alzheimers disease: supporting the person supporting their caregivers shelly zylstra...
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Alzheimer’s Disease:Supporting the Person
Supporting their Caregivers
Shelly [email protected]
360-676-6749
A Few Facts• Once considered a rare disorder,
Alzheimer’s disease is now seen as a major public health problem that is seriously affecting millions of older Americans and their families.
• In 2050, +70 million people will be over the age of 65; 20 million over the age of 85. – An estimated 14 million Americans will
have Alzheimer’s disease if a cure is not found.
• Alzheimer’s disease will be the leading cause of death among adults by the middle of this century.
What Is It?
• Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills.
• Not Normal Aging!• Alzheimer’s disease destroys
brain cells and causes abnormal structural changes in the brain
Dementia is Not Normal Aging
20 year old brain 80 year old brain
The Brain
• Adult weight: about 3 pounds
• Adult size: a medium cauliflower
• Different parts of the brain do different things
Cerebral Hemispheres
• Where sensory information received from the outside world is processed; this part of the brain controls voluntary movement and regulates conscious thought and mental activity:– accounts for 85% of
brain’s weight
Cerebellum
• In charge of balance and coordination:– takes up about 10%
of brain – consists of two
hemispheres
• Receives information from eyes, ears, and muscles and joints about body’s movements and position
Brain Stem
• Connects the spinal cord with the brain
• Relays and receives messages to and from muscles, skin, and other organs
• Controls automatic functions such as heart rate, blood pressure, and breathing
Different Parts-Different Roles
• Even though the activities are similar, a different part of the brain is involved– Walking-Kicking– Talking-Swearing– Chewing-Swallowing
Hearing Words Speaking Words Seeing Words Thinking about Words
Scans Show the Loss of Activity
Reversible Dementias
• Intoxications• Infections• Metabolic
disorders• Depression• Medication
Problems
• Brain tumors• Head injuries • Normal
pressure hydrocephalus
• Dehydration
Irreversible Dementias
• Alzheimer’s disease
• Multi-Infarct Dementia
• Parkinson’s disease
• Lewy Body disease
• Creutzfeldt-Jakob disease
• Pick’s disease• Huntington’s
disease• AIDS dementia
complex• Progressive
aphasia
Prevalence of Alzheimer’s Disease by
Age
0
10
20
30
40
50
%
65-74 75-84 85+
65-74
75-84
85+
Stages of Alzheimer’s diseaseFunction Early StageMemory Routine loss of recent
memory
Orientation Seeks familiar and avoids unfamiliar
Language Mild aphasia (word finding difficulty)
Motor Some difficulty writing and using objects
Mood Apathy & depression
ADL’s Needs reminders with some ADL’s
Stages of Alzheimer’s diseaseFunction Middle StageMemory Chronic, recent memory
loss
Orientation May get lost at times, even in home
Language Moderate aphasia (word finding difficulty)
Motor Repetitive actions; apraxia (unable to start an action)
Mood Some mood and behavior disturbances
ADL’s Needs reminders and help with most ADL’s
Stages of Alzheimer’s diseaseFunction Late StageMemory Mixes up past and
present
Orientation Misidentifies familiar places
Language Expressive and receptive aphasia; often does not understand
Motor Bradykinesia (very slow walking); fall risk
Mood Increased mood and behavior disturbances
ADL’s Needs reminders and help with all ADL’s
Stages of Alzheimer’s diseaseFunction Terminal StageMemory No link to past or present
Orientation Oblivious to surroundings
Language Mute or a few incoherent words
Motor Little voluntary movement; dysphasia, myoclonus, seizures
Mood Completely passive
ADL’s Total Care
Alzheimer’s Symptoms
• Very gradual onset• Picture may differ from person to
person• Gradual withdrawal from active
engagement with life• Narrowing social activities and
interests• Lessening of mental alertness and
adaptability• Lowering of tolerance to new ideas
and changes in routine• Thoughts and activities may be
selfish or childlike
Alzheimer’s Symptoms• Progressive memory loss• Difficulty remembering familiar things• Difficulty performing familiar tasks• Problems finding the right words• Misplacing things/ Messiness• Confusion and agitation• Poor judgment and poor decision
making skills• Changes in personality – mood swings• Loss of initiative
Might Even Involve the Law!
• Wandering/Lost• Auto Accidents• Indecent Exposure• Homicide/Suicide/Domestic
Violence• Suspicion of DUI/Intoxication• Abuse/Neglect• Trespassing• Shoplifting
Behaviors• Alzheimer’s disease
often causes a person to exhibit unusual and unpredictable behaviors.
• This can easily lead to frustration and tension in the person with Alzheimer’s as well as the person responsible for them.
Challenging Behaviors
• Agitation, anger, depression, aggression
• Combativeness• Psychosis• Wandering• Sleeplessness • Sundowning• Unpredictable
situations
Agitation, Anger, Depression
• Agitated behavior can be disruptive to the elders daily life.
• Anxiety may not be put into words but instead manifest physical symptoms such as a racing heart, nausea, or pain.
• Agitation may increase the risk of harm to the affected individual and to others.
