Mother Teresa once said, “We can do no great things – only small things with great love”. This is especially true in caring for someone with Alzheimer’s disease.

Caring in this way enables the sufferer to feel relief from the stress and anxiety the development of the disease causes, while most importantly helping them to feel safe and secure and to maintain their dignity.

Most of us feel better when we can give practical help.  This is easiest in the early stages of Alzheimers when there are a great many small things we can do to make every day a little easier. 

Practical help

Memory Loss
There are many things that can be done to enhance and assist memory and recollection.  Calendars and diaries help with tasks like bill paying, as well as orientation by ticking off days as they pass.  Lists of activities for the day can maintain habits and routines, and labels on pillboxes will allow the person to stay in control of their own medication for as long as possible.

Person Awareness
Reminiscing about people and places from the past can sometimes help focus memory, as can talking about people of the present, especially those who are not seen regularly. 

In the early stages of disease, jogging the memory is enough to help recognition of family members and close friends.  In later stages it is often better not to try to do this, as it can be futile and frustrating for both of you, leading only to emotional upset on both parts.

Language Loss
Some sufferers lose the ability to remember certain words, often replacing them in sentences with unrelated words such as Im going to wash the fish, meant as car.  This can be difficult to live with but often the best way to approach it, especially in the earlier stages, is with humour.  Done in the right way, this can help to take away the frustration that the people will undoubtedly feel at not being able to express themselves fully. 

When communication is difficult, asking questions with yes or no answers is a very effective tool.  This allows you to do the work and the sufferer to be relieved of frustration and focus on what it is they are trying to tell you. 

Body language is important - you may come to understand a lot of what is meant by the sufferer when they point, or by reading facial expressions.
 
Allowing plenty of time for a response is essential when asking questions, as is not making the person feel that you are getting frustrated.  You can help them along by being very specific in what you ask or tell them and by helping them find the words when it is obvious what they want to say, but be careful not to give the impression that you are getting impatient.

Reassurance such as saying its okay and showing some affection when the person is finding it difficult will help relieve stress and anxiety and remind the person that they are not a nuisance. 

Behavioural problems

One of the most harrowing faces of Alzheimers is seeing the slow change into an aggressive, argumentative, fearful and even violent version of their former self. 

Even more upsetting is that the verbal, emotional and physical abuse is often directed at the carer.  In this instance it is vitally important for both parties sake not to take it personally, to try to stay calm, and to continue to give love and support throughout.  The key is to acknowledge that emotional outbursts are part of the illness and accept them and deal with them as and when they arise.

Try to learn what regular situations trigger reactions and avoid them.  If you cant avoid them, anticipate them so that the upset can be minimised.   It is important to stick to a routine.  This keeps the person from being upset by changes to their schedule, which could trigger annoyance or fear.

Simplifying daily activities by limiting choices, such as what to wear or what to have for lunch will remove a lot of the difficulty for someone who has trouble making decisions or finding the right words.  Simple frustration is often the cause of angry outbursts.

Sensitivity to the problems being experienced is vital.  Showing care and respect may help to take the heat out of the situation.  Trying to reason is often futile and will only fuel the argument.  Being understanding and sympathetic to the frustration is a much more effective way to calm things down.

Avoid questioning the argument.  Instead remember that it is simply a symptom of the illness and try to let it pass and move on.  Change the subject or do something nice for the person to diffuse the anger you are both feeling.

Wandering
People with Alzheimers disease are prone to wandering and pacing, as if looking or waiting for something.  Often this is because in their minds they are back somewhere in their past, doing a job they used to do or going to a place they used to go.  Sometimes it is an apparent physical need that drives their movement  hunger, thirst or needing the toilet.  Whatever the requirement, this kind of activity usually happens after dusk and through the night.  For this reason, it is sometimes known as sundowning. 

Unless the need is obvious and can be fulfilled, this is an unavoidable part of the disease and therefore must be anticipated and accommodated.  Safety and security are the primary concern when wandering becomes an issue.

Keeping the environment simple and consistent will help to minimise the risk of injury.  Creating a confined space that you know is safe where the person can wander freely is a good idea if it is practical.  This can be a room or area in the house or a secure place in the garden.
 
Providing activities that the person can delve into such as a box full of safe things to rummage through or a task such as folding clothes is often enough to use up some of their excess energy.  An active day, satisfied needs such as thirst and hunger, and a warm bath at bedtime may be enough to reduce or eliminate the need to wander during the night. 

Gentle music or quiet television could provide enough stimulation to keep the person in the room and reduce the need to look elsewhere.

Foresight and practical planning can often take most of the worry out of living with someone prone to wandering, allowing the rest of the household to get some well-needed rest at night.

Sleep medications or tranquillisers can be used but are usually a last resort.  Sometimes a reorganisation of the days medication to give the stronger dose at night may be sufficient.

Using restraints and locking doors may become necessary but should be used with caution.  The person suffering from Alzheimers may become easily distressed, so always ask for a doctors advice before considering restraint.  It is essential that any such containment be easily removed / unlocked in case of fire or other emergency.

General Safety

Peoples behaviour changes dramatically as a result of having Alzheimers disease and while you cant be prepared for everything, you can take steps to ensure a safe and secure environment.

03/06/2009