(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 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

• Activities at Home (PDF)
• Creating a Daily Plan
• Activities for Kids & a Person with Alzheimer’s
• Respite Care
• Alzheimer’s Navigator

Citation

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

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

(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.

(NIH.gov) Making healthy food choices is a smart thing to do—no matter how old you are! Your body changes through your 60s, 70s, 80s, and beyond. Food provides nutrients you need as you age. Use these tips to choose foods for better health at each stage of life.

1. Drink plenty of liquids

With age, you may lose some of your sense of thirst. Drink water often. Low-fat or fat-free milk or 100% juice also helps you stay hydrated. Limit beverages that have lots of added sugars or salt. Learn which liquids are better choices.

2. Make eating a social event

Meals are more enjoyable when you eat with others. Invite a friend to join you or take part in a potluck at least twice a week. A senior center or place of worship may offer meals that are shared with others. There are many ways to make mealtimes pleasing.

3. Plan healthy meals

Find trusted nutrition information from ChooseMyPlate.gov and the National Institute on Aging. Get advice on what to eat, how much to eat, and which foods to choose, all based on the Dietary Guidelines for Americans. Find sensible, flexible ways to choose and prepare tasty meals so you can eat foods you need.

4. Know how much to eat

Learn to recognize how much to eat so you can control portion size. MyPlate’s SuperTracker shows amounts of food you need. When eating out, pack part of your meal to eat later. One restaurant dish might be enough for two meals or more.

5. Vary your vegetables

Include a variety of different colored vegetables to brighten your plate. Most vegetables are a low-calorie source of nutrients. Vegetables are also a good source of fiber.

6. Eat for your teeth and gums

Many people find that their teeth and gums change as they age. People with dental problems sometimes find it hard to chew fruits, vegetables, or meats. Don’t miss out on needed nutrients! Eating softer foods can help. Try cooked or canned foods like unsweetened fruit, low-sodium soups, or canned tuna.

7. Use herbs and spices

Foods may seem to lose their flavor as you age. If favorite dishes taste different, it may not be the cook! Maybe your sense of smell, sense of taste, or both have changed. Medicines may also change how foods taste. Add flavor to your meals with herbs and spices.

8. Keep food safe

Don’t take a chance with your health. A food-related illness can be life threatening for an older person. Throw out food that might not be safe. Avoid certain foods that are always risky for an older person, such as unpasteurized dairy foods. Other foods can be harmful to you when they are raw or undercooked, such as eggs, sprouts, fish, shellfish, meat, or poultry.

9. Read the Nutrition Facts label

Make the right choices when buying food. Pay attention to important nutrients to know as well as calories, fats, sodium, and the rest of the Nutrition Facts label. Ask your doctor if there are ingredients and nutrients you might need to limit or to increase.

10. Ask your doctor about vitamins or supplements

Food is the best way to get nutrients you need. Should you take vitamins or other pills or powders with herbs and minerals? These are called dietary supplements. Your doctor will know if you need them. More may not be better. Some can interfere with your medicines or affect your medical conditions.

Go to www.ChooseMyPlate.gov and www.nia.nih.gov/health/topics/nutrition for more information.

Download the free tip sheet here: Choosing Healthy Meals As You Get Older: 10 Healthy Eating Tips for People Age 65+

Citation

https://www.nia.nih.gov/health/publication/choosing-healthy-meals-you-get-older

National Institute on Aging
United States Department of Agriculture
Center for Nutrition Policy and Promotion

(BrightFocus Foundation) Older persons sometimes exhibit disruptive behaviors, specifically in the late afternoon or evening, called sundown syndrome. Learn some helpful behavioral and environmental tips to manage “sundowning,” written by an expert in geriatric care management affiliated with BrightFocus Foundation’s Alzheimer’s Disease Research program

Sundowning. Sundowner’s Syndrome. Sundowners. These commonly used terms all refer to the behaviors we often see in older persons in private homes, nursing facilities, assisted living facilities, memory care units, and hospitals. Caregivers, hospital staff, and long-term care facility staff see it in their daily work. While not a formally recognized psychiatric diagnosis, “sundowning” is a descriptive term, and is described as:

SUNDOWNING

“A set of neuropsychiatric symptoms occurring in elder­ly persons with or without dementia at the time of sunset, at evening, or at night. These behaviors represent a wide variety of symptoms such as confusion, disorientation, anxiety, agi­tation, aggression, pacing, wandering, resistance to redirec­tion, screaming, yelling and so forth. Some of these behaviors may not be specific to sundowning and can be the manifesta­tion of dementia, delirium, Parkinson’s disease, and sleep dis­turbances.

