~HANDLING TROUBLING BEHAVIOR OF A LOVED ONE WITH DEMENTIA~

~HANDLING TROUBLING BEHAVIOR OF A LOVED ONE WITH DEMENTIA/ ALZHEIMER’S~

Mom watching TV

 

 

Some of the greatest challenges of caring for a loved one with dementia are the personality and behavior changes that often occur.  You can best meet these challenges by using creativity, flexibility, patience and compassion.  It also helps not to take things personally and maintain your sense of humor.  To start, consider these ground rules:

 

*We cannot change the person

The person you are caring for has a brain disorder that shapes who he/she has become.  When you try to control or change his/her behavior, you’ll most likely be unsuccessful or be met with resistance.  It’s important to:

 

- Try to accommodate the behavior, not control the behavior.  For example, if the person insists on sleeping on the floor, place a mattress on the floor to make him more comfortable.

 

- Remember that we can change our behavior or the physical environment.  Changing our own behavior will often result in a change in our loved one’s behavior.

 

*Check with the doctor first.

Behavioral problems may have an underlying medical reason:  perhaps the person is in pain or experiencing an adverse side effect from medications.  In some cases,  like incontinence or hallucinations,  there maybe some medication or treatment that can assist in managing the problem.

 

*Behavior has a purpose.

People with dementia typically cannot tell us what they want or need.  They might do something, like take all the clothes out of the closet on a daily basis, and we wonder why.  It is very likely that the person is fulfilling a need to be busy and productive.  Always consider what need the person might be trying to meet with their behavior—and, when possible, try to accommodate them.

 

*Behavior is triggered.

It is important to understand that all behavior is triggered—it doesn’t occur out of the blue.  It might be something a person did or said that triggered a behavior or it could be a change in the physical environment.  The root to changing the behavior is disrupting the patterns that we create.  Try a different approach, or try a different consequence.

 

*What works today, may not tomorrow.

The multiple factors that influence troubling behaviors and the natural progression os the disease process means that the solutions that are effective today may need to be modified tomorrow.—or may no longer work at all.  The key to managing difficult behaviors is being creative and flexible in your strategies to address a given issue.

 

*Get support from others.

You are not alone.—There are many others caring for someone with dementia.  Call your local area agency on Aging, the local chapter of the Alzhemer’s Association, a Caregiver Resource Center or one of the groups listed in Alzheimer’s/Dementia Support Group in your local area. Be resourceful—use google for additional research and resources to find support groups, organizations and services that can help you.

Expect that like the loved one you are caring for, you will have good days and bad days.  Develop strategies for coping with the bad days.

 

* The following is an overview of the most common dementia-associated behaviors with suggestions that maybe useful in handling them.

 

WANDERING

 

People with dementia walk, seemingly aimlessly, for a variety of reasons, such as boredom, medications side effects or to look for “something” or someone.  They also may be trying to fulfill a physical need—thirst, hunger, a need to use the toilet or exercise.  Discovering the triggers for wandering are not always easy, but they can provide insights to dealing with the behavior.

 

-Make time for regular exercise to minimize restlessness.

 

-Consider installing new locks that require a key.  Position locks high or low on the door; many people with dementia will not think to look beyond eye level.  Keep in mind fire and safety concerns for all family members; the lock(s) must be accessible to others and not take more than a few seconds to open.

 

-Try a barrier like a curtain or colored streamer to mask the door.  A “Stop” sign or “Do Not Enter” sign also may help.

 

-Place a black mat or paint a black space on your front porch; this may appear to be an impassable hole to the person with dementia.

 

-Add “child-safe” plastic covers to doorknobs.

 

-Consider installing a home security system or monitoring system designed to keep watch over someone with dementia.  Also available are new digital devices that can be worn like a watch or clipped on a belt that use global positioning systems (GPS) or other technology to track a person’s whereabouts or locate him if he wanders off.

 

-Put away essential items such as the confused person’s coat, purse, or glasses.

