Hospitalization and the Alzheimer’s Patient – Things to Know

Posted by on Aug 20, 2014 in Alzheimer's Care West Palm Beach, Dementia, Patient Care

Hospitalization and the Alzheimer’s Patient – Things to Know

Hospitalization and the Alzheimer's PatientDementia patients are confused. Being hospitalized in a strange environment surrounded by strange people and being powerless to “escape” is very confusing and scary for them.

Whatever the reason is for the hospitalization everyone who interacts with your loved one will need to be aware of the dementia diagnosis and will need to, in some way, deal with the symptoms. A dementia patient requires extra care, extra supervision, and extra understanding.

The dementia caregiver will need to be an advocate, an educator, and a friend. Hospitalization is a challenging time. Here are some things that we learned during the many times our Mom was hospitalized.

Hospital Admission

A dementia patient is not usually hospitalized for the dementia symptoms. Most of them are elderly and when they are hospitalized it is often for something like cardiovascular disease or diabetes. The added symptoms and pain that these kinds of diseases bring can make hospitalization even harder for the dementia patient.

If your loved one is being hospitalized for scheduled tests or surgery you will have the opportunity to pack a bag with their toiletries and clothes and also to gather needed medical and insurance information.

Talk to your loved one about the upcoming hospitalization. Explain what it is for, what they can expect, and how long they should be hospitalized. Assure them that you will see that they get the best possible care.

Avoid making promises that you may not be able to keep, like it won’t hurt, or that you will always be with them. If you do, they may become even more confused and agitated if they feel pain or if you are separated. Do all that you can, but realize that you can’t do everything.

Emergency Room Wait Times

Most of our Mom’s hospitalizations in her later stages of Alzheimer’s disease resulted from visits to the emergency room. She was brought there by ambulance twice and once she was told to go there by her primary care physician.

Whether we were waiting in the crowded waiting room or in the treatment room to be seen by a doctor waiting was a long, trying, difficult, tiring ordeal. Mom was in pain. She was confused. And often she was not able to get up and move around. She would get angry at us for keeping her there.

Because the hospital was so crowded, and because she required extra care due to dementia, it was not unusual for her to be admitted from the emergency room, but have to wait 2, 3 or even 4 days in a small emergency room treatment “room” with just a curtain for a wall before she would be moved to a regular room.

Mom was confused, sad, and angry, in pain and there was nothing we could do to help her. Waiting with her was one of the hardest things we have done.

Always keep an “Emergency Bag” packed at home to grab as you run out the door. Having the necessities with you while you wait can make the time a little more bearable.

Find ways to distract your loved one. Listening to music or singing, talking on the phone, cuddling with a stuffed animal, telling stories, looking at picture books or magazines are all helpful activities. Set aside your own discomfort during this time and make your loved one as comfortable as possible.

Be sure the staff (all of them) knows of your loved one’s dementia symptoms so that they can adjust their care techniques to best serve her. Don’t assume that all of them have read the medical chart or even had any contact with the attending physician.

Strangers—Doctors, Nurses, Everyone!

Added to the pain, anger, and general confusion, the dementia patient will be surrounded by strangers while they are in the hospital. Doctors, nurses, specialists, therapists, food service workers, housekeeping staff, volunteers, and many, many others—sometimes more than one at a time.

Your loved one will most likely not even see their Primary Care Physician while they are hospitalized. There was one time that I (Paula) never even met my Mom’s treating physician. I kept missing him and the nursing staff could never give me an accurate time frame when he would make his rounds.

Besides trying to comfort and reassure your loved one you will also need to communicate effectively with all of those involved in her care. This can be extremely difficult when you are communicating only through notes left at the nurse’s station.

If possible, try to get the hospital to assign a specialist who is familiar with your loved one’s case. Mom had been hospitalized several times with problems related to blood clots and saw the same vascular surgeon several times. It was easier for us to talk with him because we didn’t constantly have to explain our Mom’s medical history.

Whether your loved one has a physician who is familiar with their case or not, be sure to write down his name, office contact information, specialty, and the hours he usually does his rounds. He may be reluctant to give you his office contact info saying that you can leave a message at the nurses’ station if you need to speak with him, but I would push him for it anyway. Leaving an important message with a staff member who works specifically for that doctor can be much more efficient than leaving a message with an over-worked nursing staff at the hospital.

The Dementia Patient Needs an Advocate

If you are the only caregiver you may be in for a long stay. Many sources recommend that a patient never be left alone when they are hospitalized. This is especially important for a dementia patient. A dementia patient lacks the ability to ask proper questions and to understand instructions. She needs someone to be her advocate.

