Good Afternoon. Welcome to Demystifying Alzheimer’s. I’m your hostess Mary Yamin-Garone.
Today’s topic is “The Moderate Stage of Alzheimer’s: So Many Changes.”
You and your mother decided to go out for a bite to eat at a favorite restaurant. It’s her 80th birthday. You walk in and ask the hostess for a special booth near the back of the room. It’ll be a little quieter there.
You tell her it’s your mother’s birthday. Your mother says, “You don’t have to tell the world it’s my birthday. I’m not that old. Let’s just keep it to ourselves.”
The waitress comes over to take your orders. Your mother says, “I’d like a cheeseburger and some spiders.” The waitress looks at her. “Pardon me, ma’am. What did you say?” “I’d like a cheeseburger and some spiders.” You step in. “Mom will have a cheeseburger and French fries.” The waitress gives you a knowing nod and places the order.
Your mother’s behavior has been changing. She’s more anxious when she’s out in public and she doesn’t want to do as many things as she did before. Still, she knows what she wants but now she can’t remember the words for some things.
Who could have anticipated the challenges and rewards that would come from caring for someone in the moderate stage of Alzheimer’s? Your strongest awareness may be that the life you once envisioned for you and your loved one is taking a different course. Many of their abilities have been lost yet many still remain. Focusing on what remains will give you, the caregiver, clues to knowing how to make your loved one happy and comfortable. Whatever changes you’re faced with, remember that Alzheimer’s is taking over and the changes in the person you’re caring for aren’t willful acts or done on purpose.
Self-reflection is constant throughout this disease but it comes and goes quickly. A nurse once said, “Think of Alzheimer’s [disease] like a piece of Swiss cheese. Sometimes there is great clarity and the person can see through the holes; other times things are cloudy and the person cannot understand or reflect.”
As Alzheimer’s progresses to the moderate stage, its destruction extends over the parietal lobes of the brain. When that happens, the individual loses their ability to integrate visual, sound and body sensation information.
· In this stage, despite the losses, many skills remain, especially judgment, social skills and the ability to perform some complex tasks. As a caregiver, you should focus on maintaining them and other remaining functions.
· Your loved one will have trouble dressing, get lost or disoriented and can’t figure out how to use objects.
· They generally have difficulty asking for things—or help—because the destructive process of the disease has already wreaked havoc on the temporal lobe speech areas.
· In the moderate stage, driving also can be problematic because your loved one’s reaction time is often diminished. They can’t integrate all of the environment’s visual and sound information with the proper body response for the steering wheel and foot pedals.
This is the time when individuals generally seek the help of their physician for a consultation. Once the parietal lobes become involved with Alzheimer’s destructive process, the frontal lobe compensatory mechanisms aren’t sufficient anymore and family members and friends become aware that problems requiring medical evaluation
The caregiver now moves into a more extensive phase of involvement with their loved one. As caregiver, you must understand that there are more and more activities the individual can’t do themselves. You’ll need extra resources and personnel to continue providing good, quality care and a suitable level of safety. Instead of being an advocate, you are now the negotiator.
· You witness that, as much as you’d like your loved one to have total control over their life, there are increasingly more situations that call for you to become actively involved.
· Behavior problems, like wandering and agitation, may occur during this stage and your loved one will require more supervision. When you see an inappropriate behavior, try to figure out what it means. Think about what the individual’s trying to say or do. It’s not unusual for agitated behaviors to worsen later in the day or in the early evening.
· As a caregiver, especially a spouse, you may become irritable, say genuinely mean things and give help grudgingly. It’s important to explain to your loved one why you’re behaving that way. Most likely, you’re angry at the disease, not the individual. It helps to constantly clear the air. In this stage, you may find yourself caught between balancing your own needs and those of the person you’re caring for.
· Be prepared for your own denial and the denial expressed by your loved one or other family members and friends, especially when it comes time for adjustments and transitions in living arrangements.
· Learn how to cope with your own anger and hurt. Ask others for help if you can no longer look at the situation objectively. Sometimes the one with dementia will get angry with their spouse or children and blame them for things they didn’t do. They’re also prone to making insensitive remarks.
· Reflect on how you respond to the person with Alzheimer’s. If they become combative, ask yourself if you’re in danger or if you can handle the situation. Often you can avoid harm by simply taking a few steps back and keeping your distance from the individual for a few minutes.
· Reach out—and rely on—outside sources and experts. Delegating tasks will help you preserve the strength and energy you’ll need as the disease progresses.
· Consider having family meetings to keep everyone informed of the arrangements that have been made regarding emergencies and finances. If no arrangements have been made, don’t waste any more time. Do it now.
· Don’t allow daily frustrations and stress to cause you to overreact. Focus on the fact that Alzheimer’s is responsible for your loved one’s behavior.
· Remove yourself from the caregiver role when you need respite to recharge your behavior or if you’ve lost your focus or balance.
That’s all for today. Thanks for listening. I hope this information was helpful.
Join me at 1 pm Monday when I’ll discuss Memory, Language and Complex Tasks in the Moderate Stage of Alzheimer’s.