved one might forget to eat or lose the skills needed to prepare proper meals. Call to remind him or her to eat or help with food preparation. If you make meals in advance, be sure to review how to unwrap and reheat them. You might also consider using a meal delivery service.

In addition, your loved one’s sense of smell and taste might begin to diminish, which can affect interest in eating.

As Alzheimer’s progresses, your loved one might forget table manners and eat from others’ plates or out of serving bowls. Changes in the brain might cause him or her to lose impulse control and judgment and, in turn, eat anything in sight — including nonfood items. During the later stages of the disease, difficulty swallowing is common.

Expect Agitation and Distraction

Agitation and other signs and symptoms of Alzheimer’s can make it difficult to sit still long enough to eat a meal. Distractions at mealtime might make this even worse. To reduce distractions, turn off the TV, radio and telephone ringer. Put your cellphone on vibrate. You might also clear the table of any unnecessary items.

If your loved one needs to pace, try cutting a sandwich into quarters and giving him or her a section while he or she walks.

Discourage your loved one from drinking alcoholic beverages. Although alcohol might stimulate the appetite, it can lead to confusion and agitation as well as contribute to falls.

Get Visual

Use white dishes to help your loved one distinguish the food from the plate. Similarly, use placemats of a contrasting color to help distinguish the plate from the table. Stick with solid colors, though. Patterned plates, bowls and linens might be confusing.

Try Large-handled Utensils

To prevent slipping, apply suction cups to the bottom of plates or use placemats that have traction on both sides. You could also make placemats from a roll of the rubbery mesh typically used to line shelves. Sometimes bowls are easier to use than plates.

Likewise, spoons might be easier to handle than forks. The larger the spoon’s handle, the better. Try bendable straws or lidded cups for liquids.

Offer Foods One at a Time

If your loved one is overwhelmed by an entire plate of food, place one type of food at a time on the plate. You could also offer several small meals throughout the day, rather than three larger ones.

Cut food into bite-sized portions. Finger foods are even easier — but avoid foods that can be tough to chew and swallow, such as nuts, popcorn and raw carrots.

Take Your Time

Don’t rush mealtimes. Remind your loved one to chew and swallow carefully, and allow him or her as much time as necessary.

Encourage your loved one to follow your actions, such as holding a fork or drinking from a cup — or gently place your hand over your loved one’s hand to hold a utensil and bring food to his or her mouth.

Sneak in Extra Nutrition

If you’re having a hard time getting your loved one to eat enough, prepare favorite foods. Avoid diet foods. Serve a filling breakfast or several light breakfasts in a row. You might also offer high-calorie snacks — such as protein milkshakes. Consult the doctor if sudden weight loss occurs.

Ensuring good nutrition in Alzheimer’s can be a challenge, but it’s worthwhile. Good nutrition can help your loved one better cope — both physically and emotionally — with the challenges of Alzheimer’s.

Citation

http://www.mayoclinic.com/health/alzheimers/HQ00217

© 1998-2017 Mayo Foundation for Medical Education and Research (MFMER).

 

Alzheimer’s Disease and Practical Tips for Daily Life

(UCSF Memory and Aging Center) Are you caring for a loved one with Alzheimer’s disease?  Here are some practical tips from the UCSF Memory and Aging Center that can really help. First and foremost, do your best to:

  • Facilitate their performance.
  • Keep the person as active as possible.
  • Focus on their abilities.
  • Avoid distress between you and the person.
  • If a lack of motivation is the barrier to performing a task, consider offering a reward for desired behaviors.
  • Give yourself a break from time to time.

Bathing

If the person becomes difficult to bathe, try this:

  1. A sponge bath in the tub or on a chair instead of a shower.
  2. Talk to your loved one in a soothing voice while bathing and talk through each step you take.
  3. Let your loved one do as much as possible.
  4. Plan the bath or shower for the time of day when the person with FTD is at their best.
  5. Bathe every couple of days instead of every day.
  6. Don’t force anything.

Dressing

Dressing is something your loved one may be able to do for a relatively long time. It might take them longer than it used to; but if they are safe, let them do it themselves, even if it takes all morning.

