Tips For Caregivers And Sundowning
Some simple tips that might help ease the nighttime difficulties for caregivers may include establishing a nighttime routine or leaving on a light to ease fears or confusion. Also, a sleep space and bed should be comfortable.
Make sure that the individual is not too warm or too cold, that the textures of the fabric or pajamas are not irritating, and that the environment feels safe and secure.
Sometimes a weighted blanket may help an anxious or fretful person settle down for a long night of sleep and ease other common symptoms related to dementia.
Check For Any Physical Cause Of Reduced Appetite
When you notice your loved one eating less food, your first step should be ruling out any physical health issues. Ask your loved one if ill-fitting dentures, an upset stomach, constipation, or other medical issues are bothering him or her. Some seniors may not want to admit to any health issues because they fear being a bother, so you may need to observe your loved one carefully or schedule a doctors visit to completely rule out physical issues.
A trained professional caregiver can often identify health issues family members might miss. Caring for a senior loved one can be challenging for families who dont have expertise or professional training in home care, but this challenge doesnt have to be faced alone. Family caregivers can turn to Mesa Home Care Assistance for the help they need. We provide high-quality live-in and respite care as well as comprehensive Alzheimers, dementia, stroke, and Parkinsons care.
Weight Gain Or Weight Loss
Some of the eating and drinking issues associated with dementia can lead to weight loss and people with dementia are at risk of malnutrition. If a person with dementia needs to eat pureed food, its helpful to be aware that this can be less nutritious. In this instance, you could try:
- adding skimmed milk powder to whatever you are serving. Skimmed milk powder is available from most supermarkets
- mixing skimmed milk powder with milkshake powder and full fat milk to create a high nutrient drink. Choose milkshake powders such as Nesquik that are fortified with vitamins.
It is important to note that there is different nutrition and healthy eating advice for people with dementia. For most younger people, the standard advice is to follow a low fat, low sugar diet. But older people and those with dementia especially need higher nutrients, including a purchased 10 microgram Vitamin D supplement every day.
People with frontotemporal dementia might be especially drawn to sweet things or starchy foods. If overeating or weight gain is an issue, you could try:
- serving food in a portion rather than bringing out the packet or whole dish
- replacing sweet or high calorie foods with healthier alternatives such as fruit or low calorie jelly
- encouraging the person to become more active, by taking walks or swimming, or seated exercises for people with mobility issues
- storing food away from the persons line of sight so they arent tempted
Unaware Of Memory Problems:
Researchers from McGill University found that people who were aware of their memory problems were actually less likely to be dealing with dementia. The same protein that leads to frequent falls can also keep the brain from signaling memory loss. In other words, if you KNOW youre forgetting things, the odds are in your favor.
If you, or someone you care about, is experiencing more than one of these weird signs of dementia dont ignore them. Make an appointment to see your doctor to be safe. Earlier diagnosis can help you take steps to slow down the disease so you can stay independent for years to come.
Symptoms In The Later Stages Of Dementia
As dementia progresses, memory loss and difficulties with communication often become severe. In the later stages, the person is likely to neglect their own health, and require constant care and attention.
The most common symptoms of advanced dementia include:
- memory problems people may not recognise close family and friends, or remember where they live or where they are
- communication problems some people may eventually lose the ability to speak altogether. Using non-verbal means of communication, such as facial expressions, touch and gestures, can help
- mobility problems many people become less able to move about unaided. Some may eventually become unable to walk and require a wheelchair or be confined to bed
- behavioural problems a significant number of people will develop what are known as “behavioural and psychological symptoms of dementia”. These may include increased agitation, depressive symptoms, anxiety, wandering, aggression, or sometimes hallucinations
- bladder incontinence is common in the later stages of dementia, and some people will also experience bowel incontinence
- appetite and weight loss problems are both common in advanced dementia. Many people have trouble eating or swallowing, and this can lead to choking, chest infections and other problems. Alzheimer’s Society has a useful factsheet on eating and drinking
Symptoms Specific To Frontotemporal Dementia
Although Alzheimer’s disease is still the most common type of dementia in people under 65, a higher percentage of people in this age group may develop frontotemporal dementia than older people. Most cases are diagnosed in people aged 45-65.
