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Advancing Through the Stages of Alzheimer’s: Tips to Help Manage the Many Changes

dtages of Alzheimers

Find tips to help with the changes that occur through the stages of Alzheimer’s from the Phoenix senior care experts.

When a loved one is diagnosed with Alzheimer’s disease, families are faced with a number of questions and challenges. How will the disease progress? What changes will I see in my loved one? And how am I going to handle them?

It’s important for family caregivers to equip themselves with as much information as possible about the disease, and this includes creating a plan that is proactive enough to address the current needs, while preparing for those yet to come. While each person experiences the stages of Alzheimer’s uniquely, there are some commonalities to keep an eye out for, particularly as it relates to changes in the person’s personality, mood, and the behaviors that stem from those changes:

  • Increased agitation, anxiety, and irritability
  • Loss of interest in once-enjoyed activities
  • Paranoia
  • Depression
  • Pacing and wandering
  • Physical and/or verbal aggressiveness
  • Difficulty understanding the world around them
  • Poor hygiene habits
  • Problems with falling or staying asleep, and differing sleep patterns
  • Physical challenges such as problems with vision and/or hearing
  • And many others

These effects may also come and go as the person progresses from one stage to the next, and new challenges then become apparent. And understandably, trying to help someone who’s experiencing such a wide array of emotions and behaviors can quickly become overwhelming for family caregivers.

Try these tips to bring comfort to a loved one with Alzheimer’s, from the Phoenix senior care experts at Nightingale Homecare:

  • Minimize distractions. Often, confusion and frustration are enhanced for someone with dementia when there’s an overload sensory stimulation, such as the TV or radio playing while others in the room are talking.
  • As much as possible, stick to a daily, predictable routine.
  • Avoid open-ended questions, and instead provide choices; for instance, “Would you like chicken or fish for dinner?” is often more effective than, “What would you like for dinner?”
  • Never correct or argue with the individual.
  • Use statements that reflect the person’s feelings rather than the behaviors that have manifested from those feelings: “It looks like you’re feeling angry today,” rather than, “Why are you banging your fist on the table?”

While it’s natural for family caregivers to feel upset or frustrated themselves when a loved one’s feelings are elevated and behaviors are difficult to handle, it’s also vitally important to maintain a sense of calm, even in the face of distress. The senior will pick up on your agitation, often leading to escalated behaviors. Take a step back, breathe deeply, and count to ten before responding to the senior’s needs.

At Nightingale Homecare, our specialized Connections dementia care program helps those with Alzheimer’s by utilizing a unique, creative, and compassionate approach through qualified Alzheimer’s Whisperers® who are extensively trained in effectively managing the difficult behaviors that often accompany dementia.

We begin by providing an in-depth evaluation, and then create a customized strategic plan to fully meet the person’s needs while empowering him or her to maintain the highest level of functionality at all times.

Partnering with the professional Alzheimer’s care team at Nightingale Homecare helps not just the person with dementia, but his or her family caregivers as well, providing the opportunity for the respite required to maintain a healthy life balance. Contact us at (602) 504-1555 to learn more!

Top Providers of Home Health in Scottsdale Explain the Incredible Impact of Music in Alzheimer’s Disease

home health Scottsdale

Top providers of home health in Scottsdale explain the fascinating connection between music and Alzheimer’s.

Have you ever heard a song playing on the radio and found yourself transported to a time and place from the past? Have you ever had a song stir your deepest emotions – and bring back those memories as if they were happening in the present? Have you been comforted, stimulated, saddened, elated or experienced some other powerful emotion just because of a song? Most of us have had such experiences, and the power of the “remembering” elicited by music can catch us “off guard” when the song evokes emotionally-charged memories.

Music has the same power with individuals diagnosed with Alzheimer’s disease or dementia, and knowing this provides one more tool to help families or caregivers to manage challenging behaviors, to reach someone who appears to be lost in the disease, to calm an agitated individual and encourage cooperation in activities such as bathing that might otherwise be met with resistance. Some research even indicates that music can help restore lost memories and bring those afflicted with the disease back into the present – if only for a short period of time.

