Friday, 26 April 2013

Alzheimer’s Caregiving Tips - Bathing

At some point, people with Alzheimer’s disease will need help in bathing. Because this is a private activity, people may not want help. They may also feel angry about not being able to take care of themselves.

Helping someone with Alzheimer’s disease take a bath or shower can be one of the hardest things you do. Planning can help make bath time better for both of you. If the person is afraid of bathing, follow his or her lifelong bathing habits, such as doing the bath or shower in the morning or before going to bed.

Safety Tips
To keep the person with Alzheimer’s safe during bath time:

·                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 a hand-held shower head.
·                Use a rubber bath mat and safety bars in the tub.
·                Use a sturdy shower chair to support a person who is unsteady and to prevent falls. You can buy shower chairs at drug stores and medical supply stores.

Before Bathing
Before starting 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 is comfortable.
·                Don’t use bath oil. It can make the tub slippery and may cause urinary tract infections

During a 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. Here are other tips:

           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 the person a washcloth to hold. This makes it less likely that he or she will try to hit you.

After Bathing
Try these suggestions:

           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 is incontinent, use a protective ointment, such as petroleum jelly, around
       the rectum, vagina, or penis. 
           If the person has trouble getting in and out of the bathtub, do a sponge bath instead.

Other Bathing Tips
For most people, a full bath or shower two or three times a week is enough. Between full
baths, a sponge bath to clean the face, hands, feet, underarms, and genitals is all you
need to do every day. Also:

           Washing the person’s hair in the sink with a hose attachment may be easier than        
        doing it in the shower or bathtub. 
           Get professional help with bathing if it becomes too hard for you to do on your own.

(Source:  Alzheimer's Disease Education and Referral (ADEAR) Centre, NIH, October 2012)

Monday, 22 April 2013

Aggressive Behaviour In A Person With Dementia: Advice On Preventing & Defusing Potentially Volatile Situations

Aggression—a destructive or hostile action or behavior directed toward oneself, other people or objects—is one of the most frightening behaviors displayed by some individuals with dementia.

Typically, aggressive behavior in a person with dementia involves swearing, screaming, throwing objects, slamming doors, resisting care, biting or attempting to hit other people. Less  commonly, it may be sexual in nature.

Not surprisingly, aggressive behavior can cause considerable distress for caregivers, family members and nursing home staff and is often cited as a reason why a loved one is placed in residential care.

Aggravating Factors

Many things can trigger aggressive behavior in a person with dementia. For example, aggression may be a sign of an underlying problem that the patient cannot communicate. Pain, physical illness, dehydration, depression, anxiety, a lack of sleep, frustration, a change in the person’s drug regimen or even constipation may cause the patient to act out.  That’s why it’s important to get a doctor to evaluate the person and rule out possible physical causes for aggressive behavior.

At times, seemingly innocuous actions of another person may be a trigger. An individual with dementia may strike out while a caregiver is helping him bathe or a doctor is performing an evaluation, for example, because he feels that his personal space has been invaded. The aggressive behavior is merely an attempt to defend it.

In some instances, aggressive behavior may occur when the person doesn’t understand why she or he is asked to do something. The person with dementia may misinterpret certain actions or be mistrustful of someone and react aggressively toward that person.

Identify and Adapt

You may be able to identify a pattern in the person’s aggressive behavior and take steps to prevent it by keeping a detailed written account of the events that surround the acts of aggression. The account should describe what happened immediately prior
to the outburst, what the behavior entailed and the outcome of the situation. The account should also note how often aggressive behavior occurs, whether anyone else is present when the behavior happens and what, if anything, reduces the behavior.

Information gleaned from the written account can be useful in helping you make adaptations that will help avoid triggering the aggressive behavior. For example, if your notes reveal that the person typically is aggressive when he is unable to find items such as clothes or dishes, try labeling drawers and cabinets.  If a person becomes combative when trying to make choices about eating or dressing, limit the options you present. If outbursts occur when a person receives instructions on how to do something, avoid general directives and instead give instructions that contain only one step. For example, say “put this shirt on” rather than “dress yourself.”

If the person exhibiting the aggressive behavior lives in a nursing home, take a look at the

surroundings to identify potential triggers. The facility may be overcrowded, or the person may be over or under stimulated; in some cases, a roommate may be inadvertently triggering the behavior.  Addressing those issues may help avert future outbursts.

