Posts Tagged agitated behavior

Fall Prevention

physicial therapy rehab

Every year, nearly 1/3 of all older adults will suffer from some type of fall. Older adults with dementia, however, are more than twice as likely to fall than those without cognitive impairment. Their falls may also be more severe, perhaps resulting in serious bone fractures, hospitalization, or life-threatening injuries. Persons with dementia that suffer from a fall at home are more likely to be admitted into some type of institutional care. In addition, the cost of treating and rehabilitating seniors that have fallen has sky-rocketed in recent years (Montero-Odasso, 2012).

walking down a hall

Researcher continue to study the most helpful methods for reducing risk of falls and preventing injury in those with dementia. Below are some tips that may be helpful in managing fall risk:

  • Implement a regular exercise program to maintain muscle and joint strength
  • Work with the person’s physician(s) to ensure that medication are not causing adverse side effects that could contribute to falls (e.g. dizziness, vertigo)
  • Maintain a regular toileting schedule for the person
  • Anticipate the person’s needs
  • Have a knowledge for the person’s likes, dislikes, routine, preferences, etc.
  • Ensure that clothing and shoes fit properly and are in good condition. Avoid slippers with no supportive backing, pants that are too long for the person, etc.
  • Clearly label key places in the home or residence, such as the bathroom or bedroom, even if the person has lived there for some time.
  • Ensure that the environment is clutter-free. Remove throw rugs that could slip beneath the person.
  • Create a visible pathway from the bedroom to the bathroom, particularly at night. Consider using a bedside commode.
  • If falling in bed is a concern, consider using lowering the mattress directly onto the floor. Do not install bed rails as this could increase the person’s agitation and restlessness. Many individuals with dementia may view bed rails as a sign that they are expected to be incontinent, or they perceive the rails as an obstacle to overcome, increasing the height of their fall. The person could become fatally injured if their head were to get caught between the rails.
  • Make sure the bathroom is not conducive for falls.  Remove clutter, use grab bars, and non-skid strip. A shower chair may be helpful.
  • Use color contrast where appropriate – for instance, a person may not see a white toilet in front of a white wall. Consider using a brightly colored toilet seat to draw the person’s attention.
  • Make sure there is ample lighting in well traversed areas.
  • Provide places for the person to stop and rest, if walking on a long hallway or path.
  • Ensure the person wears sensory aids, such as glasses or hearing aids, if needed.

References

Montero-Odasso, M. M. (2012). Gait and Cognition: A Complementary Approach to Understanding Brain Function and the Risk of Falling. Journal Of The American Geriatrics Society60(11), 2127-2136.

van Doorn, C. (2003). Dementia as a Risk Factor for Falls and Fall Injuries Among Nursing Home Residents. Journal Of The American Geriatrics Society51(9), 1213-1218.

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Getting Ready for the Holidays

 

1N0A3168.jpg

The holidays are a highly anticipated, but often stressful, season. For many, our financial, social, and physical demands increase significantly as the holidays rapidly approach. Buying gifts for others, entertaining guests, and making travel arrangements are common added responsibilities at this time of year. If you are a caregiver for a person with dementia, it may be difficult to juggle these additional tasks alongside your regular caregiving routine.

Little research has been done about caregiving during the holiday season, although it has been acknowledged by many as a uniquely stressful phenomenon. Below are some helpful hints on how to best prepare for and survive this special time of year. Happy Holidays everyone!

Prepare Family Members in Advance

The holidays can be a turbulent time for some, so it can help to let guests know what to expect before they arrive. Initiating the conversation early will also allow family members an opportunity to surface any questions or concerns they may have.

If the person is in the early stages of Alzheimer’s, relatives and friends might not notice any changes. But the person with dementia may have trouble following conversations or may be likely to repeat him/herself.  Family can help with communication by being patient, not interrupting or correcting, and giving the person time to finish his or her thoughts.

If the person is in the middle or late stages of Alzheimer’s, there may be significant changes in cognitive abilities since the last time an out-of-town friend or relative has visited.  These changes can be hard to accept. Make sure visitors understand that changes in behavior and memory are caused by the disease and not the person.

You may find this easier to share changes in a letter or email that can be sent to multiple recipients. Consider also including a recent photograph of the person with dementia, so family/friends are aware of any physical changes that may have taken place.

