Table of Contents
Alzheimer’s Caregiving Challenges
Alzheimer’s disease can cause a person to exhibit unusual and unpredictable behaviors that challenge caregivers, including severe mood swings, verbal or physical aggression, combativeness, repetition of words, and wandering. These behavioral changes can lead to frustration and tension, for both people with Alzheimer’s and their caregivers. It is important to remember that the person is not acting this way on purpose, and to analyze probable causes and develop care adjustments.
Common Causes of Behavior Changes in Alzheimer’s Patients
- Physical discomfort caused by an illness or medications
- Over-stimulation from a loud or overactive environment
- Inability to recognize familiar places, faces, or things
- Difficulty completing simple tasks or activities
- Inability to communicate effectively
Tips for 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
Exploring Causes and Solutions
It is important to identify the cause of the challenging behavior and consider possible solutions.
- Identify and examine the behavior
- What was the undesirable behavior? Is it harmful to the individual or others?
- What happened before the behavior occurred and did something trigger it?
Explore Potential Solutions
- Is there something the person needs or wants?
- Can you change the surroundings? Is the area noisy or crowded? Is the room well-lighted?
- Are you responding in a calm, supportive way?
Try Different Responses in the Future
- Did your response help?
- Do you need to explore other potential causes and solutions? If so, what can you do differently?
How Do You Communicate with an Alzheimer’s Patient?
People with Alzheimer’s disease often find it difficult to express themselves and understand others. They may:
- Have difficulty finding the right words.
- Use familiar words repeatedly.
- Invent new words to describe familiar objects.
- Frequently lose their train of thought.
- Experience difficulty organizing words logically.
- Revert to speaking in a native language.
- Curse or use offensive words.
- Speak less often.
- Rely on nonverbal gestures.
Tips for Enhancing Communication with Alzheimer’s Patients
- Show that you are listening and trying to understand what is being said.
- Maintain eye contact.
- Encourage the person to continue to express thoughts even if he or she is having difficulty.
- Be careful not to interrupt.
- Avoid criticizing, correcting and arguing.
- Be calm and supportive.
- Use a gentle, relaxed tone of voice.
- Use positive, friendly facial expressions.
- Always approach the person from the front, identify yourself and address him or her by name.
- Speak slowly and clearly.
- Use short, simple and familiar words.
- Break tasks and instructions into clear, simple steps.
- Ask one question at a time.
- Allow enough time for a response.
- Avoid using pronouns and identify people by their names.
- Avoid using negative statements and quizzing (e.g., “You know who that is, don’t you?”).
- Use nonverbal communication such as pointing and touching.
- Offer assistance as needed.
- Don’t talk about the person as if he or she wasn’t there.
- Have patience, flexibility, and understanding.
See Tips for Better Communication with Alzheimer’s Patients for more detail.
Home Safety and Alzheimer’s Disease
When caring for an individual with Alzheimer’s disease at home, safety and accessibility are important concerns. There are simple steps you can take to make the home safe for the person with Alzheimer’s.
1. Make potentially dangerous places less accessible.
- Lock or disguise hazardous areas.
- Install door locks out of sight.
- Use special safety devices, such as child-proof locks and door knobs, to limit access to places where knives, appliances, equipment, and cleaning fluids are stored.
2. Accommodate for visual changes.
- Diffuse bright light by removing or covering mirrors and glass-top furniture, and cover windows with blinds, shades, or sheer draperies.
- Add extra lighting in entries, outside landings, areas between rooms, stairways and bathrooms because changes in levels of light can be disorienting.
- Place contrasting colored rugs in front of doors or steps to help the individual anticipate staircases and room entrances.
3. Avoid injury during daily activities.
- Monitor the temperature of water faucets and food because the person may have a decreased sensitivity to temperature.
- Install walk-in type showers, grab bars and decals to slippery surfaces in the bathroom to prevent falls.
- Supervise the person in taking prescription and over-the-counter medications.
4. Beware of hazardous objects and substances.
- Limit the use of certain appliances and equipment such as mixers, grills, knives, and lawnmowers.
- Supervise smoking and alcohol consumption.
- Remove objects, such as magazine racks, coffee tables and floor lamps, to create safe wandering areas and reduce the possibility of injury.
- Clean out the refrigerator regularly and discard inedible food.