Try this:

  1. Find clothes with larger buttons or replacing closures with Velcro.
  2. Look for pants or skirts with elastic pull-on waists.
  3. Try shoes that fit well, stay on, and don’t require laces (to prevent tripping).
  4. Consider placing a baby monitor in their room. It will allow them to be more independent while you are nearby and alert to problems.
  5. If getting undergarments off is a problem, use wrap around skirts as clothes.

Driving

Driving tends to be one of the most contentious issues in relationships with people with neurodegenerative disease.

Try this:

  1. Get a steering wheel lock or other safety device that prevents someone with the ignition keys to take the car.
  2. If the person with dementia is upset about losing their license, take them to the DMV to get pick up the forms to get reinstated. Drive home and tell them that when the forms are completed, you can go back and file them. Rarely do the forms get completed, but your loved one usually feels better for having gone through the exercise of getting the forms.
  3. For people with language difficulties, it might be helpful for the person to carry a letter from the doctor explaining their language difficulties.

Finances

Sometimes the person only needs some support to continue managing the finances. If you can offer some support without taking over the activity, this is usually very rewarding for both patients and families. If they lack interest and you feel overwhelmed to look after them, consider asking for help. Disease can cause poor judgment which can lead to overspending (which we mention also under shopping) and other difficulties.

Try this:

  1. Involve your bank manager, a family member or a friend that you can trust.
  2. Limit access to one card/bank account only.
  3. Frequently change passwords on computers to prevent over-use or over-spending online.
  4. Consider disabling computers or removing hard drives to prevent family members from using the computer.

Grooming

If personal hygiene and grooming get neglected, look for ways to simplify the process.

Try this:

  1. Try a simple haircut that is easy to manage.
  2. Switch to an electric razor which has less risk of cuts and is easier to hold.
  3. When helping with grooming tasks, move slowly and explain what you are doing in a calm voice so that you don’t startle them.
  4. When washing the face, consider cold creams or disposable face wipes that have cleanser already in them – it will reduce the number of steps needed to finish the task.
  5. Try oral swabs if brushing becomes too difficult.
  6. If the patient is physically capable of performing these tasks but uninterested, you can try rewarding the person for completing a grooming task with a favored item or treat.

Household Chores

Decline in doing house chores can be caused by lack of motivation or by planning difficulties. Planning difficulties usually happen because the patient cannot cope with the several steps that are involved in a complex task.

Try this:

  1. Break down larger tasks into small steps like
    1. setting the table
    2. stirring
    3. preparing one dish at a time
    4. fetching, peeling, boiling, draining, allowing to cool, seasoning, etc.
  2. Find simpler tasks that the person can complete safely (such as folding laundry).
  3. Reward the person with pleasurable activities or healthy treats after finishing a chore.

Shopping

Patients with the behavioral forms of dementia may have difficulties in controlling their shopping habits, for instance they may want to buy things they do not need, spend more money than necessary or shoplift. Strategies to control impulsive shopping are closely related to the strategies for controlling finances better.

Try this:

  1. Limit the amount of money easily accessible.
  2. Take some business cards explaining your family member’s problems along with you when out in public to discretely hand out to staff in stores, restaurants and banks. These cards can be made on a home computer and can say something like: “My loved-one has an Alzheimer’s-like disorder; thank you for your patience” (click here to download cards you can print).
  3. If shoplifting is a problem, it may be helpful to let the store management know in advance so that incidents can be handled discretely.
  4. Avoid letting the person shop alone.

If the patient has difficulties in understanding the names of the products, fruits or vegetables, they might avoid shopping altogether even if they used to.

Try this:

  1. Make a list of pictures or packages to simplify comprehension and motivate them to do a familiar activity.

Sleeping

Managing your loved one’s sleep problems will ensure that both of you will get more rest.

Try this:

  1. Provide at least a little exercise every day – even if it is just a walk around the yard.
  2. Engage them in a quiet and calming activity before bedtime.
  3. Keep a consistent schedule of wake and sleep times.
  4. Give your loved one tasks to complete – folding the laundry, folding napkins, sorting things – to keep them active during the day.
  5. Keep your loved one hydrated during the day but avoid giving them a lot of fluids before bed time to decrease the likelihood of accidents and/or the need to get up during the night.
  6. Avoid a lot of TV watching during the day—it usually leads to napping.
  7. Consider hiring someone to sleep over a couple of nights a week to relieve you of night time duty.