Additional Strategies

Some caregivers find that maintaining a regular daily routine helps prevent outbursts. Playing music the person enjoys during problem times such as while bathing may also be useful.  In addition, a regular, gentle exercise program may help reduce aggression on days the patient is physically acting out.

The Medication Option

If repeated use of behavioral modification does not help control the behavior, medication may be appropriate in some situations.  While no drugs are specifically approved to treat aggression in dementia, research shows that a number of medications may be helpful. These include antidepressants, antipsychotics and anti-anxiety drugs. The doctor will make treatment decisions based on a number of factors, including the cause of the dementia, symptoms, the presence of other health conditions and the person’s caregiving arrangements.

What To do When Aggression Occurs

Despite efforts to prevent and treat aggression, episodes may occur from time to time. Knowing what to do can help defuse the situation. 
If a person with dementia becomes aggressive, try your best to stay calm and stop whatever it is you are trying to get the person to do. Give the person enough space so that he or she doesn’t feel threatened.  Don’t argue with the person, make degrading comments or punish the person physically or psychologically.  Remember, because of the person’s illness, he or she likely will not recall the event or be able to learn from it.
Talk  to the person in a calm non threatening voice using easyto-understand language. If a television or radio is on, turn down the volume or turn it off. Try to ignore the aggression or distract the person by switching to another subject.
If this doesn’t work, try to calm the person by working through the reasons for the aggression.  For example, if the person is suspicious that someone has stolen his or her wallet, spend a few minutes looking for it with the person. Some caregivers find it  helpful  to distract the person with a calming activity like sitting in a rocking chair.

Get Support

Most caregivers are not trained professionals, but learning good caregiving techniques can be worthwhile. In addition, getting support and learning how other people cope with similar situations is invaluable. Contact the Alzheimer’s Association to find out if there are caregiver training programs or caregiver support groups in your area.

(Source:  John Hopkins Memory 2013-Guide to Alzheimer’s Disease & Dementia) 

Sunday, 21 April 2013

Exercise May Help People With Alzheimer's Avoid Nursing Homes

Study finds regular activity delays physical decline, reduces falls.

Regular exercise slows disability and prevents falls in patients with Alzheimer's disease without increasing overall costs, a new study from Finland says.

The findings suggest that exercise, particularly when tailored to an individual's needs and performed at home, may help Alzheimer's patients maintain their independence and delay the move to a nursing home.

"This is an important study," said Dr. Kostos Lyketsos, Director of the Johns Hopkins Memory and Alzheimer's Treatment Center, in Baltimore. "If we could ever deliver exercise for people with dementia in their homes, I think we could accomplish very substantial benefits for patients and reduce costs, which is a very big deal ... in health care these days." Lyketsos was not involved in the new research.

Mental changes are the first wrenching signs of Alzheimer's disease, and they often are the symptoms that get the most attention.  But physical declines are also a part the disease. Over time, muscles become stiff and uncoordinated, or may start to tremor.  Alzheimer's patients may lose the ability to brush their teeth, climb stairs, and dress, feed and bathe themselves.
"These people are at very high risk of disability. That's one of the reasons they end up in institutional care," said study author Dr. Kaisu Pitkala, a general practitioner at the University of Helsinki. "They need so much help that their caregivers often get very tired, and after a few years they will end up in institutional care, which is very expensive and often not the wish of the patients nor the caregivers."

For the study, published online April 15 in the journal JAMA Internal Medicine, the researchers chose more than 200 patients with moderate to severe Alzheimer's disease who were living at home with a caregiver and showing signs of physical decline. The patients were randomly assigned to one of three groups: home exercise, group exercise at a day care center, or a control group that got usual care through the Finnish national health care system.

Those in the home-exercise group got visits from a physical therapist for one hour twice a week. The physical therapists specialized in dementia care, and they tailored these sessions to each patient's problems with function and mobility.

Patients in the group-exercise classes traveled to an adult care center twice a week, where two physical therapists guided them through exercises to improve endurance, balance, strength and mental function.

The patients in the usual-care group were followed by the study nurses and were given advice on nutrition and exercise.