- Lock firearms in a cabinet or drawer, or remove them from the house. Don’t allow unsupervised access to firearms.
5. Be prepared for emergencies.
- Keep a list of emergency phone numbers and addresses for local police and fire departments, hospitals, and poison control help lines.
- Check fire extinguishers and smoke alarms and conduct fire drills regularly.
- Enroll the person with Alzheimer’s disease in the Alzheimer’s Association Safe Return® program, a nationwide system designed to identify, locate and return to safety persons who are memory impaired.
Alzheimer’s and Driving Privileges
Driving is a complex activity that demands quick reactions, alert senses and split-second decision making. For a person with Alzheimer’s, driving inevitably becomes difficult. A diagnosis of Alzheimer’s disease does not mean the person has lost all ability to drive. Caregivers should evaluate the person regularly to determine if it is safe for him or her to drive.
Warning Signs of Unsafe Driving for Dementia Patients
- Forgetting how to locate familiar places
- Failing to observe traffic signals
- Making slow or poor decisions
- Driving at an inappropriate speed
- Becoming angry and confused while driving
For many, restricting driving privileges signifies a loss of independence and mobility, often forcing people with the disease to rely on friends, family, and community services for transportation. This sense of dependence may prevent people with dementia from giving up the car keys.
Tips to Limit Driving
- Ask a doctor to write the person a “do not drive” prescription.
- Control access to the car keys.
- Disable the car by removing the distributor cap or battery.
- Park the car on another block or in a neighbor’s driveway.
- Have the person tested by the Department of Motor Vehicles.
- Arrange for other transportation.
- Substitute the person’s driver’s license with a photo identification card (in addition to making the car inaccessible).
Hygiene and Personal Care for Alzheimer’s Patients
People with Alzheimer’s disease may need help with routine activities related to grooming and hygiene. The need for assistance can be very difficult for them because it signifies a loss of independence and privacy. It is also difficult for caregivers, especially when they assist with activities that interfere with the individual’s privacy. In this section, you will find tips on handling grooming and hygiene tasks for an individual with Alzheimer’s disease.
How to Get Dementia Patients to Bathe
Bathing is often the most difficult personal care activity that caregivers face. Because it is such an intimate experience, the person with Alzheimer’s may perceive it as unpleasant, threatening or painful and, in turn, exhibit disruptive behaviors such as screaming, resisting, and hitting. These behaviors often occur because the person doesn’t know what bathing is for or doesn’t have the patience to endure such unpleasant aspects as lack of modesty, being cold, or experiencing discomfort. Try the following:
- Do everything you can in advance to make the process easier, such as increasing the room temperature and having bath towels nearby.
- Make the person feel in control. Involve and coach him or her through each step of the process. You may need to experiment to determine if the individual prefers showers or tub baths and what time of day is best.
- Create a safe and pleasing atmosphere. Place non/slip adhesive on the floor surface and grab bars in the bathtub to prevent falls. Test water temperature in advance to prevent burns.
- Respect the person’s dignity. Some individuals may be self-conscious about their nakedness.
- Allowing the person to hold a towel in front of their body, both in and out of the shower, may ease anxiety.
- Don’t worry about the frequency of bathing. It may not be necessary to bathe every day.
- Sponge baths can be effective between showers or baths.
- Be gentle. The person’s skin may be very sensitive, so avoid scrubbing and pat skin dry instead of rubbing.
- Be flexible. You may experience the most difficulty when attempting to wash the person’s hair.
- Use a washcloth to soap and rinse hair to reduce the amount of water on the person’s face.
Using the Bathroom
It is common for persons with Alzheimer’s disease to experience loss of bladder and/or bowel control. This can be caused by many factors, including medications, stress, a physical condition, the environment, and the person’s clothing. If incontinence is a new problem, consult your doctor to rule out potential causes such as a urinary tract infection, weak pelvic muscles or medications. If the problem continues, try to:
- Provide visual cues. Signs may assist an individual in finding the bathroom. Placing colored rugs on the bathroom floor and lid covers on the toilet may help the bathroom stand out.
- Avoid having items nearby that can be mistaken for a toilet, such as a trash can.
- Monitor incontinence. Identify when accidents occur and plan accordingly. For example, if they happen every two hours, get the person to the bathroom before that time. To help control incontinence at night, limit the intake of liquids after dinner and in the evening.