It is possible that some of the people who provide care and services to your loved may not be familiar with dementia and the symptoms it produces. You, as the caregiver may need to explain why your loved one is acting the way they are acting.

It was so refreshing when we got a nurse or therapist who was well-acquainted with dementia symptoms. They were able to help us deal correctly with our Mom. When she would get out of bed, again, even though her legs were not strong enough to support her weight, the staff who understood her desire to escape would gently help her back to bed. Not everyone was as helpful as they could have been.

It may be useful to make up a sign to put in your loved one’s room (Hang it on the outside of the door, if possible, so most people who enter the room will see it.) The sign could say something like,
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“Hi! My name is ____________. I have dementia.

If I

  • Cry
  • Don’t answer your questions
  • Speak in gibberish
  • Repeat words or phrases
  • Am scared of you
  • Get out of bed and wander down the hall
  • Cannot control my bowels
  • Get very restless at night time
  • (and any other symptoms your loved one may experience)

Please understand that it is part of the disease. I am normally a very pleasant, friendly, person, but I have not been myself lately. Thank you for your understanding and support.”

Along with educating the hospital staff the dementia caregiver will also have the responsibility of reassuring the dementia patient. The confusion of the disease may make this an ongoing job, but just having your familiar face there as much as possible will help to calm the dementia patient and to reassure them that they are safe.

It is difficult enough for most patients to comprehend the diagnosis of their illness, but for a dementia patient it may be impossible. The dementia caregiver will have to be the one to ask questions and make decisions. If you have a medical power of attorney and an advance directive in place these decisions will be easier to handle.

It is also necessary for the dementia caregiver to insure the safety of their loved one. Check medications and dosages, know why a treatment is being given and what are the expected results. If something doesn’t seem right, ask questions. Get the answers you need even if you have to demand them. Don’t allow the hospital staff to be vague with you.

If possible, enlist the help of friends and family members to stay 24/7 in the hospital room. Be sure that they are familiar with your loved one’s normal symptoms and what thet can be expected to act like in the hospital.

Leave a notepad and several pens in the room for the caregiver to write down everything that happens to the patient. Designate a section in the notebook for questions and answers. If one caregiver has a question for the doctor they can write it down and even if they aren’t there when he shows up the caregiver who is on duty can ask the questions and write down the answers.

Dealing with a dementia patient in the hospital is challenging. It is tiring and it can be quite frustrating. Remember that the hospital staff, doctors and nurses included, work for you. You don’t have to be bossy, impatient, or unkind when dealing with them, but you are trusting them with someone very precious to you. Be sure your loved one receives the very best care possible.

While You Are Spending So Much Time At the Hospital . . .

Listening to audio books can be a great source of information and a relaxing distraction.

See if the Hospital Will Provide a Watcher or a Sitter

Our Mom had severe blood clots. This coupled with the dementia symptoms made her at risk for falling. Plus, she didn’t understand that the I.V., the catheter, and any other tubes or equipment could not just be pulled off. She needed someone to stay with her all the time.

With Lanette living out of town, Paula having a family with young children at home, and our step-dad having health problems that prevented him from staying 24/7 with our Mom at the hospital, we needed help.

Friends weren’t always available. For these times the hospital provided a watcher or a sitter to stay with our Mom. This person was usually a medical student or nurse of some kind and his/her job was to stay in the room and make sure that out Mom stayed in bed and had the things that she needed.

These helpers didn’t provide any support in the way of communicating with the doctors or nurses. They weren’t able to give us any medical advice. They didn’t administer medication. But what they did do was invaluable to us. With their help we knew that Mom was safe.

Fall Prevention

Many dementia patients are considered to be a fall risk. They may not be unsteady on their feet, but because they tend to like to wander they may be treated as a fall risk. This designation means that the hospital staff will do everything they can to keep them in their bed or at least in their room.

When our Mom was in the hospital they always put a brightly colored autumn leaf on her door to alert people that she was a fall risk. If a watcher/sitter wasn’t available and Mom was alone in her room they would often put restraints on her in the form of a vest that wrapped from her front to her back and was tied to the bed frame.

This may seem cruel and, honestly, it made comforting Mom even more difficult, but after she tore an I.V. out of her arm and bled so badly she required a complete change of clothes and bedding we saw the necessity of these restraints.

Know your loved one’s limitations and risks and work with the hospital staff to make them as comfortable as possible while also making them as safe as possible.

Sundowners Syndrome

Dementia patients may experience what is called Sundowners Syndrome. This is what happens when the dementia patient gets very restless and agitated in the evening and at night time. This condition seems to worsen while they are hospitalized.

