Care Of The Patient With Alzheimers
The purpose of this course it to prepare the Nursing Assistant in the recognition of symptoms and the progression of Alzheimers, and how to successfully care for the patient with the disease.
Nursing Assistants from California, only.
How Far Has The Disease Progressed
Alzheimers disease has three stages – patients at each stage require different levels of care. A person diagnosed with Alzheimers usually lives another four to eight years after diagnosis but could live as long as 20. Early stage Alzheimers patients can live relatively normal lives, although they may notice memory lapses, have difficulty organizing themselves and may struggle in particular work or social settings. Patients at this stage can usually manage to stay in their own homes, and may still have the legal capacity to make decisions about their future care preferences.
The next stage, moderate Alzheimers, can last for several years. Patients during this stage will have obvious symptoms, such as confusion, severe memory lapses, getting lost, and behavioral or personality changes, like delusions, suspicion, moodiness, changes in sleep patterns, and in some cases loss of bladder or bowel control.
Late stage Alzheimers sufferers become unable to function and eventually lose control of movement. They need 24-hour care and supervision. They are unable to communicate, even to share that they are in pain, and are more vulnerable to infections, especially pneumonia.
Caregiving In The Late Stages Of Alzheimers Or Dementia
As Alzheimers or another dementia reaches the late stages, your loved one will likely require 24-hour care. They may be unable to walk or handle any personal care, have difficulty eating, be vulnerable to infections, and no longer able to express their needs. Problems with incontinence, mood, hallucinations, and delirium are also very common.
In your role as caregiver, youll likely be combining these new challenges with managing painful feelings of grief and loss and making difficult end-of-life decisions. You may even be experiencing relief that your loved ones long struggle is drawing to an end, or guilt that youve somehow failed as a caregiver. As at the other stages of your caregiving journey, its important to give yourself time to adjust, grieve your losses, and gain acceptance.
Since the caregiving demands are so extensive in the later stages, it may no longer be possible for you to provide the necessary care for your loved one alone. If the patient needs total support for routine activities such as bathing, dressing, or turning, you may not be strong enough to handle them on your own. Or you may feel that youre unable to ease their pain or make them as comfortable youd like. In such cases, you may want to consider moving them to a care facility such as a nursing home, where they can receive high levels of both custodial and medical care.
Connecting in the late stages of care
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Can I Realistically Offer Home Care
There are a number of factors that affect whether or not you can realistically offer home care:
- How much support does the patient need?
The patients physician may be the best person to advise how much support they need, and you can also seek advice from the Alzheimers Association. The amount of support needed will depend on the stage of Alzheimers, but also the patients specific symptoms and difficulties. There are useful guidelines of what you can expect as a caregiver at every stage here.
- Is family support available?
Caring for an Alzheimers patient is an exhausting and potentially overwhelming task, and if possible should not fall on only one persons shoulders. If there are multiple, committed family members to help out, during the day and also overnight when needed, then a nursing home may not be necessary – but otherwise, it should be considered.
- Can I afford paid home help?
Paid home help is also a possibility, but the Alzheimers Association found that it costs around $20 an hour – which quickly becomes prohibitive if you need 24-hour care. However, if you are able to combine family support with brief home visits, this may be a good choice for minimal disruption to the patient. Other options include respite care and adult day centers, which can give you and your family a break. Alternatively, if you feel your loved one could use more support but is not ready for a nursing home, you could consider retirement housing or assisted living.
Quality And Risk Of Bias Assessment
Two reviewers independently assessed the studies for quality and risk of bias according to their specific study types. Any disagreements between the reviewers were resolved by discussion, with involvement of a third reviewer .
Randomised Controlled Trial studies were assessed for risk of bias using the Cochrane Risk of Bias Tool . The CEBM Critical Appraisal tool was used to assess the risk of bias in methodology, analysis and outcomes in cross-sectional studies. Mixed methods data was appraised using the Mixed Methods Appraisal Tool Version 2018 . Risk of bias in qualitative studies was appraised using a tool based on the Critical Appraisal Skills Programme Qualitative checklist . The assessment criteria for each of the quality appraisal tools used is described in Tables , , and .
