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  • Aug. 4, 2009

    Strategies for dementia caregiving

    By Angela Lunde

67 comments posted

This summer's Greater Iowa Chapter Alzheimer's Association newsletter had a piece titled, "Ten real-life strategies for dementia caregiving." I like the piece and want to share a few of them with you, plus one of my own.

Being reasonable, rational and logical will just get you into trouble.
When someone is acting in ways that don't make sense, we tend to carefully explain the situation, calling on his or her sense of appropriateness to get compliance. However, the person with dementia doesn't have a "boss" in his brain any longer, so he doesn't respond to our arguments, no matter how logical. Straightforward, simple sentences about what's going to happen are usually the best.

Therapeutic communication reduces stress.
We tend to be meticulously honest with people. However, when someone has dementia, excessive details may lead to distress, for both them and the caregiver. Does it really matter that your loved one thinks she's the volunteer at the day care center? Is it OK to tell your loved one that the two of you are going out to lunch and then "coincidentally" stop by the doctor's office on the way home to pick something up as a way to get her to the doctor?

It's perfectly normal to question the diagnosis when someone has moments of lucidity.
One of the hardest things to do is remember that we are responding to a disease, not the person. Everyone with dementia has times when they make perfect sense and can respond appropriately. We often feel like that person has been faking it or that we've been exaggerating the problem when these moments occur. We're not imagining things; they're just having one of those moments to be treasured when they occur.

Offering a sense of control goes a long way.
All of us want to feel like we're in control of our own lives and have the capability to make our own choices. This doesn't change when someone has dementia — even the later stages of Alzheimer's disease. Although somebody with advanced Alzheimer's disease is no longer capable of maintaining the independence and choice they once had, we have the opportunity to offer them at least an "illusion of control". For example, instead of saying, "I want you to take a bath now" you could say, "I know how much you love taking a bath on Sunday evenings, thank you for letting me help you out."

The advice I often give caregivers is to communicate with words, tone and body language that can most often generate reassurance and a sense of contentment.  When we communicate in this way, we're letting go of our own need to control a disease which we simply cannot.

67 comments posted

blog index
  • March 4, 2010 9:08 p.m.

    my mom has alzhiemer's has had it 8 years now she will be 69 this july in december she had her first siezures wasn't able to walk after them but eventually got herself back to walking now as good as before them but enough to get around then again over night she wasn't able to walk or sit up or stand literally overnight i am her only caregiver have been the entire 8 years i do have a paid sitter that comes 3 days a week for 3 hours i also now have hospice who has been wonderful i suggest anyone who needs help contact hospice they are such a great help even when you just need someone to talk to that actually understands i wish everyone luck who is in the same place i am with a loved one and send my prayers to you and your families it's a terrible disease to have and even more terrible to watch it happen to someone you love and know there is nothing you can do to stop it just pray and know your doing your best to make what time they have left as comfortable as possible and your doing it with love.

    - virginia

  • March 3, 2010 5:56 p.m.

    Hi, I have in the past two years lost three of the closest people in my life, to three different things. One was Lue Garics and dementia, one was to Alztimers, and on was to cancer and dementia. Well needless to say it was sad and I am reading this and I totally agree and recomend trying all these steps as hard as they are they work. Good luck to everyone who is a care giver I was their and I lived with each one as they went threw it.

    - Mindy

  • February 26, 2010 7:24 p.m.

    Hi ( for Hanna) My Dad was having this problem with my Mom. We let her physician be aware of this problem and he put her on seroquel, a very low dosage. It seems to have helped. I have also started taking her for short walks in the morning for exercise. Just a suggestion for you.

    - Melinda

  • February 17, 2010 8:55 a.m.

    My mother is 86 and has alz/dementa. She wakes up at night and goes to shower to be ready to start her day after 2 hour of sleep. I try to put her back to bed and she will wake up in 10 minutes after i have put her back to bed. Some times she is ready to start her day at 10.30 pm. If i let her start her day - she keeps on walking whole night long. I have'nt had a full night sleep for last one year. Any suggestions - any one?

    - hanna

  • February 10, 2010 3:08 p.m.

