Title: Alzheimers Disease: Supporting the Person Supporting their Caregivers
1Alzheimers DiseaseSupporting the
PersonSupporting their Caregivers
- Shelly Zylstra
- zylstra_at_dshs.wa.gov
- 360-676-6749
2A Few Facts
- Once considered a rare disorder, Alzheimers
disease is now seen as a major public health
problem that is seriously affecting millions of
older Americans and their families. - In 2050, 70 million people will be over the age
of 65 20 million over the age of 85. - An estimated 14 million Americans will have
Alzheimers disease if a cure is not found. - Alzheimers disease will be the leading cause of
death among adults by the middle of this century.
3What Is It?
- Alzheimers disease is an irreversible,
progressive brain disease that slowly destroys
memory and thinking skills. - Not Normal Aging!
- Alzheimers disease destroys brain cells and
causes abnormal structural changes in the brain
4Dementia is Not Normal Aging
20 year old brain 80 year old
brain
5The Brain
- Adult weight about 3 pounds
- Adult size a medium
cauliflower - Different parts of the brain do different things
6Cerebral Hemispheres
- Where sensory information received from the
outside world is processed this part of the
brain controls voluntary movement and regulates
conscious thought and mental activity - accounts for 85 of brains weight
7Cerebellum
- In charge of balance and coordination
- takes up about 10 of brain
- consists of two hemispheres
- Receives information from eyes, ears, and muscles
and joints about bodys movements and position
8Brain Stem
- Connects the spinal cord with the brain
- Relays and receives messages to and from muscles,
skin, and other organs - Controls automatic functions such as heart rate,
blood pressure, and breathing
9Different Parts-Different Roles
- Even though the activities are similar, a
different part of the brain is involved - Walking-Kicking
- Talking-Swearing
- Chewing-Swallowing
10Scans Show the Loss of Activity
11Reversible Dementias
- Intoxications
- Infections
- Metabolic disorders
- Depression
- Medication Problems
- Brain tumors
- Head injuries
- Normal pressure hydrocephalus
- Dehydration
12Irreversible Dementias
- Alzheimers disease
- Multi-Infarct Dementia
- Parkinsons disease
- Lewy Body disease
- Creutzfeldt-Jakob disease
- Picks disease
- Huntingtons disease
- AIDS dementia complex
- Progressive aphasia
13Prevalence of Alzheimers Disease by Age
14Stages of Alzheimers disease
15Stages of Alzheimers disease
16Stages of Alzheimers disease
17Stages of Alzheimers disease
18Alzheimers Symptoms
- Very gradual onset
- Picture may differ from person to person
- Gradual withdrawal from active engagement with
life - Narrowing social activities and interests
- Lessening of mental alertness and adaptability
- Lowering of tolerance to new ideas and changes in
routine - Thoughts and activities may be selfish or
childlike
19Alzheimers Symptoms
- Progressive memory loss
- Difficulty remembering familiar things
- Difficulty performing familiar tasks
- Problems finding the right words
- Misplacing things/ Messiness
- Confusion and agitation
- Poor judgment and poor decision making skills
- Changes in personality mood swings
- Loss of initiative
20Might Even Involve the Law!
- Wandering/Lost
- Auto Accidents
- Indecent Exposure
- Homicide/Suicide/Domestic Violence
- Suspicion of DUI/Intoxication
- Abuse/Neglect
- Trespassing
- Shoplifting
21Behaviors
- Alzheimers disease often causes a person to
exhibit unusual and unpredictable behaviors. - This can easily lead to frustration and tension
in the person with Alzheimers as well as the
person responsible for them.
22Challenging Behaviors
- Agitation, anger, depression, aggression
- Combativeness
- Psychosis
- Wandering
- Sleeplessness
- Sundowning
- Unpredictable situations
23Agitation, Anger, Depression
- Agitated behavior can be disruptive to the elders
daily life. - Anxiety may not be put into words but instead
manifest physical symptoms such as a racing
heart, nausea, or pain. - Agitation may increase the risk of harm to the
affected individual and to others.
24Agitation
- Irritability, frustration, excessive anger
- Constant demands for attention reassurance
- Repetitive questions or demands
- Stubborn refusal to do things or go places
- Constant pacing, searching, rummaging
- Yelling, screaming, cursing, threats
- Hitting, biting, kicking
25Depression
- Extreme tearfulness
- Hand-wringing
- An excessive need for reassurance
- Other signs of extreme unhappiness
- Loss of interest in things they used to love
- Excessive sleep
- Personality changes
26Aggression
- Verbal accusations and insults
- Aimless screaming
- Refusal to cooperate with simple requests
- Physical assaults
- Self-injury such as head banging or biting oneself
27Delusions
- When the person believes things that are not
true. - Common examples of delusions would be
- Believing that one is in danger from others and
that others have stolen items or money. - A spouse is unfaithful
- Unwelcome guests are in the house
- A relative or friend is an imposter and not who
they claim to be.
