Help aides understand Alzheimer’s patients
Help aides understand Alzheimer’s patients
It’s easy for aides and other staff to misunderstand Alzheimer’s disease patients and their behaviors. Often aides and caregivers will argue with patients to prevent them from wandering or doing something that might injure them or others. A more creative strategy works much better.
Cozby-Germany Home Health in Grand Saline, TX, held a two-hour inservice for aides and nurses to teach them some creative strategies for dealing with Alzheimer’s disease patients. The inservice also focused on differences between dementia associated with Alzheimer’s and other types of dementia, says Shonna DeFoy, RN, LVN, former assistant director of nurses and education coordinator for the hospital-based agency, which serves a rural area in eastern Texas.
"If someone has senility, you have to reorient them to a person, place, and time," DeFoy explains. "But if someone has Alzheimer’s disease, you can only agitate them further by having them repeat back to you the day, time, place."
The inservice dispelled myths, such as cooking with an aluminum pan causes the disease. And it included demographic facts: Most patients are older than 60, for instance. DeFoy gave the staff handouts from the Alzheimer’s Association in Chicago, and she had them take a quiz at the end of the inservice. (See quiz, inserted in this issue.) Here are the basic areas she covered:
• Creative tactics: Alzheimer’s patients often wander, which can endanger them. How ever, if an aide or caregiver tells them not to go outside, they might become agitated and argue about it. Instead, DeFoy suggests, try to prevent patients from leaving the house with this little trick from the Alzheimer’s Association: "Get a black floor mat and cut it in a half circle, and put it at the doors on the inside of the house," she says. Patients who are in the middle and late stages of Alzheimer’s will stop at the door when they see that black mat because they will think it is a black hole, she explains.
"We had some family members who tried it, and it was amazing to see the patients stop at the half circle and turn around and go somewhere else," she says. You can find the black mats at feed stores or household supply companies, she adds.
Another trick is to entertain Alzheimer’s patients with motorized stuffed animals sold in toy stores. Those little dogs or cats have a button that causes them to do flips. "Those cause hours of enjoyment," DeFoy says. "Also, you can get a box of Kleenex and let patients pull them out and organize them, putting them back in the box." Both of those distractions will keep a patient from wandering around, she says.
Home care staff can help family members cope with Alzheimer’s patients by showing them how to stay calm and reassure patients by touching them on the arm. "Speak in a distinct but a slow voice," she suggests. "You may have to repeat yourself and use simple words."
Aides and others dealing with Alzheimer’s patients should stay at eye level with them to make good eye contact. Also, avoid startling patients by coming up behind them.
Getting patients to eat may take some creativity. DeFoy suggests making the food colorful and attractive, perhaps by adding food coloring. Even if these patients have healthy teeth and gums, they may not like foods that are tough to chew, so caregivers should grind up meat or make meatloaf or chicken salad. "Use finger foods because utensils can be dangerous, and they don’t know what to do with them," she adds.
• Alzheimer’s disease stages: DeFoy covered the three stages of Alzheimer’s disease in the inser vice — early, middle, and late — and what happens when patients are in a terminal phase:
— In the early stages, patients are alert and usually can be oriented to time, place, or person, but they may have short-term memory loss. "What’s agitating about the early stage is patients can tell something is going on, but they don’t know what it is," she explains. "They wonder if they’re losing their minds."
These early-stage patients may be able to drive their cars, but they will forget to stop at a stop sign. Or they might forget to flush the toilet. "They begin to get a little impatient because they know something is going on, and they try to cover it up," she adds. "So they become paranoid and feel like people are paying too much attention to their errors."
— In the middle stages, the patient typically is alert but is disoriented to time and place. "They might know the home health aide, and they know themselves, but they don’t remember acquaintances," DeFoy says. "That’s difficult with home care because the patient might see an aide three times a week and forget the aide’s name."
Also, patients may get lost in stores or new surroundings. Their attention spans are shorter, and they may become more irritable. Their hygiene becomes poor, and they might forget to wipe after a bowel movement. "They may get up and pull the pants back up because they don’t know to wipe anymore," she adds.
— Late-stage Alzheimer’s is full-blown dementia. Patients’ faces appear dull. They become disoriented to person, place, and time. They also become incontinent, confuse days and nights, and forget who their spouses or children are. "They don’t follow simple commands, and that’s when you want to take dangerous objects away from them," she says. "If they’re long-term smokers, they don’t know if they want a cigarette anymore."
These patients should be kept away from stove burners and cigarettes. They might aimlessly open drawers, meddle through things, and even reach out to strike someone because they’re easily provoked. "They may become very paranoid and think people are stealing from them," DeFoy says.
— Patients who are bedridden typically are considered to be in the terminal phase. At this point, they have lost their ability to chew and swallow, so they lose a lot of weight. Most of these patients will be placed in nursing homes where they can be tube-fed. Terminal-stage patients usually are unable to make eye contact, and if a mirror is held to their faces, they will not be able to recognize themselves, she says.
• Diagnosing the disease: Typically, clinicians diagnose the disease when a patient exhibits various symptoms, including disorientation and gradual memory loss. "There is not a specific cognitive or clinical test developed to totally identify Alzheimer’s disease," DeFoy says. "Basically what it used to be was you were diagnosed after death because they could do an autopsy of the brain."
Now, medical researchers are finding other methods to indicate someone has the disease, including using MRIs and X-rays to analyze patients’ brain atrophy. They’re also working on an eye-drop test in which a drug will be placed in patients’ eyes; if the patient has Alzheimer’s, the drug may cause the pupils to enlarge, she says. "They’re also working on a protein test to determine protein levels in the blood," she adds.
• Treatment: "Treatment is making sure they’re eating adequately, taking in enough fluids, maintaining self-care, and allowing them to have as much independence as they safely can," DeFoy says. Make sure the house is a safe environment, by decreasing the risk of falls and making sure they are not using any hazardous equipment, she advises. "Make sure you put plugs in the wall outlets, just like for kids. And make sure there are no chemicals laying out because they don’t know the difference between water and bleach."
If the disease has progressed to the point that patients won’t allow caregivers to brush their hair or teeth or help with their other personal hygiene activities, it may be time for families to consider placing them in a long-term care facility, she says. Aides should notify the nurse in this sit uation, and the nurse should talk with the family.
sources
• Alzheimer’s Disease and Related Disorders Association, 919 N. Michigan Ave., Suite 1000, Chicago, IL 60611-1676. Phone: (312) 335-8700 or (800) 272-3900. Fax: (312) 335-0274.
• Shonna DeFoy, RN, LVN, Former Assistant Director of Nurses and Education Director, Cozby-Germany Home Health, 707 North Waldrip, Grand Saline, TX 75140. Phone: (903) 962-3026. Fax: (903) 962-7842.
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