    My mom is 87. I am not sure if she has Alz or dementia. She is able to feed herself, go to the bathroom & brush her teeth. She has hallucinations, hears people talking, says that we have 2 houses on the same street, yesterday President Obama came to the door. My question is how do I handle this? Do I agree with her or try to make her understand. She sometimes gets angry and upset because I can't see or hear what she does. Also, she sees & hears my Dad who has been dead for 4 years & gets upset when I say he is not here. What is the best way to handle this? Agree or Disagree, change the subject etc. Thanks

    - Carole

  • January 31, 2010 10:29 a.m.

    This is for Judy, Jan 18th. My mom has had alz for almost 10 years. 5years unable to communicate, walk, or dress herself. etc. She currently is unable to swallow normally and sleeps all day. We have contacted hospice for her and have found they have taken so much of the stress and indecision from us. Contact you MD and the hospice in your area. Hospice is available thru medicare for the last months of life. They are compassionate people who are there to help the entire family. Give them a call and see if they can help you. Thru the years I have also used the ALZ.org website for a wealth of info. My mom is in the last days of her life at 86yrs old. She probably will not last thru the week. I thought the end would bring relief after this horrible disease, but I am so sad that it took 10 years of my moms life. She is and has been healthy without medication, but sadly that has been the curse that has kept her alive. God bless you and your family.

    - Cathy

  • January 22, 2010 5:15 p.m.

    my mother was in hospital twice in dec 09, and since then she has lived with me. she doesn't even care to go home. so now she lives with me and i care for her.i give her all her meds. i go to work and she is so excited to see me when i get home. it is very sweet. she has forgot my name and that truly hurt but i didn't let her see that. i just laughed and asked her who do you think i am. we have had so much fun and it is hard to see her going down everyday. she has had dementia for several years but lately it has gotten worse. i have to tell her to change her diaper and clean her teeth, and clothes. she is just like a child. she took care of me and i am trying to do my best to care for her. my brother does not believe anything is wrong with her, and that really hurts that i am doing it all. someone comes over twice a week to bathe her. i don't know how long i will be able to care for my mom,but right now i am doing the best i can. she has woke up and dressed at 12.30am and was gonna start her day. i told her to go back to bed and she did. this really helps so much to talk about this.

    - robin

  • January 18, 2010 2:35 p.m.

    Hi, to all the special care-givers out there, my precious Mother has dementia since April 07, she is totally unable to move, unable to feed herself, I puree everything she eats, now it seems she can't swallow, she can't even suck on a straw, I'm feeding her liquids with a syringe only when she opens her mouth and of course if I see she can't swallow I stop. Question? have any of you experienced this stage of dementia? What's next? please help

    - Judy

  • December 31, 2009 12:11 p.m.

    THIS IS A 3 PART STORY, PLEASE SCROLL DOWN 3 TO SEE PART 1 . THANK YOU

    - Ross

  • December 31, 2009 12:08 p.m.

    to stay the night. I said we are all friends here, I know they have extra rooms let's go see if they have one for you! will both get a good night sleep have some breakfast and hop on the bus tomorrow and go home. She smiled thanked me said OK, It doesn't all ways go that smooth but one thing I learned is patience & just go with the flow hope this helps. God bless you & your family members,& the Cna's Nurse's Doctors that really care!

    - ROSS PART 2

  • December 31, 2009 12:07 p.m.

    (I had a hell of a time doing my own). She swore her coffee maker did not work after I showed her 5 times what she was doing wrong, I figured it was her Arthritis flaring up,( it wasn't). And all the other small thing I did not catch. Until time came for the Nursing home I won't go into all the stress / guilt, education about the disease, fatigue, and getting a hold of doctors and vigilantly going to the nursing home to keep an eye on her. But all my time spent with her at the home and taking her out for outings I remembered what John said. She would see Dogs & Cats walk by or just sitting next to her (She was an animal lover). And point them out to me with a smile on here face. And I would say "Oh ya what a good looking Dog, what breed is that"? ( there was no dog there) and she would say a Golden or Lab or Basset ect. It is a sad disease but JUST BE HAPPY THAT THEY ARE ON A GOOD "TRIP"! GO WITH THE FLOW! Amongst other story's about the other residents one comes to mind This Lady, Lucile was really agitated & the nurse was trying to get her to go to her room to go to bed it was around 9:00 p.m.Lucile was confused & did not know where she was at. I said Lucile whats wrong? She was on the verge of crying she told me she missed the F@$#ing bus to get home. I told her "YA DAMN IT! I did to" ( she swore like a drill Sargent,she smiled because I said "damn it") I said the bus will be back tomorrow morning to pick us up. And t

    - ROSS PART 2

  • December 31, 2009 12:07 p.m.

