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Alzheimer's Disease
 

ALZHEIMER'S DISEASE

Caring for your loved one

WHEN A LOVED ONE HAS ALZHEIMER'S DISEASE

Your loved one can't recall the name of a favourite grandson... Forgets how to get home... Asks the same question over and over again. If someone you love has Alzheimer's disease, these scenes may sound familiar. Now you wonder what lies ahead. This article can guide you. It can help you to learn more about Alzheimer's disease. It also suggests ways to cope with the challenges you now face.

What is Alzheimer's disease?
Alzheimer's is a brain disease that affects the person's ability to remember, reason and communicate. Alzheimer's is the most common cause of dementia, a general term for ongoing problems with memory and other mental functions. Dementia used to be known as "senility" and was thought to be a normal sign of getting older. But now we know that Alzheimer's and other forms of dementia are not a normal part of ageing.

How is it Diagnosed?
Alzheimer's is suspected when symptoms of dementia are present. Other diseases that cause the same symptoms must then be ruled out. These include thyroid problems, stroke and depression. The evaluation for Alzheimer's usually includes a memory test, blood tests and a brain scan. A neurologist (a doctor specialising in the brain) may be involved.


UNDERSTANDING ALZHEIMER'S

Learn all you can about Alzheimer's. It's one of the best ways to help your loved one and yourself. Alzheimer's is a disease that causes changes in areas of the brain that control memory and reasoning. This is why people with Alzheimer's have problems with day-to-day living. Why the disease develops is not yet fully understood. At present, it has no cure. But proper care can help most people with Alzheimer's live a comfortable life for many years.

How the Brain Works?
The brain controls all the workings of the body and mind. Different areas of the brain control different functions. Certain areas control physical tasks such as walking. Other areas control language skills. Still others control mental tasks such as remembering, concentrating and decision-making.

Changes in the Brain
In people with Alzheimer's, cells in certain areas of the brain begin to die. Microscopic structures, called plaques and tangles, also start to form. As cells die and plaques and tangles form, the brain can't work the way it's supposed to. The areas of the brain affected by these changes are the ones that control mental functions such as memory. Other functions, such as movement, are generally not affected until very late in the illness.

Who gets Alzheimer's?
Alzheimer's disease tends to affect people over 65. The older you are, the more likely you are to develop the disease. But people who are as young as 40 years of age can be affected. All types of people get Alzheimer's. No profession, education level or race is immune. In some cases, Alzheimer's may run in the family. In other cases, no other family members are affected.

The Effects of Alzheimer's Disease
The symptoms of Alzheimer's disease appear slowly. The average length of time from the first through the last stages is about 9 years. This time can vary widely.

In the early stage, the person seems confused and forgetful. He or she may search for words or leave thoughts unfinished. Recent events and conversations are often forgotten. However, the distant past may be remembered clearly.
In the middle stage, more and more help is needed with daily tasks. The person may not know family members, may get lost in familiar places and may forget how to do simple tasks such as dressing and bathing. He or she may be restless, moody and unpredictable.
In the last stage, memory, judgement and reason may be lost completely. Help with every aspect of daily life is generally needed.

Treating Alzheimer's Disease
The goals of treatment are to manage symptoms and keep your loved one comfortable.
Medications may improve symptoms in some cases. One type of medication sometimes helps with memory loss. Others treat symptoms such as agitation or depression. The doctor can determine which medications may help your loved one.
A management plan that includes the care and supervision is essential. Your loved one's health care professionals can help you make a plan and carry it out.
Regular doctor visits help keep track of your loved one's condition. Other problems or illnesses can be checked for and treated.


KEEPING YOUR LOVED ONE SAFE

Many of the symptoms of Alzheimer's disease can cause safety concerns. Symptoms such as forgetfulness and confusion can lead to unsafe situations. Try some of these hints to keep your loved one - and those around him or her - safe.

Organise a Safe Living Space
Look for things in each room that may be hazardous for someone who is forgetful or confused. Decide what should be changed. It can be hard for people with Alzheimer's to adjust to changes, so alter as little as possible. Try these tips for dealing with common hazards.

Reduce Clutter
Clutter makes confusion worse. It can also lead to falls. Keep living areas, walkways and stairs free from clutter.

Secure Stoves and Appliances
Stoves and other appliances may be turned on and forgotten or used in the wrong way. Remove or cover knobs or turn stoves and microwaves off by the outlet when not in use. Also, unplug or put away irons, toasters, blenders, power tools and other electrical equipment.