Early symptoms of frontotemporal dementia may include:
- personality changes reduced sensitivity to others’ feelings, making people seem cold and unfeeling
- lack of social awareness making inappropriate jokes or showing a lack of tact, though some people may become very withdrawn and apathetic
- language problems difficulty finding the right words or understanding them
- becoming obsessive such as developing fads for unusual foods, overeating and drinking
Read more about frontotemporal dementia.
Asking For The Same Information Repeatedly
If I were coming to visit my mother in a week, I’d have to field the same questions daily leading up to my trip. One of them would inevitably be, “Which train are you taking?” This unrelenting line of questioning was frustrating, of course, but it should have been alarming. According to the Alzheimer’s Association, chronic forgetfulness and asking for the same information over and over is a warning sign. Forgetting conversations is another, according to Helpguide.org. Requiring the same information a few times can be attributed to normal aging, but when the information won’t stick on a daily basis, it could be more serious.
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Body Weight Loss In Dementia
Unintentional BW loss is a prominent clinical feature in some individuals with dementia . For example, data indicate that 3040% of patients with dementia may experience clinically significant weight loss . Body weight loss in dementia may be characteristic of reduced nutritional status, which is partially explained by a reduced food intake . It has been shown that 1445% of community-dwelling patients with mild-to-moderate AD, and up to 68% of patients with severe AD, are at risk of malnutrition . Body weight loss is also observed in transgenic mouse models of dementia that recapitulate underlying neurodegenerative pathologies , albeit inconsistently , as this loss may also be explained by model-specific developmental problems or strain-specific genetic effects .
Unintentional BW loss is detrimental for the frail elderly because it is associated with higher rates of mortality , institutionalization , adverse health outcomes, decline in functional status, and overall poorer quality of life . In elderly with dementia, unintentional BW loss is associated with syndrome severity , higher rates of institutionalization , a higher incidence of behavioral problems , and ultimately mortality . In contrast, a BMI equal to or higher than overweight has been associated with reduced mortality in dementia . Thus, it appears that low or healthy adult BMI can lead to poorer health outcomes in patients with dementia, while a higher BMI may be protective.
Where To Get Help
- Your local community health centre
- National Dementia Helpline Alzheimers Australia Tel. 1800 100 500
- Dementia Behaviour Management Advisory Service Tel. 1800 699 799 for 24-hour telephone advice for carers and care workers
- Aged Care Assessment Services Tel. 1300 135 090
- My Aged Care Tel. 1800 500 853
- Cognitive Dementia and Memory Service clinics Tel. 1300 135 090
- Carers Victoria Tel. 1800 242 636
- Commonwealth Respite and Carelink Centres Tel. 1800 052 222
Pharmacotherapies For Dementia: Effects On Body Weight And Body Mass Index
The US Food and Drug Administration has currently approved four unique formulations for the treatment of dementia: donepezil, rivastigmine, galantamine, and memantine . Donepezil, rivastigmine, and galantamine are acetylcholinesterase inhibitors and vary only slightly in pharmacological properties. Acetylcholinesterase inhibitors are at the forefront of symptomatic treatment for AD and LBD , diseases that are most often characterized by a loss of cholinergic neurons in the brain, reducing the amount of acetylcholine available for neurotransmission, leading to a deficient cholinergic system . Acetylcholinesterase inhibitors bind to brain cholinesterase enzymes in a reversible manner and inhibit them from breaking down acetylcholine at the synapse level. Thus, AChEIs increase the level and duration of neurotransmitter action in forebrain regions, in an attempt to compensate for the loss of functioning cholinergic neurons . Most systematic reviews and meta-analyses that assess the efficacy of AChEIs report modest improvements in cognitive function and other benefits in patients with mild-to-moderate AD or LBD , but marginal effects of uncertain significance in VaD .