Re-Evaluate Holiday Traditions

It’s likely that both  the person with dementia and the family would still like him/her to participate meaningfully in the holiday celebrations. Involve the person by building on past traditions and memories. Focus on activities that are meaningful to the person with dementia. Your family member may find comfort in singing old holiday songs or looking through old photo albums. As the person’s abilities allow, invite him or her to help you prepare food, wrap packages, and help decorate or set the table. This could be as simple as having the person measure an ingredient or hand decorations to you as you put them up. (Be careful with decoration choices. Blinking lights may confuse or scare a person with dementia, and decorations that look like food could be mistaken as edible.)

Sticking to the person’s normal routine will help keep the holidays from becoming disruptive or confusing. For instance, if the person is accustomed to eating lunch at a scheduled time, stick to that time. Encourage family members and friends to assist you in this. Plan time for breaks and rest.

Be flexible and adjust traditions appropriately. For example, a smaller, shorter gathering during the day may be more successful than a large celebration that carries on into the late evening.

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Traveling with Dementia

traveling

The summer season is almost upon us, and for many, this is the time of year to let our hair down and take that vacay! For those that are caring for someone with Alzheimer’s disease or a related dementia, however, the challenges associated with traveling can be daunting. Below are some tips and strategies for making your next excursion as stress and worry-free as possible.

Tips for a calm traveling experience:

  • Plan ahead
  • Learn to recognize the warning signs of anxiety and agitation and have a plan to address them. Discuss this plan with the person with dementia.
  • Try not to overload the person with a lot of directions or too much information.

General travel considerations:

  • Environmental changes can trigger wandering or confusion. Enroll in MedicAlert + Alzheimer’s Association Safe Return, a 24-hour nationwide emergency response service for individuals with dementia who wander or have a medical emergency. Call 888.572.8566 or visit alz.org/safety to enroll. Those already enrolled should notify MedicAlert + Safe Return of travel plans.
  • It may be helpful to stick with the familiar. Travel to known destinations that involve as few changes in daily routine as possible.
  • Evaluate options for the best mode of travel. Based on needs, abilities, safety and preferences, decide what would provide the most comfort and the least anxiety.
  • When selecting destinations, consider those that have easy access to emergency health services and pharmacies.
  • Consider the needs and desires of the person with dementia as you plan your trip; elaborate sightseeing trips or complicated tours may cause anxiety and confusion.
  • If you will be staying in a hotel, consider informing the staff ahead of time of your specific needs so they can be prepared to assist you.
  • Have a backup plan in case your trip needs to change unexpectedly.
  • Travel during the time of day that is best for the person. For example, if he or she is more agitated in the late afternoon, try to avoid traveling at this time.

What to keep in mind for visits to family and friends:

Be sure to prepare friends or family members for the visit by explaining dementia and the changes it may have caused. Go over any special needs and explain that the visit could be short or that you may need to change activities on short notice. Some additional considerations:

  • It may be helpful to stay as close to your normal routine as possible. For example, bathing and eating times should be on a similar schedule to that followed at home. Eating in familiar settings, such as at a dining room table, may be less confusing than eating in a crowded restaurant.
  • Be realistic about abilities and limitations. Allow for extra time when scheduling activities.

Suggestions for air travel:

Moving through an airport requires focus and attention, as the level of activity can be distracting, overwhelming and difficult to understand. Please consider the following when traveling by air:

  • Avoid scheduling flights that require tight connections.
  • Even if walking is not difficult, consider requesting a wheelchair so that an airport employee is assigned to help you get from place to place. Most airlines ask for at least 48 hours of notice.
  • Contact the Transportation Security Administration (TSA) at least 72 hours prior to travel for information about what to expect during the security screening. While at the airport, remind the person what he or she can expect and inform the TSA agent at the security checkpoint that the person has dementia.
  • Do not hesitate to ask for assistance from airport employees and in-flight crew members.
  • If the person needs help using the restroom, look for companion care bathrooms so you can more easily assist.
  • Stay with the person at all times.

 

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Fall Prevention

physicial therapy rehab

Every year, nearly 1/3 of all older adults will suffer from some type of fall. Older adults with dementia, however, are more than twice as likely to fall than those without cognitive impairment. Their falls may also be more severe, perhaps resulting in serious bone fractures, hospitalization, or life-threatening injuries. Persons with dementia that suffer from a fall at home are more likely to be admitted into some type of institutional care. In addition, the cost of treating and rehabilitating seniors that have fallen has sky-rocketed in recent years (Montero-Odasso, 2012).

walking down a hall

Researcher continue to study the most helpful methods for reducing risk of falls and preventing injury in those with dementia. Below are some tips that may be helpful in managing fall risk:

