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Specific Strategies for Coping with
Physical and Behavioral Problems

Difficulty communicating

Effective communication is an exchange of thoughts, information, and other messages from one person to another. Since Alzheimer's patients have a brain impairment, it can be very difficult for them to understand and communicate. Word finding and other communication problems can leave patients feeling anxious, agitated, and upset. To help minimize these problems, remember to:

Poor vision

Poor vision can add to already existing communication difficulties in patients with Alzheimer's. Vision is an important part of communication. Watching facial expressions, establishing eye contact, seeing gestures and nods can all help good communication. Poor vision can also increase the risk of falls and injury.

Poor vision may include apparent signs of clumsiness, falls, and bumping into things. To cope with such problems:

Hearing problems

Hearing problems can aggravate the symptoms of Alzheimer's disease. They can add to a patient's isolation and confusion and, in some cases, are related to auditory hallucinations and paranoia. To cope with hearing problems:

Pain

Alzheimer's patients may be unable to tell you when they are experiencing pain. It's important that you look for secondary signs such as:

If you notice these symptoms, or suspect the patient is in pain, consult your physician.

Loss of motor skills or driving ability

Deciding when a patient should or shouldn't drive is a difficult decision. Driving is often associated with one's feelings of independence, adulthood and freedom. Unfortunately, a motor vehicle is also a lethal weapon. Patients with Alzheimer's often experience problems that make driving dangerous. If the patient is unwilling to stop driving you may want to:

Whatever you do, be sure to arrange for alternate transportation so that the patient does not become isolated when they stop driving.

Wandering

Wandering is a stressful and potentially dangerous symptom of Alzheimer's disease. It is important to consider the possible causes of wandering, including:

How to prevent wandering

Even though wandering can seem like an unsurmountable problem, there are steps you can take to prevent or minimize wandering. These steps include:

Whether you can prevent the patient's wandering or not, it is important that you make the changes necessary to insure their safety:

Catastrophic reactions

Catastrophic reactions are extreme outbursts of emotion, most often anger or agitation. Catastrophic reactions are difficult to work with so the best strategy is to work on preventing them. Common triggers for catastrophic reactions include:

You can decrease the likelihood a catastrophic reaction will occur by:

Once a catastrophic reaction has started there are some things you can do. Try to:

Keep your responses kind and supportive during a crisis and also remember to give praise and pay attention to the patient at non-crisis times (such as when they are cooperative and pleasant). That way you will reinforce the patient's behavior when they are behaving well and make it more likely that they will behave this way more often.

Bathing

As Alzheimer's disease progresses, patients need assistance in caring for themselves. Alzheimer's patients may forget the need to bathe, feel frightened of bathing, or feel uncomfortable having someone help them with such a private task. To make bathing as easy as possible try to:

If a patient won't cooperate,

Dressing

Being comfortably and nicely dressed is often important to the patient's sense of well being. With clear suggestions and directions, patients are often able to do a fair amount for themselves. Encourage the patient to do as much as possible and be aware of eliminating frustrations, such as too many choices of clothing, or items that are difficult to fasten. When assisting a patient with dressing:

Eating

Many Alzheimer's patients have difficulty with eating. Here are some ways to prevent such problems:

Medication safety

As a caregiver, it is important that you understand the effects of medications and how to use them. Be alert to possible side effects and be careful to have your physician evaluate all medications regularly.

Some other medication reminders are:

Toileting

Good toileting habits can prevent an array of health and behavioral problems. Some things to consider:

Depression

About 20 to 30 percent of patients with Alzheimer's disease will also develop depression. Depression is treatable. Make sure you are aware of the symptoms and seek help for the patient when they occur. Here are some common signs of depression:

If a patient can no longer speak, watch their body language. See if you can notice changes in the patient's mood:

If depression is suspected, a physical exam is necessary to be sure the dementia patient doesn't have a medical condition that is affecting their mood. It is unknown what really causes depression. Some depression may be brought about by:

What can you do to reduce depression in a patient?

Emotions, behavior, and thought all work together to maintain depression and contribute to a downward spiral of mood. In a depressed patient it is important to try to:

Use your knowledge of the patient to find activities they will enjoy. Make a list of these activities and schedule them regularly (such as daily or weekly). Give the patient lots of reassurance and support for participating. Some ideas for pleasant activities include:

For pleasant events to be successful they must:

Paranoia or suspicious behavior

About one-third of patients with Alzheimer's disease develop paranoid or suspicious behaviors. These behaviors can be very disturbing to caregivers. It is important not to take these behaviors personally. Be aware of factors that can aggravate paranoia:

When the behavior occurs, don't try to orient, correct, or argue with the patient (this can just make them feel frustrated). Instead try to:

Some ways to avoid paranoid or suspicious reactions are to:

Hallucinations and delusions

Hallucinations are seeing, hearing, smelling, tasting, or feeling, things that aren't there. Hallucinations occur in about 20 percent of patients with Alzheimer's disease. The most common hallucinations are visual and auditory.

Delusions are beliefs that are contrary to the truth (such as when a patient thinks they are at a stranger's house when in fact they are at home).

Both hallucinations and delusions are secondary symptoms of the disease and do not mean that the patient is "going crazy." It is important to remain calm, consistent, and supportive of the patient when hallucinations or delusions occur. The following are some suggestions for managing these symptoms:


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adrcweb@u.washington.edu
UW ADRC Director--Murray Raskind, M.D.
UW ADRC Education and Training Director--James Leverenz, M.D.
Last Modified: Friday, 09-Jan-2009 13:34:55 PST