Question

Using your knowledge of the progression and stages of Alzheimer’s disease identify possible safety issues that may arise for persons diagnosed and their family members in the middle, and late stages of the disease.

Please provide your analysis by the end of the day on Weds and your assigned response by the end of the day on Friday.

For your assigned scenario analysis (identified below ) please discuss:

• the main safety issues you identify
• the possible implications of the situation and challenges for the person with dementia in terms of transition points and decisions to be made
• the possible implications for the caregiver(s)/family member(s) in the scenario

Once your group members have provided their responses, for your assigned SCENARIO response (identified below) discuss:

• resources/strategies that you think may be useful to the caregiver and/or person with dementia in this situation
• barriers that may exist that could prevent the use of these resources/strategies

Scenario 1

Your Mom has AD and lives alone. She manages fairly well now you have disabled the stove etc. and you visit each day on your way home from work to prepare her meals and help with medications etc. Then you go home to cook for your husband/wife and three teenagers. However, late at night Mom often thinks someone is trying to break into her house. Understandably she gets very agitated and calls the police – this happens several times a week.

Analysis:

Response:

Scenario 2

Your Dad was diagnosed with Alzheimer’s disease three years ago and has been doing very well. Your Mom is reluctant to discuss any problems they may be having and says everything is “fine.” One of your Dad’s past co-workers (he retired 10 years ago) has told you that your Dad was sitting in the car in the parking lot of his former work last week and they had to drive him home to your Mom.

Analysis:

Response:

Scenario 3

You live with your spouse who was diagnosed with dementia several years ago. Your adult son lives with you and works second shift and often overtime too. You have help during the day (home care for 3 hours x3/week). However, the nights are becoming difficult as your spouse does not seem to wish to sleep. He gets up and walks around the house and is sometimes disorientated when trying to find the bathroom

Analysis:

Response:

Scenario 4

Your Mom lives 150 miles away and has been becoming increasingly frail and forgetful. She has lived in the same neighbor since she got married and has many close friends. The Pastor from her Church (two block-walk away from her house) called you to say your Mom arrived at Church ready for service but on the wrong day!

Analysis:

Response:

Answer 1

Alzheimer's disease is a progressive disorder that causes brain cells to waste away (degenerate) and die. Alzheimer's disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that disrupts a person's ability to function independently.

Stage 1: No Impairment. During this stage, Alzheimer's is not detectable and no memory problems or other symptoms of dementia are evident.
Stage 2: Very Mild Decline
Stage 3: Mild Decline
Stage 4: Moderate Decline
Stage 5: Moderately Severe Decline
Stage 6: Severe Decline
Stages 7: Very Severe Decline

Stage 1: No Impairment
During this stage, Alzheimer’s is not detectable and no memory problems or other symptoms of dementia are evident.

Stage 2: Very Mild Decline
The senior may notice minor memory problems or lose things around the house, although not to the point where the memory loss can easily be distinguished from normal age-related memory loss. The person will still do well on memory tests and the disease is unlikely to be detected by loved ones or physicians.

Stage 3: Mild Decline
At this stage, the family members and friends of the senior may begin to notice cognitive problems. Performance on memory tests are affected and physicians will be able to detect impaired cognitive function.

People in stage 3 will have difficulty in many areas including:Finding the right word during conversations, organizingand planning, remembering names of new acquaintances. People with stage three Alzheimer’s may also frequently lose personal possessions, including valuables.

Stage 4: Moderate Decline
In stage four of Alzheimer’s, clear-cut symptoms of the disease are apparent. People with stage four of Alzheimer’s:Have difficulty with simple arithmetic, have poor short-term memory (may not recall what they ate for breakfast, for example), inability to manage finance and pay bills, may forget details about their life histories

Stage 5: Moderately Severe Decline
During the fifth stage of Alzheimer’s, people begin to need help with many day-to-day activities. People in stage five of the disease may experience:

• Difficulty dressing appropriately
• Inability to recall simple details about themselves such as their own phone number
• Significant confusion
• On the other hand, people in stage five maintain functionality. They typically can still bathe and toilet independently. They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.

