On this page, you will find the following:
- Memory Loss
- Daily Activities
As Alzheimer’s disease progresses, the person will likely have trouble understanding what is happening and what is expected of him or her. The individual will not be able to effectively communicate emotions or thoughts; this can be very frustrating for both the person with Alzheimer’s disease as well as the caregiver. The following techniques may improve communication:
- Speak directly to the person and look directly at him or her to ensure you are heard.
Speak slowly and in a calm tone of voice.
- Use short sentences with only one idea in each. Instead of confusing the person by asking what he or she wants, use declarative sentences like, “It’s time to eat now.” Ask yes or no questions.
- Try not to discuss topics that the patient can no longer remember. Encourage talk of familiar things and times.
- Eliminate distractions, such as noise and activities when speaking. It may be difficult for the patient to hear you.
- Pay attention to nonverbal cues and facial expressions.
- Compensate for changing capacities and assist in remembering information by using memory aids such as small books with names, addresses, phone numbers, directions, maps and thoughts/ideas. Label items around the house, post reminders for daily tasks, keep calendars with appointments and photos with information about those pictured.
- Use “validation” to enter the person’s world. It is very unlikely that the caregiver or anyone else will be able to change the person’s concept of reality. It is much easier to respond positively rather than try to correct misconceptions. Avoid arguing with the person as it will only frustrate both the patient and the caregiver.
People with Alzheimer’s disease sometimes have difficulty remembering good hygiene and may refuse to bathe. Bathing may have become too complicated to complete, the person may fear water or feel a loss of privacy. Vision problems can make it difficult to distinguish the shape of the tub or shower. The person may have forgotten how to operate a faucet or may no longer remember how to bathe. As Alzheimer’s disease progresses, poor coordination can add to safety concerns.
Whatever the reasons, avoid discussing the need for a bath, but simply state, “It’s bath time.” This can be more effective if there are established routines for a bathing time and place. Remember to remove the lock from the bathroom door, put away potentially dangerous items such as razors and electrical appliances, and lock cabinets. The following may help bath time go more smoothly:
- Have everything you need prior to starting.
- Make sure the room is warm enough.
- Fill the tub with only a few inches of water and check the temperature of the water.
- Avoid using bath oils or any additive that will make the tub slippery.
- Break activity into steps. Try this approach: “Here’s the washcloth, wash your arm.”
- Be calm and gentle, but firm; avoid distractions or discussions. It is best to focus on the task at hand.
- Do not hurry and never leave the person unattended.
- Check for skin rashes or sores.
- Use several towels if necessary for warmth and a sense of privacy.
- Be flexible. If the person refuses to step into the tub, consider a sponge bath using towels to keep the person warm and covered, and rinse-free soap.
People with Alzheimer’s disease should be encouraged to continue to dress themselves as long as they are able.
To extend independence and prevent frustration with dressing:
- Lay out or hang all clothes in the order they will be used.
- Use numbers or magazine pictures to label clothing drawers.
- Avoid asking for clothing preferences, but don’t argue if the person wants to wear a favorite outfit numerous times; consider buying duplicates. Remove seldom-used clothing to reduce choices.
- Never hurry the person.
- Use simple, comfortable garments, such as track suits. Velcro® can replace many fasteners, and elastic waistbands work well. Cardigan sweaters are easier to use than pull on sweaters.
- Ensure that clothing fits properly to prevent accidents, such as tripping on pant legs.
Deciding when the person with Alzheimer’s should stop driving can be difficult. Many people in the early stages of the disease may able to continue driving safely. Even at this point, they should only drive on familiar short, routes in daylight and good weather. Since it is a habitual skill, people can appear capable of driving competently well into the disease, so driving ability should be carefully observed over a period of time. Single occurrences of errors may not be a result of the disease, but persistent problems such as making slow decisions, failure to observe traffic signals and hitting curbs are warning signs.
In addition to noting particular driving problems, the caregiver needs to answer the following questions. Could the person with Alzheimer’s disease react instantly in an emergency? Are reflexes and muscular coordination still good? Are eyesight and hearing unimpaired? Can decisions still be made quickly and accurately? If there is any doubt about the answer to any of these questions, then the risks of driving are probably too high.
Driving tends to be an emotional subject because it represents personal independence, so the situation should be calmly and positively discussed, ideally even before problems arise. When told that he or she cannot drive, the person with Alzheimer’s disease may react with relief, anger or stubbornness and should be offered sympathy and understanding. However, for the sake of safety, the caregiver must remain firm and may need to enlist others, including a physician, to reinforce the decision. To ease the transition, investigate and offer alternative forms of transportation and reduce the number of activities that require driving. For example, prescriptions and groceries can be delivered rather than picked up at a store. Driving is often part of an individual’s social life, so try to find other ways to continue these interactions, such as asking friends and family to visit. If the person insists on keeping the car keys, it may be necessary to give him or her keys that don’t work, temporarily park the car elsewhere or disable the engine.