After one year, all the groups saw declines in physical function, but the groups that exercised regularly fared better than those who got usual care. Those in the home-exercise group did the best. Their physical function declined about half as much as that of the control group. Importantly, they also had half as many falls as those who got usual care.

Group exercisers showed some signs of better health -  their strength improved over the course of the year - but those results were not statistically significant. And although the study found an association between exercise and better health among Alzheimer's patients, it didn't prove a cause-and-effect relationship.

The researchers think one reason the group exercisers didn't see bigger benefits was because they were more likely to skip their sessions than those who exercised at home.
"When the taxi came to the person's home to take them to the group-based exercise, they could say often, 'Today I'm tired; I'm not coming,'" Pitkala said. "When there's a person coming to your home and telling you, 'Let's do a little bit today,' it's much easier to say yes than it is to go outside your home."

During the year they exercised, patients in the home group had fewer hospital admissions and about half as many falls as those in the control group. The money they saved on medical bills more than offset the cost of regular private sessions with a physical therapist. The average annual cost of caring for a patient in the home-exercise group was about $25,000, but it was about $34,000 for patients who received only usual care. The annual cost for group-exercise patients was even lower, at about $22,000.

Another expert who was not involved in the study praised the research and said it offered a practical blueprint to improve the lives of patients and families affected by Alzheimer's disease.

"If you can do something that can improve their physical functioning and mobility and help them stay home and not actually cost anything - or be cost neutral - I think you can make a huge potential impact on a family's quality of life," said Dr. James Galvin, a Professor of Neurology and Psychiatry at NYU Langone School of Medicine, in New York City.

(Source:  HealthDay News, 15 April 2013)

Saturday, 20 April 2013

The Seven Stages of Alzheimer's Dementia

The Seven Stages of Alzheimer's describes the Progression and Pattern of Symptoms that typically occur in individuals living with Alzheimer’s Dementia.

It is important to note that not everyone living with Alzheimer's or a related dementia will experience the same symptoms or progress at the same rate over time. As a result, the Seven Stages of Alzheimer's should be look at as guidelines to expectations.

People with Alzheimer’s typically live an average of 8 years after diagnosis, but may survive anywhere from 3 to 20 years.

The framework for this section is a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline. This framework is based on a system developed by Barry Reisberg, M.D., Department of Psychiatry at the New York University Langone Medical Center.

Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe and severe Alzheimer’s disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage and late-stage categories.

Stage 1: No Impairment (Normal Function)

Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.

Stage 2: Very Mild Cognitive Decline (May be normal age-related changes or earliest signs of Alzheimer's disease.

Individuals may feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers.

Stage 3: Mild Cognitive Decline

Early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms:

·              Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:

·                Word- or name-finding problems noticeable to family or close associates.

·                Decreased ability to remember names when introduced to new people.

·                Performance issues in social or work settings noticeable to family, friends or co-workers.

·                Reading a passage and retaining little material.

·                Losing or misplacing a valuable object.

·                Decline in ability to plan or organize.

Stage 4: Moderate Cognitive Decline (Mild or Early-Stage Alzheimer's Disease)

At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:

·                Decreased knowledge of recent occasions or current events.

·                Impaired ability to perform challenging mental arithmetic-for example, to count backward from 75 by 7s.

·                Decreased capacity to perform complex tasks, such as planning dinner for guests, paying bills and managing finances.

·                Reduced memory of personal history.

·                The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations.

Stage 5: Moderately Severe Cognitive Decline (Moderate or Mid-Stage Alzheimer's Disease)

Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential.   At this stage, individuals may:

·               Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated.

·               Become confused about where they are or about the date, day of the week or season.

·              Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s.

·               Need help choosing proper clothing for the season or the occasion.

·              Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children.

·                Usually require no assistance with eating or using the toilet.

Stage 6: Severe Cognitive Decline (Moderately Severe or Mid-Stage Alzheimer's Disease)

Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may:

·                Lose most awareness of recent experiences and events as well as of their surroundings.

·                Recollect their personal history imperfectly, although they generally recall their own name.

·               Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces.

·               Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet.

·                Experience disruptions of their normal sleep/waking cycle.

·               Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue  properly).

·                Have increasing episodes of urinary or fecal incontinence.

·               Experience significant personality changes and behavioural symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviours such as hand-wringing or tissue shredding.