These facts about the power of music seem to fly in the face of the progressive loss of memories associated with Alzheimer’s disease – starting with the most recent and steadily erasing long ago memories going back in time. However, it is important to know that the memories of music are “wired” differently in the brain than other memories – it is almost as if the brain is made to contain music. Whereas short-term memories are stored in the hippocampus, music is stored everywhere in the brain, and music with all of its emotional meanings continues to be accessible to people with Alzheimer’s disease, even when they have lost the ability to speak – many can still sing!

What a powerful idea this is! If caregivers fully appreciated the significance of music they would use it all the time and to facilitate many activities of daily living. Caregivers have shared that they engage the person with Alzheimer’s in singing while the individual is bathed and dressed. Nurses sometimes use music while they are performing a painful procedure such as dressing a wound or drawing blood – music can distract, can soothe and can engage the person with Alzheimer’s disease.

Recent research conducted by Brandon Ally, an assistant professor at Boston University, where 32 Alzheimer’s patients participated in a study that examined the power of music, found that these subjects were able to learn more lyrics when the words were set to music than when they were spoken. Ally believes that the results of this study suggest that those with Alzheimer’s could be helped to remember things that are necessary to both their independence and well-being. For instance, creating a short ditty about taking medications or the importance of brushing one’s teeth might be a strategy to help those with Alzheimer’s disease maintain abilities to perform these necessary skills. This was the first study to demonstrate that using music can help people with Alzheimer’s to learn new information.

In the famous YouTube video Man in Nursing Home Reacts To Hearing Music From His Era, we see Henry, a man who was almost totally unresponsive, begin to respond with sound, movement and facial animation when he uses an iPod programmed with “Henry’s music.” After the iPod is removed, Henry is not only quite spirited, but totally involved in the ensuing conversation. He is able to discuss his favorite musician, Cab Calloway, and when asked, “What is your favorite Cab Calloway song?” Henry begins to sing, “I’ll Be Home for Christmas.” Not only is his speech perfectly clear, his face is expressive, he uses his hands in explaining the emotional power of music. The interviewer inquires of Henry, “What does Cab Calloway’s music mean to you?” Henry talks about what music does for him – that the Good Lord changed him through music and made him a “holy man.” The transformation of Henry is nothing short of miraculous and raises questions about why music is not used in every home, in every assisted living facility, and in every skilled nursing home where someone with Alzheimer’s is cared for.

Music should be a routine part of care; not only does it bring joy to the person with this terrible disease, it allows for continuing connections between the caregiver and the person with Alzheimer’s disease. It diminishes the lonely isolation that is part of the disease when the afflicted person appears to be locked in a world that is isolated and isolating to others.

One more story about the power of music: a gentleman named Ben shared this story about his wife who had been diagnosed with Alzheimer’s and was well into the middle stage when he placed her in a facility for care. Ben visited often, and one of the techniques he used to stay connected to his wife and to make the visits pleasant and meaningful for both of them was to draw on his wife’s past history with music. She had sung for many years with the Sweet Adelines and she retained her lovely singing voice despite the ravages of Alzheimer’s disease. Ben loaded music that his wife had sung through her years with the Sweet Adelines. He attached two sets of earphones into an iPod – one for his wife and one for himself, and they would sing together. Music was a powerful connection between them that remained until his wife passed away.

At Nightingale Homecare, providers of the highest quality home health Scottsdale families trust, we are passionate about helping those with Alzheimer’s disease live life to the fullest. Our Connections Dementia Care program incorporates music and a variety of other creative techniques to enhance quality of life. Contact us at (602) 504-1555 for a free in-home consultation to learn more about our specialized dementia care services.

 

About the Author: Verna Benner Carson
P.D., PMHCNS-BC, is president of C&V Senior Care Specialists and Associate Professor of Nursing at Towson University in Baltimore, MD. Dr Carson can be reached at 
vcars10@verizon.net

Occupational Therapy Can Help Alzheimer’s Patients

Scottsdale senior home care

Learn how occupational therapy can enhance the quality of life for those with Alzheimer’s.