Some people with Alzheimer’s may overeat or attempt to eat things that are not edible, but many individuals forget to eat or don’t eat enough because they lose some of their sense of taste and smell. However, meals can be the high point of the day, and may be made more enjoyable through establishing a regular routine, minimizing distractions and serving dishes adapted to the person’s limitations. The following strategies may help:
- Ensure that the person eats a varied and nutritious diet.
- Avoid distractions, but interact with the person and try to make mealtimes special.
- Consider offering more frequent, smaller meals, rather than 3 large ones during the day.
- Serve one food at a time so the person will not have to decide which to eat first.
- Use a bowl instead of a plate to help prevent spills; if drinking from a cup is a problem, consider using straws or covered “sip” cups designed for children.
- Avoid very hot beverages to avoid the risk of scalding.
- Use brightly colored dishes that contrast with the food.
- To minimize frustration, cut food into bite-size pieces.
- If the person has forgotten how to use a fork, demonstrate the technique. If this does not help, offer a spoon or consider serving nutritious finger foods.
- A smaller spoon will encourage him or her to take smaller bites and avoid choking and digestion problems.
- Plastic aprons and tablecloths or placemats will make cleanup simpler.
- If the person forgets when he or she has eaten, post a meal schedule. If necessary, divert attention to another activity.
- Keep healthy snacks on hand to prevent indiscriminate eating.
- If the person rummages for food, consider locking the refrigerator and cabinets or moving certain foods to other storage areas.
As Alzheimer’s disease progresses, it often leads to changes in sleeping patterns. Many times, those with Alzheimer’s are restless and sleepless at night which can lead to wandering. Also, they may confuse night and day, and sleep for much of the day. All of this can be very stressful for the caregiver who needs to get proper rest. The following may help minimize sleeping problems:
- Establish consistent times for waking and going to bed.
- It may help to expose the person to sunlight or even indoor lighting in the morning.
- If the person is not sleeping at night, avoid daytime naps or allow only short naps in the early part of the day.
- Try to have the person exercise and engage in activities each day, but do not allow exercise too close to bedtime.
- Consult a physician about any medications that might cause sleeplessness.
- Avoid stimulants such as caffeine.
- Make sure the person uses the toilet before going to bed.
Staying active on all levels can be helpful to those with Alzheimer’s disease. Although some newly diagnosed patients may want to withdraw from their usual activities out of depression or embarrassment, this can actually worsen a person’s condition. People need to recognize their limitations, but can prolong the quality of life by maintaining a healthy level of stimulation physically, mentally and socially. Social interaction can help ward off depression, so the caregiver should encourage the person with Alzheimer’s disease to maintain contact with friends and family. The individual may also enjoy participating in non-demanding tasks and simple activities related to past hobbies and interests. Often, in the later stages of the disease, people are happy to perform repetitive tasks that offer a sense of accomplishment.
Support groups are highly recommended for those with Alzheimer’s disease. In these groups, people often are better able to come to grips with this disease and the future by expressing their feelings and thoughts with others. For many Alzheimer’s patients, support groups help to “digest” the news of the diagnosis, overcome denial and adjust to the changes in their lives. Support groups offer practical advice on dealing with memory loss, social situations and adjustments in day-to-day living, and information on community resources. They usually offer activities designed to stimulate the patients’ memory and keep the mind active. These groups can contribute greatly to the quality of life.
Each person is different, but caregivers and their loved ones with Alzheimer’s may want to consider the following beneficial activities:
- Interaction with others, including family, friends, children and pets. Visitors can provide an appreciated human connection.
- Joining a support group.
- Engaging in creative activities, favorite pastimes and hobbies; play games and solve puzzles. Make sure the activities are simple to avoid frustration and try to establish a routine for doing them daily. However, some activities may not work every day, and they will also need to be adjusted as the disease progresses.
- Listen to music; sing familiar tunes.
- Look at photographs and home videos, which can stimulate the mind, elicit memories and offer a calming sense of continuity.
- Simple household tasks that do not rely too much on memory, such as meal preparation, gardening or light cleaning.
- Take the person for a scenic drive, go on nature outings or to the zoo. These should be shared with a companion who can ensure safety.
- A light, regular exercise routine.
- Adult day centers where the person can engage in supervised activities such as games, craft projects and light exercise.
