A guide to understanding Alzheimer’s Disease-Part III

Caregiving for an Alzheimer’s patient at home can be a difficult and daunting task. Dr Chawla concludes his series on Alzheimer’s Disease with a must-read manual for caregivers. You can read Part II and Part I here and here. 

SAFETY FIRST

Providing for safety of the patient is an important job for care givers and the most important part of Alzheimer’s management. A safe environment can help prevent falls and injuries, besides keeping the patient relaxed and less overwhelmed.  The environment should be studied, hazards discovered and adaptations done from the point of view of the needs and difficulties of the patient.

Here are the safety guidelines:

• Don’t expect the person to do things safely
• Eliminate potential hazards
• Be patient and slow down. Accidents happen when patient is rushed.
• Simplify routines and provide step by step guidance, especially during personal care activities like bathing, toilet and dressing
• Be prepared to balance safety with needs for privacy and independence
• Be realistic. You can’t anticipate and prevent every risk or problem

Home safety room by room

Guarding against choking and poisoning:

•  Due to the disease, the patient may not understand that swallowing foreign substances could cause choking or poisoning
• Lock cabinets and rooms that contain toxic chemicals
• Lock up all medications. Keep track of how many pills are being taken
• Hide potentially dangerous items like razor blades
• Remove any toxic plants from the room
• Don’t let food spoil in the refrigerator or pantry
• Test the temperature of the food before serving as the patient may not be able to discern if food is too hot or cold
• Be prepared for the unusual as some patients may eat items like paper, gravel, dirt or soap

Knives, appliances and electrical goods

• Be aware that the person may not remember how to use appliances and tools
• Potential hazards include toaster ovens, stoves, coffee makers, power tools etc
• Know that even apparently safe devices can be hazards. For example a person may try to open a can with a screw driver
• Place at eye level the appliances that the person can safely use
• Discourage the person from entering the kitchen without you
• Consider precautions such as locking up knives, hiding appliances and removing knobs from the stove when not in use
• Unplug all heat producing appliances when not in use
• Consider turning off gas and electricity in certain areas
• Regularly check electrical cords for frays, breaks and other damage
• Put safety covers on electrical outlets
• Don’t let electrical or other cords dangle

Be careful about heat, cold and fire

• Keep in mind that a person with Alzheimer’s may lose sensitivity to temperature extremes and may forget about their dangers.
• Be cautious about items such as stoves, heaters, irons, microwave food, electric blankets and heating pads
• Take precaution against scalding hot water. Avoid heating water to high temperatures. Install anti-scald devices on taps. Help the person test water temperatures and mix cold water with hot
• Avoid accidents associated with cooking and heating- Do not let the person wear loose clothes while cooking, Do not place containers of hot liquid near the edges of tables and counter tops, pour hot liquids away from the person’s body, keep the pot as far away as possible, test the temperature of microwave prepared foods, use table mats instead of table cloths
• Cover all light bulbs with shades or globes
• Hide matches and cigarette lighters
• Keep a person with dementia from smoking or be nearby
• Install fire extinguishers and smoke alarms and check them monthly

Prevent slips and falls

• Make sure the person wears non-skid shoes
• Reduce clutter
• Remove extra rugs, extension cords and other obstacles
• Don’t let pets sleep in traffic areas
• Avoid rearranging furniture
• Wipe up spills immediately
• Make staircases safe. Keep them well lit, provide handrails on both sides, make sure steps are even and uniformly deep
• Make sure lighting is evenly distributed to avoid hot spots and shadows
• Install night lights on the path to the bathroom.

Bathroom safety

• Install devices such as grab bars, bath seats and commode chairs
• Put non slip mats in bathroom, tubs and showers
• Remove electrical appliances to reduce the chance electrocution or shock
• Make sure water doesn’t stand anywhere on the floor of the bathroom

Home safety behaviour to behaviour

• Prevent wandering. Consider installing safety doorknobs
• Put locks at the top or bottom of doors, out of the person’s line of sight
• Camouflage the outside door or place a dark rug in front of it to discourage the person from approaching it
• Get an intercom system or the door with attached bell or chimes so that you can stay aware of the person’s activities while in another room
• Hand chimes on doors
• Install electronic alert alarms
• Make sure the person wears an identification bracelet with recorded name and address on it

One can take care of an Alzheimer’s patient by educating oneself about the disease and its manifestations and by following the above guidelines without getting overwhelmed. For the caregiver, caring for an alzheimer’s patient remains a very demanding task which may be challenging to say the least. The caregiver could also do the following:

• Create an emergency plan
• Prepare a list of emergency phone numbers such as the police, doctor, ambulance, hospitals and poison control centres
• Develop escape plans in case of fire
• Recruit someone who lives nearby to help in case of an emergency
• Be in touch with the local Alzheimer’s Association

SUPPORT GROUPS

Total awareness and involvement is required day in and day out to care for an Alzheimer’s patient. If one has to tackle the above guidelines alone then it can be stress producing for the care-giver. A care-giver must seek help in the form of keeping a domestic help, eliciting the help of relatives and neighbours besides taking the help of professional bodies like Alzheimer’s Associations, Geriatric Physicians and hospitals, Community care nurses and physiotherapists etc. Care giver support groups are there which can be joined. Family members should be regularly involved. Care giver should take care that he or she doesn’t develop anxiety or depression. Someone should relieve the care giver for a few hours or days regularly. A caregiver should be a member of the support group of the Alzheimer’s patient.

Care-givers also face the agony of seeing their loved ones’ minds and personalities disappear and they have to shoulder physical, social and emotional burdens over a long period of time. The effects on the affected families are personally profound and financially devastating. Therefore, care-givers need the support of the whole family and relatives. They need to take help from multiple sources rather than going it all alone which can become very stressful for even a strong person. The care- givers themselves might also need help of Psychotherapists, counsellors and psychiatrists and should not hesitate to seek such help.

Ultimately, the caregiver’s ability to cope depends on many factors like the kind of relationship and the quality of relationship the caregiver shared with the person with Alzheimer’s disease prior to the onset of the disease or the the caregiver’s emotional and physical health. What also matters is the type, frequency and disruptive effects of behavioural and psychological symptoms exhibited by the patient; the caregiver’s response to and tolerance of these symptoms; the availability of support services; the caregiver’s perception of whether he or she receives sufficient emotional support and the caregiver’s ability to make lifestyle adjustments including taking over household responsibilities and decision making within the home.