  • Implement a regular exercise program to maintain muscle and joint strength
  • Work with the person’s physician(s) to ensure that medication are not causing adverse side effects that could contribute to falls (e.g. dizziness, vertigo)
  • Maintain a regular toileting schedule for the person
  • Anticipate the person’s needs
  • Have a knowledge for the person’s likes, dislikes, routine, preferences, etc.
  • Ensure that clothing and shoes fit properly and are in good condition. Avoid slippers with no supportive backing, pants that are too long for the person, etc.
  • Clearly label key places in the home or residence, such as the bathroom or bedroom, even if the person has lived there for some time.
  • Ensure that the environment is clutter-free. Remove throw rugs that could slip beneath the person.
  • Create a visible pathway from the bedroom to the bathroom, particularly at night. Consider using a bedside commode.
  • If falling in bed is a concern, consider using lowering the mattress directly onto the floor. Do not install bed rails as this could increase the person’s agitation and restlessness. Many individuals with dementia may view bed rails as a sign that they are expected to be incontinent, or they perceive the rails as an obstacle to overcome, increasing the height of their fall. The person could become fatally injured if their head were to get caught between the rails.
  • Make sure the bathroom is not conducive for falls.  Remove clutter, use grab bars, and non-skid strip. A shower chair may be helpful.
  • Use color contrast where appropriate – for instance, a person may not see a white toilet in front of a white wall. Consider using a brightly colored toilet seat to draw the person’s attention.
  • Make sure there is ample lighting in well traversed areas.
  • Provide places for the person to stop and rest, if walking on a long hallway or path.
  • Ensure the person wears sensory aids, such as glasses or hearing aids, if needed.

 

References

Montero-Odasso, M. M. (2012). Gait and Cognition: A Complementary Approach to Understanding Brain Function and the Risk of Falling. Journal Of The American Geriatrics Society60(11), 2127-2136.

van Doorn, C. (2003). Dementia as a Risk Factor for Falls and Fall Injuries Among Nursing Home Residents. Journal Of The American Geriatrics Society51(9), 1213-1218.

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A Book Review for The 36-Hour Day by Nancy L. Mace and Peter V. Rabins

Picture of The 36-Hour Day

A Book Review

The 36-Hour Day:A Family Guide to Caring for People Who have Alzheimer’s Disease, Related Dementia, and Memory Loss

Caregiving for a person with dementia is a daunting task. It requires the acquisition of new skills and knowledge, the mobilization of resources and family members, and it can leave the primary caregiver feeling burnt out or overwhelmed. On the other hand, caregiving can also produce moments of joy and happiness, a sense of pride, and meaningful connections with loved ones. This is the key message conveyed in The 36-Hour Day: A Family Guide to Caring for People Who have Alzheimer’s Disease, Related Dementia, and Memory Loss by Dr. Nancy Mace and Dr. Peter Rabins.  The book discusses the undeniable challenges associated with caregiving, while deftly outlining numerous tactics for addressing day-to-day and long range caregiving concerns.  It shows that dementia can be managed effectively with moments of delight along the way.

 

Each family’s story is unique, and that is reflected in the style of The 36-Hour Day.  The guide includes short vignettes and personal stories, which are derived from actual family members that have called or written in to share their experiences. The chapters can be read sequentially, or the reader can skip to sections that are most pertinent to their situation, a useful option for those caregivers and professionals who may have difficulty finding time to read a detailed book.

 

Don’t miss out on your opportunity to own this must-read. Call (248) 996-1053 to purchase your copy today!

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Getting Ready for the Holidays

holiday

The holidays are a highly anticipated, but often stressful, season. For many, our financial, social, and physical demands increase significantly as the holidays rapidly approach. Buying gifts for others, entertaining guests, and making travel arrangements are common added responsibilities at this time of year. If you are a caregiver for a person with dementia, it may be difficult to juggle these additional tasks alongside your routine care provision.

Interactions with family members may add another layer of stress or possibly contention. Family members that visit for the holidays may be taken aback by the changes they observe in the person with dementia. They may be unsure of how to respond to the person with Alzheimer’s, and they may not use appropriate techniques. For others, suspicions that a family member has a memory loss disorder could be surfaced for the first time at a holiday gathering. Other issues, such as the person’s safety or whether he/she should be living alone, may not be addressed until the family comes together. Members of the family may disagree and conflict could ensue.

Little research has been done about caregiving during the holiday season, although it has been acknowledged by many as a uniquely stressful phenomenon. Below are some helpful hints on how to best prepare for and survive this special time of year. Happy Holidays everyone!