·                Tend to wander and become lost.

Stage 7: Very Severe Cognitive Decline (Severe or Late-Stage Alzheimer's Disease)

This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement.

·               Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered.

·                Individuals need help with eating and toileting and there is general incontinence of urine.

·                Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.

(Source:  Alzheimer’s Reading Room, Update 19 April 2013)

Tuesday, 16 April 2013

Music Therapy: A Helpful Add-On to Traditional Therapy for Depression

Music has long been known to affect mood - but can it relieve Depression?  According to recent studies, Music Therapy, which typically combines traditional "Talk Therapy" with listening to music or creating it, may work to alleviate Depression in several ways.

·       Playing an instrument allows depressed people to express themselves non verbally when they  can't easily talk about how they feel.
·       Listening to soothing music helps others relax so they're better able to let go of feelings that are troubling.
·        Still others may find that sharing a musical experience with a Therapist - playing or listening -  help them feel more comfortable discussing their problems and feelings.

Music Therapy is either active or receptive and does not require prior musical background or abilities.

·         In Active Music Therapy, the Therapist and the patient improvise, recreate, or compose music using a drum, mallet instrument or the voice. The goal is for the patient to share thoughts and feelings that arise with the music making and, as a result, develop insight into his or her problems.
·         In Receptive Music Therapy, patients listen to music while meditating, drawing or reminiscing. This process allows patients to improve their mood and develop coping and relaxation skills.

The duration and frequency of Music Therapy Sessions vary, but they typically last 20 minutes to one hour. Patients may undergo sessions daily, weekly or monthly. Music Therapy Sessions can take place in a group or individually in a hospital, therapist's office or patient's home.

What the Research shows
Some studies of music therapy for depression have been encouraging. A review of five small randomized, controlled trials found that in four of the studies, depressive symptoms were reduced more in patients who participated in music therapy than in those who received standard treatment. However, the methodological quality of these studies was moderate to poor, and the types of music therapy and standard treatments used and patients studied varied considerably.

Is Music Therapy right for you? 
Although Music Therapy appears to be helpful, it's likely most suitable as an add-on to traditional therapies such as medication and other forms of psychotherapy. Anyone receiving treatment for depression should first discuss the use of Music Therapy with his or her health care provider.

(Source: John Hopkins Health Alert, posted in Depression and Anxiety on April 2, 2013) 

Reality Check: Staying Safe on the Road as You Age

To many of us, driving is synonymous with independence. So, when the time comes to consider whether our driving skills are as sharp as they once were, being honest with ourselves can be difficult. That said, simply being a certain age doesn't automatically mean you have to give up your car keys.

Chronological age has nothing to do with determining driving ability. As long as physical and cognitive issues aren't preventing you from driving - and you're not putting yourself or others at risk - you should be able to continue navigating the roads.

It's true that no matter how healthy you are, aging will eventually affect your driving skills. And as you age, your risk of being injured or killed in a motor vehicle crash increases. The key to driving safely is to recognize when your skills are beginning to decline, correct poor habits and learn how to adapt your driving.

Consider having your driving assessed by a professional car safety specialist if any of these sound like you:

·         Other people have expressed concern about your driving or are afraid to get in the car with you.
·         You're afraid to make left turns or go through intersections.
·         You have difficulty turning around or backing up.
·         You've been involved in an accident or have had several close calls.
·         You have difficulty judging gaps in traffic while waiting to turn or cross a road.
·         You have difficulty seeing traffic signs or signals.
·         Your car has multiple dents and scrapes from objects like fences, garage doors and mailboxes.
·         You frequently hit curbs when driving.
·         You have trouble moving your foot from one pedal to the other or have confused the gas and brake pedals.
·         You have trouble staying in your lane.
·         You're increasingly nervous about driving.
·         Other vehicles or pedestrians often seem to appear out of nowhere.
·         You're easily distracted when driving.
·         You feel exhausted after driving.
·         You've received traffic tickets or warnings.
·         You're taking a longer time to drive to regular destinations than you have in the past.
·         You're frequently honked at.
·         You easily become angry and frustrated with other drivers.
·         You get lost in familiar places.

(Source:  John Hopkins Health Alert, posted in Memory on April 15, 2013)