What Caregivers Can Expect in Alzheimer’s Patients as the Disease Progresses:

• A decline in logical thinking and judgment
• Inappropriate social behaviors
• Confusion and disorientation
• Wandering
• Rummaging and hiding objects
• Aggressiveness, anger, and frustration
• Hallucinations
• Paranoia
• Night wakefulness
• Refusal to eat

Tips to Lessen the Stresses of Caring for a Loved One With Alzheimer’s Disease:

Alzheimer’s Patient Who Tends to Wander

• Recognize common precursors to wandering, such as restlessness and disorientation.
• Reassure and reorient the person.
• Reduce noise levels and distractions.
• Involve the person in productive daily activities and exercise.
• Have a written plan for yourself if the person does wander.
• Keep a recent photograph of the person to give to police if the person does wander.
• Inform the police and your neighbors of the person’s tendency to wander.
• Have the person wear bright, distinctive clothing.

Alzheimer’s Patient Who Rummages and Hides Things

• Lock cabinets and specific rooms.
• Store valuables and unsafe substances out of reach of the person.
• Learn where the person tends to hide objects.

Alzheimer’s Patient Who Becomes Angry or Aggressive

• Don’t take the person’s belligerence personally.
• Don’t confront the person about their behavior, it may be beyond their control.
• Give the person (safe) space to let their anger play out.
• Look for patterns in potential anger triggers.

Alzheimer’s Patient Who Hallucinates or Is Paranoid

• Don’t argue with the person about whether or not what they are talking about is real.
• Increase lighting so there are less shadows.
• Remove mirrors.

Alzheimer’s Patient Who Cannot Sleep at Night

• Limit intake of caffeine.
• Increase physical activity during the day.
• Either limit naps, or encourage naps (depending on the person’s normal daily routine).
• Establish a nighttime routine, including calming elements such as a bath, soft music, and a warm drink (such as milk).
• Keep a nightlight on all night.

Alzheimer’s Patient Who Refuses to Eat

• Provide the person with a number of small meals throughout the day rather than a few large meals.
• Make the person’s favorite food.
• Provide finger food.
• Provide soft foods that don’t require chewing.
• Remove distractions during mealtimes.
• Have a different caregiver help the person with eating.

Caregiver Burden

The daily routine of caring for a chronically ill person can put tremendous physical and emotional strain on caregivers, particularly for families who have assumed care responsibilities more recently. A number of studies have been conducted regarding interventions targeting Alzheimer’s caregivers, as research has shown that caretaker burden is a primary reason for placing Alzheimer’s patients in nursing homes.

Project Care was a 5-week long, randomized controlled trial that found that specifically targeted, group-based behavioral interventions reduced caregiver distress related to neuropsychiatric symptoms in the patient (such as irritability, anxiety, and depression). The Resources for Enhancing Alzheimer’s Caregiver Health (REACH initiatives conducted by the National Institutes of Health) have found that targeted interventions with multiple components may be more effective for caregivers than broader, psychoeducational interventions.

The importance of easing the mental and physical burdens of those who care for Alzheimer’s patients cannot be underestimated, as the health of Alzheimer’s patients is closely related to the health of their caregivers.

RESOURCES:

Alzheimer’s Association
http://www.alz.org

HelpGuide
http://www.helpguide.org

References:

Gaugler JE, Kane RL, Kane RA, Clay T, Newcomer RC. The effects of duration of caregiving on institutionalization. Gerontologist. 2005 Feb 1. 45(1):78-89.

Gonyea JG, O'Connor MK, Boyle PA. Project CARE: a randomized controlled trial of a behavioral intervention group for Alzheimer's disease caregivers. Gerontologist. 2006 Dec 1.46(6):827-832.

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