Archive for January, 2009

Posted on January 30, 2009 - by Nurse Virginia

Caregiver Tips: Words That Help – When the elder you care for has Alzheimer’s Disease

Positive communication and the confused elder.

 
Just as words can be negative (see: Words That Hurt) words can also be used to make a person feel good about themselves. It can be:
• The way you say it.
• The words you use.
• The body language you show.

The way you say it – say it with a smile.

 
When words are said with a negative voice – if the confused elder has lost their word skills, and no longer understand the word – they only have the tone of the voice to go on. Even a compliment will sound bad if the tone of the voice is negative. When the tone of the voice communicates anger, impatience, and disgust – the person will become very aware of their dysfunction.

When you say something with a smile on your face – it will be communicated into the tone of your voice. It has been proved to take more face muscles to frown than to smile – so give your face a rest and smile.

Avoid negative words – use positive words.

 Avoid words like don’t, no, can’t, and stop. Use words like thank you, good Job, let’s do that together, words that make a person feel positive and helpful. Elders with Alzheimer’s disease want to contribute and be helpful. It is so easy to say “thank you” and build that persons self esteem.

The confused elder can still read body language.
 Crossing your arms, tapping a foot, showing impatience, people with Alzheimer’s disease can read body language very late into the disease process. When the confused elder no longer has verbal skills they can still read the caregiver’s body language.

Talking about the person – in front of them as though they are not there is never appropriate.

Use words that build –not words that tear down and see the difference in the person you are caring for.

Posted on January 30, 2009 - by Nurse Virginia

Caregiver Tips: Words that Hurt, When you are Caring for an elder with Alzheimer’s Disease.

Babies wear diapers the confused elder needs another word.

When the caregiver really gets to know the person they are caring for; who they are, where they have been, what they have done and what they would like to be remembered for, it is much harder to say “Let’s change your diaper.” Babies wear diapers, adults don’t. Elderly people who have had careers, raised children, earned degrees, served in the Armed Forces, don’t when they become incontinent due to Alzheimer’s, aging or illness deserve to be treated like babies.

These very necessary products can be called briefs, underpants, underwear, your protection, whatever word preserves the dignity of the person. Use a product that more resembles normal underwear – that pulls up rather than one that tapes on at the sides when possible.

Bib – a word that treats the confused elder like a baby.

Babies wear bibs, adults wear clothing protectors, napkins, words that describe the purpose or use. When caring for an elder, don’t take that clothing protector and use it to wipe the face of the person you are assisting to eat. That gesture of wiping an elder’s face with something attached to them treats them like a baby. Even when wearing a clothing protector the adult should have a napkin on their lap, which can be then used to wipe a mouth.

Words are powerful, be careful how you use them.

Words have the ability to make the elder feel good about themselves or bad about themselves. There is power in words, the words you choose, the way you say them, the relationship you have with the person you care for.

Protect the dignity of the confused elder you care for. The words you use are so important; choose wisely, it can make all the difference.

Posted on January 30, 2009 - by Nurse Virginia

Caregiver Tips: When the Confused Elder Stops Eating, or Starts Losing Weight.

It’s Not Always The Alzheimer’s Disease

Even if an elder is diagnosed with Alzheimer’s disease, every problem or symptom an elderly person has shouldn’t be automatically blamed on the disease. Especially in the case of eating. When any elderly person stops eating or starts to lose weight every possible cause needs to be investigated. The big difference involving elders with Alzheimer’s disease, is that it will take more effort on the part of the caregiver to discover the problem.

Because the person with Alzheimer’s may not be able to verbally communicate or express a problem, behavior can become a way of communicating feelings or needs.

8 Possible reasons the confused elder stops eating:

• If the individual wears dentures, do they fit well? Dentures have to be re-lined when needed as well as the use of denture products for cleaning and adhesives when appropriate.
• The person who wears dentures needs to have their gums checked to make sure there aren’t any sore areas.
• The condition of teeth and gums need to be regularly monitored by a dental professional.
• Lack of interest in eating may indicate illness.
• Any pain might distract a person from eating.
• Being uncomfortable in wet incontinent products may distract a person.
• Change in medications.
• Vision problems – especially if the person has had a stroke and may have a limited vision field.

People with Alzheimer’s disease may have lost some of their sense of taste. They might also be only able to express likes or dislikes by pushing food away, making negative vocal noises or refusing to open their mouth.