    Hello, Mom, passed away last May with dementia I have some thoughts hopefully to help some folks. A few years before Mom got "sick" a friend of mine came back from a funeral. He told me that his Two elderly Aunts had lived together, one had Alzheimer's & the other one was as healthy as a horse. I said "Oh sorry to hear,was it the aunt with Alzheimer's that passed"? No he said, you know how life seams to always serve you up a ... sandwich it was the aunt that was healthy as a horse that passed away."Yes I know" I said, he then proceeded to tell me he did not think that Alzheimer's was that bad of a disease. I said "John what the hell are you talking about? It has to be a nightmare for the person & the caregiver! He said "Ya maybe but my healthy Aunt knew how to handle her sister never argued or tried to reason with her, Just went along with the flow. And the Aunt that had Alzheimer's was crying and having a hard time at the funeral... Once they closed the casket she forgot who was in the box and she started laughing & carrying on, and thought she was at a wedding and was having a great time"! John I said. That's what I like about you,you always look on the bright side of things. A few years later my mom started having all the signs that I over looked probably like most people, like she could not see to well to balance her check book. So I took her to the Eye doctor 3 or 4 times,Doctor could not find any thing wrong wi

    - ROSS PART1

  • December 5, 2009 5:28 p.m.

    My Uncle lives with me and is experiencing more "mini strokes". He doesn't remember what he has done the day before. He just got upset because he could not change the TV channels by holding his finger on his nostril. I tried to reason with him and realized that was a mistake so I told him it didn't work that way anymore and he had to use the remote control. He does not want to use his oxygen anymore - but I put in on him and turned it on. I am looking for an online support group so I can ask questions. He is safe at home because he doesn't cook and he has arthritis so he can't get out and wander. I feel like I should be doing more, but I guess I just have to go with the flow. Any ideas?

    - Phyllis

  • November 30, 2009 7:33 p.m.

    Mom just passed away after 6 yrs. of Alzheimers. Dad kept her at home with gals coming in to help. It was cheaper than a nursing home- dad didn't feel guilty and mom felt at home even tho she didn't know us. When she stopped wanting to eat or drink the doctor told us it was time for Hospice. They were so great! Helped us to let her go - gave her water or ensure if she wanted, a couple ounces was all she wanted, and then a week ago she just drifted out...a peaceful departure. Ask your doctor or community agencies for ALL THE SUPPORT you need for these trying years! They are OUT THERE and really CAN HELP!

    - Suzanne

  • November 20, 2009 4:49 a.m.