28Hallucinations
- This is a false perception of objects or events
involving the senses. - The person may see, hear, smell, taste or feel
something that is not there. - If it doesnt cause a problem it might be best to
ignore it. - If it becomes continuous then look for a possible
underlying physical cause.
29Look for The Why
- Physical discomfort caused by an illness or
medications. - Over-stimulation from or overactive environment
- Inability to recognize familiar places, faces, or
things - Difficulty completing simple tasks or activities.
- Inability to communicate effectively.
30There is usually a Cause
- Physical factors
- Is the person tired because of inadequate rest or
sleep? - Are medications causing side effects?
- Is the person unable to let you know he or she is
experiencing pain? - Environmental factors
- Is the person over stimulated by loud noises, an
overactive environment, or physical clutter? - Does the person feel lost or abandoned?
31Sleeplessness and Sundowning
- About 20 experience periods of increased
confusion, anxiety, agitation, and disorientation
from dusk to dawn. - End-of-day exhaustion (mental physical)
- An upset in the internal clock causing a
biological mix-up between night day - Reduced lighting and increased shadows
- Disorientation due to the inability to separate
dreams from reality when sleeping - Less need for sleep, which is common among older
adults
32Responding to Challenging Behaviors
- Stay calm and be understanding
- Be patient and flexible
- Dont 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.
33Try to Determine the Cause
- Often the trigger is some change in the persons
environment. - Clutter, new person in the room
- Change in routine
- Pain
- Hunger
- Thirst/dehydration
- Full bladder/UTI
- Fatigue/pending illness
- Infections
- Skin irritation
- Constipation
34Hints to Manage Behavior
- Dont
- Argue or disagree
- Confront
- Raise your voice
- Take offense
- Corner, crowd
- Try to reason
- Do
- Simplify the environment, tasks and routines
- Allow adequate rest between stimulating events
- Use labels or clues to remind
35- Do
- Back off
- Use calm, positive statements
- Reassure
- Slow down
- Offer guided choices between two options
- Limit stimulation and offer simple exercises
- Dont
- Restrain,
- Shame, criticize
- Demand or try to force
- Talk down, ignore
- Explain, teach
- Rush
- Show alarm
- Make sudden movements
36Communication
- Communication is critical and can be the basis
for poor behavior - Are you asking too many questions or making too
many statements at once? - Are your instructions simple and easy to
understand? - Is the person picking up on your own stress and
irritability? - Are you being negative or critical?
37Communication
- Remember people with Alzheimers Disease often
find it hard to remember the meaning of words
that you are using or to think of the words they
want to say. - Identify yourself by name and call the person by
name. Dont ask, Do you know who I am? - Approach the person slowly from the front and
give them time to get used to your presence.
Maintain eye contact.
38Communication
- Try to talk away from other distractions such as
a loud TV or others trying to join the
conversation. - Speak slowly and distinctly. Use familiar words
and short sentences - You may feel angry but dont show it. If you are
about to lose it try counting to ten. REMEMBER
that this person has a disease and is not
deliberately trying to make things difficult for
you.
39- Keep things positive.
- Offer positive choices with no wrong answers
- If the person seems frustrated and you dont know
what he or she wants, try to ask simple questions
that can be answered with yes or no or one-word
answers. - Use gestures, visual cues, and verbal prompts to
help. - If conversation causes agitation drop the issue
rather than try to clear it up.
40- Use memory aids such as calendars lists.
- Explore various solutions.
- Accept the behavior as a reality of the disease
and try to work through it. - Acknowledge requests and respond to them.
- Respond to the emotion and not the behavior.
- Offer corrections as a suggestion. Avoid
explanations that sound like scolding. Try I
thought that was a spoon.
41Caregiver Support
- Provide Information
- Provide Assistance
- Respite Care
- Adult Day Care
- Counseling or Support Groups
- Training
- Supportive Services
- Caregiver Consultants
- Loan Closet
42Resources
- http//www.ahaf.org/alzdis/about/adabout.htm
- http//www.mayoclinic.com/health/alzheimers-caregi
ver/AZ00018 - http//www.agis.com/
- http//www.nia.nih.gov/Alzheimers/Publications/car
egiverguide.htm - Or Call your local Alzheimer Association Chapter