Remove Other Hazards
Turn the hot-water heater temperature down to below 38C to prevent burns.
Remove locks from the inside of bathroom and bedroom doors.
Keep pool or hot-tub areas locked.
Check stored food for spoilage. A person with Alzheimer's may not realise when food has gone bad.
Keep purses, keys, bills, check books and other important items out of sight. People with Alzheimer's may move or hide objects and not recall doing so.

Prevent Driving
For a person with Alzheimer's, driving may not be safe. Your loved one may not want to give up driving. But for everyone's sake, do as much as you can to prevent him or her from getting behind the wheel.
Have an authority figure, such as a doctor, lawyer or insurance agent; tell your loved one not to drive.
Call your local department of motor vehicles. Some states require a driving test when a person is diagnosed with Alzheimer's disease.
Limit access to the car. Hide the keys and keep the car locked up. Try storing the car out of sight.

Control Wandering
Persons with Alzheimer's disease may become restless and confused. They may wander around the house or even leave the house and get lost.
Put night-lights in the hallways and bathrooms.
Install door locks that are hard for your loved one to operate.
Ask neighbours to call you if they see your loved one out alone.
Go with your loved one if he or she insists on leaving the house. Avoid arguing or yelling. Rather, gently persuade him or her to return home.
Call your local Alzheimer's Association for details about programmes that help with wandering.


CARING DAY TO DAY

Caring for a person with Alzheimer's means planning activities and looking after daily personal needs. Having a regular daily schedule can help. Your loved one will feel most secure with a familiar routine.

Plan Daily Activities
People with Alzheimer's disease often become bored and frustrated. They may want to be active, but can't begin something on their own. Plan ahead to help keep your loved one involved.

Tips that may help
Keep it simple. If a task is too complex, your loved one may become frustrated. Tasks that involve repetition are good choices. Alter activities as your loved one's abilities change.
Do things together. Let your loved one do as much as possible, but be there to help. Choose activities with many easy tasks, such as baking a cake. Do the tasks that are too hard for your loved one, such as measuring. Let him or her do the rest.
Don't withdraw. Make activities simpler rather than dropping them. Instead of meeting a group of friends, visit with just one. Instead of running three or four errands, stick to one.
Stay active. Regular exercise can help both you and your loved one release pent-up energy. Exercise lessens restlessness and improves sleep. Walking is a great way to exercise together.

Help with Personal Care
Over time, your loved one will need more and more help with daily tasks. But, at any stage, let your loved one do as much as possible.

Eating and drinking
At least once a day, sit down together for a meal. Meals are a nice time to be social. It also lets you keep better track of the amount and type of food that's being eaten.
Make a meal as healthy as possible. Ask the doctor whether food supplements will help.
Be sure to provide plenty of fluids.

Dressing
If your loved one dresses him or herself, don't worry if the clothes don't always match.
Choosing what to wear may be too much for a person with Alzheimer's. Try laying out an outfit each day.
When help is needed, try to hand over each item of clothing and tell them how to put it on.

Bathing and grooming
Your loved one may be sensitive about being reminded to bathe. It may help to treat bathing as an expected activity that happens at a fixed time each day.
Prepare the water and other bath items ahead of time.
Visits to a barbershop or beauty salon may be helpful for hair washing, hair styling and shaving.

Taking medications
Keep track of daily medications. A sectioned pillbox and a checklist may help.
Don't rely on your loved one's word that medication has been taken. Watch to be sure it is taken on time and in the right amount.
Store medications in a safe place to prevent too much from being taken by mistake.


COMMUNICATION AND BEHAVIOUR

Alzheimer's disease makes it harder for your loved one to understand and be understood. It can also cause your loved one to act in ways that frustrate or upset you. Keep in mind that these problems are due to the disease and are not done on purpose. Learn ways to cope with challenging situations and avoid making them worse.

Strategies for Improving Communication
People with Alzheimer's have trouble understanding the meaning of what is being said. However, they are very sensitive to how things are said. An agitated tone can upset your loved one. A calm tone can reassure. Keep a positive tone in your voice as much as you can. These other tips may also help you to communicate better.

Avoid arguing about reality
Your loved one will become confused about reality and not be able to separate past from present. He or she may even forget who you are. This can be upsetting. But don't insist on your version of reality - it may just cause more confusion and stress. Decide how important each issue is. If you can "play along," you may spare both of you much frustration.