    FOR SOMEONE WHO MISSES FAMILY WHILE LIVING IN A RESIDENCE, I HAVE FOUND THAT IN ONE TO ONE CARE THAT I HAVE PUT TOGETHER A THREE RINGED BINDER WITH A PERSONALIZED FRONT PAGE "ESPECIALLY FOR", THEN THE PHOTO OF THE PERSON WITH A NOTE ON THE BOTTOM...WITH LOVE FROM YOUR FAMILY AND FRIENDS. THEN, FAMILY MEMBERS & FRIENDS SEND ME A NOTE WITH A PHOTO ATTACHED WHICH I PRINT OFF, PUT IN A PLASTIC COVER..THEN WE READ THE NOTE, LOOK AT THE PHOTO AND CHAT. THE RESIDENT KEEPS THE PHOTO BINDER TO LOOK AT IN THEIR OWN TIME...IT SEEMS TO ASSIST IN HELPING ONE FEEL THAT THEY ARE STILL INVOLVED IN THEIR FAMILY'S LIFE, ARE LOVED, THAT THEY MAKE A DIFFERENCE TO FAMILY & FRIENDS - IT ALSO ASSISTS WITH NOT FEELING SO ALONE IN BETWEEN VISITS. THIS IS JUST ONE INSTANCE WHERE THIS WAS HELPFUL, EACH INDIVIDUAL IS SO UNIQUE AND ONE MUST CONSIDER OF WHETHER THIS WOULD BRING A POSITIVE TO THAT PERSON. IT SEEMS TO HELP FAMILY STAY CONNECTED BY SENDING UPDATED NOTES AND PHOTOS, GOOD THERAPY FOR ALL. IT ENABLES ALL TO APPRECIATE, ACKNOWLEDGE AND CELEBRATE OUR LOVED ONES/FRIENDS WITH ALZHEIMERS - FOR US ALL TO STAY IN THE MOMENT, APPRECIATING THE PERSON BEFORE US, THE MOMENT AT HAND AS IT IS AND BE GRATEFUL THAT WE CAN SHARE IT TOGETHER.

    - LINDA

  • November 19, 2009 8:34 p.m.

    MY HUSBAND HAS ALZHEIMERS FOR 5 YRS. NOW..IT'S GETTING HARDER ON ME AS WELL AS HE. HIS SPEECH IS HAVING SOME DIFFICUKTIES TALKING AND OF COURSE FORGETTING AND EVEN NOT FINISHING WHAT HE STARTED SAYING TO ME OR OTHERS. HE 64 HAS HAD THIS 5 YRS. WE ARE MARRIED 43 YRS. WENT FOR 3 YRS BEFOR THAT I WAS NOT YET 15YRS. I LOVE HIM BUT I GET SO ANGRY AT THIS DESEASE I READ SOME OF THE OTHERS AND UNDERSTAND WHAT A CARTAKER GOES THROUGH NOW. I HAD TRIBLE-BY-PASS 2 YRS. AGO AND IT'S HARD SOMETIMES..I HAVEN'T PUT MYSELF FIRST AT ALL NOT DOING WHAT I SHOULD WITH SLEEPING,EATING AND DR.S I JUST MAKE SURE HE IS BEING TAKEN CARE OF ALL THE TIME. I TRY TO MAKE LIGHT OF THINGS BUT AT TIMESW I CRY WHEN HE ASLEEP SO HE DOESN'T SEE. MY QUESTION IS ..HOW LONG IS IT OR DOES IT TAKE FOR THIS ILLNESS TO GET WORST OR WHERE DO I TURN FOR HELP ...THE INSURANCE DOESN'T COVER ALOT..AND WE ARE ON A SET INCOME ..CAN I GET FOOD STAMPS? OR ANY THING ELSE THAT WOULD HELP US ALITTLE. I JUST FOUND OUT ABOUT HEALTH CARE I'LL BE PAYING 230 STARTING JUNE WHEN HE TURNS 65 .HE ALWAYS TOOK CARE OF THE BILLS SO I NOW TAKE CARE OF EVERYTHING AND I REALLY DON'T UNDERSTAND SOME OF THESE INSUREANCE OR MEDICARE STUFF. WHAT TO DO?????TKS FOR YOUR INFO AND HELP JOANNE,FL.

    - JOANNE

  • November 9, 2009 1:36 p.m.

    My 83 year old wife with 7 years into Alzheimers has recently started to eat very little. What should I do? I am the sole caregiver. I have two hours of hired respite twice a week. I am one of those who do not want to give up caring. I placed her in an Alzheimer unit for 5 days with some disasterous results.

    - kenneth

  • November 6, 2009 8:30 p.m.

    This is for Sally. We live in Bryan, TX and we have the Rose Home here. I had to put my Mom there this week and though I agonize over if I have done the right thing(she is heself, sometimes), they are houses with 3-5 people and at least one nurse's aide there 24/7. The cost is much less and the care is great. She is realizing what has happened and is very angry. Tomorrow she may or may not remember. I love my Mom and I just cannot be there to protect her all the time. It hurts soo much to have to do this.

