Caregiver Tips: Words that Hurt, When you are Caring for an elder with Alzheimer’s Disease.

Babies wear diapers the confused elder needs another word.


When the caregiver really gets to know the person they are caring for; who they are, where they have been, what they have done and what they would like to be remembered for, it is much harder to say “Let’s change your diaper.” Babies wear diapers, adults don’t. Elderly people who have had careers, raised children, earned degrees, served in the Armed Forces, don’t when they become incontinent due to Alzheimer’s, aging or illness deserve to be treated like babies.

These very necessary products can be called briefs, underpants, underwear, your protection, whatever word preserves the dignity of the person. Use a product that more resembles normal underwear – that pulls up rather than one that tapes on at the sides when possible.

Bib – a word that treats the confused elder like a baby.

Babies wear bibs, adults wear clothing protectors, napkins, words that describe the purpose or use. When caring for an elder, don’t take that clothing protector and use it to wipe the face of the person you are assisting to eat. That gesture of wiping an elder’s face with something attached to them treats them like a baby. Even when wearing a clothing protector the adult should have a napkin on their lap, which can be then used to wipe a mouth.

Words are powerful, be careful how you use them.

Words have the ability to make the elder feel good about themselves or bad about themselves. There is power in words, the words you choose, the way you say them, the relationship you have with the person you care for.

Protect the dignity of the confused elder you care for. The words you use are so important; choose wisely, it can make all the difference.

Aging: Elderly Woman with Alzheimer’s Disease no Longer Able to use Reasoning Ability – First sign Weight Loss.

Confused elderly function well with routine.


An elderly woman, in her early 80’s, still lives on her own and seems to be doing fine. Her daughter checks in on her frequently, usually everyday. Her mother has her life long routines in place and the apartment is always neat and her Mom is well groomed. However she soon notices that Mom has lost some weight. The daughter immediately responds and looks into possible causes of the weight loss.

The daughter soon discovers that her mother’s local grocery has remodeled the store and moved everything around. The mother was able to go to the store and find the same things, in the same location for years. Her “routine” in place allowed her to function for a long time independently. The store moving those items and making the store look “different” to her made her unable to function there any more.

Confused elderly lose ability to reason.


The woman no longer had decision making reasoning abilities. When this situation happens to another person – they either ask an employee where the item is, or using their reasoning abilities figure it out for themselves. They think to themselves,””well, if the bread was moved over there, then the hamburger buns must be close by.”

Because this woman could not think this through, she was going to the store, walking for hours through the store, and not buying anything. She no longer could function in the store independently, find her items and purchase them.

Confused elderly’s lack of reason and decision making may be demonstrated by:

• The elder who no longer can afford their home, unable to consider alternatives, so does nothing.
• The elder who needs home repairs, has the finances, but no longer able to make phone calls and decide on a company or price. So they do nothing.
• The elder continues to drive old, unsafe vehicle – when they have the finances to replace it. They can’t make a decision of what car to buy so they do nothing.
• The elder who is accumulating clutter – unable to decide what to throw away, so they do nothing.

Families want to give their elders independence – watching for signs helps the family know when to step in.

Caregiver Tips: Elderly with Alzheimer’s disease, lose the ability to care for themselves in reverse order they gained ability.

Losing the ability to care for yourself.


We know that no two people are exactly alike, and that Alzheimer’s disease affects people differently, depending on what area of the brain is most affected. The loss of function usually follows a pattern. Most elders lose abilities in the reverse order that they gained the ability.

The order you gain abilities.


Take the ability to dress themselves. Children learn first to put on simple items such as shirt and pants. The child progresses to being able to button, put on socks and shoes, and later tie her shoes. For a long time she may put on shorts with a winter sweater before learning that certain things go together. She progresses to the point where she learns the necessity of changing and wearing clean clothes. And eventually she learns about the right season, occasion, or temperature for which she is dressing.

Losing abilities – dressing.


Elders with Alzheimer’s disease will lose the last learned ability first. They will be unable to dress correctly for the season or temperature. So you may see elders in summer with a winter coat and hat on that they insist on wearing. They are still able to follow through with the long practiced skills of putting on clothes correctly, but they can no longer choose appropriately. See: Caregiver Tip: Working with Patients with Alzheimer’s disease using Body Memory

Losing abilities – incontinence.


The most troublesome ability for elders with Alzheimer’s disease is the issue of continence. Small children will become continent of bowels before urine. They progress to be able to toilet themselves and finally to provide for their own hygiene. So also, the elder losing the skills in the reverse order no longer provides adequate bathroom hygiene. Then he has trouble making it to the bathroom in time, or finds the bathroom, but becomes incontinent of urine and finally bowels. Knowing this progression of the disease can aid family members in their expectations of the elder.