Caring for a loved one with Alzheimer’s disease is a constantly evolving process, seemingly changing from day to day or even hour to hour. In the morning, your loved one may be perfectly content to reminisce over family photos and enjoy a walk around the neighborhood; while later in the day, the person may become highly agitated and experience difficulties with sundowning. It can be challenging to know how to most effectively manage the ups and downs of dementia and ensure the senior enjoys the highest possible quality of life.

At Nightingale Homecare, we implement a variety of personalized strategies through our Connections Dementia Care Program, right in the comfort of home, that help those with Alzheimer’s disease live life to the fullest in whatever stage of the disease they happen to be. One of our top recommendations for families is to include an in-home occupational therapist in the care team, something many families haven’t considered. Occupational therapists are trained to adapt the environment of the person with dementia to maximize safety, while focusing activities on the senior’s strengths and interests, leading to a safer and more fulfilling life.

Here are just a few of the challenges that can arise with Alzheimer’s, and how an occupational therapist can help:

Wandering. Wandering is one of the more dangerous problems in dementia, and can be difficult to overcome. An occupational therapist can develop a variety of customized activities that are engaging and enjoyable for the senior that offer the mental stimulation needed to distract and divert away from the urge to wander. Additionally, other methods can be implemented, such as posting stop signs on doors, recommending the most effective types of door locks, and utilizing a GPS monitor to ensure the senior stays safe.

Dependency. A loss of some degree of independence is inherent to Alzheimer’s disease; yet it’s extremely important to help seniors maintain as much freedom and autonomy as possible. An occupational therapist will observe the senior’s strengths and work with those strengths to create adaptations that allow the person to continue to do as much as possible independently.

Memory loss. Preserving memory helps seniors maintain an emotional connection to both those they love and their own life history. Occupational therapy services can help by providing recommendations for memory-prompting activities, particularly in focusing on long-term memory, which is often better preserved than short-term. Occupational therapists can also create strategies for managing the more difficult aspects of memory loss, such as forgetting who family members are.

We’re pleased to offer professional in-home occupational therapists for help in these areas and many others. Contact us at (602) 504-1555 any time to request an in-home evaluation or to learn more about how our full range of home health care services, including occupational therapy, can help older adults with dementia or any other condition of aging live better lives. Our Scottsdale senior home care experts are always here to help!

Top Tips for Maintaining Oral Care in Alzheimer’s Disease

in-home care Paradise Valley, AZ

Proper oral care is crucial for those with Alzheimer’s disease. Learn tips here.

Maintaining good oral health is essential to everyone’s wellbeing. For a person struggling with Alzheimer’s disease or dementia, daily attention to oral health can prevent problems like painful cavities, infections, digestive problems and eating difficulties. Your loved one may not be able to express the pain of a toothache or gum problems, and without proper attention, this can lead to tooth decay, untreated lesions, possible abscess and serious health complications.

When a person suffers from Alzheimer’s disease or another type of dementia, attention to oral care often gets overlooked. As the disease progresses, those with memory challenges need varying levels of support to keep up with their oral hygiene routine. In the early stages of the disease, your loved one may just need reminders on how to brush and why it is important; however, as the disease progresses, your hands-on attention to this important daily routine is critical in maintaining your loved one’s oral health and overall wellbeing.

Try these tips to help ensure your loved one with Alzheimer’s disease maintains healthy teeth and gums, courtesy of the professionals in in-home care Paradise Valley, AZ seniors need and trust at Nightingale Homecare:

Keep the teeth and mouth clean. Very gently brush the person’s teeth, gums, tongue and roof of the mouth at least twice a day, with the last brushing after the evening meal (see below for instructions).

Try different types of toothbrushes. Experiment until you find the right choice for your loved one. You may find that a children’s toothbrush works best, as the head is smaller and the bristles are softer. You may also want to try a long handled or angled brush, which can be easier to use than a standard toothbrush. Be cautious with using an electric toothbrush on a person with Alzheimer’s disease, as this can create fear and agitation.