However, what distinguishes sundowning from the above mentioned conditions is that persons with sundown syndrome characteristically show disruptive behaviors specifically in the late afternoon, in the evening, or at night.”

Being the caregiver for one experiencing sundowning can be stressful and exhausting, caregivers can become sleep deprived. Behavioral and environmental approaches can be effective in lessening or even preventing some symptoms, and where appropriate should be used as the first line of intervention.

Persons with Alzheimer’s or other dementias are thought to experience sundowning for a variety of reasons, including extreme fatigue, late day lighting, pain, vision problems, hunger or thirst, and depression. These are just a few of the possible causes, and when your loved one is sundowning, determine first what is bothering him or her. This will help you determine how to respond.

Environmental Approaches

Environmental cues can impact a person’s sundowning, adding to their agitation, confusion or aggressiveness. To set up the immediate environment to lessen the symptoms of sundowning, try the following:

• During the daytime, keep window coverings open for maximum exposure to bright light.
• At dusk, close the window coverings and turn lights on to eliminate any shadows caused by the late day light. Shadows can cause confusion for one with dementia.
• Create a quiet routine for the early evening. This might include an early evening walk, or calming background music.
• Minimize loud background noises such as banging pots, or sudden loud noises.
• If needed, create some white noise, the type of noise that is low and in the background. It can help to lessen the impact of sudden noises.
• Minimize clutter in rooms.
• Minimize the number of people in the room;
• Monitor TV watching and the images on the screen. Many TV scenes can be upsetting, especially to one with dementia.

Behavioral Approaches

• Structure the day and maintain a stable routine, as much as possible. Routine and structure will help your loved ones know what to expect, which is comforting for them.
• Give simple instructions for meals, bathing, etc.
• Eliminate caffeine and alcohol, especially in the late day.
• Get them outside during the day for physical activity and exercise.
• Keep daytime naps short, and earlier rather than later in the day.

Responding to Sundowning as it Happens

Just as you have tools when loved ones are agitated or fixed on something at other times of the day, you have tools to help them settle down and relax when sundowning.

• Listen carefully. It can be difficult to identify the source of their fear or agitation, but keep listening and try different things to help them calm down. For instance, they may see someone in the room, but maybe it is the shadow created by the light outside the window.
• Redirect where possible. Is it almost time for dinner? Go ahead and eat. Does your loved one like to fold the laundry? Find some, even the laundry that is already folded and in the closet. Pull it out to start all over again. Towels and napkins are always useful for this activity. If it is after dinner and a good night for a walk, go out. Sometimes a TV or a radio program can be a good method to redirect and take their mind off things that are bothering them. Just be careful about the images on the screen.
• Use gentle touch to connect. Hold their hand, stroke their back, hug them. Such touch will be soothing, and may be just what they need.

Resources

Citation

http://www.brightfocus.org/alzheimers/article/tips-managing-sundowning

References

Kahchiyants, N. et al (2011). Sundown Syndrome in Persons with Dementia: An Update. Psychiatry Investigation, pp. 275-287.

By Kathleen Allen, LCSW, C-ASWCM, Senior Care Management Services, LLC

(NIH Senior Health) At some point, people with Alzheimer’s disease will need help with bathing, dressing, and grooming. Because these are private activities, people may not want help. They may feel embarrassed about being naked in front of caregivers. They also may feel angry about not being able to care for themselves.

Bathing

The person with Alzheimer’s may be afraid. To reduce these fears, follow the person’s lifelong bathing habits, such as doing the bath or shower in the morning or before going to bed. Here are other tips for bathing.