Patients with this syndrome may lie down and then sit back up repeatedly, pick at the bed covers, pull the covers on and off over and over again, doze off, but keep their eyes half open then suddenly wake up again and start these behaviors again.

No one yet knows exactly what causes this phenomenon or how to prevent it. While our Mom was like this the only thing we found that helped was to distract ourselves. We kept an eye on her to be sure she was safe, but we would read, listen to music, watch movies, etc.

Sundowners Syndrome is exhausting to watch. Our Mom would experience it very badly in the hospital and for a couple of weeks after being released. Anticipate needing to deal with this, and prepare yourself.

Dementia Patient Emotions during Hospitalization

No one wants to stay confined to bed, especially if they are kept there with restraints. Being hospitalized brings fear, anger, confusion, sadness, and pain. These emotions are magnified in the dementia patient.

Our Mom would get angry at us for keeping her there and demand that we release her so she could go home. If we had to leave her while she was awake she would cry and become so sad.

She thought that the doctors and nurses were holding her hostage and tried many times to escape. It was so difficult to see our Mom act this way.

Whatever symptoms your loved one experiences under normal circumstances, expect them to worsen while in the hospital. Do what you can to reassure and comfort them, but realize that the treatment they are receiving is necessary and that it is for their good.

Understanding Discharge Instructions

Ultimately the goal of a hospital stay is for the dementia patient to be released well on the road to recovery. As the dementia caregiver it is your responsibility to understand the discharge instructions and to provide the care your loved one will require at home.

If it will not be possible for them to return to their old living arrangements then you will need to research care homes, assisted living homes, or nursing homes, or the possibility of moving the dementia patient into your home or the home of another caregiver.

Work with the doctors and nurses well ahead of discharge time to be aware of what your options may be. Know what level of care will be necessary after discharge and make appropriate plans. If possible have everything in place before your loved one is discharged as trying to hire help, interview care homes, etc. will be extremely difficult if you must bring your loved one along with you.

If you need to apply wound dressings, administer injections, monitor any symptoms or any other special care, be sure that you thoroughly understand these instructions before the patient is discharged.

Depending on the reason for the hospitalization it is possible that your loved one’s dementia symptoms will have worsened by the time they are released. Our Mom got steadily worse following each hospital stay. There is nothing that can prepare you for having a parent or spouse forget your name, but you can prepare yourself for the possibility that your job as caregiver may be more difficult following a loved one’s stay in the hospital.

For more information or to learn more about hospitalization for a loved one who has Alzheimer’s Disease or Dementia, contact ElderCare today at 800-209-4342.
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7 Ways to Help Manage Aggression in the Alzheimer’s Patient

Posted by on Aug 11, 2014 in Alzheimer's Behavioral Problems, Alzheimer's Care at Home, Alzheimer's Help, Alzheimer's Training for Caregivers, Dementia

7 Ways to Help Manage Aggression in the Alzheimer’s Patient

7 Ways to Help Manage Aggression in the Alzheimer's PatientSome people with Alzheimer’s disease may become aggressive.  This can be very upsetting to caregivers and family members.

Aggressive behaviors may be verbal – such as shouting, name calling or they can be physical – such as hitting, pinching, punching or shoving.  These behaviors can occur suddenly, with no apparent reason, or can result from a frustrating situation.

Whatever the case, it is important to try to understand what is causing the person with Alzheimer’s disease to become angry or upset.  These 7 tips can help you choose the best way to respond:

Managing Aggression:

1.  Rule out pain as the cause of the behavior.  Pain can cause a person with dementia to act aggressively.

2.  Try to identify the immediate cause.  Think about what happened right before the reaction that might have triggered the behavior.

3.  Focus on feelings, not facts.  Rather than focusing on specific details, consider the person’s emotions.  Look for the feelings behind the words or actions.

4.  Don’t get upset.  Be positive and reassuring. Speak slowly and in a soft tone.

5.  Limit distractions.  Examine the person’s surroundings and adapt them to avoid other similar situations.

6.  Try a relaxing activity.  Use music, massage or exercise to help soothe the person.

7.  Shift the focus to another activity.  The immediate situation or activity may have unintentionally caused the aggressive response.  Try something different.

 

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3 Myths About Alzheimer’s Disease

Posted by on Aug 5, 2014 in Alzheimer's News, Dementia

Three Myths About Alzheimer’s Disease

Alzheimer’s disease is one of the biggest medical challenges of our century. Here are 3 of the biggest myths about Alzheimer’s:

3 Myths About Alzheimer's DiseaseMyth #1 – Only senior citizens get Alzheimer’s disease. Fact: Although 5 million Americans suffer from Alzheimer’s disease, Early Onset Alzheimer’s disease affects over 200,000 people in their 40′s and 50′s.  It’s the most common form of dementia, plaguing the brain with memory loss.