Stage 6: Severe Decline
People with the sixth stage of Alzheimer’s need constant supervision and frequently require professional care. Symptoms include:

• Confusion or unawareness of environment and surroundings
• Inability to recognize faces except for the closest friends and relatives
• Inability to remember most details of personal history
• Loss of bladder and bowel control
• Major personality changes and potential behavior problems
• The need for assistance with activities of daily living such as toileting and bathing
• Wandering

Stages 7: Very Severe Decline
Stage seven is the final stage of Alzheimer’s. Because the disease is a terminal illness, people in stage seven are nearing death. In stage seven of the disease, people lose the ability to communicate or respond to their environment. While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living. In the final stages of Alzheimer’s, people may lose their ability to swallow.

Home safety is important for everyone, but this is especially true if you're caring for someone with Alzheimer's disease or a related dementia. A throw rug or a stray toy on the steps could easily cause a fall or injury.To prevent stressful and dangerous situations, consider these home safety tips for caregivers. Periodically, it might be helpful to request a physical therapy referral for a home safety evaluation.

1. In the bathroom:

Install a shower chair and grab bars. Place grab bars near the toilet, near the bathtub and in the shower. A hand-held shower head also might be useful.

Address slippery surfaces. Place nonskid strips or a mat in the bathtub and shower. Unless the bathroom is carpeted, place nonskid strips on the floor near the bathtub, shower, toilet and sink, too.
Use a faucet cover in the bathtub. A foam rubber faucet cover can help prevent serious injury if the person with dementia falls in the bathtub.
Lock up potentially hazardous products or electrical appliances. Install childproof latches on cabinets and drawers to limit access to potentially dangerous items. Use child-restraint caps on medication containers.
Reduce water temperature. Set the thermostat on your hot water heater to below 120 F (48.9 C).
Remove door locks. Consider removing locks from the bathroom doors to prevent the person from accidentally locking himself or herself in.Kitchen safety tips

2. In the kitchen:

Prevent access to potentially dangerous appliances. Install safety knobs on the stove to prevent the person with dementia from turning the stove on or off. Disconnect the garbage disposal.
Remove artificial fruits or vegetables or food-shaped magnets. These objects might appear to be edible.
Lock up breakable or potentially dangerous supplies. Install childproof latches on cabinets and drawers to limit access to items such as cleaning products, alcohol, matches, knives, scissors and even plastic bags.
3. Bedroom safety tips
In the bedroom:

Install a monitoring device. A baby monitor will help you hear if the person with dementia needs help. This might be particularly helpful if he or she has advanced dementia.
Take caution when using heating devices. Don't use portable space heaters in the person's bedroom. If electric blankets or heating pads are used, keep the controls out of reach.
If the person with dementia tends to get up at night to drink, eat or use the bathroom, try to meet these needs before he or she goes to bed.

4. Living room safety tips
In the main living areas:

Avoid clutter. Recycle newspapers and magazines. Keep areas where people walk free of furniture and cords. Keep plastic bags out of reach. Limit decorative objects. Trim large plants, and remove plants that might be toxic if eaten.
Mark glass doors, windows and furniture. Place a decal on glass at the person's eye level to help him or her see glass panes.
Take caution when using fireplaces. Don't leave the person with dementia alone with an open fire in the fireplace.
Laundry room safety tips
In the laundry room:

Lock up potentially hazardous products. Install childproof latches on cabinets where you keep detergent and other potentially hazardous supplies.
Prevent access to the washer and dryer. Close and latch the doors and lids to the washer and dryer. Consider removing large knobs if the person tries to tamper with the machinery.
If the laundry room has a door, consider keeping it locked.

5. Garage, shed and basement safety tips
In the garage, shed and basement:

Lock up potentially dangerous items. Install childproof latches or locks on cabinets where you keep tools, tackle, machines, sporting equipment, paint, fertilizer, gas, cleaning supplies or other toxic materials. Remove all guns or weapons from your home.
Lock all vehicles. Consider covering or removing vehicles and bikes that aren't frequently used if the person has advanced dementia.
Consider locking the doors to these areas as well.

