Showing posts with label Daily Activities. Show all posts
Showing posts with label Daily Activities. Show all posts

Saturday, 28 September 2013

HOW IMPORTANT IS PLAY FOR ALZHEIMER’S PATIENTS IN THE LATE STAGES?

I call that place the “zombie wall.”
By Mary Gazetas

My husband is living in the last stages of Alzheimer's. Clinically
he’s a Seven.
He’s in a home and he can’t walk, rarely talks, and he can
no longer participate in organized activities.
Reading, writing or watching television disappeared over two
years ago.

One question readers might ask is, “Gosh, Well Then What Can He Do?”

Part of an answer is to share what I tell my children, my three grown children who live far away.  When they check into see how their Dad is doing, I find a huge part of my response is to describe to them what he loves to play with.

He’s now playing with things that would amuse and keep occupied a 9 month old - a one year old child.  I am no expert.  May be it is even a younger age.  I don’t know.

It took me awhile to realize how important it was that he had things in front of him to touch and move around.  It was about a year ago when he could still more or less feed himself to a degree that I began to notice he loved to play with his food.  I called it the “sand box.”

Anything close by his meal tray in the dining room became fair play.  Things that were within reach and that he could see that were there to make him curious.

It was common to see him rip open paper sugar packets, pour his cup of milk into another vessel or make a puddle to put his fingers into. Use his paper napkin to fold into a shape to cover a cup or a piece of uneaten food. Use his blue terry cloth bib to cover and hide things under.  Activities most of us would associate with what a very young child likes to do.

Besides eating, the playing part was a large part of his meal experience as I sat beside him.

For him this was fun. So I never tried to discourage him despite some objections from the residence staff. To me, that kind of behaviour indicated he was still curious about things. He wanted to play. He was bored!  Why would I want to tell him it was not cool to do that?

I read that having a “rummage basket” close at hand was a beneficial method to keep people like him active. I brought in objects from home that I hoped might be a-connect for him. Things that may be he might remember or be curious about.


Into the basket went objects such as his empty wallet, decorated wooden Easter eggs, pens, really small art books of his favourite artists, toy animals, a water gun, and hard-boiled egg covers made of wool from my mother’s kitchen.  He didn’t seem that interested in those objects. Then one day when I showed up one of the care-aides had put the basket on its side on his table. Now he could actually see inside. What a difference!

Pasted on the wall above his bed is a care plan that describes to all the staff what I think is important re his level of care. No more parking him in his wheelchair by a wall after lunch with nothing for his hands to do. I call that place the “zombie wall.” Instead over time they now get it. After the noon meal, take him back to his room so he can sit beside an open window, with his bedside table in front of him, to place an assembly of toys to touch.

A few weeks ago it struck me he needed some new toys. I went to the local IKEA store children’s area and bought a set of stacking cups and another piece made of wooden thick rings to place on top of one another on a small pole.

They are now his favourites.

When I entered his room this afternoon he was wide awake, playing with all in front of him -   stacking, grouping, curious and happy.

One of his care-aides told me another staff person had come into the room earlier and mentioned she had bought the same toys recently - toys for her one year old grandson. I wasn’t there for that conversation.  But I did hear that there is a need to create an awareness that people like my husband have returned to a very early stage of a childhood from long ago.

Meanwhile, I am going to take the wooden stacking rings home to make the holes larger with my drill because he has trouble seeing how to get them to fit on the vertical pole.  I don’t want him to struggle to do that.  I want him to feel he is winning.

Is P L A Y important?  You bet it is. The job of a caregiver is to figure out what is best for their loved one. There are no easy answers - it’s all about trial and error. Plus experimenting to see what might engage them and what might not.

In Bob’s words - Welcome to the Alzheimer's World, we have to be playful and have fun too.

Mary Gazetas was an artist, a writer, a volunteer who lived in
Richmond B.C. Canada.  At the beginning she knew nothing about Alzheimer’s.  In fact she didn’t even know how to spell that word.
At first she and her husband were overwhelmed by so much information available.  Looking back it was a slow learning curve.  Once diagnosed (February 2008) the progression of her husband’s Alzheimer’s was fairly slow until he went into a steep and sudden decline.

Mary went to Heaven on April 17, 2012. Her words sing loud and true.