Women Are At A Higher Risk
Surprisingly, the same results were not seen in the male study participants. Post-menopausal hormonal changes can be one reason, says Knopman; while its possible that another reason could be social stigma. Since middle-aged men are less likely to prepare their own meals, and usually have spouses or adult children to take care of them, the sense of smell does not affect them as much as it does women.
However, since women take on the majority of the household responsibilities, as the brain damage starts, they forget to shop for groceries regularly, dont cook daily, and even eat less resulting in poor nutrition that leads to extreme weight loss as the disease progresses.
This being said, UK dementia stats claim that 61 percent of dementia patients are females , while in the US, every 1 in 6 women is susceptible to dementia. This means that, regardless of the persons weight, women are at a higher risk of developing dementia later on in their lives.
You May Have Confusion And Disorientation
“In the earlier stages, memory loss and confusion may be mild. The person with dementia may be aware of and frustrated by the changes taking place, such as difficulty recalling recent events, making decisions or processing what was said by others,” says the Alzheimer’s Association. “In the later stages, memory loss becomes far more severe.”
Stocking Up And Storing Food
A person with dementia might need help keeping track of what food they have at home and storing food safely. You could try:
- storing food in ways that are easy to access and eat, such as pouring cereals into clear pots or cutting cheese into cubes
- buying frozen ready meals; but be mindful that the person might need help reheating frozen foods safely. You could put labels with clear cooking instructions on the top of the meal. You could put notes reminding the person that the meals are in the freezer on the freezer door
- buying ambient temperature ready meals is another option, as these do not need to be stored in the fridge or freezer, so may be more accessible for some people
- checking the persons cupboards and disposing of anything out of date
Sundowning And Other Sleep Issues
They also state that an estimated 20% of individuals with Alzheimers experience increased agitation, irritability, and confusion later in the day and around dusk. Hence the term sundowning.
Some potential factors that may contribute to sundowning may include end-of-the-day exhaustion, confusion of days and nights by the persons internal body clock, fear or confusion due to decreased light, reactions to the non-verbal cues of caregivers who are tired at the end of the day, or simply a decreased need for sleep.
Difficulty With Complex Tasks
A person with dementia may have trouble with reading, writing or complex mental tasks like following directions or making calculations. Familiar chores, like paying bills or cooking favorite recipes, may become difficult, says the Centers for Disease Control and Prevention. “As the memory problems pick up, the individual with early dementia will leave tasks incomplete, avoid complex games and projects and give up the financial management to a spouse or partner,” says Hammond. And to get through life at your healthiest, don’t missThe #1 Cause of Diabetes, According to Doctors.
What Were The Basic Results
The researchers included 1,895 cognitively normal participants at baseline . Over an average period of 4.4 years, 524 participants developed MCI. Those who developed MCI were more likely to be older, have cardiovascular disease, diabetes, and be carrying the APOE*E4 gene.
A significant difference in average weight change per decade was found between participants who developed MCI and those who did not a loss of 2.0kg compared to a loss of 1.2kg respectively.
When examining by gender, men who developed MCI had significantly greater weight loss than men who did not . For women, there was not much of a difference.
The researchers calculated that a larger weight decline per decade was associated with a 4% increased risk of MCI . This was after adjusting for the possible confounding effects of sex, education, and the presence of the APOE*E4 genotype. Statistical modelling found a weight loss of 5kg per decade to correspond to a 24% increased risk of MCI.
No link with development of dementia was reported.
You May Exhibit Inappropriate Behavior
“The diseases that cause dementia can damage parts of the brain that usually stop us behaving in inappropriate ways,” says the Alzheimer’s Society. “Remarks or actions of a nature can cause problems, particularly if directed at a friend or family member. However, it is important to realise that they are usually a symptom of the person’s dementia. Care home staff should know this and be trained in how to respond.”