6. Outdoor safety tips
To ensure safety outdoors:

Check exits. If the person with dementia uses a walker or wheelchair, make sure he or she will be able to get in and out of your home — when necessary. Consider widening doorways or adding ramps.
Keep steps safe. Mark the edges of steps with bright tape. Keep steps sturdy and textured to prevent falls in wet or icy weather.
Restrict access to the pool. If you have a swimming pool or hot tub, surround it with a fence. Install a gate with a lock. Cover the pool or hot tub when it's not in use.
Avoid clutter. Keep hoses, foliage and other debris off the walkways.
Safely store fuel sources. Remove fuel sources for your grill or other equipment when not in use.
Other safety precautions
In addition, consider taking these safety precautions throughout your home:

Prepare for emergencies. Display emergency numbers and your home address near all telephones.
Use night lights. Place night lights in the person's bedroom and the bathroom to help prevent tripping if he or she gets up at night.
Treat slippery or uneven surfaces. Remove throw rugs. Place nonskid strips or wax on hardwood and tile floors.
Adjust the home phone and voice mail settings. Lower the ringer volume of your home phone to prevent distraction and confusion. Set the answering machine or voice mail to turn on after the lowest number of rings. A person with dementia might be unable to take messages or could become the victim of telephone exploitation.
Keep stairs safe. Install light switches at the top and bottom of stairs. Make sure stairs have at least one handrail that extends beyond the first and last steps.

Cover stairs in carpet or apply nonskid strips. If the person with dementia has balance problems, install safety gates in front of stairs.

Install smoke alarms and carbon monoxide detectors. Place them in or near the kitchen and all sleeping areas. Check them regularly to make sure they work. If the person with dementia has vision or hearing problems, install a smoke alarm with a vibrating pad or flashing light.
Check the locks. Make sure there are working locks on all windows and front and back doors. Keep a spare set of house keys outside of the house, in case the person with dementia locks you out. Install deadbolts high or low on outside doors to make it harder to get out.
Address outlets and electrical cords. Place lamps close to electrical outlets. Cover unused electrical outlets with childproof plugs.
Keep computer equipment out of the way. If you store valuable documents on your computer, protect the files with passwords and create backup files. Consider monitoring the person's computer use.

Strategies for care givers

Tip 1: Prepare for the road ahead
The more you learn about your loved one’s disease and how it will progress over the years, the better you’ll be able to prepare for future challenges, reduce your frustration, and foster reasonable expectations. In the early stages of Alzheimer’s, for example, you can support your loved one’s independence and self-care, but their cognitive and physical regression means they will ultimately require 24-hour care.

Though it may be hard to contemplate such a difficult outlook, the sooner you put plans in place, the more your loved one can be involved in the decision-making process. Paying for long-term care can be a major source of stress, so it’s important to research all your options as early as possible. Consult with the patient’s medical team and other family members to make legal and financial arrangements and determine the long-term care options that are best suited to you and your loved one.

Who will make healthcare and/or financial decisions when the person is no longer able to do so? While a difficult topic to bring up, if your loved one is still lucid enough, getting their wishes down on paper means they’ll be preserved and respected by all members of the family. You’ll want to consider power of attorney, both for finances and for healthcare. If the person has already lost capacity, you may need to apply for guardianship/ conservatorship.
How will care needs be met? Sometimes family members assume that a spouse or nearest family member can take on caregiving, but that’s not always the case. Caregiving is a major commitment that gets bigger over time. Family members may have their own health issues, jobs, and responsibilities. Communication is essential to make sure that the needs of the Alzheimer’s patient are met, and that the caregiver has the support to meet those needs.
Where will your loved one live? Is their own home appropriate, or is it difficult to make safe for later? If your loved one currently lives alone or far from any family or other support, it may be necessary to relocate or consider a facility with more support.
Tip 2: Develop a personal support plan
Balancing the enormous task of caring for a cognitively-impaired adult with your other responsibilities requires skill, attention, and meticulous planning. By focusing so diligently on your loved one’s needs, it’s easy to fall into the trap of neglecting your own welfare. If you’re not getting the physical and emotional support you need, you won’t be able to provide the best level of care, and you face becoming overwhelmed.

Ask for help. You cannot do it all alone. It’s important to reach out to other family members, friends, or volunteer organizations to help with the daily burden of caregiving. Accepting help for mundane tasks such as grocery shopping and cleaning can free you up to spend more quality time with the patient. Schedule frequent breaks throughout the day to pursue hobbies and interests and stay on top of your own health needs. You’re not being neglectful or disloyal to your loved one. Caregivers who take regular time away not only provide better care, they also find more satisfaction in their caretaking roles.

Learn or update caregiving skills. Being thrust into the role of caregiver doesn’t come with an instruction manual, but there are books, workshops, and online training resources that can teach caregiving skills. As the disease progresses and challenges change, you’ll need to update your skillset and find new ways of coping.