Prepare Family Members in Advance

The holidays are full of emotions, so it can help to let guests know what to expect before they arrive. Initiating the conversation early will also allow family members an opportunity to surface any questions or concerns they may have.

If the person is in the early stages of Alzheimer’s, relatives and friends might not notice any changes. But the person with dementia may have trouble following conversation or tend to repeat him/herself.  Family can help with communication by being patient, not interrupting or correcting, and giving the person time to finish his or her thoughts.

If the person is in the middle or late stages of Alzheimer’s, there may be significant changes in cognitive abilities since the last time an out-of-town friend or relative has visited.  These changes can be hard to accept. Make sure visitors understand that changes in behavior and memory are caused by the disease and not the person.

You may find this easier to share changes in a letter or email that can be sent to multiple recipients. Consider also including a recent photograph of the person with dementia, so family/friends are aware of any physical changes that may have taken place. Here are some examples of what you may write:

>> “I’m writing to let you know how things are going at our house. While we’re looking forward to your visit, we thought it might be helpful if you understood our current situation before you arrive.

>> “You may notice that ___ has changed since you last saw him/her. Among the changes you may notice are ___.

>> “Because ___ sometimes has problems remembering and thinking clearly, his/her behavior is a little unpredictable.

>> “Please understand that ___ may not remember who you are and may confuse you with someone else. Please don’t feel offended by this. He/she appreciates your being with us and so do I.”

For more ideas on how to let others know about changes in your loved one, join ALZConnected, our online support community where caregivers like you share tips on what has worked for them.

Re-evaluate Holiday Traditions

It’s likely that both  the person with dementia and the family would still like him/her to participate meaningfully in the holiday celebrations. Involve the person by building on past traditions and memories. Focus on activities that are meaningful to the person with dementia. Your family member may find comfort in singing old holiday songs or looking through old photo albums. As the person’s abilities allow, invite him or her to help you prepare food, wrap packages, help decorate or set the table. This could be as simple as having the person measure an ingredient or hand decorations to you as you put them up. (Be careful with decoration choices. Blinking lights may confuse or scare a person with dementia, and decorations that look like food could be mistaken as edible.)

Sticking to the person’s normal routine will help keep the holidays from becoming disruptive or confusing. For instance, if the person is accustomed to eating lunch at a scheduled time, stick to that time. Encourage family members and friends to assist you in this. Plan time for breaks and rest.

Be flexible and adjust traditions appropriately. For example, a smaller, shorter gathering during the day may be more successful than a large celebration that carries on into the late evening.

Adapt Gift-Giving

gift

Encourage safe and useful gifts for the person with dementia. Some gifts may be unusable or even dangerous to a person with dementia. If someone asks for gift ideas, suggest items the person with dementia needs or can easily enjoy. Ideas include: an identification bracelet (available through MedicAlert® + Alzheimer’s Association Safe Return®), comfortable clothing, audiotapes of favorite music, videos and photo albums. Also, put respite care on your wish list. If friends or family ask what you want for a gift, suggest a gift certificate or something that will help you take care of yourself as you care for your loved one. This could be a cleaning or household chore service, an offer to provide respite care, or something that provides you with a bit of rest and relaxation.

When the Person is in a Care Facility

  • Consider joining your loved one in any facility-planned holiday activities
  • Bring a favorite holiday food to share
  • Sing holiday songs and ask if other residents can join in
  • Read a favorite holiday story or poem out loud

References

Liken, Michelle A, PhD,R.N., C.S. (2001). (Not) a hallmark holiday: Experiences of family caregivers of a relative with alzheimer’s disease. Journal of Psychosocial Nursing & Mental Health Services, 39(12), 32-7. Retrieved from http://search.proquest.com/docview/225538122?accountid=27927

http://www.alz.org/care/alzheimers-dementia-holidays.asp

http://www.alz.org/national/documents/topicsheet_holidays.pdf

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Not All Those Who Wander Are Lost

Wandering behavior is a common phenomenon among those that are diagnosed with dementia. Approximately 60%-67% of those with a diagnosis will exhibit wandering behavior over the course of their illness. Despite the prevalence of wandering, it remains a difficult issue to tackle and the consequences of a wandering incident can be dire. However, there are benefits to wandering, if done is a safe, supervised environment.

What is wandering?    