BOOK EXCERPT FROM:  Please Get To Know Me – Aging with Dignity and Relevance by – Virginia Garberding with Cecil Murphey

Caregiver Tips: Working with Elderly with Alzheimer’s disease using their Body Memory.

Body Memory

What is body memory?

 
An elderly man with Alzheimer’s disease is walking down the hall in a Nursing Home in full view of the staff. Suddenly he blacks out, loses consciousness and instead of falling and possibly breaking a leg or a hip – he tucks his head down and goes into a perfect roll forward landing uninjured on his back – everyone saw it.

What happened here? This was body memory! You see when this man was young he studied a martial art called Hapkito. In this form of martial art you learn to roll. So even though he had not practiced this roll for many years and didn’t even remember learning this art, his body remembered and still knew how to roll.

The memory that helps when taking care of the confused elder.
This is the memory (body memory) that you want to use when working with your elder when brushing teeth, dressing, going to the bathroom. All of those familiar and over practiced movements that are still remembered by the body.

For an elder with memory loss – focusing on the abilities that remain and that the body remembers, (because these activities the body learned at a very young age and have been repeated daily over so many years) – this is the memory that the elder with Alzheimer’s need for daily living and that provide for the elder an opportunity for success in their day.

Every time the caregiver puts their hand over the patients hand while they eat, to “get them going.” And then the patient continues the movement of spooning something to their mouth – the caregiver has tuned into the elder’s body memory.

Caregiver Tips: The Pain of Shingles – so much worse for the confused, elderly with Alzheimer’s

Shingles

It’s 2 o’clock in the morning and I can’t sleep. I’m thinking about my dear friend who was just diagnosed with shingles. And a particularly severe and painful attack involving not only her skin and nerve endings but her eyes.

“Attack” is really a good way to refer to something so painful and therefore so debilitating. Talking to Shari and hearing how she is suffering – she and I could not help but think of those we care for. It is so like Shari in her suffering to think of those who due to their dementia are living in the moment.

They don’t think of the past and remember when they had Chicken Pox as a child, that led to the pain they have now. The Chicken Pox virus, after the lesions are gone, goes down your nerve endings where it stays until either stress or being exposed to someone with shingles brings the virus back to the surface.

Living in the moment the Alzheimer’s patient with shingles doesn’t see the future when this will be resolved. Or live with the hope when this pain will be gone.

Signs of pain in someone with Alzheimer’s disease:
Increased restlessness or thrashing
Rubbing or pulling at a body part as though they would like to tear it off and throw it away
When the blister starts to drain it is extremely itchy
Worsening of any previous negative behaviors
Facial expression; frowning, grimacing, sad expression, looking worried, crying.

Keep in mind that when the skin lesions are gone the patient may still have pain, in some cases for even years, and be unable to tell anyone.

So it is now 2:30 a.m. and I am thinking of my friend. I know the wee hours of the night well, having worked the night shift for over 10 years of my career. I know that pain is so much worse at night when people and distractions of the day are gone. Now I sip my Earl Grey tea and think of my dear friend, I think of all of the faces from the past and I think of all of you – the caregivers, families, healthcare workers and the suffering.

Caregiver’s Tips: Caregiver approach makes a difference for elderly with Alzheimer’s Disease

Caregiver Approach Affects Behaviors of Persons with Alzheimer’s Disease

When working with elderly with Alzheimer’s disease make sure that you are calm, not in a hurry and able to focus your attention on this individual. Remember that people with Alzheimer’s disease are very much in the moment. So for that moment they are not thinking of the future or the past and you need to be in the moment with them, for what ever task you are trying to accomplish.

Before you approach the elder, have a plan.


If you need supplies for your task have everything prepared.

Always approach a person from the front so that they can see you coming. This is especially true for a male caregiver and a male patient.

Position yourself on the level of the elder. If in a wheelchair squat a little to the side, in front of the person.

Never speak to the person from the back, above or the side of them.

Person’s with Alzheimer’s disease need to have a connection with you before you can interact with them.

SMILE – most important part of your approach.

Say the person’s first name or whatever name they are used to responding to.

Do not touch the person before they are aware of you and you have made that connection.

Establish a connection with the person before you attempt any type of care.

Remember people with Alzheimer’s disease are very sensitive to body language, tone of voice, negative gestures. If what you present to them is negative they will mirror the behavior they see and become negative as well.

Just as children are in the moment, much can be learned from working with a person with Alzheimer’s disease who is living in the moment. When you are in the moment you can experience and enjoy what is happening right now, without the stress of the future.

Safe Approaches for Caregivers when working with someone with Alzheimer’s disease who has Negative Behaviors

Over reactive responses of distress demonstrate the inability to understand, interpret or cope with a real or imagined situation. Identifying the cause that triggered the negative reaction as well developing safe approaches for this person is the key to success. When a behavior, that is triggered by a physical or psychosocial stimulus is anticipated, the use of a distraction can be put in place pro-actively. See Blogs “Communication”