(Source:  Alzheimer’s Reading Room, 5 September 2013)

Friday, 9 August 2013

ALZHEIMER'S DISEASE (Guide To the Diagnosis, Treatment and Prevention of Conditions)

What is Alzheimer's Disease?
According to the National Institute of Neurological Disorders and Stroke, Alzheimer's disease is a progressive, neurodegenerative disease that occurs when nerve cells in the brain die. The disease often results in the following behaviors:

·                Impaired memory, thinking, and behavior
·                Confusion
·                Restlessness
·                Personality and behavior changes
·                Impaired judgment
·                Impaired communication
·                Inability to follow directions
·                Language deterioration
·                Impaired thought processes that involve visual and spatial awareness
·                Emotional apathy

With Alzheimer's disease, motor function is often preserved.

When Alzheimer's was first identified by German doctor Alois Alzheimer in 1906, it was considered a rare disorder. Today Alzheimer's disease is recognized as the most common cause of dementia (a disorder in which mental functions deteriorate and break down). An estimated 5.3 million Americans have Alzheimer's disease. According to the Alzheimer's Association, this number includes 5.1 million people over the age of 65, as well as 200,000 to 500,000 people younger than 65 who have early-onset Alzheimer's and other types of dementias.

How is Alzheimer's Different from Other Forms of Dementia?
Alzheimer's disease is distinguished from other forms of dementia by characteristic changes in the brain that are visible only upon microscopic examination during autopsy. Brains affected by Alzheimer's disease often show presence of the following: 

-   Fiber tangles within nerve cells (neurofibrillary tangles)
-   Clusters of degenerating nerve endings (neuritic plaques) 

Another characteristic of Alzheimer's disease is the reduced production of certain brain chemicals necessary for communication between nerve cells, especially acetylcholine, as well as norepinephrine, serotonin, and somatostatin.

What Causes Alzheimer's Disease?
Although intense investigation has been underway for many years, the causes of Alzheimer's disease are not entirely known. The National Institute on Aging says that suspected causes often include the following:

·                Age and family history
·                Certain genes
·                Abnormal protein deposits in the brain
·                Other risk and environmental factors
·                Immune system problems

What are the Warning Signs or Symptoms of Alzheimer's Disease?
According to the Alzheimer's Association, the following are the most common symptoms of Alzheimer's disease. However, each individual may experience symptoms differently. Symptoms may include:

·                Memory loss that affects job skills, especially short-term memory loss
·                Difficulty performing familiar tasks
·                Problems with language
·                Disorientation to time and place
·                Poor or decreased judgment
·                Problems with abstract thinking
·                Misplacing things
·                Changes in mood or behavior
·                Changes in personality
·                Loss of initiative

Loss of ability to recognize who people are, even people well known to the individual, such as his or her child or spouse, when the disease progresses to a severe stage

The symptoms of Alzheimer's disease may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is Alzheimer's Diagnosed?
There is not a single, comprehensive test for diagnosing Alzheimer's disease. By ruling out other conditions through a process of elimination, doctors, or other specialists, can obtain a diagnosis of probable Alzheimer's disease with approximately 90 percent accuracy. However, the only way to confirm a diagnosis of Alzheimer's disease is through autopsy.

Examination and evaluation are essential in determining whether the dementia is the result of a treatable illness. In addition to a complete medical history and extensive neurological motor and sensory exam, diagnostic procedures for Alzheimer's disease may include the following: 
  • Mental Status Test - This is a brief and simple test of memory and some other common cognitive or thinking skills; it is usually part of a complete neurological exam.
  • Neuropsychological Testing
  • Blood Tests
  • Lumbar Puncture (Spinal Tap) - A procedure performed by inserting a hollow needle into the lower back (lumbar spine).
  • Urinalysis - Laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection, or excessive protein.
  • Chest X-Ray - A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Electroencephalogram (EEG) - A procedure that records the brain's continuous electrical activity by means of electrodes attached to the scalp.
  • Computed Tomography Scan (also called a CT or CAT Scan) - A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body.  A CT Scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT Scans are more detailed than general X-Rays.
  • Magnetic Resonance Iimaging (MRI) - A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Genetic Testing - Some genetic testing is available, especially in some research settings. Because there is no cure or effective treatment for Alzheimer's, the decision to undergo genetic testing is one that requires careful consideration and counseling with a specialist in genetics.