Many people with Alzheimer’s become restless and agitated in the early evening (around sundown), possibly because they are tired, bored or confused by the waning light. The following suggestions may help minimize some negative behaviors:
- Ensure that the person is comfortable physically; check with a physician to determine whether medications or illness may be causing the behavior.
- Create a calm, relaxing atmosphere by minimizing distractions and noise.
- Have the person take a short nap or enjoy some quiet time in the afternoon if it doesn’t interfere with sleeping at night.
- Offer an early dinner or late afternoon snack.
- Ensure that the home is well lit. Dim light can lead to fear and agitation.
- Try to spread activities throughout the day, but schedule more demanding ones earlier.
People with Alzheimer’s sometimes have difficulty getting to the bathroom in time. A physician can determine if there is a physical cause for incontinence. However, even if there is no underlying medical problem, accidents may occur due to memory loss. The person may not be able to communicate his or her needs, have trouble remembering where the bathroom is located or how to complete toileting tasks. The following suggestions may help:
- Establish a regular schedule for using the toilet. Start with two-hour intervals, as well as first thing in the morning and after naps. Adjust intervals as necessary.
- Put nightlights in the bedroom, corridor and bathroom to help find the bathroom.
- Look for non-verbal cues (e.g., grimacing) that the person needs to use the toilet.
- Paint the bathroom door a bright color or put an identifying sign on it.
- Consider putting a commode in the bedroom for nighttime use.
- Try protective bedding and adult diapers if necessary.
- React calmly when accidents do occur – the person may be embarrassed and frightened.
- In the later stages of the disease, adult diapers may likely be necessary.
More than half of those with Alzheimer’s may wander at some point during the course of the disease, and this behavior can be frightening and dangerous. Wandering may be caused by the general memory loss and disorientation of the disease, or it may be an attempt by the person to communicate a physical need such as a reaction to medication, hunger, thirst, or the urge to use the bathroom. Wandering may be triggered by boredom, restlessness, overstimulation, or the memory of an activity performed at a certain time. For example, the individual may remember leaving for work each morning and try to repeat that routine. The caregiver may want to observe the person for a number of days to determine the reason for wandering, take steps to remove the stimulus and attempt to prevent the behavior. Try to determine why the person is wandering – is he or she seeking stimulation, looking for something, reacting to fear, stress, or disruption in routine? The following suggestions may inhibit wandering:
- Check with a doctor to determine whether medication may be causing the behavior.
- Offer a snack or drink if hunger or thirst seems to be the cause.
- Clearly mark the bathroom and try to determine whether the person needs to use the toilet.
- If the wandering seems to occur at the same time each day, try to distract the person with an activity.
- Allow the person to pace or “wander” in a safe place, such as room that provides a clear path free from clutter, rugs, furniture and electrical cords. A supervised walk in a securely fenced garden or along a quiet sidewalk can also help.
- If the person won’t leave without personal items such as a coat or purse, consider hiding them.
- Ensure that the home is secure by using safety measures such as locks placed out of reach, alarms, etc.
To prevent serious incidents of wandering and getting lost make sure the individual wears an ID bracelet and put name tags with phone numbers in his or her clothing. Notify neighbors, local merchants and police about the person’s condition. In case of emergency, ensure that the caregiver has a recent photo of the person with Alzheimer’s disease and recently worn, “scented” clothing placed in a plastic bag.
Sometimes people with Alzheimer’s disease become agitated and even aggressive. These behaviors may have a medical cause or may be triggered by something in the person’s environment. Consult a physician if you believe there is a medical reason for the person to act this way. Often, however, a change in routine, caregivers or surroundings can cause fear, anxiety or fatigue and result in agitation. The individual may be frustrated by his or her limitations, misunderstand what is happening or simply forget how to respond appropriately.
The caregiver should try to determine the source of the problem to see if modifying the environment helps change the behavior. If non-medical intervention does not work, a physician should be consulted. A physician may prescribe treatments for depression, psychosis or anxiety. The following are suggestions for non-medical intervention to avert agitation:
- Incorporate light exercise and regular activities into the person’s routine.
- If the person becomes agitated, avoid arguing or trying to reason with him or her. Reassure the individual that all is well.
- Simplify and modify the person’s environment; remove any potential causes of fear or anxiety.
- Distract the person with an interesting activity.
- Remain calm and quietly remove the person from the upsetting situation.
- Offer physical comfort – a snack or drink, a kind word, a touch or perhaps a hug.
- Engage the person in calming activities such as listening to music or reminiscing about the past or favorite activities.
Last Review: 01/10/12
© 2000 – 2012 American Health Assistance Foundation. All rights reserved.