Floss regularly. Take the time to floss daily. Flossing can be distressing to a person with Alzheimer’s, so try using a “proxabrush” to clean between teeth. A Waterpic is another option, if the person can tolerate it, which is gentler on the gums and much easier than trying to manipulate string floss. As when using an electric toothbrush, remember to proceed slowly and calmly, letting your loved one know what you are going to do next. Monitor the water temperature, pressure setting and the angle of the nozzle while working. Instead of using only water in the reservoir of the appliance, add a small amount of anti-cavity mouthwash.

Be aware of potential mouth pain. Investigate any signs of mouth discomfort during mealtime. Refusing to eat or strained facial expressions while eating may indicate mouth pain or dentures that don’t fit properly.

Monitor sugar intake. As we know, sugar can cause tooth decay, especially when it’s frequently eaten. If your loved one with dementia is in need of a snack, try to avoid giving too many sugary foods. Tooth-friendly foods and snacks include:

  • Vegetables
  • Fresh fruit
  • Yogurt
  • Bread with sugar-free spreads
  • Crackers and cheese
  • Pita bread with hummus
  • Rice cakes

Keep your loved one hydrated. Proper hydration helps keep the mouth moist and inhibits bacterial growth. Saliva is meant to serve this purpose, but may older adults suffer from dry mouth caused by a wide range of medications. There are several over-the-counter mouth rinses specifically for dry mouth that aid in keeping the mouth moist. The last step to any meal should be using water to wash everything away.

Timing foods for oral care. Offering fruit at the end of each meal can go a long way in helping break down the sugar and starch from a meal. Crunchy fruits and veggies help remove plaque from the teeth.

Brushing Your Loved One’s Teeth

Everyone should have their mouth cleaned twice a day, so make sure your loved one continues to keep up this routine, and provide assistance when needed. You may find that some days you can just direct the steps, and other days you may have to actually perform the care. Keep these pointers in mind as you accomplish the task of brushing.

  • Provide short, simple and clear instructions, broken into steps, such as, “Hold your toothbrush. Now put toothpaste on the brush.”
  • Use a “watch me” technique. Hold a toothbrush and demonstrate to your loved one what to do.
  • You may need to guide by putting your hand over the person’s hand, gently guiding the brush.
  • If your loved one seems agitated or uncooperative, postpone brushing until later in the day.
  • Observe your loved one for signs of discomfort: grimacing, bleeding gums or sensitivity to hot or cold. These are signs your loved one may need to see the dentist.

If you need to brush your loved one’s teeth:

  • Support the person’s jaw to keep the teeth together to help clean the outer surfaces of the teeth.
  • Encourage the senior to open wide to help you clean the inside and biting surfaces of the teeth.
  • Use a pea-sized amount of toothpaste.
  • Use gentle, circular movements, paying extra attention to the area where the tooth meets the gum.
  • Encourage your loved one to spit out the toothpaste rather than rinse it out. The fluoride in the toothpaste will continue to protect their teeth.
  • Clean the teeth from the outer surfaces to the biting surfaces and finally to the inner surfaces.
  • Replace the toothbrush when it begins to show wear, or every three months.
  • If you notice your loved one’s gums are bleeding, this means there is some residual plaque in the mouth, which is irritating the gums. Continue to brush the person’s teeth, but if the bleeding continues more than a week, make an appointment with a dentist.

Dealing with Dentures

Many people living with Alzheimer’s disease have dentures, and it’s important to ensure they are cleaned daily and replaced when necessary. Follow these tips to ensure your loved one’s dentures are cared for:

  • Rinse dentures with plain water after meals and brush them daily to remove food particles.
  • Clean dentures with a special denture brush and denture paste or non-perfumed liquid soap and water to remove all food and plaque deposits.
  • Each night, remove the dentures and soak in a denture cleanser or mouthwash.
  • Ensure your loved one cleans remaining teeth and/or gums before going to bed. Use a soft-bristled brush or moistened gauze if there are no natural teeth.

Dental Appointments

Most dental insurance plans cover a teeth cleaning (prophylaxis) every six months. Since it can be extremely difficult getting a person living with Alzheimer’s disease to comply with brushing and flossing twice a day, you may want to consider increasing dental visits to every three months. This can help combat plaque and tartar buildup on the teeth. Additional cleanings also help to prevent serious gum conditions like gingivitis and periodontitis, which contribute to decay and tooth loss.