Can Alzheimer's Disease Be Prevented?
Because the cause of the disease is unknown, there are no prevention protocols to follow at this time. And, because the controllable risk factors for Alzheimer's disease are unknown, it is not yet possible to reduce the chances of developing the disease.
  
What is the Treatment for Alzheimer's?
Specific treatment for Alzheimer's disease will be determined by your doctor based on:

·                Your age, overall health, and medical history
·                Extent of the disease
·                Your tolerance for specific medications, procedures, or therapies
·                Expectations for the course of the disease
·                Your opinion or preference

At this time, there is No Cure for Alzheimer's, No Way of slowing down the progression of this disease, and no treatment available to reverse the deterioration of Alzheimer's disease. New research findings give reason for hope, and several drugs are being studied in clinical trials to determine if they can slow the progress of the disease or improve memory for a period of time.

There are some medications available to assist in managing some of the most troubling symptoms of Alzheimer's disease, including the following:

·                Depression
·                Behavioral disturbance
·                Sleeplessness

In managing the disease, physical exercise and social activity are important, as are proper nutrition, health maintenance, and a calm and well-structured environment.

What are Alzheimer's Rehabilitation Programs?

The Rehabilitation Program for people with Alzheimer's differs depending on the symptoms, expression, and progression of the disease, and the fact that making a diagnosis of Alzheimer's is so difficult. These variables determine the amount and type of assistance needed for the Alzheimer's individual and family.

With Alzheimer's rehabilitation, it is important to remember that, although any skills lost will not be regained, the caregiving team must keep in mind the following considerations:

·                To manage the disease, plan a balanced program of physical exercise, social activity, proper nutrition, and health maintenance activities.

·                Plan daily activities that help to provide structure, meaning, and accomplishment for the individual.

·                As functions are lost, adapt activities and routines to allow the individual to participate as much as possible.

·                Keep activities familiar and satisfying.

·                Allow the individual to complete as many things by himself or herself as possible. The caregiver may need to initiate an activity, but allow the individual to complete it as much as he or she can.

·                Provide "cues" for desired behavior (for example, label drawers, cabinets, and closets according to their contents).

·                Keep the individual out of harm's way by removing all safety risks (for example, car keys and matches).

·                As a caregiver (full-time or part-time), understand your own physical and emotional limitations.



(Source: John Hopkins Medicine Health Library)

DAILY CARE ACTIVITIES - ENHANCING DAILY LIFE OF PWDs

ACTIVITIES

A person with Alzheimer's or other dementia doesn't have to give up the activities that he or she
loves.  Many activities can be modified to the person's ability.  In addition to enhancing quality of life, activities can reduce behaviors like wandering or agitation.   

Choosing Activities                                               
In the early stages of dementia, the person may withdraw from activities he or she previously enjoyed.  It is important to help the person remain engaged.  Having an open discussion around any concerns and making slight adjustments can make a difference.  For example, a large social gathering may be overwhelming, but the person may be able to interact more successfully in smaller groups.

As Alzheimer's progresses, you may need to make other adjustments to the activity. Use the following tips:

·      Keep the person's skills and abilities in mind
A person with dementia may be able to play simple songs learned on the piano years ago. Bring these types of skills into daily activities.

·      Pay special attention to what the person enjoys
Take note when the person seems happy, anxious, distracted or irritable. Some people enjoy watching sports, while others may be frightened by the pace or noise.

·      Consider if the person begins activities without direction
Does he or she set the table before dinner or sweep the kitchen floor mid-morning?  If so, you may wish to plan these activities as part of the daily routine.

·      Be aware of physical problems
Does he or she get tired quickly or have difficulty seeing, hearing or performing simple movements?

·      Focus on enjoyment, not achievement
Find activities that build on remaining skills and talents. A professional artist might become frustrated over the declining quality of work, but an amateur might enjoy a new opportunity for self-expression.

·      Encourage involvement in daily life
Activities that help the individual feel like a valued part of the household — like setting the table — can provide a sense of success and accomplishment.