Posted on January 30, 2009 - by Nurse Virginia

Caregiver Tips: Angels of Mercy: The Blessing of Being a Caregiver for an elder with Alzheimer’s disease.

“The King will reply, `I tell you the truth whatever you did for one of the least of these brothers of mine, you did for me.’ (Matthew 25:40)

Whether you are a family member, spouse, son, daughter or have had the good fortune to have picked caregiving as a profession, you are blessed. So many times in my career, when I have told people what I do for a living, working with

Posted on January 30, 2009 - by Nurse Virginia

Caregiver Tips: Confused Elderly Man with Alzheimer’s Disease Scared by Snowman

Thinks Someone is in His/Her Room in the Nursing Home.

It was an early winter’s day and the family was in to visit Dad, who had Alzheimer’s disease, in the Nursing Home. While they were there they played some cards with their Dad, ate some of his favorite foods they had brought in, and decorated his room for the season. Everyone had a great time, especially Dad.

That night when it was time for George to go to bed. The staff took him to his room and helped him get ready for bed, then turned out the light, said “good night George” and closed the door. Very soon after they heard George yelling “get out, get out of my room!” The staff member Grace responded immediately, reassured the old man that no one was in his room. When George quieted down she once again said good night, turned off the light and closed the door.

Once again George started yelling “get out of my room!” This time when Grace responded, she thought this just isn’t like George; he usually goes right to sleep. So Grace decided to stay with George and see if she could figure out why he was so afraid. This time when Grace turned out the light and closed the door – she saw it! Right there on the back of George’s bedroom door was a cardboard cutout of a snowman, about 5 feet high, on the back of the door. The snowman glowed in the dark and you could clearly see his bright smiling face in the dark.

Alzheimer’s disease affects the brain in ways, where the person may no longer understand what they see. Vision is affected by the aging process, but the interpretation of what you are seeing, happens in the brain. So to George, in the dark, the snowman was a stranger in the room.

Being a caregiver for someone with Alzheimer’s disease is like being a detective. The behavior is telling you something, and you need to discover what it is telling you. The snowman was removed, George was able to sleep, and the staff was a little wiser.

Posted on January 22, 2009 - by Nurse Virginia

Aging: Elderly Woman with Alzheimer’s Disease no Longer Able to use Reasoning Ability – First sign Weight Loss.

Confused elderly function well with routine.

An elderly woman, in her early 80′s, still lives on her own and seems to be doing fine. Her daughter checks in on her frequently, usually everyday. Her mother has her life long routines in place and the apartment is always neat and her Mom is well groomed. However she soon notices that Mom has lost some weight. The daughter immediately responds and looks into possible causes of the weight loss.

The daughter soon discovers that her mother’s local grocery has remodeled the store and moved everything around. The mother was able to go to the store and find the same things, in the same location for years. Her “routine” in place allowed her to function for a long time independently. The store moving those items and making the store look “different” to her made her unable to function there any more.

Confused elderly lose ability to reason.

The woman no longer had decision making reasoning abilities. When this situation happens to another person – they either ask an employee where the item is, or using their reasoning abilities figure it out for themselves. They think to themselves,””well, if the bread was moved over there, then the hamburger buns must be close by.”

Because this woman could not think this through, she was going to the store, walking for hours through the store, and not buying anything. She no longer could function in the store independently, find her items and purchase them.

Confused elderly’s lack of reason and decision making may be demonstrated by:

• The elder who no longer can afford their home, unable to consider alternatives, so does nothing.
• The elder who needs home repairs, has the finances, but no longer able to make phone calls and decide on a company or price. So they do nothing.
• The elder continues to drive old, unsafe vehicle – when they have the finances to replace it. They can’t make a decision of what car to buy so they do nothing.
• The elder who is accumulating clutter – unable to decide what to throw away, so they do nothing.

Families want to give their elders independence – watching for signs helps the family know when to step in.

Posted on January 22, 2009 - by Nurse Virginia

Caregiver Tips: Elderly with Alzheimer’s disease, lose the ability to care for themselves in reverse order they gained ability.

Losing the ability to care for yourself.

We know that no two people are exactly alike, and that Alzheimer’s disease affects people differently, depending on what area of the brain is most affected. The loss of function usually follows a pattern. Most elders lose abilities in the reverse order that they gained the ability.

The order you gain abilities.