Supervision and Safety

It can be a difficult to decide when a patient’s activities might be hazardous to themselves or others. Some patients may become less vigilant to risks (crossing a busy street, for example) or show poor judgment (leave the house without telling you). Many patients have trouble acknowledging the risks and hazards and may resist suggestions for increased safety and security. The following are strategies that may be employed.

University Health Network (UHN) in Toronto, Canada put together this list of home safety tips and recommendations for people who have problems with their vision due to dementia.

  1. Find a companion for the patient
    • Hire a college student to accompany the patient on walks, trips to the movies, or lunch.
    • Network with religious and social organizations to find the right person.
    • Hire an aide through a private agency or your local county health services.
    • Set up a schedule with other family members, so there is not one single family member shouldering the entire burden.
  2. Take the patient to work with you if not too disruptive. Some patients may be able to participate in tasks or be content to “hang out.”
  3. Hire a social worker or case manager for help in locating resources.
  4. Try a day program with an environment and activities that are appealing to the patient. Work with the day program staff to help them understand the needs of your loved one.
  5. Have an up-to-date picture of the patient that can be given to local law enforcement in the event the patient gets lost.
  6. The patient can be registered with the Alzheimer’s Association Safe Return® program. This is a nationwide identification program that provides assistance when a person with dementia becomes lost.
  7. Consult a legal expert for advice in setting up trusts, protecting assets, and obtaining financial assistance (state or federal) for caregiving costs.
  8. Secured (locked) units are an option in the event there are safety concerns for the patient or others.

Talking

As the disease progresses, the patient may lose the ability to understand you or to be understood. Simplify what you say and closely observe their behavior for clues.

Try this:

  1. Use simple words and short sentences with a calm and soothing tone of voice.
  2. Maintain a respectful approach and avoid speaking to the person like they are a child.
  3. Minimize distractions like the television and radio when talking so that your loved one can focus on the conversation.
  4. Include your loved one in the conversation even if they don’t or can’t respond. They may very well be able to hear and understand but not be able to respond.
  5. Try engaging them by completing the following sentences:
    • I remember when…
    • Thank you for…
    • I’m proud of…
  6. Don’t rush your loved one – give them time to express themselves.
  7. Try to read the body language for clues.
  8. Reading and writing may also be affected, so offer to help proofread or copy letters for them so they stay in touch with friends and family.
  9. Aphasia identification cards explaining that the person has a language problem can aid in communicating the person’s condition to others.

Using the Telephone

Using the telephone can be difficult for people with diseases affecting language as they may feel pressured, but those with behavioral variants may abuse the telephone in other ways – online purchases, inappropriate calls, messages not received, etc. People with memory impairment might forget to write down messages or important information.

Try this:

  1. Help them prepare a script to be used when they make a telephone call to reduce the stress of coming up with the words.
  2. Contact your telephone service provider to block incoming calls from telemarketers and sales people
  3. Lock the keypad on your cellphone to prevent outgoing calls.
  4. Have people contact you on your cellphone where they can leave a message you will receive.

Visitors

Having friends and family visit can help relieve social isolation and depression, but be aware that visits can cause fatigue or agitation in your loved one from too much stimulation. You can prepare visitors ahead of time by printing or emailing sections of this website which explain the disease.

Try this:

  1. Pay attention to how your loved one responds to visitors.
    • Are they welcomed?
    • Are visits tiresome?
    • Do they make your loved one more restless or agitated?
  2. Explain to visitors:
    • How to approach.
    • How to talk to the patient.
    • What to expect from the patient: patients may seem apathetic or disengaged from the visitors. Encourage visitors not to take this personally. The visit can be helpful to the patient and the caregiver, even if the patient seems disinterested. Conversely, inappropriate behavior toward visitors can emerge; if this is likely, warn the visitors in advance and give them an “exit strategy” if it becomes too uncomfortable for them.
  3. Keep visits short without any expectation of “entertaining” the guest.
  4. Try having visiting hours scheduled into your daily routine and use that time to play games, go for a walk or do something else that your loved one finds enjoyable.
  5. If you have a meal with friends, prepare them for any changes in eating behavior in advance, so that you do not feel embarrassed. You will be surprised how understanding some friends can be.
  6. If the patient gets upset when people leave, try leaving as a meal is served to the patient. The meal often provides enough distraction so that the patient does not get distressed by the caregiver or visitors leaving.
Citation

http://memory.ucsf.edu/caregiving/tips

© 2016 The Regents of the University of California

 

Alzheimer’s Disease and Creating a Daily Plan

(Alzheimer’s Association) Daily routines can be helpful for both you — the caregiver — and the person with Alzheimer’s. A planned day allows you to spend less time trying to figure out what to do, and more time on activities that provide meaning and enjoyment.