    - SJ

  • November 4, 2009 1:24 p.m.

    people with Alzheimer's are not "crazy" and they are not children and it is counter productive if they are treated in that manner. Remember that they have lived adult lives and the person is still inside and their feelings remain with them.Treating them with respect and dignity -- and love --will be reflected in their behavior. They respond happier and calmer, and with fewer outbursts from frustration. Their increased feeling of security improves the life of person and caregiver. The 11 years that my husband and I shared his disease, as chronicled in my memoir (Everything Will Be Alright: an Alzheimer's memoir) shows how awakening emotional memories made it possible for us to grow closer than ever to each other. Being a caregiver is not just about physical needs, but the psychological needs as well. I donate proceeds from my book to Alzheimer's research.

    - glory

  • November 2, 2009 8:02 a.m.

    My mother has Dementia. She has started declining quickly. She is hungry all of the time and craving sweets. She will eat dinner and say she has had enough then in just a few min she says she is hungry. When we give her something else she says "what's that, I can't eat all of that" then she does. She has also been craving sweets. She is insulin dependent diabetic. None of her doctors have ever heard of this. We keep fresh fruits and several healthy snacks around for her. We have tried bulkey foods, pasta, rice anything to fill her up. She is constantly hungry and gets very aggitated when we do not give her something to eat even though we know she can't be hungry. When we tell her she has just eaten she ask "what did I eat" She does not remember eating anything.

    - Sherri

  • October 30, 2009 8:53 p.m.

    My father was diagnosed with dementia just recently and was put into a nursing home dementia unit. He is high functioning and when he sees me he asks to be taken home immediately. I am finding it difficult to go to see him, yet I know he depends on me. I feel as though I have abandoned him.

    - No name given

  • October 13, 2009 7:49 a.m.

    I help care for my girlfriend's ninety-year old dad on a farm in rural Minnesota. He's had dementia for a few years and does not like the idea of leaving the old farm house and dog to live at a nursing home in town. He grew up drinking milk straight from the cow and is independent as the day is long so trying to get him to mind is not easy. Two things help though: Speaking in a soft tone helps. And, trying to make tasks such as using the toilet or taking a bath sound like fun. Reminding him that he'll feel better after completing the task or associating the task with a pleasant memory sometimes makes both of our lives a little easier. Many thanks to the Mayo Clinic and all the contributors.

    - craig

  • October 12, 2009 7:57 a.m.

    Very helpful article on caregiver strategy. Hope you can visit our rural Maine Alzheimer's blog at hazidaze@blogspot.com

    - barb and gordon

  • October 11, 2009 10:20 p.m.

    My ex-stepmother had a stroke a few months ago and was placed in a nursing home by my brother. The doctors felt that she would not be able to take care of herself properly after being released from the rehab center. She was able to walk at this point, but had difficulty remembering how to do things. She, of course, did not want to go to a nursing home, but attempts at having her stay with a daughter or have her sister stay with her failed. The nursing home staff says she is verbally abusive, kicks, etc. There have been 2 ocassions when my brother went to see her that she was completely zoned out...slack jaw, drooling, non-responsive. The last time, about 3 weeks, my brother questioned her mental and physical condition to the nursing home staff and has been making random visits. Since the last episode, she has been fairly alert, able to read and answer questions posed by my brother, has known my brother, her other children and grandchildren. It has been said that she suffers from Lewy Bodies Dementia. Does this type of dementia cause the zoned out physical state that my brother found her in?

    - Gail

  • October 1, 2009 3:12 p.m.

    Sally - Yes, the costs are horrendous. You need to contact an Elder/Estate Law attorney. The Alz Assn in your state might have some names or your Area Agency on Aging will have the names of a Senior Advocate in your area, referral names, etc. While you still have resources, you might be able to protect some of your assets or legitimately spend down some of them before you need to place your husband into a care center, if it gets to that point and you decide that you can no longer caretake him at home. Medical Assistance rules vary from state to state, my state has a 7 year look back period. Don't delay -preparation is essential. May God Bless You and your family during this journey. Remember to smile, laugh, breathe deeply, enjoy the fall colors, hug another and Celebrate TODAY!

    - MK

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