Discover the importance of learning life stories when providing dementia care.
When we are working with those diagnosed with Alzheimer’s, it is important to know their stories. What is their history? Where did they live? Who comprised their family? What are some of their most powerful memories? What did they do for a living? And what were their hobbies? If you’re not getting the picture, you might wonder why all of this matters.
It matters because those with Alzheimer’s increasingly live in the past, so that the “old memories” are new again. This applies to so many things in their reality. For instance, a gentleman I remember would become very agitated when it snowed and fret that the animals would freeze if they weren’t protected. At first the family thought that Dad was having a psychotic episode since he had never talked about animals before. Then one day his children discovered a very old picture of their dad when he was a little boy. It was probably taken in the 1920s and showed their dad standing in a field surrounded by cattle. This was right before the Great Depression, when his family lost their farm and the gentlemen lost his dad. He would have been a great-grandfather to the current children, who knew nothing about these losses. Their dad had never talked about what he’d been through, but now he was reliving it. Once the family realized what was happening, they would reassure their father whenever there was bad weather that every animal was locked safely in the barn. He continued to ask about the animals when it snowed, but he was able to relax after hearing they were safe.
Another gentleman had been a wood carver all his life and now lived in North Carolina with his son and daughter-in-law. They were concerned about his failing memory and had him evaluated by a geriatric neurologist, who diagnosed the man with Alzheimer’s at Stage 4-5 on the FAST scale. The family worried that it was no longer safe for Dad to carve wood, but the doctor assured them that wood carving was second nature to their father. They just needed to watch him and they would know when this hobby was no longer safe for him. They did this over the course of several years as his Alzheimer’s continued to grow worse. Finally, they decided assisted living was the safest place for him.
When he was admitted to the facility, the daughter-in-law told the staff how important carving was to Dad and supplied him with bars of Ivory soap and plastic picnic knives every week. The old man would sit in a chair with a trash can between his knees, lean forward, and carve the Ivory soap. Did he carve the beautiful woodland figurines that he had once carved? No, but he continued to carve. His family knew how important this was to their father’s well-being, so they made it happen in a very safe way.
The stories of our patients are like valuable, buried treasures. When caregivers can unlock the past and dig up these stories, it is a transformative experience for the story teller and the listener, too.
The Scottsdale home care team at Nightingale Homecare is always thinking creatively when it comes to enhancing quality of life for those with Alzheimer’s disease. Our Connections Dementia Care Program, staffed by Alzheimer’s Whisperers®, helps those with dementia better manage a full range of challenging behaviors: wandering, repetition, nutritional concerns, sundowning, and much more. Contact us for a free in-home consultation to allow us to offer care solutions for your loved one by calling (602) 504-1555 any time.
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.
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
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!
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.
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:
Sedatives
Anti-anxiety or anti-depressant meds
Antihistamines
Corticosteroids
Narcotics
Cardiovascular 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.
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 