Some individuals will not go out without certain articles.

 

-Have your relative wear an ID bracelet and sew ID labels in their clothes.  Always have a current photo available should you need to report your loved one missing.  Consider leaving a copy on file at the police department or registering the person with the Alzheimer’s Association Safe Return Program. (See Resources available in your area)

 

-Tell neighbors about your relative’s wandering behavior and make sure they have your phone number.

 

INCONTINENCE

 

The loss of bladder or bowel control often occurs as dementia progresses.  Sometimes accidents result from environmental factors; for example, someone can’t remember where the bathroom is located or can’t get to it in time.  If an accident occurs, your understanding, patience and reassurance will help the person maintain dignity and minimize embarrassment.

-Establish a routine for using the toilet.  Try reminding the person or assisting her to the bathroom every two hours.

 

-Schedule fluid intake to ensure the confused person does not become dehydrated.  However,  avoid drinks with a diuretic effect like coffee, tea, cola, or beer.  Limit fluid intake in the evening before bedtime.

 

-Use signs (with illustrations) to indicate which door leads to the bathroom.

 

-A commode, obtained at any medical supply store, can be left in the bedroom at night for easy access.

 

-Incontinence pads and products can be purchased at the pharmacy or supermarket.  A urologist may be able to prescribe a special product or treatment.

 

-Use easy-to-remove clothing with elastic waistbands or Velcro closures, and provide clothes that are easily washable.

 

AGITATION

 

Agitation refers to a range of behaviors associated with dementia, including irritability, sleeplessness, and verbal or physical aggression.  Often these types of behavior problems progress with the stages of dementia, from mild to more severe.  Agitation may be triggered by a variety of things, including environmental factors, fear and fatigue.  Most often, agitation is triggered when the person experiences “control” being taken from him/her.

 

-Reduce caffeine intake, sugar and junk food.

-Reduce noise, clutter or the number of persons in the room.

-Maintain structure by keeping the same routines.  Keep household objects and furniture in the same places.  Familiar objects and photographs offer a sense of security and can suggest pleasant memories.

-Try gentle touch, soothing music, reading or walks to quell agitation.

Speak in a reassuring voice.  Do not try to restrain the person during a period of agitation.

-Keep dangerous objects out of reach.

-Allow the person to do as much for him/herself as possible—support his/her independence and ability to care for himself/herself.

-Acknowledge the confused person’s anger over the loss of control in his/her life.  Tell him/her you understand his/her frustration.

-Distract the person with a snack or an activity.  Allow him to forget the troubling incident.  Confronting a confused person may increase anxiety.

 

Once again, the key to handling these challenges is by using your own creativity, flexibility, and above all, your patience, understanding, and compassion— your compassionate and loving heart  will always be the answer to handing the challenges you face in handling the troubled behavior of your loved ones affected with dementia.

 

In my next article, we will discuss the causes and suggestions to handling the “Repetitive Speech or Actions”; “Paranoia” and “Sleeplessness/Sundowning” of a loved one with Dementia / Alzheimer’s.

 

 

Resource:  (Southern Caregiver Resource Center @San Diego)

 

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FDA may approve Alzheimer test for living patients

PET scan of a human brain with Alzheimer's disease
Image via Wikipedia

One of the many frustrations of Alzheimer’s disease is the difficulty in pinpointing just who has it. According to published research, as many as one in five people told they have Alzheimer’s are mislabeled. A definitive diagnosis can  be made only after death, by an autopsy that reveals a distinctive buildup – known as amyloid plaques – in the patient’s brain. This week, however, the FDA will consider a new diagnostic test that may be able to identify those plaques through PET scans – a type of brain scan – on living patients.

In a small study run by Avid Radiopharmaceuticals and made public Tuesday in the Journal of the American Medical Association , PET scans identified the telltale plaques in 97 % of patients who actually had them, as determined by a subsequent autopsy.

