Managing Behavioral Changes

Communication

  • Choose simple words and short sentences and use a gentle, calm tone of voice.
  • Avoid talking to a patient like a baby or talking as though they are not present.
  • Minimize distractions and noise--such as television or radio--to help the patient focus on what you are saying.
  • Call the patient by name, making sure you have their attention before speaking.
  • Allow time for response. Be careful not to interrupt.
  • If the patient is struggling to find a word or communicate a thought, gently try to provide the word he or she is attempting to say.
  • Frame questions and instructions in a positive way.
  • Do not overwhelm the patient with too much information or anything that is not immediately relevant.

Bathing

  • Plan the bath or shower for the time of day when the patient is most calm and agreeable. Be consistent. Try to develop a routine.
  • Bathing oftentimes becomes scary and uncomfortable for some patients with Alzheimer's disease. Be gentle and respectful.
  • Tell the patient what you are going to do, step by step, and allow them to do as much as possible.
  • Prepare in advance. To lessen frustration, have everything needed ahead of time.
  • Warm up the room beforehand and keep extra towels and a robe nearby. Test the water temperature before beginning; warm is good, hot is not.
  • Minimize safety risks by using a handheld showerhead, shower bench, grab bars and nonskid bath mats. Never leave the patient alone in the bath.
  • Bathing may not be necessary every day. A sponge bath can be effective between showers or baths and makes it easier for both patient and caregiver.

Dressing

  • Try to have the patient get dressed at the same time each day so that he/she will come to expect it as part of the daily routine. Routine, routine, routine.
  • Encourage the patient to dress him/herself to whatever degree possible. Plan and allow extra time so there is no pressure or rush. Focus on success and provide positive cues as much as possible.
  • Allow the patient to choose from a limited selection of outfits. If they have a favorite outfit or color, consider purchasing several identical outfits.
  • Arrange the clothes in the order that they are to be put on to simplify the process.
  • Provide clear, step-by-step instructions if the patient needs prompting.
  • Choose clothing that is comfortable, easy to get on and off and easy to clean. Elastic waists and Velcro enclosures minimize struggles with buttons and zippers.

 

Sleep Problems

For the exhausted caregiver, sleep can't come soon enough. For many people with Alzheimer's disease, however, the approach of nighttime may be a difficult time. Many patients become restless, agitated and irritable around dinnertime.

  • Encourage exercise during the day and limit daytime napping, and make sure the patient does not become too fatigued during the day. Fatigue may increase late afternoon restlessness.
  • Try to schedule more physically demanding activities earlier in the day.  Bathing could be earlier in the morning, appointment and large family meals could be midday.
  • Set a quiet, peaceful tone in the evening to encourage sleep. Schedule simple, calming activities in the afternoon and evening. Keep the lights dim, eliminate loud noises and play soothing music if the patient seems to enjoy it.
  • Keep bedtime at a similar time each evening. Developing a bedtime routine may help.
  • Restrict access to caffeine late in the day.
  • During the afternoon hours, make sure lighting is adequate, not too bright and not too dim (reduce shadows). Use night lights in the bedroom, hall and bathroom if the darkness is frightening or disorienting.
  • Reassure and tell the patient what time it is and what they are to do.
  • Avoid arguing or asking for explanations. Rational expectations on the caregiver's part only provoke the patient's frustration.

 

Incontinence

  • Establish a routine for taking the patient to the bathroom and stick to it as closely as possible. Don't wait for the patient to ask.
  • Watch for signs that the patient may need to go to the bathroom, such as restlessness or pulling or removal of clothes. Respond quickly, don't delay.
  • Limit frustrations when accidents occur. Stay calm and reassure the patient if they are upset. Try to keep track of when accidents occur and help plan ways to avoid them.
  • To help prevent nighttime accidents, limit certain types of fluids, such as those with caffeine in the evening. Prepare the bed with protective mattress covers.
  • If you are going to be out with the patient, plan ahead. Know where the restrooms are located, and have the patient wear simple, easy-to-remove clothing. Take an extra set of clothing along in case of an accident.
  • Once the patient's physician has established that the incontinence is not a physical illness, seriously consider the use of incontinence products.

 

Eating

  • View mealtimes as an opportunity for social interaction and success for the patient with Alzheimer's disease. Be patient, avoid rushing and enjoy this time together.
  • Aim for established quiet, calm and reassuring mealtimes and adapt to the patient's changing needs and taste buds; be aware of the increased risk of choking as the disease progresses.
  • Serve small portions, and choose dishes and eating tools that promote and empower independence. Use straws or cups with lids to make drinking easier.
  • Maintain routine dental checkups and daily oral hygiene. Make sure the dentist understands his/her illness.
  • If the patient has difficulty using utensils, consider serving finger foods.

 

Wandering

  • Make sure the patient carries some kind of identification or wears a medical bracelet. Consider enrolling the patient in a Safe Return and MedicAlert Bracelet or electronic monitoring bracelet program. If the patient gets lost and is unable to communicate adequately, identification will alert others to the medical condition. Notify neighbors, local authorities and the health care provider in advance that the patient has a tendency to wander.
  • Keep doors locked. Consider a keyed deadbolt or additional lock high or down low on the door. If the patient can open a lock because it is familiar, a new latch or lock may help.
  • Secure or put away anything that could cause danger, both inside and outside the house.
  • Ensure that the patient does not have access to car keys.
  • If wandering is a high risk, an electronic monitoring program may be the only alternative for safety during this stage.

Information on Alzheimer's Community Care's Locator ID program and Silver Alert Legislation.

Hallucinations and Delusions

  • A person with Alzheimer's disease may experience hallucinations and/or delusions. Delusions occur when the patient sees, hears, smells, tastes or feels something that is not there.
  • Hallucinations and delusions may be a sign of physical illness. Keep track of what the patient is experiencing and discuss it with a doctor.
  • Avoid arguing with the patient about what they see or hear. Respond to the feelings they are expressing and provide reassurance and comfort.
  • Try to distract and redirect the patient to another topic or activity. Sometimes moving to another room or going outside for a walk with the patient may help.
  • Change the channel or turn off the television set when violent or disturbing programs are on. The patient with Alzheimer's disease may not be able to distinguish television programming from reality.
  • Make sure the patient is safe and does not have access to anything they could use to harm themselves or others.