Organizing the Day

A person with Alzheimer’s or other progressive dementia will eventually need a caregiver’s assistance to organize the day. Structured and pleasant activities can often reduce agitation and improve mood. Planning activities for a person with dementia works best when you continually explore, experiment and adjust.

Before making a plan, consider:

  • The person’s likes, dislikes, strengths, abilities and interests
  • How the person used to structure his or her day
  • What times of day the person functions best
  • Ample time for meals, bathing and dressing
  • Regular times for waking up and going to bed (especially helpful if the person with dementia experiences sleep issues or sundowning)

Make sure to allow for flexibility within your daily routine for spontaneous activities.

As Alzheimer’s disease progresses, the abilities of a person with dementia will change. With creativity, flexibility and problem solving, you’ll be able to adapt your daily routine to support these changes.

Checklist of Daily Activities to Consider

  • Household chores
  • Mealtimes
  • Personal care
  • Creative activities (music, art, crafts)
  • Intellectual (reading, puzzles)
  • Physical
  • Social
  • Spiritual

Writing the Plan

When thinking about how to organize the day, consider:

  • What activities work best? Which don’t? Why? (Keep in mind that the success of an activity can vary from day-to-day.)
  • Are there times when there is too much going on or too little to do?
  • Are spontaneous activities enjoyable and easily completed?

Don’t be concerned about filling every minute with an activity. The person with Alzheimer’s needs a balance of activity and rest, and may need more frequent breaks and varied tasks.

Daily Plan Example (for early- to middle-stages of the disease)

Morning

  • Wash, brush teeth, get dressed
  • Prepare and eat breakfast
  • Have coffee, make conversation
  • Discuss the newspaper, try a craft project, reminisce about old photos
  • Take a break, have some quiet time
  • Do some chores together
  • Take a walk, play an active game

Afternoon

  • Prepare and eat lunch, read mail, wash dishes
  • Listen to music, do crossword puzzles, watch TV
  • Do some gardening, take a walk, visit a friend
  • Take a short break or nap

Evening

  • Prepare and eat dinner, clean up the kitchen
  • Reminisce over coffee and dessert
  • Play cards, watch a movie, give a massage
  • Take a bath, get ready for bed, read a book

In general, if the person seems bored, distracted or irritable, it may be time to introduce another activity or to take time out for rest. The type of activity and how well it’s completed are not as important as the joy and sense of accomplishment the person gets from doing it.

Other Resources

Citation

http://www.alz.org/care/dementia-creating-a-plan.asp

Copyright © 2017  Alzheimer’s Association®. All rights reserved.

 

How To Help Alzheimer’s Patients Enjoy Life, Not Just ‘Fade Away’

(Kaiser Health News) Alzheimer’s disease has an unusual distinction: It’s the illness that Americans fear most — more than cancer, stroke or heart disease.

The rhetoric surrounding Alzheimer’s reflects this. People “fade away” and are tragically “robbed of their identities” as this incurable condition progresses, we’re told time and again.

Yet, a sizable body of research suggests this Alzheimer’s narrative is mistaken. It finds that people with Alzheimer’s and other types of dementia retain a sense of self and have a positive quality of life, overall, until the illness’s final stages.

They appreciate relationships. They’re energized by meaningful activities and value opportunities to express themselves. And they enjoy feeling at home in their surroundings.

“Do our abilities change? Yes. But inside we’re the same people,” said John Sandblom, 57, of Ankeny, Iowa, who was diagnosed with Alzheimer’s seven years ago.

Dr. Peter Rabins, a psychiatrist and co-author of “The 36-Hour Day,” a guide for Alzheimer patients’ families, summarized research findings this way:

“Overall, about one-quarter of people with dementia report a negative quality of life, although that number is higher in people with severe disease.”

“I’ve learned something from this,” admitted Rabins, a professor at the University of Maryland. “I’m among the people who would have thought, ‘If anything happens to my memory, my ability to think, I can’t imagine anything worse.’

