PATIENTS WITH ALZHEIMER’S DISEASE
Progressive aging of the population in highly developed countries has led to a significant increase in patients suffering from degenerative changes in the nervous system, such as dementia. There are many types of dementia, each one differing in its dynamics of development, causes and prognosis.
Alzheimer’s disease remains the most common type of dementia. Estimates suggest that more than twenty million people suffer from it around the world and the number is continuing to increase. People affected by the disease gradually lose independence and cease to be aware of their environment and other people around them. As a result, a person affected by it requires complete care of another person. The disease progresses with time increasing the scope of care required by the affected person.
WHAT ARE THE CAUSES OF ALZHEIMER’S DISEASE?
For many years, scientists have been trying to investigate the cause of change in dementia patients’ brains. Their primary focus is to find out how to stop the precursors that lead to permanent dementia and disability for millions of people.
So far, there have been no definite answers for the underlying causes for degeneration of the nervous system. However, some risk factors have been identified. These include the following:
- Gender: Females appear to be affected more than males
- Age: Alzheimer’s cases are more common in people over the age of 65
- Genetic Predisposition: People with a family history of Alzheimer’s disease are more likely to be affected
- Hypertension: Chronic stress and depression can also cause an onset of the disorder
- Increased Cholesterol: Higher fat concentration in the body can have an adverse effect on brain function
- Diabetes: Excessive blood sugar can also affect the brain’s working
- Head Injuries: People who have suffered a trauma or head injury are more likely to develop the disorder
- Lifestyle: Lack of physical and mental activity also appears to trigger Alzheimer’s disease
HOW DOES ALZHEIMER’S DISEASE START?
The first symptoms of the disease can be barely noticeable to the doctor or health care worker who deals with the patient. Only the person closest to the patient’s environment may notice subtle changes in behaviour.
Memory impairment (especially problems with recalling words, names of objects and current events) and difficulties in focusing on everyday activities are the usual first signs. The patient may deny the first symptoms, become indifferent and depressed or on the contrary, irritable and aggressive.
This is the light dementia phase which may last longer or shorter, depending on the progression of the disease. People with high, initial intellectual capacity do not lose their brain functions as quickly as people with low mental capacity.
In the next stage, memory problems become deeper in the affected person impeding his or her contact with the environment and other people. Natural conversations and daily activities like shopping and communicating with children becomes difficult. The person may get lost even in their local area and lose the ability to recognize faces of people close to them. Affected people may also lose the ability to dress or wash themselves.
Once Alzheimer’s progresses to this degree, the person requires assistance of a 24-hour carer. The last stage of the disease is the total loss of intellectual and emotional contact with the world. The person neglects personal hygiene and loses even the simplest of abilities to recognize or communicate with others.
Alzheimer’s disease may also cause psychiatric disorders such as depression, sleep disorders, delusions, anxiety or excessive excitability that leads to aggression. Delusional behaviour can be particularly unpleasant for the carer where the patients accuse the people around them of acting to their detriment. The patients may claim that others are trying to starve them, beat them or attempting to poison them. We should remember that all these symptoms are only a result of the disease and not the actual attitude of the patient.
HOW TO CARE FOR A PERSON WITH ALZHEIMER’S DISEASE?
Although every case of illness is different and every family situation of the patient is unique, you can find some common elements among Alzheimer’s patients. We present tips, observations and advice based on the experience of many professional carers who have worked with patients in various stages of dementia – including Alzheimer’s disease.
In most cases, the family does not notice the first signs of the disease. The disease develops slowly and unnoticed. Distractions, inattention, lack of concentration, forgetfulness, endless questions or their repetition is often present with old age and modern lifestyle. Early diagnosis can give patients a chance to take early treatment that slows down the development of the disease. This can extend the time of their independent functioning.
The first symptoms of the disease are problems with memory, difficulty in choosing words, limited vocabulary and inability to name things properly. The carer often has to guess what our client wants to say.
Two things that are very important in working with the person are patience and understanding.
Carers can help by forming questions where the clients can answer “yes” or “no”. The instructions should be short and clear. For example, ‘take off your shoes’, ‘wash your hands’ etc. The tone of voice and facial expression are important here. We should remember that an ill person will not always understand the meaning of words, but they always react to the tone of our voice. They can be complaint when met with pleasant and balanced tone while the opposite can cause irritation and conflict.
It is worth reminding the patient every day, what day of the month it is. The carer can put a calendar with dates marked with large numbers in visible place. They should inform the patient about the weather and engage them in simple activities such as washing, vacuuming, watering plants and peeling vegetables. The carer should also suggest activities that stimulate the brain such as memory games, watching TV programs, arranging puzzles, browsing photos, painting etc. Music can also have a soothing effect on the behaviour of the person and fill his or her time.