Myth #2 – Alzheimer’s disease is not fatal. Fact: Unfortunately this is also not true.  Even though the disease may progress slowly, it ultimately leads the body into decline and results in death.

Myth #3 – Alzheimer’s disease affects both men and women equally. Fact: Not true. Women make up 2/3 of Alzheimer’s cases and also carry the burden of caring for family members with Alzheimer’s disease. 60% of caregivers are women.

There is no cure for Alzheimer’s disease but there is increasing evidence that there are some things we can do that help.

  • Exercise
  • Eat a heart healthy diet
  • Stimulate our brains with continuing education and social connections

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Alzheimer’s Disease and the Mediterranean Diet

Posted by on Jul 27, 2014 in Alzheimer's Care at Home, Caring for the Caregiver

Alzheimer’s Disease and the Mediterranean Diet

Mediterranean dietDiet is one of the top items on most people’s list of things they want to pay more attention to, but the foods you choose can affect more than your weight. According to a growing number of studies, diet can play a key role in protecting your brain against Alzheimer’s disease and other types of age-related cognitive decline. What should you eat to lower your risk of cognitive problems? Closely following a Mediterranean diet has been linked by researchers in a number of studies with a significantly lower risk of cognitive impairment as you age.

What makes the Mediterranean diet a smart choice for protecting your brain’s ability to function (as well as protect the health of your heart and lower your risk of obesity and diabetes)? This approach to eating has an anti-inflammatory effect, which fights inflammation throughout the body. It is also a low glycemic diet, which can have a positive effect on your blood sugar levels.

Typically, a Mediterranean diet focuses on:

  • Whole foods (unprocessed and unrefined, with no artificial additives, sweeteners, colorings, or preservatives)
  • Plant-based foods
  • Fruits and vegetables
  • Lean protein, especially fish
  • Healthy fats, especially olive oil
  • Beans, peas, nuts, and legumes
  • Foods that contain a high amount of fiber, like whole grain breads and pastas and fruits such as blackberries and pears

What the science says about Mediterranean diet and the brain

Over the years, several studies that have found a link between eating a Mediterranean diet and a decreased risk of cognitive problems as you age. One recent study used information collected in a large, national study on stroke that included more than 17,000 men and women with an average age of 64. That study found that the people who consistently and closely adhered to a Mediterranean diet not only had a lower risk of stroke and depression, they also had a 40 percent reduced risk of cognitive impairment. Even people who did not adhere to the diet as rigorously had a similar reduction in their risk of cognitive impairment.

Another study reviewed the data collected in 11 observational studies and one controlled randomized controlled trial. The researchers, who were based in the United Kingdom, discovered that the more closely people adhered to the Mediterranean diet, the lower their rate of cognitive decline and risk of Alzheimer’s disease.

Positive Benefits of the Mediterranean Diet

More evidence supporting the positive benefits of a Mediterranean diet was uncovered by researchers comparing the effect of that diet with the DASH (Dietary Approaches to Stop Hypertension) diet on cognitive function. The 11-year study, which included nearly 4,000 men and women over the age of 65, found that both approaches to eating protected cognitive function. People who closely followed either diet scored better on cognitive tests at the start of the study. The participants’ cognitive function declined at about the same rate over the course of the study, which means that those who started with higher cognitive function maintained that advantage. The researchers noted that two food groups (whole grains and nuts and legumes) appear to be primarily responsible for the protective effects of both diets.

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Things You Can Do To Prevent Dementia

Posted by on Jul 22, 2014 in Dementia

Things You Can Do To Prevent Dementia

Preventing DementiaCurrently, most causes of dementia are not preventable. However, the National Institute on Aging (NIA) of the National Institutes of Health (NIH), along with various pharmaceutical companies, foundations, non-profit organizations and others, are all actively engaged in facilitating research and clinical trials aimed at slowing, delaying and preventing many forms of dementia—particularly Alzheimer’s disease (AD).

While there are no magic pharmacological bullets to prevent dementia, there’s lots of research that indicates that there are steps you can to take to reduce your risk for developing conditions leading to dementia, particularly Alzheimer’s disease.

What You Can do Now
We do know that it’s possible to reduce the risk of developing vascular dementia caused by a series of small strokes: If you smoke, quit. If you have high blood pressure and/or diabetes, talk with your doctor about how you can get those under control. Plus, many studies strongly suggest that eating a low-fat diet and exercising regularly may also reduce the risk of vascular dementia.