Table 1 Risk of bias summary. Randomised controlled trials. Cochrane Risk of Bias Tool
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Caregivers Trained In Dementia Care & Alzheimers Care
Our caregivers are trained in dementia care & Alzheimers care so that they can competently deal with Alzheimers and related dementia. We recognize that each situation is unique. We understand how Alzheimers & dementia can affect clients and their families as it is a difficult process for both. Nurse Next Door provides support and guidance to clients and their families in dealing with ongoing challenges and responsibilities of providing care.
Preserving Your Loved Ones Independence
Take steps to slow the progression of symptoms. While treatments are available for some symptoms, lifestyle changes can also be effective weapons in slowing down the diseases progression. Exercising, eating and sleeping well, managing stress, and staying mentally and socially active are among the steps that can improve brain health and slow the process of deterioration. Making healthy lifestyle changes alongside your loved one can also help protect your own health and counter the stress of caregiving.
Help with short-term memory loss. In the early stages, your loved one may need prompts or reminders to help them remember appointments, recall words or names, keep track of medications, or manage bills and money, for example. To help your loved one maintain their independence, instead of simply taking over every task yourself, try to work together as a partnership. Let your loved one indicate when they want help remembering a word, for example, or agree to check their calculations before paying bills. Encourage them to use a notebook or smartphone to create reminders to keep on hand.
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Cope With Changes In Communication
As your loved ones Alzheimers or dementia progresses, youll notice changes in how they communicate. They may have trouble finding words, substitute one word for another, repeat the same things over and over, or become easily confused. Increased hand gestures, losing their train of thought, and even inappropriate outbursts are all common as well.
Even if your loved one has trouble maintaining a conversationor less interest in starting oneits important to encourage social interaction. Making them feel safe rather than stressed will make communication easier, so try to manage your own frustration levels.
Be patient. If your loved one has difficulty recalling a word, for example, allow them time. Getting anxious or impatient will only inhibit their recall. Gently supply the word or tell the person that you can come back to it later.
Be aware of your body language. Your loved one responds to your facial expression, tone of voice, and nonverbal cues as much as the words you choose. Make eye contact, stay calm, and keep a relaxed, open posture.
Speak slowly and clearly. Give one direction or ask one question at a time, use short sentences, and give your loved one more time to process whats being said. Find a simpler way to say the same thing if it wasnt understood the first time.
Maintain respect. Dont use patronizing language, baby talk, or sarcasm. It can cause hurt or confusion.
/7 Care Consistent Visits
Our 24/7 dementia care & Alzheimer care service gives you peace of mind and reassurance that your loved one is receiving quality one-on-one care, minimizing any risk or harm to them. Our clients are carefully matched with caregivers based on our expert Care Designers assessment. To avoid confusion for clients, we always strive for consistency when sending in caregivers so they can recognize any inconsistencies in a clients routine and clients are comfortable receiving care from someone they trust.
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Focus On The Individual
Dementia and Alzheimers certainly do have patterns, but no two patients are the same when it comes to how symptoms present themselves and how the disease progresses. What might work for one patient might not work with another patient. As you remember to stay flexible, youll be able to tailor care plans for individual patients that will help them deal with the frustrations that can be presented each day. Remember to keep the individual in mind as you read through the rest of these tips.
Nursing And Dementia: Reducing Family Stress And Increasing Coping Skills
DementiaDementia, Family and Family StressNurse InterventionsReferences
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Tips For Nurses Working With Alzheimers And Dementia Patients
Working with dementia patients or those with Alzheimers disease can be a challenge, especially if its a new specialty for a nurse. The care required is extensive, challenging, and requires nearly constant actions. While it isnt an area for everyone, working with these types of patients can be a rewarding career move. If you are currently working with this demographic or are looking to make the move, keep reading for a few great tips for nurses working with Alzheimers and dementia patients.
Mental Health And Self
Death may be a normal part of your job as a nurse, but providing end-of-life care can still take its toll. You should take some time to look after your mental health, both on and off the clock. Self-care can look different for everyone, but the following suggestions can help you get started:
- Keep a consistent routine
- Look for opportunities to take a mental break during work
- Exercise or be physically active outside of work
- Practice mindfulness, deep breathing, meditation, or gratitude
- Eat a balanced and nutritious diet
- Try a new hobby or enjoy an existing one
- Spend time with friends and loved ones
- Do a relaxing activity, such as reading
- Stay hydrated
- Keep a journal
- Get professional support if you feel you need it.
You may have to try different strategies to find something that works well for you. Dont be afraid to get creative, and dont give up if it takes time to find the right self-care practice.
