Patient Care At Every Stage

Early stage care-giving

What usually happens at this stage…

Your loved elder may

  1. Forget to keep appointments and take medicines on time
  2. Find it confusing to make financial decisions
  3. Start forgetting names, faces, addresses frequently

At this stage, your loved one may still be able to participate in social and familial responsibilities. They may be independent and may be able to do most routine tasks on their own.

At this stage, your role will be supportive. You may have to assure your loved elder that you are there to take care of any difficulty if it arises; e.g., if they forget to pay a monthly bill, you may have to take over.

At this stage, you should ensure that your loved one continues socializing and remains physically active.

Some things you can do to help

  1. Check if their medicines need refilling
  2. Help them in managing their finances
  3. Remind them about appointments
  4. Help them stay involved in social activities
  5. Encourage them to stay in touch with their friends
  6. Motivate them to keep their brain active (Solving crosswords, simple riddles, etc.)
  7. Motivate them to take up a hobby (gardening, playing music)
  8. Ensure that their homes are safe and well-lighted
  9. Encourage them to stay physically active
  10. Call or visit every day or at least several times a week

Middle stage care-giving

What usually happens at this stage…

Your loved elder may

  1. Have trouble in communication
  2. Need help in routine chores like cooking and dressing up
  3. Experience mood swings and sleep problems
  4. May have a tendency to wander

At this stage, your loved one may require more assistance in everyday tasks.
At this stage, your caregiving role will be more participative. You may have to get more involved as your loved one may start depending on you even for simple chores, e.g., cooking, grooming, etc.
As abilities begin to decline more and more, you may require help from family or other services available, e.g., hire a nurse attendant for some part of the day.
At this stage, the person with Alzheimer’s is at risk of wandering and getting lost. It is no longer safe for them to live alone.
It may be a challenging time for you, too, as the changes in your loved elder may be tough for you to accept. You may require patience and understanding as they may often be confused and disoriented or unexpectedly aggressive or suspicious.

1. Communication

At this stage, your loved one may fumble to find the right words and be unable to construct a sentence. They may struggle to express themselves and ask many questions repeatedly.

Read more…Tips to ease communication

Some tips to deal with barriers to communication in Alzheimer’s disease

  1. Speak slowly and clearly
  2. Break a sentence into short phrases
  3. Use simple words
  4. Give them time to respond
  5. Do not interrupt or distract them
  6. Be patient and supportive
  7. Minimize distractions like loud noises or music while talking
  8. Give step-by-step instructions
  9. Use gestures like pointing or touching an object
  10. Maintain eye contact

2. Every-day chores

At this stage, doing simple everyday chores may start seeming tough for your loved elder and you may have to support or assist them often. Read more…How to assist an AD patient in every-day chores

Grooming tips

  1. Keep only a few items of clothing in their wardrobes to avoid confusion
  2. Lay out the clothes in the order in which they have to be worn
  3. Choose the colours that they used to like
  4.  Choose comfortable fabric
  5. Switch from zippers and hooks to press buttons and Velcro fastenings
  6. Be flexible to accommodate their preferences

Meal-time tips

As your loved one’s thinking ability begins to diminish, feeding them nutritious foods may become a challenge. They may throw tantrums about food choices and sometimes forget to or refuse to eat their meals.

  1. Serve small meals every two to three hours
  2. Limit distractions while eating…e.g. switch off the T.V.
  3. Be flexible to their likes and dislikes
  4. Use spoons and forks with blunted edges to prevent them from hurting themselves
  5. Check the temperature of food before serving
  6. Make bite-sized portions of food
  7. Try to make meal-times as family times
  8. Give them sufficient time to eat
At this stage, doing simple everyday chores may start seeming tough for your loved elder and you may have to support or assist them often. Read more…How to assist an AD patient in every-day chores

2. Mood swings and changes in behaviour

As the cognitive and memory decline continues, the sufferer may find it difficult to understand the changes in his mental abilities and may become irritable, depressed, and frustrated. They may suffer from sleep disturbance. Wandering tendency may also increase at this stage.

Tips to deal with sleep disturbance

  • Adhere to a regular sleep schedule
  • Serve a light meal at night
  • Encourage light exercise like a brisk stroll after dinner
  • Create a comfortable sleep environment with dim lights and controlled temperature
  • Avoid serving coffee or tea in the evening
  • Avoid distractions like television or loud music before sleep-time
Tips to prevent wandering Are you aware that 6 in 10 people with Alzheimer’s wander? Wandering is a common phenomenon in Alzheimer’s disease. Since the sufferers are already disoriented about their names and addresses, this can lead to the grave danger of them getting lost. The family may experience incomparable anxiety and distress when the loved one gets lost.
  1. You can minimize this problem with the following tips
  2. Try to follow a structured routine
  3. Engage your loved one in activities that they enjoy
  4. Try to reassure them when they become anxious
  5. Keep keys out of reach
  6. Tie a name and address tag around their arm
  7. Avoid crowded places like markets or malls
  8. Keep a recent close-up photo handy
  9. Download an app that can help you monitor and trace your loved one

Late stage care-giving

What usually happens at this stage…

Your loved elder may

  1. Have difficulty in walking, communication and eating
  2. Be dependent on you for personal care
  3. Be susceptible to infections
  4. Become unresponsive and locked in their own world

At this stage, you must focus on making your loved elder’s life as comfortable as possible. The sufferers may seem unresponsive and distant and may have lost the ability to express or understand. However, they may still experience your love and care through their senses. Preserving their dignity and quality of life as much as possible is vital.

Here are some tips to try to connect

  1. Browse through favorite photographs together
  2. Describe the incident that went with the photograph
  3. Read out to them
  4. Play their favorite songs
  5. Tell them about your day
  6. Talk about old-time friends

Since your loved one may require round-the-clock assistance in the late stage of Alzheimer’s, you may have to involve external aid or think about other facilities that provide quality care; this may be one of the toughest decisions you have to make in your lifetime.

Some challenges of late-stage Alzheimer’s caregiving

1. Bladder and bowel incontinence

Your loved elder may start losing the ability to control his/ her bowels and bladder. You can handle this better by
  • Limiting fluids before bed-time
  • Using adult diapers and plastic sheets for bed
  • Monitoring their schedule routinely

2. Nourishment

Nutrition is one of the most important aspects of late-stage care as your loved elder becomes more and more dependent. You can deal with this better by
  • Feeding them if necessary
  • Choosing soft foods or thick liquids
  • Ensuring that they are in an upright position while eating
  • Constantly reminding them to chew and then swallow

3. Hygiene

Your loved elder may become dependent upon you for personal care at this stage. You must take care of

  • Oral hygiene by cleaning mouth, tongue and teeth after every meal
  • Prevention and treatment of bed ulcers or sores
  • Monitoring of water temperature before bathing