Take the ability to dress themselves. Children learn first to put on simple items such as shirt and pants. The child progresses to being able to button, put on socks and shoes, and later tie her shoes. For a long time she may put on shorts with a winter sweater before learning that certain things go together. She progresses to the point where she learns the necessity of changing and wearing clean clothes. And eventually she learns about the right season, occasion, or temperature for which she is dressing.

Losing abilities – dressing.

Elders with Alzheimer’s disease will lose the last learned ability first. They will be unable to dress correctly for the season or temperature. So you may see elders in summer with a winter coat and hat on that they insist on wearing. They are still able to follow through with the long practiced skills of putting on clothes correctly, but they can no longer choose appropriately. See: Caregiver Tip: Working with Patients with Alzheimer’s disease using Body Memory

Losing abilities – incontinence.

The most troublesome ability for elders with Alzheimer’s disease is the issue of continence. Small children will become continent of bowels before urine. They progress to be able to toilet themselves and finally to provide for their own hygiene. So also, the elder losing the skills in the reverse order no longer provides adequate bathroom hygiene. Then he has trouble making it to the bathroom in time, or finds the bathroom, but becomes incontinent of urine and finally bowels. Knowing this progression of the disease can aid family members in their expectations of the elder.

BOOK EXCERPT FROM:  Please Get To Know Me – Aging with Dignity and Relevance by – Virginia Garberding with Cecil Murphey

Posted on January 22, 2009 - by Nurse Virginia

CAREGIVER TIPS: Confused elder with Alzheimer’s Disease, wants to wear the same clothes all the time.

Can’t get confused elder to change clothes.

 
Many times I have heard family caregivers say that one of the hardest tasks is to get the individual who is confused to change clothes. Sometimes the favorite outfit is also used to sleep in. Recently a man was telling me about his wife’s favorite outfit and how he had tried to get her to change for a holiday dinner in a restaurant they were invited to. He turned and said “Here she is now.” To my surprise came a very cheerful woman in her woman in her late 70′s with dyed red hair in a purple sweat suit. This was the favorite outfit that was worn every day, every season.

Clothing helps confused elder feel put together.

 
Our clothing has many meanings for us socially. Many confused elderly have a sense of security when they are dressed. As though if they are dressed they may feel more put together and in control mentally as well. And so they resist changing, bathing, getting in pajamas, anything that might not let them feel as put together.

9 Things to  do when dressing is an issue for confused elder:

 
• Remove all out of season clothes and store.
• Have limited selection of outfits, so closet doesn’t seem overwhelming.
• Have clothes that reflect the individual’s life long choices in style and color, but are now in fabrics that are wrinkle free and easy to maintain.
• Everything needs to be washable and mainly cotton, which doesn’t hold on to odors like other man made fabrics.
• When there is a favorite coat – outfit it helps to have a matching one to substitute while the other is being cleaned.
• Simplify dressing whenever possible with Velcro closures when a person can no longer manage buttons – if dressing is just too hard and too much trouble why bother anymore, the person might think.
• Brassieres that open in front may be easier to manage.
• Elastic shoe laces can assist in allowing shoes to remain tied and yet be slipped on.
• Front opening clothing is easier than over the head styles. Likewise short sleeves are easier to get on than long sleeves.

Dressing can be an opportunity for success for confused elder.

 
Be aware that every activity – especially dressing is made up of many small steps. Completing every step is an opportunity for success and a feeling of accomplishment. Keep in mind that less is more when it comes to talking and instruction. Patience, being in the moment, praise and acceptance go a long way.
See: Caregiver Tips: Working with Elders with Alzheimer’s disease using their Body Memory

Posted on January 22, 2009 - by Nurse Virginia

CAREGIVER TIPS: How to help the confused elder with Alzheimer’s get dressed.

Know the elder’s routine.

 
What was their routine? Keeping to persons routine is so important. If someone was used to – for many years- getting up in the morning and eating breakfast in their robe, and then getting dressed, you want to continue to do that. There is much comfort in doing things in a familiar routine. Confused people can get upset when they are unsure of what happens next. The caregiver may never know why the person is upset.
See web site: www.pleasegettoknowme.com

This is not the time to do it your way – dressing is about their way.