Bathing Safety Tips

• Never leave a confused or frail person alone in the tub or shower.
• Always check the water temperature before he or she gets in the tub or shower.
• Use plastic containers for shampoo or soap to prevent them from breaking.
• Use a hand-held showerhead.
• Use a rubber bath mat and put safety bars in the tub.
• Use a sturdy shower chair in the tub or shower. This will support a person who is unsteady, and it could prevent falls. You can get shower chairs at drug stores and medical supply stores.
• Don’t use bath oil. It can make the tub slippery and may cause urinary tract infections.

Preparing for a Bath or Shower

• Get the soap, washcloth, towels, and shampoo ready.
• Make sure the bathroom is warm and well lighted. Play soft music if it helps to relax the person.
• Be matter-of-fact about bathing. Say, “It’s time for a bath now.” Don’t argue about the need for a bath or shower.
• Be gentle and respectful. Tell the person what you are going to do, step-by-step.
• Make sure the water temperature in the bath or shower is comfortable.

During the Bath or Shower

• Allow the person with Alzheimer’s to do as much as possible. This protects his or her dignity and helps the person feel more in control.
• Put a towel over the person’s shoulders or lap. This helps him or her feel less exposed. Then use a sponge or washcloth to clean under the towel.
• Distract the person by talking about something else if he or she becomes upset.
• Give him or her a washcloth to hold. This makes it less likely that the person will try to hit you.

After a Bath or Shower

• Prevent rashes or infections by patting the person’s skin with a towel. Make sure the person is completely dry. Be sure to dry between folds of skin.
• If the person has trouble with incontinence, use a protective ointment, such as Vaseline, around the rectum, vagina, or penis.
• If the person with Alzheimer’s has trouble getting in and out of the bathtub, do a sponge bath instead.

Dressing

People with Alzheimer’s often need more time to dress. It can be hard for them to choose their clothes. They might wear the wrong clothing for the season. They also might wear colors that don’t go together or forget to put on a piece of clothing. Allow the person to dress on his or her own for as long as possible.

Dressing Tips

• Lay out clothes in the order the person should put them on, such as underwear first, then pants, then a shirt, and then a sweater.
• Hand the person one thing at a time or give step-by-step dressing instructions.
• Put away some clothes in another room to reduce the number of choices. Keep only one or two outfits in the closet or dresser.
• Keep the closet locked if needed. This prevents some of the problems people may have while getting dressed.
• Buy three or four sets of the same clothes, if the person wants to wear the same clothing every day.
• Buy loose-fitting, comfortable clothing. Avoid girdles, control-top pantyhose, knee-high nylons, garters, high heels, tight socks, and bras for women. Sports bras are comfortable and provide good support. Short cotton socks and loose cotton underwear are best. Sweat pants and shorts with elastic waistbands are helpful.
• Use Velcro® tape or large zipper pulls for clothing, instead of shoelaces, buttons, or buckles. Try slip-on shoes that won’t slide off or shoes with Velcro® straps.

Grooming

For the most part, when people feel good about how they look, they feel better. Helping people with Alzheimer’s brush their teeth, shave, or put on makeup often means they can feel more like themselves. Here are some grooming tips.

Mouth Care

Good mouth care helps prevent dental problems such as cavities and gum disease.

• Show the person how to brush his or her teeth. Go step-by-step. For example, pick up the toothpaste, take the top off, put the toothpaste on the toothbrush, and then brush. Remember to let the person do as much as possible.
• Brush your teeth at the same time.
• Help the person clean his or her dentures. Make sure he or she uses the denture cleaning material the right way.
• Ask the person to rinse his or her mouth with water after each meal and use mouthwash once a day.
• Try a long-handled, angled, or electric toothbrush, if you need to brush the person’s teeth.
• Take the person to see a dentist. Some dentists specialize in treating people with Alzheimer’s. Be sure to follow the dentist’s advice about how often to make an appointment.

Other Grooming Tips

• Encourage a woman to wear makeup if she has always used it. If needed, help her put on powder and lipstick. Don’t use eye makeup.
• Encourage a man to shave, and help him as needed. Use an electric razor for safety.
• Take the person to the barber or beauty shop. Some barbers or hairstylists may come to your home.
• Keep the person’s nails clean and trimmed.

For more caregiving tips, see NIA’s guide, Caring for a Person with Alzheimer’s Disease.

Citation

https://nihseniorhealth.gov/alzheimerscare/personalcare/01.html

(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

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