Wandering has proven difficult  to define because it is an inherently broad concept. In fact, a US Department of Veterans Affairs study (1985) concluded that its imprecision “defies definition”. Although there is not consistent agreement on what constitutes wandering some definitions include:

  • Behavioral problem of AD patients that involves cognitive impairment affecting abstract thinking, language, judgement, and spatial skills
  • Disorientation and difficulty relating to the environment
  • Aimless or purposeful motor activity that causes a social problem such as getting lost, leaving a safe environment, or intruding in inappropriate places
  • Meandering, aimless or repetitive locomotion that exposes the individual to harm; frequently incongruent with boundaries, limits, or obstacles

Wandering statistics

  • Up to 67% of those with dementia will wander.
  • 45% of wanderers will perish if not found in the first 24 hours
  • 83% have wandered before
  • 95% are found within 1.5 miles

Why does wandering occur?

The reasons why wandering occurs are as varied as the individuals that exhibit this pattern of behavior. Although it may not be readily apparent why the person with dementia is exhibiting wandering behavior, it likely originates from a physical, mental, or social need.

Determining Risk

  • Consider premorbid personality and lifestyle
  • Sleep disturbances sometimes predictive of wandering
  • Increased cognitive impairment correlated with increased likelihood of wandering behavior
Other Indicators:

  • Returns from a regular walk or drive later than usual.
  • Tries to fulfill former obligations, such as going to work.
  • Tries or wants to “go home,” even when at home.
  • Is restless, paces or makes repetitive movements.
  • Has difficulty locating familiar places like the bathroom, bedroom or dining room.
  • Asks the whereabouts of current or past friends and family.
  • Acts as if doing a hobby or chore, but nothing gets done.
  • Appears lost in a new or changed environment.

One interesting theory suggests that wandering in outdoor or woodland settings is a natural, human impulse and should be embraced rather than stymied. In Mape’s (2012) study, researchers piloted the idea of facilitating controlled wandering in a woodland environment in their study Wandering in the Woods. Researchers found after participants were exposed to outdoor exercise, subjects exhibited improved sleep, improved dietary intake, multi-sensory engagement and associated joy, increased verbal expression, and improved memory.

Where do they go?

Picture1

Evidence-Based Interventions

Environmental Modifications

  • Provide safe place for person to wander, such as walking path or ‘man cave’.
  • Enhance visual appeal of environment with interesting décor.
  • Maintain safety by removing clutter and dangerous objects.
  • Remove ‘triggers’, such as car keys, from the environment.
  • Place locks out of the line of sight. Install either high or low on exterior doors.
  • Subjective barriers, such as camouflage doors and doorknobs, and dark floor mats.
  • Use devices that signal when a door or window is opened.
  • Use confounding locks on doors to prevent exit/entry.
  • Provide supervision. Never lock the person with dementia in at home or leave him/her in a car without supervision.
  • Use large print signs/photographs to assist in finding key areas.
  • Ensure pathway to bathroom is clear and accessible, especially at night. Restrict fluids an hour or two before bed to avoid nighttime wandering.
  • Avoid environments that are confusing and can cause disorientation, such as grocery stores, shopping malls, or large holiday gatherings.

Physiological and Psychosocial Interventions

  • Having a routine can provide structure and reduce restlessness.
  • Encourage regular exercise, such as walking after meals.
  • Identify the times of day that wandering may occur. Plan activities at that time.
  • Ensure all basic needs are met. Has the person gone to the bathroom? Is he/she thirsty or hungry?
  • Assess for and treat depression.
  • Provide social interaction and engagement.
  • Encourage the person to engage in meaningful activities.
  • Reassure the person if he or she feels lost, abandoned, or disoriented.  Validate feelings.
  • Engage person in stress relieving activities, such as music, art, massage, etc.

References

Bushnell, R., & Collins-Fadell, C. (2012, September 1). For those who wander. The Best of Aging(11).

Futrell, M., Melillo, K., & Remington, R. (2010). Evidence-based guideline: wandering [corrected] [published erratum appears in J GERONTOL NURS 2010 Mar;36(3):1p]. Journal Of Gerontological Nursing36(2), 6-16. doi:10.3928/00989134-20100108-02

Lai, C., & Arthur, D. (2003). Wandering behaviour in people with dementia. Journal Of Advanced Nursing44(2), 173-182.

Mapes, N. (2012). Have you been down to the woods today? Working with Older People18 (1), 7-16. doi:10.1108/13663661211215105

Robinson, L., Hutchings, D., Dickinson, H. O., Corner, L., Beyer, F., Finch, T., Hughes, J., Vanoli, A., Ballard, C., & Bond, J. (2007). Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. International Journal of Geriatric Psychiatry22, 9-22. doi:10.1002/gps.1643

US Department of Veterans Affairs (1985) Dementia Guidelines for
Diagnosis and Treatment. Author, Washington, DC.

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