Join a support group. You’ll be able to learn from the experiences of others who have faced the same challenges. Connecting with others who know first-hand what you’re going through can also help reduce feelings of isolation, fear, and hopelessness.

Make use of available resources. There are a wealth of community and online resources to help you prioritize your efforts and provide effective care. Start by finding the Alzheimer’s Association in your country. These organizations offer practical support, helplines, advice, and training for caregivers and their families. They can also put you in touch with local support groups.

Plan for your own care. Visit your doctor for regular checkups and pay attention to the signs and symptoms of excessive stress. It’s easy to abandon the people and activities you love when you’re mired in caregiving, but you risk your health and peace of mind by doing so. Take time away from caregiving to maintain friendships, social contacts, and professional networks, and pursue the hobbies and interests that bring you joy.

Get moving. Regular exercise not only keeps you fit, it releases endorphins that can really boost your mood. Aim for at least 30 minutes of exercise on most days. If it’s difficult to get away for that long at once, break the time up into 10 minute sessions sprinkled throughout the day.

Talk to someone.Talk to a trusted friend, family member, clergy member, or therapist, about what you’re going through. The simple act of talking face-to-face with someone who cares can be extremely cathartic—and a great stress reliever.

Practice a relaxation technique.Caregiving for a loved one with dementia can be one of the most stressful tasks you’ll undertake in life. To combat this stress and boost your mood and energy levels, you need to activate your body’s natural relaxation response. As well as exercising and connecting face-to-face with others, try relaxation techniques such as deep breathing, meditation, or yoga.

Tip 3: Cope with changes in communication
As your loved one’s Alzheimer’s or dementia progresses, you’ll notice changes in communication. Trouble finding words, increased hand gestures, easy confusion, even inappropriate outbursts are all normal. Here are some do’s and don’ts on communicating with your loved one.

Tip 4: Develop day-to-day routines
Having a general daily routine in Alzheimer’s and dementia care helps caregiving run smoothly. These routines won’t be set in stone, but they can give a sense of consistency, which is beneficial to the patient even if they can’t communicate it.

Keep a sense of structure and familiarity. Try to keep consistent daily times for activities such as waking up, mealtimes, bathing, dressing, receiving visitors, and bedtime. Keeping these things at the same time and place can help orientate the person with dementia.

Let your loved one know what to expect even if you are not sure that they completely understand. You can use cues to establish the different times of day. For example, in the morning you can open the curtains to let sunlight in. In the evening, you can put on quiet music to indicate it’s bedtime.

Involve your loved one in daily activities as much as they’re able. For example, they may not be able to tie their shoes, but may be able to put clothes in the hamper. Clipping plants in the yard may not be safe, but they may be able to weed, plant, or water.

Planning activities
As you develop daily routines, it’s important to include activities and visitors. You want to make sure that the Alzheimer’s patient is getting sensory experiences and socialization, but not to the point of getting overstimulated and stressed. Here are some suggestions for activities:

Start with the person’s interests. Ask family and friends about interests your loved one used to have. You’ll want to tailor the interests to their current level of ability so they don’t get frustrated.Vary activities to stimulate different senses—sight, smell, hearing, and touch—and movement. For example, you can try singing songs, telling stories, dancing, walking, or tactile activities such as painting, gardening, or playing with pets.

Planning time outdoors can be very therapeutic. You can go for a drive, visit a park, or take a short walk. Even sitting on a balcony or in the backyard can be relaxing.Consider outside group activities designed for those with Alzheimer’s or dementia. Senior centers, community centers, or adult day care programs may host these types of activities.

Tip 5: Deal with problem behaviors
One of the major challenges of caring for a loved one with Alzheimer’s or another dementia is coping with the troubling behavior and personality changes that often occur. These behaviors include aggressiveness, wandering, hallucinations, and eating or sleeping difficulties that can be distressing to witness and make your role as caregiver even more difficult.

Often, these behavioral issues are triggered or exacerbated by your loved one’s their inability to deal with stress, their frustrated attempts to communicate, or their environment. By making some simple changes, you can help ease your loved one’s stress and improve their well-being, along with your own caregiving experience. See Alzheimer’s and Dementia Behavior Management.