For most Alzheimer’s patients, the memory problem becomes worse over time. The patient starts to lose orientation in time and space. They do not recognize friends or members of their family. Carers may also notice changes in mood, personality and behaviour as well as disturbances in the schedule such as sleeping during the day and staying up at night.
Gradually, the person stops controlling their physiological needs and the physical condition becomes worse. In the advanced stage, the disease makes it impossible to perform even simple everyday activities and the client will require constant care and attention.
LIVING CONDITION ADJUSTMENTS FOR ALZHEIMER’S PATIENTS
Alzheimer’s disease affects the family’s lifestyle as well. Daily routine adjustments help provide adequate care to their loved one. This may involve a change of job, place of residence and request help from other family members. Additional help can be acquired through live-in, home care professional caregivers. Professional carers are experienced in providing care to Alzheimer’s patients inside their homes. We would not recommend changing the place of residence of a person affected by the disorder, as it is better to stay in the familiar surroundings for the longest time possible.
The patient’s apartment should be adapted to their needs. Furniture and fixtures are moved around gradually to avoid radical changes. It is worth removing rugs and runners on which it is easy to slip, while the furniture should be placed closer to the wall, so that the ill person cannot bump into it.
A carer should also arrange a permanent, comfortable corner in the patient’s room or the living room to make the patient feel secure and safe there. This can be a comfortable armchair or a rocking chair with a table nearby with their favourite picture album or other favourite items.
Additional changes made to the entire household of the person include pictures or inscriptions on the doors of individual rooms. This improves orientation at home and helps the person feel more secure. People on family photographs can have their first names written on them. It is necessary to properly secure and adapt the bathroom with non-slip mats, handles in the toilet and in the shower cabin or a bathtub lift. Hazardous chemical agents should be locked away.
Similar safety measures must be applied to the kitchen and gas stoves so that the client can use them safely. Particular attention should be paid to dangerous objects, chemicals or medicines. The carer should ensure that gas and water supply are turned off after use. An electric appliance with an automatic switch can replace the gas kettle.
There should be a list of important phone numbers next to the phone. These should be written with large digits similar to the ones you find on digital alarm clocks. It is a good idea to remove the locks in the internal doors, so that the patients cannot lock themselves in from the inside. The entrance and balcony doors must be secured so that they do not leave the flat without a guardian.
ALZHEIMER’S PATIENT INDEPENDENCE & DIGNITY
Care for the suffering person should be adapted to his or her condition and abilities. Carers should not help the patients in all activities that they can perform on their own. The person should be given tasks to keep them active even by simple activities such as fastening some buttons, unpacking the shopping or self-catering. This is very important for maintaining their physical and mental health.
One major problem for many caregivers is the night activity of the client. Alzheimer’s can cause insomnia and night activity for many people. Engaging the patient and keeping them active during the day can reduce or eliminate this problem altogether. A good form of rehabilitation for the client involves daily walks with a caregiver. This can be accompanied with simple physical exercises or just muscle stretching. The patient can exercise with music or counting loudly together with the carer. The mental activity of the patient is stimulated by talking to him, playing counters, word associations, simple numerical or verbal digit additions and reading. Another way to stimulate the brain is through stimulation of the patient’s other senses, such as smell (pleasant aromas) or taste (favourite foods).
CARE SAFETY STANDARDS
During all activities, the carer must be mindful about the safety of their charge. One problem for older people is that they tend to fall down due to weak muscles and disorientation. This can have severe consequences if the fall results in fractures.
Carers must avoid sudden changes in position for the person and install supports on stairs and other areas. They can also remove small sidewalks and carpets where it is easy to slip. In the case of patients with deeper dementia, they have a tendency to escape from the house. Carers must keep the doors, windows and balconies locked and ensure that the client cannot endanger their lives by accidents such as turning on a gas stove or oven.
It is also very important to help the patient with food and medicine to ensure they are well nourished. Malnutrition may be one of the factors that worsen the prognosis. If the clients can prepare meals on their own or use the kitchen, it is worth describing individual cabinets and shelves to them. This will make it easier for the patient to find the necessary items. Most patients require help for taking medication at specific times of the day.
Carers should avoid making sudden drastic changes in the patient’s surroundings through renovations and rearranged furniture. This destroys their regulated lifestyle and causes patient disorientation.
Above all, there is a need for a great deal of understanding and patience from the carer, which allows them to understand the needs of the client and adjust to their pace. This includes performing particular activities for the client and conducting a conversation to fulfil their social needs. Proper care increases the patient’s comfort and slows down dementia processes.