Remember that practicing self-care is not selfish. Not only does neglecting your emotional needs negatively impact your health, but it can also affect your patients. You cannot provide the best care to your patients if you feel emotionally exhausted or upset. Simply put, taking care of yourself and your mental health is essential to being a great nurse and having a long, fruitful career.
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Caring For Patients With Dementia Or Alzheimers Disease
Caring for someone with Alzheimers Disease or dementia can be one of the most challenging tasks a CNA faces during his or her career. In addition to taking care of the patients physical ailments, there are constant challenges that come with mental impairment. Often confused, patients may lash out when they do not understand what is happening. Helping to ease their minds by staying calm is one of the most important techniques, though there are other things that can greatly help when dealing with these patients.
Safety
It is common for Alzheimers or dementia patients to wander and become lost or take the wrong actions when they are confused. However, there are some small actions that can be taken to decrease their risk.
- Use locks or child gates to block stairs, doors, and windows.
- Provide an ID bracelet/necklace with a phone number.
- Keep medications, sharp objects, poisonous materials, and other potentially harmful materials locked up.
- When possible, activate controls for stoves and electronics.
- Do not speak loudly, restrain the patient, or make sudden moves.
Communication and Memory
When communicating with confused patients, there are several strategies that tend to help them understand better.
Different Perceptions
Is My Loved One Safe At Home
There are several factors that you should consider when you evaluate the Alzheimers patients safety in their own home:
- Alzheimers disease can cause sufferers to put themselves at risk. They may, for instance, leave pans on the stovetop, leave the gas on, ingest poisonous chemicals, or slip and fall. They may wander out into the street and get lost, or stumble into traffic. There are steps that can be taken to make the home safer, but at some point, you may feel that your loved one would be more secure in a nursing home.
- If you are not physically strong enough to help them, then as they become more physically dependent on you, you may not be able to protect them from falls or safely lift them up.
- Some Alzheimers sufferers develop aggressive behaviors that could put others around them at risk. Or, if they are sharing the home with family members, their forgetful behavior could cause harm to their co-habitants.
Alzheimers facilities provide round-the-clock supervision, as well as full security if your family member has a tendency to wander.
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Dementia: Symptoms And Warning Signs
Dementia refers to the loss of memory, decision-making skills, and thinking abilities that are severe enough to negatively impact daily life. It isnt a disease in and of itself, but rather a group of symptoms related to memory impairment. Several different conditions, including Alzheimers disease, can cause dementia.
The Centers for Disease Control notes that age is the biggest risk factor for developing dementia, as people age 65 and older are most likely to be affected. However, dementia can still impact younger people. Early-onset dementia most commonly affects people in their 40s and 50s, but in some cases, symptoms can begin when someone is in their 20s or 30s.
Its always best to detect and begin treating dementia as early as possible. Be on the lookout for the following warning signs of dementia, regardless of a patients age:
- Changes, even small ones, in short-term memory
- Shifts in mood or personality
- Inappropriate or out-of-character behavior
- Trouble following directions or stories
- Difficulty with spatial reasoning and coordination
- General confusion or disorientation.
Initial symptoms are typically mild someone in the earliest stages of dementia may seem perfectly healthy. It can be even more challenging to detect dementia early in senior adults, as it can be mistaken for normal signs of aging.
Get Dementia Information Emails
Sign up to the NHS website Dementia Information Service, which can help guide you through the often-difficult time after a dementia diagnosis.
You’ll receive a weekly email for 6 weeks, each one covering a different need-to-know topic.
Find out more about the Dementia Information Service.
Page last reviewed: 26 July 2018 Next review due: 26 July 2021
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Lack Of Trained Staff
Frequently patients with dementia are highly dependent and need one-to-one care, especially for nutrition and fluid intake and even more so when they are also suffering from delirium. However, many acute medical and surgical wards occupied by older people with dementia are currently understaffed, with fewer trained nurses and more non-trained staff . There may also be fewer doctors and therapists per patient. This can directly increase the risk of adverse events particularly falls, drug errors, poor nutrition and dehydration. Nursing staff need to be given training in `risk enablement and management backing to take `calculated risks, for example by encouraging mobility in a patient at risk of falls in the overall best interests of their patients. A lack of personal interaction as a result has a particularly damaging effect on cognition-nearly half of carers report that being in hospital had a negative effect on the general physical health of the person with dementia which was not a direct result of the medical condition .