Alzheimer's Disease Health Article

Nursing care and safety

The person with Alzheimer's disease will gradually lose the ability to dress, groom, feed, bathe, or use the toilet without help; in the late stages of the disease, the individual may be unable to move or speak. In addition, the person's behavior becomes increasing erratic. A tendency to wander may make it difficult to leave the patient unattended for even a few minutes, which would make even the home a potentially dangerous place. In addition, some patients may exhibit inappropriate sexual behaviors.

Nursing care required for AD patients is simple enough to learn. The difficulty for many caregivers comes in the constant but unpredictable nature of the demands put on them. Additionally, the personality changes presented in AD can be heartbreaking for family members as a loved one deteriorates, seeming to become a different person. Not all AD patients develop negative behaviors: some become gentle, spending increasing amounts of time in dream-like states.

A loss of grooming skills may be one of the early symptoms of AD. Mismatched clothing, unkempt hair, and decreased interest in personal hygiene become more common. Caregivers, especially spouses, may find these changes socially embarrassing and difficult to cope with. The caregiver will begin to assume more and more grooming duties for the patient as the disease progresses.

Ensuring proper nutrition for the AD patient may require using a colored plate to focus the patient's attention on the food. Finger foods may be preferable to those foods requiring utensils. Later, the caregiver may need to feed the patient. As movement and swallowing become difficult, a feeding tube may be placed into the stomach through the abdominal wall, which will require special attention.

For many caregivers, incontinence becomes the most difficult problem to deal with at home, and is a principal reason for pursuing nursing home care. In the early stages, limiting fluid intake and increasing the frequency of toileting can help. Careful attention to hygiene is important to prevent skin irritation and infection from soiled clothing.

Safety will become of prime importance. In all cases, a person diagnosed with AD should not be allowed to drive, because of the increased potential for accidents and the increased likelihood of wandering far from home while disoriented. In the home, grab bars in the bathroom, bed rails on the bed, and clutter-free passageways can greatly increase safety. Electrical appliances should be unplugged and put away when not in use, and matches, lighters, knives, or weapons should be stored out of reach. The hot water heater temperature should be set lower to prevent accidental scalding. A list of emergency numbers, including the poison control center and the hospital emergency room, should be posted by the phone.

A calm, structured environment with simple orientation aids such as calendars and clocks may reduce anxiety and increase safety. Labeling cabinets and drawers may keep the patient's attention focused. Scheduling meals, bathing, and other activities at regular times and places will provide emotional security and routine, since unfamiliar places and activities can be disorienting for the patient. Sleep disturbances may be minimized by keeping the patient engaged in activities during the day, offering structure and providing physical activities.

Care for the caregiver

Family members or others caring for a person with AD have a difficult and stressful job, which becomes harder still as the disease progresses. It is common for caregivers to develop feelings of anger, resentment, guilt, and hopelessness, in addition to the sorrow they feel for their loved one and for themselves. Depression is an extremely common consequence of being a full-time caregiver for an AD patient. Support groups are an important way to deal with the stress of caregiving. The location and contact numbers for AD caregiver support groups are available from the Alzheimer's Association; they may also be available through a local social service agency, the patient's physician, or pharmaceutical companies that manufacture the drugs used to treat AD. Medical treatment for depression may be an important adjunct to group support.