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November is Alzheimer’s Disease Awareness Month, so it is time to have a closer look at this horrible illness. Alzheimer’s is a type of dementia that causes a progressive loss of memory and cognitive functioning. It is one of the most common conditions that require care by a Certified Nursing Assistant, with 60% of Long Term Care residents having a diagnosis of Alzheimer’s disease. Furthermore, it is projected that 7.7 million people will be living with Alzheimer’s Disease by the year 2030.
Caring for an Alzheimer’s patient can be extremely challenging, but with the right attitude and information, you can feel like you have some control and strategies to deal with difficult behaviors and situations.
Maximize Functional Capacity
Monitor Changes in Behavior
It is very important to closely monitor any acute changes in your patient’s cognition and agitation. Any changes in confusion or behavior can signal an acute illness or discomfort and pain. People with Alzheimer ’s disease are often unable to express pain or if they are feeling unwell so any changes should be reported right away. Something as simple as a urinary tract infection can cause a patient to become extremely confused.
Sleep, Nutrition, and Elimination
Hunger, thirst or the need to go to the bathroom can all cause escalating behaviors and aggression in patients with Alzheimer’s. To prevent agitation, make sure your patient is provided with plenty of fluids and enough food. You can also try putting them on a toileting routine where they are brought to the bathroom at regular times and prompted to void. Many times, patients with Alzheimer’s are unable to both express and recognize hunger and the need to eliminate.
Encourage Independence
It is very tempting to want to take over and do something when you see someone struggle or when they are taking a long time to complete a task. But allowing your patients to do as much as they can for themselves not only helps them to feel more independent but also helps to exercise their brain as they have to remember how to complete a task. Provide visual clues like setting their clothes out in the order they should go on to help them remember what they are supposed to do. Provided graded help with self-care tasks, allowing them to do as much as they can before stepping in to help. Encourage mobility to keep them active and healthy and modify their environment to keep mobility safe. Encouraging independence can help people with dementia feel like they still have control over their lives.
Address Behavior Issues
Identify and Eliminate Environmental Triggers
Alzheimer’s patients are very sensitive to their environments and agitation can be triggered by very subtle changes in their environment. Each person, however, is triggered by different things. To identify individual triggers try thinking back to when the patient became agitated and try to change or remove triggers. Room temperature, excessive noise or visual triggers can all cause an increase in agitation. Visual hallucinations can be common in people with dementia and can be very distressing. Sometimes the difference between reality and representation is not understood, and items like family photos can be extremely disturbing. Swirling patterns on a carpet may be mistaken for snakes and even a mirror reflecting their reflection might seem like a stranger is in their room. Close observation and careful deduction may be used to avoid triggers in the patient’s environment.
Create Familiar Routines
Familiar routines are important in everyone’s lives. Whether it’s reading the morning paper or walking the dog, routine gives us a feeling of control over our environment. The same is even more true for people with Alzheimer’s disease where control may be slipping away at an alarming rate. Maintaining a predictable routine as close as possible to their past activities can help a dementia patient stay grounded and avoid becoming distracted and forgetting what they were doing. A predictable order of events can transfer a daily routine into the long-term part of their memory, allowing them to continue performing daily tasks and maintaining as much independence as possible.
Recognize Behaviors as Unmet Needs
Disruptive or aggressive behaviors are often the result of unmet needs. If these needs are met, then the patient’s behaviors will improve along with their quality of life. It is important to understand their background factors, such as chronic diseases, underlying cognitive function, demographics, and psychiatric conditions before determining which needs are unmet. Proximal factors, such as the physical and social environment the patient is in also plays a role in the expression of unwanted behaviors. For example, a patient might wander in part because they were always an active person who was always in motion, and their underlying dementia may have affected their wayfinding ability, and they have lost their sense of direction. Reducing noise, for example, might resolve much of the patients wandering behavior as they are no longer searching for the source of all that noise.
Communication Strategies
Take your time
No one likes to be rushed, particularly when you are confused and can’t quite remember how to perform tasks. When caring for your Alzheimer’s patients allow lots of time for them to complete tasks, so they don’t feel rushed. Expect things to take longer and allow time for breaks. You may be busy and have a mountain of tasks to complete, but rushing a patient with Alzheimer’s will take up more time in the long run. If possible, give your patient a task to do, like washing their face while you do something else, like making their bed, so they don’t feel rushed, and you can still do your job in a timely fashion. When communicating with your patient give them lots of time to answer. It can be difficult for people with dementia to find the right words and allowing them enough time to respond can make them feel involved and engaged in the conversation
Provide Choices
People love feeling like they have control over themselves and their lives. Try giving your patients a choice between two options that are acceptable to you. An example would be “Do you want to have your bath before breakfast or after?” Both options involve having a bath, but the patient can choose when it occurs.
Provide Simple Instructions
Giving Alzheimer’s patients instructions with too many steps can confuse and agitate them. Try to keep instruction simple and with only one or two steps. “Come sit in this chair” can be broken up into three steps: “Turn around” “Reach behind you” and “Sit down in the chair.” Provide as many redirections as needed, repeating the simple instruction before moving on to the next step.
Give Visual Cues
To help demonstrate a task or a concept use visual cues to help your patient understand. If trying to get them to brush their teeth, hold out their toothbrush, or put it in their hand. If asking them if they want a coffee, show them the cup while you are asking. Using visual cues helps them understand what is being said and be able to actively participate in the conversation.
Yes or no questions
Communication can be daunting for people with Alzheimer’s. Open-ended questions force them to try to come up with more complicated answers. Instead of asking “What would you like for breakfast?” which forces them to try and remember something they might eat at breakfast, try asking “Would you like toast for breakfast?”. This way they still have some control over what they eat for breakfast without becoming frustrated or confused.
Do not ground in reality
We always want to tell our patients the truth, but constantly reminding your patients of the death of a loved one or reorienting them to their current situation can be upsetting and cruel. Find ways to redirect them while remaining truthful. For example, if your patient asks about their mother or husband that you know has passed away, redirect them by asking about their loved one and encouraging them to tell a story or share a memory they have of them.
Forget Logic and Reasoning
Using logic and reasoning is an advanced thought process and can be very difficult in people who have Alzheimer’s. Reasoning with them or trying to get them to think logically will get you nowhere. Instead, give simple instructions and a few limited choices that all end in the desired outcome. Similarly, arguing with and confronting patients only serve to increase their agitation and trigger disruptive behaviors.
Caring for patients with Alzheimer’s can be incredibly difficult and extremely rewarding. Some simple strategies are very helpful in dealing with patients who are frustrated or confused. Using these strategies and techniques, you can provide excellent care and avoid escalations in agitation and aggression while helping your patients maintain a feeling of autonomy and self-worth.