7.11.2016 Mary Yamin-Garone
Good afternoon. Welcome to Demystifying Alzheimer’s. I’m your hostess Mary Yamin-Garone.
On Saturday’s podcast I talked about changing behavior and Alzheimer’s. I’ll talk more about that today.
Individuals with Alzheimer’s frequently repeat a single word, sentence or question. They might repeat a gesture, such as brushing lint off their shirtsleeve or crumbling a piece of paper or tissue over and over. Typically, this type of behavior is harmless for the person with AD. It can, however, be annoying or stressful to those around them.
Try and figure out what may be triggering their repetitive behavior. Is he asking when David is coming home because he’s bored? Nervous? Afraid of being alone? Or is he fussing with his clothes because he’s uncomfortable or needs to use the bathroom?
It might be easier if you don’t discuss plans with a confused loved one until right before an event. If they’re anticipating something, such as a meal, or their child’s arrival, you may be able to quell anxiety and uncertainty by putting a sign on the table that says, “Dinner at 6” or “David due home at 5” to diminish their anxiety and uncertainty.
It’s important to be sensitive to how distressing it is for a mature adult to know they’re losing their ability to do simple things they’ve always done for themselves and others. Try to convey that you’re helping them with basic tasks, not taking away more of their independence and dignity. Let them do as much for themselves as possible.
Those suffering from Alzheimer’s sometimes mimic what you’re doing. They’ll follow you around, talk incessantly or interrupt you while you’re talking. This behavior often occurs late in the day and can be irritating for exhausted caregivers. Try distracting them with a snack or activity.
Remember, it’s senseless to remind someone who asks the same question over and over that you’ve answered it six times. Someone with AD can’t remember what they’ve asked or what you’ve told them.
If your loved one suddenly becomes jealous or suspicious, sees things no one else does or accuses you of something you haven’t done, you’ll probably be upset, angry or hurt. Don’t forget, whatever they’re experiencing is real to them. There’s no point in arguing or disagreeing with someone who perceives something that isn’t real. The best thing you can do is reassure them, perhaps by helping them look for the source of their anxiety.
Help them look for things they think someone has taken. Try to find their favorite hiding places for storing objects they later claim are lost. Consider stocking up on replacements for commonly lost or misplaced items, like wallets and hats.
Nonverbal reassurances, like a gentle touch or hug, go a long way in comforting someone who’s out of sorts because of Alzheimer’s symptoms. Respond to the feeling behind the accusation and then reassure them. You might try saying, “I see this frightens you. Stay with me. I won’t let anything happen to you.”
If your loved one sees or hears things no one else does and doesn’t seem bothered by it, don’t worry. If the pattern continues, bring it up with their doctor. Seeing shadows and patterns on a wall or reflections on the TV or in the mirror often causes hallucinations in someone with Alzheimer’s. Sometimes someone with AD may think they’ve heard something, like children playing outside, or smelled something, like smoke from a barbecue grill, that may also make them believe they saw something that wasn’t there. Redirect their attention to what you were saying. Try phrasing your responses like, “I see why you think that was a bat. It’s a shadow.”
If your loved one becomes suspicious, be sure to explain to family members, caregivers and home helpers that their accusations are part of their illness. This is especially important with those who don’t know them well or with children and teenagers, who might not understand.
Your loved one also is losing their ability to recognize faces and distinguish time and place. So if a grandchild they haven’t seen in a while suddenly stops by for a visit, they may mistake them for a stranger. Or they might think they’re the handyman they’ve been expecting and wonder why he’s sitting down to chat rather than fixing the washing machine.
Some AD sufferers’ symptoms seem to worsen during late afternoon or evening. They become particularly agitated and have difficulty going to bed and staying asleep. Experts believe this behavior, also known as sundowning, is caused by a combination of exhaustion and changes in their biological clock that confuse day and night.
Try to increase their daytime activity. Napping should be discouraged. Look out for foods that can increase insomnia. Plan smaller meals throughout the day, including a light meal, like a half a sandwich, before bedtime.
Alzheimer’s experts recommend turning lights on well before sunset and closing the curtains at dusk to minimize shadows and diminish confusion. Be sure there are nightlights in your loved one’s room, hallway and bathroom.
Also be sure the house is safe. Use gates to block off stairs, lock the doors and put away dangerous items. If none of those suggestions work, you might want to speak with their doctor about medication to help them relax and sleep. Be aware that sleeping pills and tranquilizers may solve one problem but create another one, like sleeping at night but being more confused the following day.
Sexually inappropriate behavior, such as undressing or masturbating in public or making unreasonable sexual demands or lewd remarks, may occur during the illness. This behavior can be shocking and upsetting. It’s important to remind yourself—and others—that’s caused by the disease.
Talk to the doctor about possible treatment plans. In the meantime, devise an action plan to follow if their behavior occurs in certain situations. Decide what you’ll do if they undress at home, outside of the home or around other adults or children. Try to identify what triggers the behavior. Sometimes it’s simply that their clothing is making them uncomfortable.
Aggressive behavior is one of the most unsettling and frightening symptoms of Alzheimer’s. It can make caring for your loved one extremely difficult and, at times, potentially unsafe for everyone involved. Outbursts tend to occur when a person is dressing, bathing or during a doctor’s appointment. In those situations, a person with AD is more likely to misinterpret certain actions, grow anxious and respond aggressively. Aggression also can be triggered by a physical illness, such as constipation or infection, pain, depression, anxiety or lack of sleep.
It’s important to have your doctor evaluate them to identify any physical complaints that may be contributing to the problem. Keep in mind that establishing a routine may help someone with Alzheimer’s feel more at ease. According to AD specialist Eric Tangalos, MD, “People with Alzheimer’s do better when they have a routine. It allows them to refresh and reinforce their pattern of behavior every day. They get to learn their habits over and over and this is good.”
Try to make difficult daily tasks easier—even pleasant—by doing them when your loved one is calm and alert. Bathe in the morning, if that’s their best time. Talk a walk with them in late afternoon if that’s when they get aggressive. Regular and gentle exercise can help reduce agitation and aggressive behavior. If the behavior is ongoing and difficult, your doctor may prescribe medications to treat the problem.
Improving your communication skills is one of the most effective ways to handle difficult behavior in someone with Alzheimer’s, according to the National Family Caregiver Alliance, a go-to source of information, advice and referrals for the estimated 44 million Americans who provide unpaid care to another adult at home.
Better communication can make caregiving less stressful, improve the quality of your relationship and enhance your ability to handle difficult behavior. Try these strategies:
- Actions speak louder than words.
- Set a positive mood by talking to your loved one in a pleasant and respectful manner.
- Show affection with your facial expressions, tone of voice and physical touch.
- Limit distractions and noise. Turn off the radio or TV, close the curtains or shut the door.
- Use simple words and sentences.
- Speak slowly, distinctly and in a reassuring tone.
- Ask simple questions that require a simple yes or no answer.
- Break down large, complex activities into a series of manageable tasks.
- Respond with affection and reassurance.
- Talk about the good old days.
- Maintain your sense of humor
- Listen with your eyes, ears and heart.
Remember, despite everything you do, you and your loved one are battling a relentless disease whose symptoms—including outbursts—will continue. When that happens, try your best to remain calm and defuse the situation. Knowing what you now know, you’ll get through it.
That’s all for today. Thanks for listening. I hope this information was helpful.
Join at 1 pm on Saturday when I’ll talk about money matters and legal issues.