As the disease progresses, those with Alzheimer’s/dementia may become increasingly agitated and noncompliant during cleanings. Finding the right dentist with experience working with the elderly and persons with dementia is critical. Difficult dementia behaviors and diminishing capacity will eventually make regular cleanings too traumatic for your loved one. At that point, assisting your loved one with flossing, brushing and rinsing as often as possible is the best way to maintain oral health.

If providing oral care for someone with Alzheimer’s disease (or meeting any other care needs) is overwhelming, please know that you always have a trusted partner in care with Nightingale Homecare. As the top provider of in-home care Paradise Valley, AZ and the surrounding area has to offer, we can provide a full range of professional Alzheimer’s care services through our specialized Connections Dementia Care program. Call us at (602) 504-1555 to learn more.

Eating Challenges with Alzheimer’s and Dementia

Phoenix, AZ home care

Overcome the challenges of getting proper nutrition with dementia with these tips.

Alzheimer’s and dementia often present numerous eating challenges. Regular, nutritious meals are important to maintain, as poor nutrition and eating habits can aggravate confusion and lead to physical decline. These tips will help you understand what causes eating challenges in your loved one with Alzheimer’s/dementia, and how you can encourage good nutrition in each stage of the disease.

In the early stages of Alzheimer’s/dementia, your loved one may forget to eat and lose the skill needed to plan for and prepare nutritious meals. As the disease progresses, your loved one may experience a diminished sense of smell and taste, which can cause a loss of interest in eating. Your loved one may also lose the ability to effectively use utensils necessary to eat. Agitation and distraction may affect mealtime greatly, so it will be important to plan for a distraction-free and consistent mealtime. In the later stages of the disease, your loved one will experience difficulty chewing and swallowing, which will challenge your ability to ensure proper nutrition.

Tips to Improve Nutrition

  • Maintain familiar routines.
  • Don’t rush mealtime.
  • Don’t worry about messes!
  • Offer favorite foods and drinks.
  • Check food temperature before offering.
  • Offer vegetables, fruits, whole grains and lean proteins.
  • Cut down on refined sugars, high saturated fats, high salt and cholesterol.
  • Provide foods that are calorie-dense and dementia-friendly: peanut butter sandwiches, milkshakes with added protein supplement, pudding cups, ice cream, pureed fruit and sweetened yogurt.
  • Keep distractions to a minimum; use a soothing voice and turn off the TV and cell phones. Calming music may be helpful.
  • Be sure your loved one is in a seated position at 90 degrees to prevent choking.
  • Serve meals on bright, solid-colored dishes. A color contrast between the tableware or placemat and the dinnerware serves as a visual cue for self-feeding.
  • Your loved one may need assistance at meals to increase caloric intake. If she says that she does not want to eat more, allow her to rest, and then try to get her to eat more with your assistance.
  • Be mindful of textures that she is most responsive to.
  • Place a beverage directly in front of your loved one, not off to the side.
  • Be sure dentures are in place for all meals and secure with denture adhesive if necessary. If your loved one is refusing to wear his or her dentures, it may be dental issues or it may be necessary to modify the diet.
  • Bowls are easier than plates. Spoons are easier than forks.
  • Bowls with suction cups are helpful.
  • Use straws or lidded cups for liquids.
  • Offer one or two types of food at a time, in small portions.
  • Offer three meals and snacks, or smaller meals throughout the day.
  • Provide the major caloric meal early in the day.
  • Add butter, syrup and dipping sauces to increase calories.
  • Offer foods that are easy to chew and swallow. Avoid popcorn, nuts, raw vegetables and other foods that are difficult to chew.
  • Remind your loved one to thoroughly chew and swallow carefully throughout the meal.
  • Cut food into bite-sized portions. Finger foods are even easier: pieces of fruit, cheese, crackers and other snacks.
  • Eating your meal with your loved one often improves intake.
  • Your loved one’s physician may add supplements if weight loss and nutrition are a problem. You may consider adding an instant breakfast drink mixed with ice cream.