- Remove obstacles. Make sure clothing is easy for the individual to remove.
- Provide reminders. Because the person with Alzheimer’s may forget to use the bathroom, you may need to remind him or her periodically. Also watch for visible cues such as restlessness or facial expressions that may indicate the person needs to use the bathroom.
- Be supportive. Help the person with Alzheimer’s retain a sense of dignity despite incontinence problems. A reassuring attitude will help lessen feelings of embarrassment.
Dental Care for Alzheimer’s Patients
Good oral hygiene can be a challenge for individuals with Alzheimer’s. Brushing is sometimes difficult due to the individual’s inability to understand and accept assistance from others. To help the individual:
- Provide short, simple instructions. “Brush your teeth” may be too difficult. Instead try: “hold your toothbrush,” “put paste on the brush,” and “brush your top teeth,” etc.
- Use a mirroring technique. Hold a brush and show the individual how to brush his or her teeth.
- Monitor daily oral care. Brush teeth or dentures after each meal and floss daily. Remove and clean dentures every night, and brush the person’s gums and roof of the mouth. If the person refuses to open his or her mouth, try using oral hygiene aids available from your dentist to prop the mouth open. Strained facial expressions during dinner or refusal to eat may indicate oral discomfort.
- Caregivers are essential in helping the person maintain oral hygiene, noticing any problems and seeking help from a dentist. Notify the dentist in advance that the person has Alzheimer’s so that an oral care routine can be developed.
Dressing a Patient with Alzheimer’s
Physical appearance contributes to everyone’s sense of self-esteem. Clothing can be a form of self-expression, so it’s important to consider the person’s tastes and dislikes. To help the person with dressing:
- Simplify choices. Each morning, offer two choices of shirts and pants for the individual. Keep the closet free of excess clothing.
- Organize the process. Lay out clothing in the order it needs to be put on, or hand the person each piece while giving short, simple instructions. Don’t rush the individual; it will only create anxiety.
- Be flexible. If the individual wants to wear the same outfit repeatedly, try getting a duplicate of the outfit or have similar options available.
- Choose comfortable and simple clothing. Cardigans or shirts that button in front are sometimes easier to work than pullover tops. Substitute Velcro™ for buttons, snaps, or zippers that may be too difficult to handle. Make sure the individual has comfortable shoes that are not slippery.
With all personal care activities, it is important to incorporate the individual’s past routine whenever possible into the current one. As you assist the person, be patient and creative. An approach that worked one day may not work the next, so be flexible.
Long-Distance Caregiving for Alzheimer’s
Caring for a loved one who lives far away can be emotionally and financially exhausting. Concerns about your loved one’s safety, nutrition, health, and care may seem overwhelming. You may also feel guilty and anxious because you cannot be there every day to see how the person is doing. This section offers advice on coping with long-distance caregiving and considerations for when it’s time to move your loved one into an assisted living facility.
Determine What Services Are Needed
If the person with Alzheimer’s disease lives alone, it is important to monitor his or her ability to manage various daily tasks. Visit the person with Alzheimer’s disease to determine what kind of assistance he or she may need. Make the following observations:
- Is there appropriate and adequate food available?
- Is the person eating regular meals?
- What is the condition of the living environment? Has it changed?
- Are the bills paid?
- Is the checkbook in order?
- Do friends and relatives visit regularly?
- Is the person maintaining personal care routines such as bathing and grooming?
- Is the person still able to drive safely?
Turn to Others for Help
Establishing an informal support system can help ensure the person’s safety and give you peace of mind.
- Family members and friends can provide companionship. Ask them to visit once a week or so, depending on how far away they live.
- Neighbors can check regularly on your loved one. Ask if they will remain alert to anything unusual such as the smell of smoke or the sound of an alarm coming from your relative’s home.
- Community organizations, such as churches, synagogues, neighborhood groups, and volunteer organizations often provide companion services.
If you are unable to answer these questions, the person’s doctor, neighbors, family members and friends can be good sources of information.
Make the Most of Visits
Few long-distance caregivers are able to spend as much time with their loved one as they would like. The key is to make periodic visits and use your time effectively:
- Make appointments with your loved one’s physician, lawyer, and financial adviser during your visit to facilitate decision making.