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Alzheimer’s Disease Studies You Haven’t Heard About Yet – Synergy Clinical Research

by Rose Broyles

All across the country, sponsored private and university based studies are being conducted  to help find cures and improvements to Alzheimer’s Disease and other brain disorders.  This unassuming house below is actually the outpatient clinic for Synergy Clinical Research Group here in San Diego. I had the opportunity last week to sit down and speak with Shauna Blackmun, one of the marketing liaisons for this doctor-owned private research group. We discussed the nature of Synergy’s studies which include far more than just Alzheimer’s.  These are paid, volunteer research studies (FDA approved or pending approval)  and you can find out more about Synergy Research’s Programs here. While some may cringe at the idea of becoming a “guinea pig”, these studies are an important part of the process of fighting devastating diseases such as Alzheimer’s and truly benefit the participant and future patients.

Synergy Clinical Research, San Diego, CA

Synergy Clinical Research, San Diego, CA

Alzheimer’s Studies in Progress

Head: Dr. Mohammad Bari – Geriatric Psychiatrist.

Studies in Progress: 2

Study 1 - ICARA

Current medications on the market focus on maximizing the remaining brain activity. This is a new investigational drug called bapineuzumab being tested on slowing down the progression of Alzheimer’s Disease itself.

Who is Eligible to Receive ICARA (Bapil)?

  • Age 50-88
  • Mild-Moderate Alzheimer’s Diagnosis
  • Using Aricept regularly for at least three months or not taking any Alzheimer’s medication.
  • No history of cancer
  • Able to attend ALL office visits
  • Lives with or spends long periods of time with a regular caregiver who is welling to attend all trial visits, oversee the patient’s compliance with instructions and report on the patient’s status.

What is Involved in the ICARA study?

  • Participants receive, at no cost, the investigational drug, physical exams, laboratory tests, Radiology tests such as: CT,etc.
  • Attend 15 study visits in an 83 week period
  • Receive six infusions of the drug every 13 weeks for 65 weeks
  • Participants are randomly assigned to receive one of three does of the drug or a placebo (no active ingredients). There is a 60% change of receiving the drug and 40% chance of receiving the placebo.

Study 2 - Alzheimer’s Nutritional Drink Sponsored by Dannon

The makers of the Activia yogurt brand are sponsoring a study of a nutritional drink similar to Ensure. This study is to test whether the nutritional drink is effective and safe for the dietary management of Alzheimer’s Disease.

Who is Eligible for the Alzheimer’s Nutrional Drink Study?

  • Clinically diagnosed with mild-moderate Alzheimer’s Disease
  • Taking Aricept, Exelon, Razadyne, and/or Namenda for the past 3-4 months.
  • Over 50 years of age
  • Not previously diagnosed with vascular dementia, Huntington’s Disease, Parkinson’s Disease, or seizures
  • Not living in a nursing home
  • Lives with or spends long periods of time with a regular caregiver who is welling to attend all trial visits, oversee the patient’s compliance with instructions and report on the patient’s status.

What is Involved in the Alzheimer’s Nutritional Drink Study

  • The drink is to be consumed once every day for 6 months.
  • The patient will be regularly monitored and tested by study staff for any changes in memory and thinking abilities.

Clinical Participant Information and Perks

Not only does the patient receive these investigational drugs and products, they receive compensation for their time an effort. Some of these include:

  • $50 per visit for both the caregiver and the patient.
  • Free medical and physical evaluations
  • Free Tests
  • Free transportation
  • New studies come out every few months including studies geared towards caregivers.
  • Free to the public

It’s a relief to know that there are studies such as these taking place; as each new drug hits the market, I know that we are that much closer to finding a cure . I only wish that I knew about these studies when Mom was healthier. She is now in the moderate-advanced stage of Alzheimer’s so although Namenda may be helping her, I don’t know if these particular studies would benefit her much at all. I asked Shauna if Mom would qualify and she said we should bring her in. This will be something that my family and I will have to decide on. As with any study, there are risks involved. So, we will have to see if the rewards outweigh the risks.

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