Staying Hydrated

Staying hydrated can be one of the bigger challenges in your loved one with Alzheimer’s/dementia. Offering small cups of water and fluids throughout the day is very important. Be sure adequate amounts of liquids are consumed at meals. Generally, your loved one may not request something to drink—you need to provide it to her. A health shake between meals may be a way to hydrate her as well as provide added calories. Offer other foods with high water content, such as fruit, soups and smoothies. It may be necessary to offer fluids every two hours to maintain hydration.

Watching for signs of dehydration will be imperative in maintaining your loved one’s overall health: 

  • Weight loss of two pounds or more in a 24-hour period
  • Increased confusion
  • Dizziness or headaches
  • Dry mouth
  • Sunken eyes
  • Inability to sweat or produce tears
  • Rapid heart rate
  • Low blood pressure

Staying Alert for Swallowing Difficulty

“Dysphagia,” or difficulty swallowing, often occurs in the late stages of Alzheimer’s disease when the patient loses the gag reflex and has decreased levels of consciousness. Ensure that your loved one is sitting up straight with her head slightly forward when eating. At the end of every meal, be sure and check your loved one’s mouth to ensure that all food has been chewed and swallowed. Aspiration pneumonia is a leading cause of death in those with Alzheimer’s, so it is critical you watch for the signs of dysphagia and refer to a speech therapist when you notice these signs:

  • Coughing or choking at meals
  • Wet vocal quality during or after meals
  • Decrease in the amount of food eaten
  • Increasing time and effort spent at mealtime
  • Food, liquids or saliva leaking out of the mouth
  • ‘Cheeking,’ or holding foods in the mouth instead of swallowing them
  • Spitting out food
  • Difficulty swallowing medications
  • Unexplained weight loss
  • Excessive drooling
  • Eating too fast, or cramming food into the mouth
  • Extended chewing before swallowing
  • Clearing throat frequently during a meal
  • Dehydration
  • Chest congestion
  • Aspiration pneumonia

Combating Swallowing Challenges

Using all of the techniques mentioned above will help combat swallowing challenges in your loved one. In the later stages, offering pureed foods and a soft diet will help aid in swallowing. Using a commercial thickener like “Thick-It” in thin liquids may also be recommended for your loved one with swallowing challenges. Thickened liquids won’t trickle down the throat as readily as thin liquids and are less likely to cause coughing, choking and aspiration. Your loved one’s physician, speech therapist or nurse will recommend the thickness necessary, depending upon the patient’s ability to chew and swallow. If your loved one is on thickened liquids, then ALL liquids provided must be thickened to the recommended consistency.

The clinician will recommend the minimal level of thickness needed for swallowing safety. As with anything, there are benefits to these thickening agents, but there are also risks. These preparations don’t work for everyone, and in some cases, they can lead to dehydration. They may also reduce the effectiveness of medications when taken together with the thickening agent.

Things to be Alert to When Feeding Your Loved One

In the later stages of the disease, it may become necessary for you to feed your loved one in order to maintain safety and nutrition. When it comes to this, be sure to follow the above pointers on eating and maintain a relaxed, comfortable environment, sticking to a routine. It will be very important for you to take your time with feeding, to avoid choking and agitation. Never rush your loved one when it comes to feeding.

Follow these additional pointers to ensure feeding success!

  • Be sure that the last bite has been swallowed before the next is provided.
  • Give only small bites of food on a spoon.
  • You may need to be prepared to give the next bite after your loved one swallows the last bite, to maintain her interest in eating.
  • If your loved one has difficulty opening her mouth for food entry, you may brush a spoon against the lips, to aid in opening her mouth.
  • You may gently brush her cheeks and neck to encourage swallowing.
  • Place food well into the mouth to assist with chewing.
  • Frequent cueing may be necessary, i.e.: “Open your mouth, chew the food, and now swallow.”
  • Alternating liquids with solids may assist with swallowing each bite.
  • Check for pocketing. Food must be cleared before adding the next bite.
  • It’s best to end with liquids.

For more helpful resources to assist in caring for a loved one with Alzheimer’s, or to learn more about our highly specialized Connections Dementia Care Program, contact the Phoenix, AZ home care experts at Nightingale Homecare at (602) 504-1555.