Have everything ready. When helping someone who is confused, with any activity of daily living, the first thing to do is be prepared. If you are dressing, have a routine. If you are family and lived with this person try to remember how they did things. If you are a caretaker who didn’t know this person, see if anyone in the family does know how they did things. This is not the time to do things your way. Think about how you dress – do you put a shirt on before pants or the pants on first? You like to do things in the same way, so do they. Have all of the clothes laid out ready before you start. If you have to stop dressing to look for something – remember a person who is confused is IN THE MOMENT and the moment for dressing can be over for them when you walk away.

Take the time – the confused elder still knows impatience.

Don’t be in a rush. Confused elders can tell when you are impatient. Even elders with Alzheimer’s who no longer speak can tell by tone of voice or body language that someone is impatient with them. Let the person do as much for themselves as they are able. If it takes 2 hours for a confused elder to dress themselves with a little assistance, they need to still do this for themselves, so that:
• they can feel successful.
• they can maintain the ability to dress.
• this is their activity – everyone needs something to do.

Remember to use elder’s body memory when dressing.

Use their BODY MEMORY. Children start to dress themselves when they are very little, before they start school. So an elderly person has dressed themselves for many years – every day. The body remembers. (see: Caregiver Tips: Working with Elders with Alzheimer’s disease using their Body Memory.) If a person has forgotten how to put a shirt on. When the caregiver helps with one sleeve and then drapes the shirt around the person, the feel of the one sleeve on and the shirt on the neck, can trigger the person to put their other arm in the sleeve. The caregiver wants the person to have the time to feel what they are doing. Have clothes one size to large – to make things easier to get on.

Dressing is great exercise.

 If a person is still able to dress themselves with a little assistance, practicing this ability will make sure they will be able to continue to dress themselves longer. And dressing is great exercise. Everyone knows how tiring it is to go shopping and try on clothes. Putting your arm through a sleeve, bending the elbow and then extending the arm are all exercise. Say something like “Oh, I forgot Mary, your sister is coming for lunch today, and you know how she likes your pink sweater, let’s change and put that on for her.” Dressing and then re-dressing helps a person with their body memory and is great exercise.

Posted on January 22, 2009 - by Nurse Virginia

Caregiver Tips: Assisting the confused elder with Alzheimer’s Disease to Shave.

Elderly with Alzheimer’s disease are in the moment.

Anytime you are working with a person with Alzheimer’s disease you must provide enough time. People with Alzheimer’s disease are very aware of tone of voice and body language. If the caregiver shows impatience the person will know it. If the caregiver is talking to someone on a cell phone while providing care, the patient will think they are talking to them. Having the television on may also prove to be way too much distraction.
BE IN THE MOMENT – YOU ONLY HAVE THIS MOMENT – PERSONS WITH ALZHEIMER’S DISEASE ARE ALWAYS IN THE MOMENT – NO WHERE TO RUSH TO – JUST THE SUCCESS HOWEVER SMALL OF THE MOMENT

8 Steps for shaving the confused elder.

• Have all equipment ready – when someone has Alzheimer’s disease, it is difficult to leave the patient and have them wait till you come back. Remember when they are in the moment, they can and will quickly move on to something else if you leave.
• Have patient assist as much as he is able and to offer suggestions.
• Heat, moisture and lather help reduce surface tension and soften a beard.
• Shave sideburns with downward motion.
• Pull skin taunt when shaving around nose, mouth and neck areas
• Use short upward strokes on neck.
• Wash off lather.
• Apply lotion with palms of hands.

Any of the steps that a patient can do independently, they need to be able to continue to do to maintain their body memory. (See: Caregiver Tips: Working with Elderly with Alzheimer’s disease using Body Memory)

Hand over hand technique for assisting confused elderly with shaving.

When the patient no longer initiates shaving – putting your hand over the elder’s – whether it is with a safety razor or an electric and shaving “with them” can remind the body how to do the movement.

Caregiver mirroring technique for shaving confused elderly.
In order to prompt a person, who is able, to shave independently the caregiver can also shave their own face. Looking in the mirror at the patient or looking directly at the patient – to encourage them to shave also by imitating caregiver.

Including elderly in shaving activity.
Holding another Shaver – even if the patient is in the late stages of their disease and unable to participate. If they are being shaved with an electric razor and they are given to hold another electric razor that is on –so they feel the vibration – they can still experience the feeling of satisfaction in participating in their own care.

THE GOAL WITH ALL ACTIVITES OF DAILY LIVING IS TO PROVIDE FOR THE ELDER AN OPPORTUNITY FOR SUCCESS