Eating In The Later Stages Of Dementia
It is common for people in the later stages of dementia to lose a considerable amount of weight. People may forget how to eat or drink, or may not recognise the food they are given. Some people become unable to swallow properly.
Providing nutrition supplements may need to be considered. If a person has swallowing difficulties, or is not consuming food or drink over a significant period of time and their health is affected, nutrition supplements may be considered for consumption other than by mouth.
This information is based on Finger Foods for Independence: For people with Alzheimers disease and other eating difficulties, by Lois Newton and Dr Alan Stewart, and Reduce the risk: A common sense guide to preventing poor nutrition in older people, by Carolyn Bunney and Rudi Bartl.
How Can Weight Loss In Patients With Alzheimers Disease Be Treated
Treatment should be focused on the identified causes of weight loss. If other health problems are suspected to contribute to weight loss, they need to be identified and treated. Current medications that are no longer required should be discontinued. Prescription medications, over-the-counter products and supplements that are thought to be a source of weight loss should be discontinued and replaced with medications that are not associated with weight loss. An appetite stimulant, such as megestrol acetate , dronabinol , mirtazapine , or growth hormone secretagogues may be prescribed.
A speech therapist may recommend a feeding strategy if there are reversible causes for the eating problems.
Support For Healthy Eating
1. Choosing a plate that has a different color from the food so that the person with dementia can see it more clearly.
It also helps to offer flavourful food.
2. Feeding them or putting a drink in their hand if they have difficulties seeing it.
3. Giving the individual enough time to eat and drink.
4. Encouraging the person to participate in exercise during the day can help to increase appetite.
You can opt for activities like taking short walks, swimming, dancing and playing games that the person with dementia finds pleasurable.
5. Try and give them foods that they enjoy, especially if you can provide a healthier option so that the suffering person can always look forward to mealtimes.
For instance, if a person prefers sweet food, you can always serve them a lot of fruit and a little forward so that at the end of the day, they still consume a balanced diet that is good for their health.
Note that smells and tastes from their favorite foods can stimulate the appetite.
Additionally, it is essential to serve tender food that is cut into small bites so that the person with dementia does not have a tough time chewing and swallowing the food.
6. Avoid distractions and overstimulation in the dining areas.
Turning off the TV or radio and making sure people do not make too much noise during meal times can help create the ideal eating environment.
8. At times, in dire cases, family members may consider going the artificial feeding route.
Finding Food And Drinks
People with dementia may struggle to ask for food if they have difficulty finding the words to express themselves. Food and drinks need to be visible and available throughout the day so that people can eat and drink whenever they feel hungry or thirsty.
Ensure that snacks and drinks are easy to access and see so that people with dementia can take a drink or eat without having to wait for it to be offered.
Choosing The Right Weighted Blanket For Dementia
When selecting the right weighted blanket there are some important factors to consider. The first is the weight. Ideally, a weighted blanket should weigh 10% of the persons body weight plus one to two pounds. So, a person who weighs 120 pounds would need a blanket that is between 12 and 14 pounds to experience the proper amount of pressure.
Next, consider the fabric. Does the individual get hot easily and sweat at night? Or do they constantly require extra layers of clothing or blankets due to easy chills? Cotton blends are more breathable and stay cooler.
Flannel holds in heat. Some all-season weighted blankets are also available for those who sometimes need extra warmth or sometimes need a more breathable fabric.
Stage 6: Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
Progression And Later Stages Of Vascular Dementia
Vascular dementia will generally get worse, although the speed and pattern of this decline vary.
Stroke-related dementia often progresses in a ‘stepped’ way, with long periods when symptoms are stable and periods when symptoms rapidly get worse. This is because each additional stroke causes further damage to the brain. Subcortical vascular dementia may occasionally follow this stepped progression, but more often symptoms get worse gradually, as the area of affected white matter slowly expands.
Over time a person with vascular dementia is likely to develop more severe confusion or disorientation, and further problems with reasoning and communication. Memory loss, for example for recent events or names, will also become worse. The person is likely to need more support with day-to-day activities such as cooking or cleaning.