“But I’ve seen that you can be a wonderful grandparent and not remember the name of the grandchild you adore. You can be with people you love and enjoy them, even if you’re not following the whole conversation.”

The implication: Promoting well-being is both possible and desirable in people with dementia, even as people struggle with memory loss, slower cognitive processing, distractibility and other symptoms.

“There are many things that caregivers, families and friends can do — right now — to improve people’s lives,” said Dr. Allen Power, author of “Dementia Beyond Disease: Enhancing Well-Being” and chair for aging and dementia innovation at the Schlegel-University of Waterloo Research Institute for Aging in Canada.

Of course, the final stages of Alzheimer’s disease and other types of dementia are enormously difficult, and resources to help caregivers are scarce — problems that shouldn’t be underestimated.

Still, up to 80 percent of people with dementia are in the mild and moderate stages. Here are some elements of their quality of life that should be attended to:

Focus On Health

One notable study analyzed lengthy discussions between people with dementia, caregivers and professionals at six meetings of Alzheimer’s Disease International, an association of Alzheimer’s societies across the world.

Those discussions emphasized the importance of physical health: being free from pain, well-fed, physically active and well-groomed, having continence needs met, being equipped with glasses and hearing aids and not being overmedicated. Cognitive health was also a priority. People wanted “cognitive rehabilitation” to help them learn practical techniques for promoting memory or compensating for memory loss.

Up to 40 percent of people with Alzheimer’s disease suffer from significant depression, and research by Rabins and colleagues underscores the importance of evaluating and offering treatment to someone who appears sad, apathetic and altogether disinterested in life.

Foster Social Connections

Being connected with and involved with other people is a high priority for people with dementia. Based on research conducted over several decades, Rabins listed social interaction as one of the five essential elements of a positive quality of life.

But fear, discomfort and misunderstanding routinely disrupt relationships once a diagnosis is revealed.

“The saddest thing that I hear, almost without exception, from people all over the world is that family, friends and acquaintances desert them,” said Sandblom, who runs a weekly online support group for Dementia Alliance International, an organization for people with dementia that he co-founded in January 2014.

Adapt Communication

Not knowing how to communicate with someone with dementia is a common problem.

Laura Gitlin, a dementia researcher and director of The Center for Innovative Care in Aging at Johns Hopkins School of Nursing, offered these suggestions in an article in the International Encyclopedia of Rehabilitation: Speak slowly, simply and calmly, make one or two points at a time, allow someone sufficient time to respond, avoid the use of negative words, don’t argue, eliminate noise and distraction, make eye contact but don’t stare, and express affection by smiling, holding hands or giving a hug.

Also, understand that people with dementia perceive things differently.

“You have to understand that when you have dementia you lose a lot of your natural perceptions of what others are doing,” Sandblom said. “So, a lot of us get a little nervous or suspicious. I think that’s a natural human reaction to knowing that you’re not picking up on things very well.”

Address Unmet Needs

Needs that aren’t recognized or addressed can cause significant distress and a lower quality of life. Rather than treat the distress, Power suggested, try to understand the underlying cause and do something about it.

Which needs are commonly unmet? In a study published in 2013, Rabins and colleagues identified several: managing patients’ risk of falling (unmet almost 75 percent of the time); addressing health and medical concerns (unmet, 63 percent); engaging people in meaningful activities (53 percent); and evaluating homes so that they’re safe and made easier to navigate (45 percent).

Respect Autonomy And Individuality

Rabins called this “awareness of self” and listed it among the essential components of a positive quality of life. Sandblom called this

“being seen as a whole person, not as my disease.”

At the Alzheimer’s Disease International meetings, people spoke of being listened to, valued and given choices that allowed them to express themselves. They said they wanted to be respected and have their spirituality recognized, not patronized, demeaned or infantilized.

In a review of 11 studies that asked people with dementia what was important to them, they said they wanted to experience autonomy and independence, feel accepted and understood, and not be overly identified with their illness.

None of this is easy. But strategies for understanding what people with dementia experience and addressing their needs can be taught. This should become a priority, Rabins said, adding that

“improved quality of life should be a primary outcome of all dementia treatments.”

Citation

http://khn.org/news/ how-to-help-alzheimers-patients-enjoy-life-not-just-fade-away/

By Judith Graham

© 2017 Kaiser Family Foundation. All rights reserved.