·      Relate to past work life
A former office worker might enjoy activities that involve organizing, like putting coins in a holder or making a to-do list. A farmer or gardener may take pleasure in working in the yard. 

·      Look for favorites
The person who always enjoyed drinking coffee and reading the newspaper may still find these activities enjoyable, even if he or she is not able to completely understand what the newspaper says.

·      Consider time of day
Caregivers may find they have more success with certain activities at specific times of day, such as bathing and dressing in the morning.

·      Adjust activities to disease stages
As the disease progresses, you may want to introduce more repetitive tasks. Be prepared for the person to eventually take a less active role in activities.

Your approach
                                                                                                             
·      Help get the activity started
Most people with dementia still have the energy and desire to do things 
but may lack the ability to organize, plan, initiate and successfully complete the task.                                   

·      Offer support and supervision
You may need to show the person how to perform the activity and provide simple, easy-to-follow steps.

·      Concentrate on the process, not the result
Does it matter if the towels are folded properly?  Not really. What matters is that you were able to spend time together, and that the person feels as if he or she has done something useful.

·      Be flexible
When the person insists that he or she doesn't want to do something, it may be because he or she can't do it or fears doing it. Don't force it. If the person insists on doing it a different way, let it happen, and change it later if necessary.

·      Assist with difficult parts of the task
If you're cooking, and the person can't measure the ingredients, finish the measuring and say, "Would you please stir this for me?"

·      Let the individual know he or she is needed
Ask, "Could you please help me?" Be careful, however, not to place too many demands upon the person.

·      Stress a sense of purpose
If you ask the person to make a card, he or she may not respond. But, if you say that you're sending a special get-well card to a friend and invite him or her to join you, the person may enjoy working on this task with you. 

·      Don't criticize or correct the person
If the person enjoys a harmless activity, even if it seems insignificant or meaningless to you, encourage the person to continue.

·      Encourage self expression
Include activities that allow the person a chance for expression. These types of activities could include painting, drawing, music or conversation.

·      Involve the person through conversation
While you're polishing shoes, washing the car or cooking dinner, talk to the person about what you're doing. Even if the person cannot respond, he or she is likely to benefit from your communication.

·         Substitute an activity for a behavior
If a person with dementia rubs his or her hand on a table, provide a cloth and encourage the person to wipe the table. Or, if the person is moving his or her feet on the floor, play some music so the person can tap to the beat.

·         Try again later
If something isn't working, it may just be the wrong time of day or the activity may be too complicated. Try again later, or adapt the activity.




MUSIC, ART AND ALZHEIMER'S

Music and Art can enrich the lives of people with Alzheimer's disease.  Both allow for self-
expression and engagement, even after dementia has progressed.

Music

Music can be powerful.  Studies have shown music may reduce agitation and improve behavioural issues that are common in the middle-stages of the disease. Even in the late-stages of Alzheimer's, a person may be able to tap a beat or sing lyrics to a song from childhood. Music provides a way to connect, even after verbal communication has become difficult.

Use these tips when selecting music for a person with dementia:

•   Identify music that’s familiar and enjoyable to the person. If possible, let the person choose the music.
•   Choose a source of music that isn't interrupted by commercials, which can cause confusion. 
•   Use music to create the mood you want. For example, a tranquil piece of music can help create a calm environment, while a faster paced song from someone's childhood may boost spirit and evoke happy memories.
•   Encourage movement (clapping, dancing) to add to the enjoyment.
•   Avoid sensory overload; eliminate competing noises by shutting windows and doors and by turning off the television. Make sure the volume of the music is not too loud.

Art

Art projects can create a sense of accomplishment and purpose.  They can provide the person with dementia — as well as caregivers — an opportunity for self-expression.

When planning an art activity for someone with middle- to late-stage Alzheimer's, keep these tips in mind:

·      Keep the project on an adult level.  Avoid anything that might be demeaning or seem child-like.
·      Build conversation into the project.  Provide encouragement, discuss what the person is creating or reminiscence.
·      Help the person begin the activity.  If the person is painting, you may need to start the brush movement.  Most other projects should only require basic instruction and assistance.
·      Use safe materials.  Avoid toxic substances and sharp tools.
·      Allow plenty of time, keeping in mind that the person doesn’t have to finish the project in one sitting.