Tip 6: Make time for reflection to help with acceptance
One of the biggest challenges as a caretaker for someone with dementia is to accept what is happening to your loved one. At each new stage of the disease, you have to alter your expectations about what your loved one is capable of. By accepting each new reality and taking time to reflect on these changes, you can better cope with the emotional loss, and deepen the feelings of satisfaction in your caregiving role.

Keep a daily journal to record and reflect on your experiences. By writing down your thoughts, you can mourn losses, celebrate successes, and look for those thought patterns that keep you from acting in the present.Count your blessings. A daily gratitude list can chase away the blues and let you focus on what your loved one is still capable of, rather than the abilities they’ve lost.

Celebrate what is possible. Your loved one still has many abilities. Structure activities to invite participation on whatever level is possible, and you will both find enjoyment.Try to envision your loved one’s world. Imagine not being able to remember and do life’s simple tasks. By valuing what your loved one is able to give, you can find satisfaction on even the toughest days.Improve emotional awareness. Remaining engaged, focused, and calm in the midst of such tremendous responsibility can challenge even the most capable caregivers. By developing your emotional awareness skills, however, you can relieve stress, experience positive emotions, and bring new peace and clarity to your caretaking role.

Scenario1:

Due to complex changes occurring in the brain, people with Alzheimer's disease may see or hear things that have no basis in reality. Hallucinations involve hearing, seeing, smelling, or feeling things that are not really there.These false perceptions are caused by changes within the brain that result from Alzheimer's, usually in the later stages of the disease. Hallucinations are caused by changes in the brain which, if they occur at all, usually happen in the middle or later stages of the dementia journey. Hallucinations are more common in dementia with Lewy bodies and Parkinson's dementia but they can also occur in Alzheimer's and other types of dementia.

Response:

• Respond in a calm, supportive manner. You may want to respond with, "Don't worry.
• Gentle patting may turn the person's attention toward you and reduce the hallucination.
• Acknowledge the feelings behind the hallucination and try to find out what the hallucination means to the individual.

Scebario 2:

A version of disorientation typical for people with mid- to late-stage Alzheimer's disease, or related dementia, is sundowning. Sundowning is also known as sundown syndrome and late-day confusion. It's symptoms are increased confusion and stress in the late afternoon and evening.The main underlying cause of memory loss and confusion is the progressive damage to brain cells caused by Alzheimer's disease. While current medications cannot stop the damage Alzheimer's causes to brain cells, they may help lessen symptoms for a limited time.

Response :

Stay calm.
Respond with a brief explanation.
Show photos and other reminders.
Travel with the person to where he or she is in time.
Offer corrections as suggestions.
Try not to take it personally.
Share your experience with others.

Scenario3:

End-of-day exhaustion (both mental and physical) An upset in the "internal body clock," causing a biological mix-up between day and night. Reduced lighting and increased shadows causing people with Alzheimer's to misinterpret what they see, and become confused and afraid.The causes of sundowning are not well understood. One possibility is that Alzheimer's-related brain changes can affect a person's “biological clock,” leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors.

Response :

Maintain regular times for meals and for going to bed and getting up.
Seek morning sunlight exposure.
Encourage regular daily exercise, but no later than four hours before bedtime.
Avoid alcohol, caffeine and nicotine.
Treat any pain.

Scenario 4:

In the later stages, memory loss becomes far more severe. A person may not recognize family members, may forget relationships, call family members by other names, or become confused about the location of home or the passage of time. He or she may forget the purpose of common items, such as a pen or a fork.Those with Alzheimer's disease may have impairments in short-term memory, however remote memory can be left relatively intact. So they're able to remember public and personal events many decades ago, but unable to recall what happened earlier that day.

Response:

Communicating with a person with memory loss can be difficult, but the right strategies can bridge the gap and foster a more fulfilling relationship between you and your patient or loved one. Those struggling to communicate with a person who has memory loss are not alone.

Be educated about the disease.
Be realistic in your expectations for yourself and your loved one.
Develop predictable routines and schedules.
Do not argue with your loved one.
Don't underestimate the power of good nutrition.
Give them independence when possible.

Keepa notebook or smartphone with you to keep track of important information, phone numbers, names, ideas you have, appointments, your address, and directions to your home.

Put sticky notes around the house with reminders for yourself.
Label cupboards and drawers with words or pictures that describe their contents.
Ask a friend or family member to call and remind you of important things you need to do during the day, like taking medication and going to appointments.
Keep photos of people you see often, and label the photos with their names.