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.
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!
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:
Bread with sugar-free spreads
Crackers and cheese
Pita bread with hummus
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.
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.
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 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
Dizziness or headaches
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
Eating too fast, or cramming food into the mouth
Extended chewing before swallowing
Clearing throat frequently during a meal
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.
When a senior loved one begins to show signs of memory loss, our first thought might immediately be whether he might be in the beginning stages of Alzheimer’s disease. After all, memory loss is one of the hallmark characteristics of the disease, and it’s becoming increasingly prevalent in our society.
Yet there are a number of conditions unrelated to Alzheimer’s that can cause memory loss as well. It’s important to rule out the following with your loved one’s physician when memory loss issues occur, in addition to checking for Alzheimer’s disease:
Delirium: The main difference between delirium and dementia is in the onset of symptoms. With delirium, mental changes such as memory loss and confusion, occur suddenly, while in Alzheimer’s, there’s a slow, gradual progression. If delirium is suspected, seek medical attention immediately.
Medication Side Effects:Certain medications can produce dementia-mimicking effects, including memory loss. Check with the doctor if your loved one is taking any of the following:
Anti-anxiety or anti-depressant meds
Medications to treat Parkinson’s disease
Thyroid Disorder: Either too much or too little production of thyroid hormones (hyperthyroidism or hypothyroidism) can result in cognitive problems.
Deficiency in Vitamin B12: Pernicious anemia, while rare, is caused by low levels of B12. Along with confusion and memory problems, other symptoms include fatigue, a yellow tint to the skin, headaches, numbness, shortness of breath, and difficulties with balance. If the physician determines this to be the problem, B12 injections started early can often reverse the symptoms.
Alcoholism: A particular condition in those with an alcohol addiction, Wernicke-Korsakoff Syndrome can lead to confusion and memory deficiencies. Abstaining from alcohol may help to restore mental functionality.
Whatever the cause of your loved one’s memory problems, the Phoenix live-in home health care team at Nightingale Homecare can help. Our Connections Dementia Care Program provides seniors with the expertise of our highly skilled Alzheimer’s Whisperers®, who have been uniquely trained to effectively manage even the most challenging of dementia-related behaviors.
We work hard to ensure that each senior in our care receives the services needed to enable the highest possible level of functionality, dignity, and independence at all times, through a full range of care that can include, as needed, skilled nursing, physical, occupational, and/or speech therapy, companionship and non-medical caregiving, and so much more.
Whether the need is for just a few hours each week of respite care, or full-time, live-in home health care services (or anything in between), families know they can trust Nightingale Homecare for the professional home care services their senior loved ones need to achieve the highest possible quality of life. Serving Phoenix and the surrounding areas, contact us to learn more at (602) 504-1555.
Among the many challenging behaviors the caregivers of Alzheimer’s patients may experience, those of aggression and agitation may be the most upsetting and scary. Although it can be difficult to cope with, it is often helpful for caregivers to understand that the person with Alzheimer’s is not behaving this way on purpose, and that there are ways to help identify the cause and manage these behaviors.
Aggressive and agitated behaviors may exhibit physically or verbally and can come on suddenly, with no obvious reason. Due to the loss of cognitive function, those with dementia are unable to articulate or adequately identify their discomfort or frustration, and instead attempt to communicate with agitation or aggression. Some likely causes of this behavior may be physical discomfort, poor communication, or environmental factors, but whatever the cause, when caregivers are prepared, they can more easily identify the precipitating events, and work towards managing the behavior.
Possible Causes of Aggression
Physical discomfort or pain
Thirst or hunger
Incontinence or soiled underwear
Depression or loneliness
Too much noise or confusion
Inadequate sleep or rest
Sudden change in place or routine
New or multiple people in the environment
Pressure to complete a task
Frustration with not remembering
Too many questions or instructions aimed at the patient
Medication reaction or interaction
Ways to Respond
When you begin to notice signs your loved one is feeling agitated, like pacing, restlessness, sleeplessness or yelling, here are some ways you can respond to the behavior before it escalates:
Try to identify the cause; think back to what occurred right before the agitation. Try to rule out pain as the cause as soon as possible.
Focus on feelings, not the patient’s words, when you communicate. Look for the feelings behind the words.
Reassure the patient while listening and speaking calmly to address concerns and frustrations.
Keep a routine as much as possible, while building periods of activities and quiet time into the day.
Keep the house filled with familiar objects, pictures and keepsakes which can help the patient to feel secure.
Limit clutter, noise and unfamiliar people.
Minimize distractions. Assess the patient’s surroundings and adapt them to avoid similar reactions in the future.
Slow down your movements and relax around the patient; do not get upset. Be positive and reassuring.
Shift the focus to another activity. Try using music, massage or exercise to help soothe the patient.
Take a break. If the patient is in a safe place and you are able to walk away and take a deep breath and a moment for yourself, do it.
Physically Violent Behaviors
When you are a caregiver on the receiving end of an outburst or physically aggressive behavior, your safety as well as that of the patients are top priority. When violent aggression is directed at you, keep a safe distance, putting a large piece of furniture between you and the patient. Continue to remain calm and speak in a soft, slow tone, using reassurance. If it is necessary to protect yourself and the patient from hurting himself or herself, or another person, call 911.
If you do call, be sure and notify responders that the person has dementia which causes him or her to act aggressively. If you are unable to find the cause of agitation, it is occurring more frequently, or you need more solutions for the behaviors, get help from the senior’s physician or health practitioner. A medical exam to discover the reasons behind the agitation and aggression may be in order. Ask the senior’s health practitioner if he or she recommends a medication to prevent or reduce the behavior.
Take Time for You
Being a caregiver for a patient with Alzheimer’s can be challenging in the best of times, but when your loved one has moments of aggressive behavior, it can be highly stressful. In the aftermath of these moments, do not overlook your own health, and the need to retreat, reflect and decompress. Such self-care time will give you a chance to refuel and continue to provide the important work you do for your loved one.
Nightingale Homecare is always on hand to provide trusted and highly specialized care for those with dementia, allowing family members to take a much-needed break. Our Dementia Connections Care Program offers a unique approach to better managing the unique challenges of Alzheimer’s through certified Alzheimer’s Whisperers® who not only work to make life as comfortable as possible for the person with dementia, but provide training to family members so they can apply the same strategies themselves.
Contact Nightingale Homecare, top providers of professional in home care Paradise Valley, AZ seniors need, any time by calling (602) 504-1555 to schedule a free in-home consultation to learn more, or to request additional resources related to effective care for those with dementia.
A Nightingale representative would be happy to answer your questions or help you arrange for home care that is custom-fit to your needs.