Agitation• Irritability, frustration, excessive anger• Constant demands for attention &
reassurance • Repetitive questions or demands• Stubborn refusal to do things or go
places• Constant pacing, searching,
rummaging• Yelling, screaming, cursing, threats• Hitting, biting, kicking
Depression
• Extreme tearfulness• Hand-wringing• An excessive need for
reassurance• Other signs of extreme
unhappiness• Loss of interest in things they
used to love• Excessive sleep• Personality changes
Aggression
• Verbal accusations and insults• Aimless screaming• Refusal to cooperate with
simple requests• Physical assaults• Self-injury such as head
banging or biting oneself
Delusions• When the person believes things
that are not true.• Common examples of delusions
would be:– Believing that one is in danger
from others and that others have stolen items or money.
– A spouse is unfaithful– Unwelcome guests are in the
house– A relative or friend is an imposter
and not who they claim to be.
Hallucinations • This is a false perception of
objects or events involving the senses.
• The person may see, hear, smell, taste or feel something that is not there.
• If it doesn’t cause a problem it might be best to ignore it.
• If it becomes continuous then look for a possible underlying physical cause.
Look for The “Why”
• Physical discomfort caused by an illness or medications.
• Over-stimulation from or overactive environment
• Inability to recognize familiar places, faces, or things
• Difficulty completing simple tasks or activities.
• Inability to communicate effectively.
There is usually a Cause• Physical factors
– Is the person tired because of inadequate rest or sleep?
– Are medications causing side effects?– Is the person unable to let you know he
or she is experiencing pain?
• Environmental factors– Is the person over stimulated by loud
noises, an overactive environment, or physical clutter?
– Does the person feel lost or abandoned?
Sleeplessness and Sundowning
• About 20% experience periods of increased confusion, anxiety, agitation, and disorientation from dusk to dawn.– End-of-day exhaustion (mental & physical)– An upset in the “internal clock” causing a
biological mix-up between night & day– Reduced lighting and increased shadows– Disorientation due to the inability to
separate dreams from reality when sleeping
– Less need for sleep, which is common among older adults
Responding to Challenging Behaviors
• Stay calm and be understanding• Be patient and flexible• Don’t argue or try to convince the
person• Acknowledge requests and respond
to them.• Try not to take behaviors personally• Accept the behavior as a reality of
the disease and try to work through it.
Try to Determine the Cause• Often the trigger is some change in
the person’s environment.– Clutter, new person in the room– Change in routine– Pain– Hunger– Thirst/dehydration – Full bladder/UTI– Fatigue/pending illness – Infections– Skin irritation– Constipation
Hints to Manage Behavior
Don’t• Argue or
disagree• Confront• Raise your voice• Take offense• Corner, crowd• Try to reason
Do• Simplify the
environment, tasks and routines
• Allow adequate rest between stimulating events
• Use labels or clues to remind
Don’t• Restrain, • Shame, criticize• Demand or try to
force• Talk down, ignore• Explain, teach• Rush• Show alarm• Make sudden
movements
Do• Back off• Use calm,
positive statements
• Reassure• Slow down• Offer guided
choices between two options
• Limit stimulation and offer simple exercises
Communication
• Communication is critical and can be the basis for poor behavior– Are you asking too many questions
or making too many statements at once?
– Are your instructions simple and easy to understand?
– Is the person picking up on your own stress and irritability?
– Are you being negative or critical?
Communication• Remember people with Alzheimer’s
Disease often find it hard to remember the meaning of words that you are using or to think of the words they want to say.
• Identify yourself by name and call the person by name. Don’t ask, “Do you know who I am?”
• Approach the person slowly from the front and give them time to get used to your presence. Maintain eye contact.
Communication
• Try to talk away from other distractions such as a loud TV or others trying to join the conversation.
• Speak slowly and distinctly. Use familiar words and short sentences
• You may feel angry but don’t show it. If you are about to “lose it” try counting to ten. REMEMBER that this person has a disease and is not deliberately trying to make things difficult for you.
• Keep things positive. • Offer positive choices with no wrong
answers • If the person seems frustrated and you
don’t know what he or she wants, try to ask simple questions that can be answered with yes or no or one-word answers.
• Use gestures, visual cues, and verbal prompts to help.
• If conversation causes agitation drop the issue rather than try to clear it up.
• Use memory aids such as calendars & lists.
• Explore various solutions.• Accept the behavior as a reality of the
disease and try to work through it.• Acknowledge requests and respond to
them.• Respond to the emotion and not the
behavior.• Offer corrections as a suggestion. Avoid
explanations that sound like scolding. Try “I thought that was a spoon.”
• Provide Information • Provide Assistance• Respite Care
– Adult Day Care• Counseling or Support Groups• Training• Supportive Services
– Caregiver Consultants– Loan Closet
Caregiver Support
Resources• http://www.ahaf.org/alzdis/about/
adabout.htm• http://www.mayoclinic.com/health/
alzheimers-caregiver/AZ00018• http://www.agis.com/• http://www.nia.nih.gov/
Alzheimers/Publications/caregiverguide.htm
• Or Call your local Alzheimer Association Chapter