Alzheimer's Disease Education

Mealtime can become a power struggle when a patient with Alzheimer’s disease refuses to eat or becomes finicky. Their tastes may change, they may lose their appetite or they may not understand how or why to eat. Some people with cognitive illnesses become afraid that others are trying to poison them.

 
Unless there is an important reason for a specific diet, getting the patient to eat is more important than what they eat. Check with their physician to make sure the lack of appetite is not due to a physical problem, such as difficulty swallowing.

Tips to help with mealtime: 

• Offer one item to eat at a time. Several different colors and textures can be confusing.
• Provide several small meals or snacks instead of three large meals per day.
• Provide choices instead of asking them to eat something specific.
• Serve meals at the same time and place every day to maintain consistency and repetition, which is soothing to patients with cognitive challenges.
• Show them the steps to begin eating.
• Use simple plates with no elaborate decorative designs to keep their focus on the food.

Exercise improves memory and could become a promising treatment for Alzheimer’s disease. Regular exercise: 

• Helps eliminate damaging free radicals.
• Helps regulate chemicals that maintain nerve function, mood and cognition.
• Improves brain processing.
• Improves motor function, auditory attention, memory and executive functions, cerebral blood flow and brain use of oxygen and glucose.
• Improves positive feelings, self-confidence and quality of sleep.
• Reduces brain aging.

How Exercise Affects Brain Health 
Aging and Alzheimer’s disease shrink the hippocampus (memory bank) of the brain. Controlled studies have shown that aerobic exercise increases the volume of the anterior hippocampus by 2%. This helps improve spatial memory and increase hippocampal volume. 

 
There is growing evidence that both aerobic and resistance training can help maintain brain health in old age and perhaps improve cognitive function in Alzheimer’s disease. Exercise has been shown to increase Mini Mental State Examination scores in patients with Alzheimer’s disease.

Alzheimer’s disease can diminish understanding of the need to bathe. Some patients may fear falling in the bathtub or getting wet, and many feel a loss of privacy or control.

How to manage hygiene issues:

• Arrange for a professional caretaker or nurse to bathe the patient two or three times per week. In between visits, you can give sponge baths. 
• Maintain a calm demeanor to balance potential fears. 
• Make bathing part of their regular routine so it is perceived as a common activity.
• Never leave the patient alone in the bathtub or shower.
• Provide as much privacy and independence as is safe.
• Install handrails and a shower chair. 
• Take a break and try again later if bathing upsets the patient. It’s okay to occasionally skip a bath. 
• Use the bathtub instead of the shower, if possible, to prevent falling.

Signs that it is no longer safe for a patient with Alzheimer’s disease to drive can include:

• Becoming disoriented or upset while driving in a familiar neighborhood
• Frequently driving somewhere unintended (such as a previous job)
• Driving excessively fast or slowly

The loss of independence associated with driving can cause anger, disappointment and frustration. When it is time to prohibit driving, be sensitive to the patient’s emotions, but remain firm and unwavering. If they injure someone while driving, they can be financially responsible. 

How to deter patients from driving:

• Ask the patient’s physician to prohibit them in writing from driving due to the illness, medications and side effects.
• Discuss the dangers of driving before a tragedy occurs. 
• Hide the keys or get rid of the vehicle, if necessary.
• Offer to drive them places or ask friends and family to help you by providing transportation.

Common occurrences of wandering include a desire to “go home” when they are already home. Or they might begin looking for someone from their past, as though they are near. Many patients wander away from a new setting or when seeking a familiar place, such as the bathroom. 

Help prevent wandering by following these tips:

• Avoid busy, crowded settings, such as shopping malls, loud sporting events or grocery stores that can be disorienting.
• Maintain a daily routine — keep a regular schedule for sleeping, eating and other normal activities. Routines help reduce anxiety, which can lead to wandering. 
• Make your home wander-resistant with modifications, such as “hiding” door locks, painting or covering door handles to match the door, using motion detectors and bells on doorknobs, using night lights, and keeping car keys out of sight. 
• Pay attention to signs of discomfort, pain, hunger and thirst to prevent patients from wandering to look for these things. Ask them if they are comfortable or need anything.
• Reassure patients that they are safe and remind them where they are.

Have a plan in place when wandering begins to occur, such as: 

• Ask neighbors to alert you if they see your loved one wandering, and ask for and store their contact information.
• Keep a recent photo handy. 
• Notify local police in advance about their condition and that they may wander.
• Provide the patient with a medical alert identification bracelet that displays their condition and contact information. 

Alzheimer’s disease can cause agitated or aggressive behavior, as well as physical discomfort or difficulty expressing emotions such as frustration, fear or anger. 

Tips to safely manage aggressive behavior:

• Distract the patient. If a certain activity has caused frustration or anger, changing the activity can help.
• Do not argue or negotiate with them. Patients often cannot follow complex conversations, which frustrates them further.
• Do not punish “bad” behavior. The patient may not recall why they are being punished, possibly causing more agitation or violent behavior. 
• Remain calm, if possible. If you escalate your emotions, the patient may also instinctively escalate theirs. 
• Remove all firearms and weapons from the reach of the patient and stay away from someone whose violence puts you in danger. 

Reduce aggression by following these tips:

• Involve the patient in exercise to keep them energized during the day, which will help them sleep at night. Exercise helps maintain a healthy body and reduces aches and pains that can cause frustration and anger.
• Keep a written account of aggressive or violent behaviors. The record can help you identify situations that can lead to outbursts.
• Maintain a daily routine. Keep a regular schedule for sleeping, eating and other normal activities. Routines help soothe patients. 
• Pay attention to signs of discomfort, pain, hunger and thirst because they often have difficulty communicating these feelings. Ask them if they are comfortable or need anything. 
• Prepare patients for upcoming changes by using short, direct sentences to make it easier for them to understand and remember. Keep your delivery positive and remember you might have to repeat this information right before the activity. 

Eventually, the patient will not be able to handle their own finances. It may be difficult for them to discuss turning financial control over to someone else. 

Tips to help manage finances: 

• Do not divulge information about the patient’s disease to avoid being scammed. Work with the bank or credit card company to set limits on the patient’s access without offering a reason. 
• Discuss how finances will be handled once the patient is unable to handle it themselves. 
• Identify a trusted person who can help with finances and who is willing to take over when necessary. 
• Make sure your loved one is on the Do Not Call list to reduce phone solicitations.
• Seek guidance from an attorney who is trained in geriatric law. Ask your provider to refer you to a social worker to discuss legal resources. You can also find help at your local Alzheimer’s Association office and LawHelp.org.

Alzheimer’s disease can affect the portion of the brain that regulates inhibitions. As the disease progresses, formerly modest people may begin to exhibit an uncharacteristic lack of self-control. 

How to manage inappropriate behavior: 

• Control your shock. Calmly guide the patient to a bathroom or more secluded location and cover them, if necessary.
• Do not reprimand or show anger to avoid confusing them. They do not understand they have done something inappropriate. 
• Distract the patient with another activity.

People with Alzheimer’s disease may repeat a question or activity multiple times. This can be because they are anxious, bored or don’t remember they have already done the activity. 

How to manage repetitiveness: 

• Ask them for help if the patient is repeating an activity so they feel useful and active. 
• Listen to what words they are repeating and in what tone. You may be able to discern an anxiety or emotion behind the words. Respond to the concern rather than the specific words.
• Provide a distraction from the repeated question or activity.
• Some repetitive actions signal that the patient’s brain is “stuck” in that mode. A simple touch or redirected activity can break the cycle.
• Write down the answers to repetitive questions and put the list where the patient can easily see it.