As vascular dementia progresses, many people also develop behaviours that seem unusual or out of character. The most common include irritability, agitation, aggressive behaviour and a disturbed sleep pattern. Someone may also act in socially inappropriate ways.
Occasionally a person with vascular dementia will strongly believe things that are not true or – less often – see things that are not really there . These behaviours can be distressing and a challenge for all involved.
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You May Have Personality Changes
“People with dementia often act in ways that are very different from their ‘old self,’ and these changes can be hard for family and friends to deal with. Behavior changes for many reasons,” says the Weill Center for Neurosciences. “In dementia, it is usually because the person is losing neurons in parts of the brain. The behavior changes you see often depend on which part of the brain is losing cells.”
Early And Middle Stages Of Vascular Dementia
Some symptoms may be similar to those of other types of dementia. Memory loss is common in the early stages of Alzheimer’s, but is not usually the main early symptom of vascular dementia.
The most common cognitive symptoms in the early stages of vascular dementia are:
- problems with planning or organising, making decisions or solving problems
- difficulties following a series of steps
- slower speed of thought
- problems concentrating, including short periods of sudden confusion.
A person in the early stages of vascular dementia may also have difficulties with:
- memory – problems recalling recent events
- language – eg speech may become less fluent
- visuospatial skills – problems perceiving objects in three dimensions.
As well as these cognitive symptoms, it is common for someone with early vascular dementia to experience mood changes, such as apathy, depression or anxiety. Depression is common, partly because people with vascular dementia may be aware of the difficulties the condition is causing. A person with vascular dementia may also become generally more emotional. They may be prone to rapid mood swings and being unusually tearful or happy.
Need advice on managing behaviour changes?
Read our top tips for managing and reducing out of character behaviour.
The Weight Loss Theory
A recent study has suggested that accelerated weight loss is a possible sign of dementia. Weight loss in the elderly is a common finding. However, researchers at Washington University in St. Louis studied 449 elderly patients and found that although all the subjects in the study lost weight, an accelerated weight loss of double the annual loss of weight predicted the onset of dementia in the following year.
Another study also points to weight loss as a potential indicator of future dementia. A recent study at the Mayo Clinic in Rochester, MN, indicates that women may actually start losing weight as much as a decade before the onset of dementia. They found that women started losing weight at a more accelerated pace 10 years before they developed dementia. The study did not show the same findings in men.
The reasons for weight loss as a marker for dementia is not clear. Some researchers believe that early weight loss results as a result of problems in an area of the brain called the hypothalamic system. This system may be involved early in dementia and cause changes in appetite.
Unintended weight loss can also be a sign of other serious medical problems and a thorough general medical evaluation should also be completed to rule out other causes.
End Stage Of Dementia
The end stage of dementia is the most difficult stage for those suffering from the disease, and also for family members, caregivers, and healthcare professionals. Victims lose what is left of their intellectual and physical capabilities and become completely dependent on others. The model is still shifting in considering end stage dementia an end of life condition; experts are pushing this model in order to advocate for better pain and distress management for those suffering at their end.
What Can Hospice Do
Hospice is an important support system for families struggling with the level of care a loved one with end-stage dementia requires whether that is in a home or a memory care environment.
At this point, the individual is dependent for all personal care, and often confined to bed. In the later stages of dementia, the individual may be unable to effectively communicate when they are experiencing pain. Hospice staff are trained to recognize and alleviate the symptoms of discomfort and pain. Medication and medical supplies such as incontinence products, hospital beds and wheelchairs are included in the hospice benefit at no charge to the patient or family.
In addition to providing care and companionship to the patient, the hospice team is available to provide the patients family with emotional support, end-of-life planning, assistance in making funeral arrangements and bereavement support.
You may request a hospice evaluation from Crossroads Hospice & Palliative Care at 1-888-564-3405 at any time to determine if your loved one is approaching end-stage dementia. Even if they do not yet qualify for hospice care, palliative care may be appropriate to help with symptom management.