Reassure
Your loved one may ask the same question over and over again. This can be annoying but try to understand why the question is being asked. Foe instance, your loved one may be worried about missing an appointment or being left behind.

Use distraction
Your loved one may try to do something unsafe, such as leaving the house alone. Arguing may make the situation worse. Instead, try distraction. Your loved one may soon forget what he or she had planned to do.

Try statements, not questions
Your loved one may not want to do a certain activity, such as take a bath. Phrasing the requests as statements rather than questions can help to avoid arguments.

Coping with Personality Changes
At times, your loved one's personality may seem to change. Common changes associated with Alzheimer's disease include depression, withdrawal, apathy, irritability, suspiciousness and restlessness. Hallucinations (seeing things that aren't there) and delusions (irrational beliefs) can also occur. If these problems are sudden, severe or create a danger, discuss them with your doctor. In general, try not to take things that your loved one says and does personally.
Remember: To a person with Alzheimer's, the world can be a very stressful place. Try to see things from that point of view.

PLANNING FOR THE FUTURE

Because your loved one's needs change over time, plan ahead. Arrange a living situation, get legal advice and look closely at finances.

Choose a Care-giving Situation
Supervision is a must for persons with Alzheimer's. Choosing the right caregiving situation means first deciding how much supervision your loved one needs. Depending on the stage of the disease and how well your loved one functions, this can range from daily visits to around-the-clock care. First decide the right amount of supervision. Then decide how best to provide it. Your options may include:

Hired help
Adult day care
A live-in caregiver (often a family member)
Assisted living facilities (senior living with personal help)
Nursing homes
No matter what option is chosen, look at it from time to time to be sure it's still the best for all concerned. Always know what your next choice will be when the current situation stops working.

Consider Legal and Financial Issues
The time will come when your loved one can no longer make sound decisions. It's best to prepare for this. Talk to your loved one about these issues. Do so as early as possible, when he or she can still understand your goals and freely agree to make changes. If you can, contact a lawyer who specialises in elder care. A lawyer can help you with your legal and financial planning.
Some Issues to Consider
Durable power of attorney and living trusts: These transfer financial and legal power from your loved one to a person who can make sound decisions in your loved one's interest.

Medical expenses: Medicare, Medicaid and private insurance carriers all have limits on what types of care they will cover. Look closely at your insurance coverage. Also check to see what kinds of aid your state offers. If you plan ahead, you can avoid unexpected bills.
Advance medical directives, such as living wills: These let your loved one say what types of medical treatment he or she wants - or doesn't want - down on the line.


TAKING CARE OF YOURSELF

Caring for your loved one will take up much of your time. But look after your own needs, too. Build a support network. This network can include friends, family and organised groups. Also realise when it is time to look at other caregiving options.

Make Time for You
Spend some time outside of your role as caregiver. You may not feel right about being away from your loved one. But doing things for yourself helps you to keep healthy and better prepared to face the challenges of caregiving. Try things such as the following:

Plan activities with friends or family members.
Pursue a hobby that you enjoy.
Exercise to help relieve stress and keep healthy.
Relax. Read a good book or take a nap.
Look into ways to get regular breaks from caregiving. Family, friends or hired aids can help. Call your local Alzheimer's Association for suggestions of resources.

Accept Your Emotions
At times you may feel anger, frustration, fear or resentment. Don't feel guilty. These are normal emotions. Share your feelings with someone you can talk to. If you feel depressed, tell your doctor. Also watch for signs that others in the family, such as children, need help dealing with emotions. Finally, your loved one will sometimes do things that you find amusing. Don't be afraid to laugh. Encourage your loved one to laugh, too.

Get Help and Support
Look to others to help you with caregiving. Even if they can't help out, friends and family can be a source of comfort and support. Alzheimer's support groups can also be a good resource. These groups let you share stories and tips with others who care for loved ones with Alzheimer's.

Know When to Make a Change
The time may come when you may no longer be able to care for your loved one safely. Or you may find that you can no longer cope with the responsibilities of caregiving. When this happens, it doesn't mean you've failed. Changing the situation may be the best for everyone. Your next option may be a long-term care facility, such as a nursing home. These facilities are often specially equipped for people with Alzheimer's. They can help to ensure that your loved one is safe and well cared for.










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