- Meet with neighbors, friends, and other relatives to hear their observations about how the person is doing. Ask if there have been any behavioral changes, health problems, or safety issues.
- Take time to reconnect with your loved one by talking, listening to music, going for a walk, or participating in activities you enjoy together.
Consider Carefully Before Moving a Loved One into Your Home
The decision to move the person to your home is influenced by many factors. Here are some things to think about before moving the person into your home:
- Does he or she want to move? What about his or her spouse?
- Is it possible to create an environment similar to their own home using same furnishings and draperies?
- Can accommodations be made for the person’s pet?
- Can favorite artwork or pictures be placed on the walls in the new home?
- Is your home equipped for this person?
- Will someone be at home to care for the person?
- How does the rest of the family feel about the move?
- How will this move affect your job, family, and finances?
- What respite services are available in your community to assist you?
Moving a person with Alzheimer’s disease from familiar surroundings may cause increased agitation and confusion. You may want to talk with your loved one’s physician or a social worker or call your local Alzheimer’s Association chapter for assistance before making a decision. In some situations, an assisted living or a residential care setting may be a better option for the individual.
Caring for a Loved One in a Facility
- Whether your loved one lives in an assisted living or a residential care facility, it is important to maintain ongoing communication with the care staff and friends who visit regularly.
- Work with the managing nurse and physician. Agree on a time when you can call to get updates on the person’s condition and progress.
- Call family, friends, or other visitors and ask for their observations.
- When you visit, meet with the staff members who have primary responsibility for your loved one’s care.
Resolving Family Conflicts
Caregiving issues can often ignite or magnify family conflicts, especially when people cope differently with caregiving responsibilities. Family members may deny what is happening, resent you for living far away, or believe you are not helping enough. There may also be disagreement about financial and care decisions. To minimize conflicts, try to acknowledge these feelings and work through them.
- Have a family meeting. Talking about caregiving roles and responsibilities, problems, and feelings can help ease tensions. You may want help from a professional counselor or clergy.
- Recognize differences. Some family members may be hands-on caregivers, responding immediately to issues and organizing resources. Others may be more comfortable with being told to complete specific tasks.
- Share caregiving responsibilities. Make a list of tasks and include how much time, money, and effort may be involved to complete them. Divide tasks according to the family member’s preferences and abilities.
- Continue to communicate. Periodic family meetings or conference calls keep the family up-to-date and involved. Discuss how things are working, reassess the needs of both the person with Alzheimer’s and the caregiver, and decide if any changes in responsibilities are needed.
Many long-distance caregivers feel guilty for living far away from the person with Alzheimer’s. This guilt, compounded by the grief related to seeing a loved one’s decline, may make it difficult to emotionally recover from a visit. It is important to seek support from family, friends, a counselor, or the Alzheimer’s Association to help deal with these feelings. See 6 Ways for Caregivers to Manage Feelings of Guilt for more tips.
Monitoring Abuse of Alzheimer’s Patients
People with Alzheimer’s are vulnerable to abuse by people close to them. They may also fall prey to strangers who take advantage of their cognitive impairment.
Types of Abuse
- Physical — causing physical pain or injury.
- Emotional — verbal assaults, threats of abuse, harassment and intimidation.
- Neglect — failure to provide necessities, including food, clothing, shelter, or medical care.
- Confinement — restraining or isolating the person.
- Financial — the misuse or withholding of the person’s resources to his or her disadvantage or the advantage of someone else.
- Sexual abuse — touching, fondling, or any sexual activity when the person is unable to understand, unwilling to consent, or threatened or physically forced.
- Willful deprivation — willfully denying the person medication, medical care, food, shelter, or physical assistance, and thereby exposing the individual with Alzheimer’s to the risk of physical, mental, or emotional harm.
Source: American Medical News (1992), vol. 35, no. 46
Coping with stress
Caregivers — both family and professionals — are most often the abusers of older people. In many cases, stress and frustration may provoke unintentional violent feelings in caregivers. Family caregivers may feel isolated, depressed, and resentful toward their loved as the disease progresses and may become abusive without realizing it. Other issues, such as substance abuse, emotional problems, and dependency may also lead to mistreatment.
If you are having difficulty dealing with stress related to caregiving, it is important to get the support you need through a counselor, clergy, or Association-sponsored support group. Learn more by viewing our infographic on Senior Abuse Awareness & Prevention.