And remember, there are also some conditions that mimic dementia or have dementia-like symptoms (such as changes in blood sugar, sodium, and calcium and low vitamin B12 levels) that, if caught early enough may be treatable—which is one of many reasons why you shouldn’t delay getting diagnosed by a qualified medical professional.

Here’s the thing: In terms of preventing dementias (versus reducing the risk), we really don’t know anything for sure; but scientists all over the world are working on it. Currently, we know the most about Alzheimer’s disease. It’s the most common form of dementia, and the most studied. Thus, based upon these studies, consider the following:

Diet
There is some interesting evidence suggesting that eating a Mediterranean diet may decrease your risk of developing AD. A Mediterranean diet is one that includes relatively little red meat and emphasizes whole grains, fruits and vegetables, fish and shellfish, and nuts, olive oil and other healthy fats.

Other studies have examined foods rich in antioxidants and anti-inflammatory components to find out whether those foods affect age-related changes in the brain. For example, studies in rats and mice have shown that dietary supplementation with blueberries, strawberries, and cranberries can improve cognitive function, both during normal aging and in animals that have been bred to develop AD. And another study found that curcumin, the main ingredient of turmeric (the spice that gives American mustard its bright yellow color), can suppress the build-up of harmful amyloid plaques in the brains of rodents.

Mental Exercise
Studies have shown that keeping the brain active is associated with reduced AD risk. For example, in a rather famous long-term study called the Religious Orders Study, investigators periodically asked more than 700 participants—older nuns, priests, and religious brothers—to describe the amount of time they spent in seven information-processing activities. These activities included listening to the radio, reading newspapers, playing puzzle games, and going to museums.

After following the participants for four years, the investigators found that the risk of developing AD was 47 percent lower, on average, for those who did the activities most often than for those who did them least frequently. And, there are other studies that have found that those who have pursued higher levels of education appear to enjoy a protective effect for both cognitive (e.g., thinking, reasoning) and emotional outcomes.

Health experts believe that engaging in this level of mental exercise creates or contributes to your having a “cognitive reserve.” In other words, it’s not that this population isn’t just as prone to developing AD. But rather, they’ve developed additional neurons and pathways in their brains.

Think of it like this: If “normally” your brain has one road to transport information from point A to point B, and there’s a roadblock or dead end along the way, the information won’t make it to point B. However, people that have developed new ways of thinking about things have developed multiple and alternative routes in their brains to point B, as well as have developed additional destinations, overall.

So, you may want to seriously consider exercising your brain. Start doing crossword puzzles, learn how to do new things, like how to play bridge, dance, or anything that you’ve always wanted to learn how to do.

Social Engagement
There is some compelling research suggesting that seniors who spend most of their time in their immediate home environment are almost twice as likely to develop Alzheimer’s disease compared to those who travel out of town. These findings, however, may also reflect the general health of the individual. So, this might be a chicken versus the egg phenomena.

Be that as it may, we do know that actively engaging in the world around you is good for one’s health – mentally, physically, and emotionally.

Aerobic Exercise
There are studies suggesting that when older adults with AD engage in aerobic exercise, it improves their psychological and behavioral symptoms. Note: In these studies, aerobic exercise was defined as repetitive and rhythmic movement of large muscle groups, such as the legs.

For example, investigators looked at the relationship of physical activity and AD risk in about 1,700 adults aged 65 years and older over a six year period. They found that the risk of AD was 35 to 40 percent lower in those who exercised for at least 15 minutes, three or more times a week than in those who exercised fewer than three times a week.

Smoking
There are studies suggesting that current smoking increases your risk of developing AD and other dementias —but having smoked in the past doesn’t appear to increase your risk. So, if you still smoke (and even if you’ve smoked for years), now is the time to quit. Talk with your doctor about ways of quitting that could work for you.

According to the National Institute of Neurological Disorders (NINDS), here are some other potentially preventive actions you may want to consider:

Lowering Cholesterol Levels
Research has suggested that people with high cholesterol levels have an increased risk of developing AD. Cholesterol is involved in formation of amyloid plaques in the brain. Mutations in a gene called CYP46 and the APOE e4 gene variant, both of which have been linked to an increased risk of AD, are also involved in cholesterol metabolism. Several studies have also found that the use of drugs called statins, which lower cholesterol levels, is associated with a lower likelihood of cognitive impairment.

Lowering Homocysteine
There’s a building block of protein that naturally circulates in the blood called homocysteine (an amino acid). Recent studies suggest that having higher than average blood levels of homocysteine is a risk factor for a number of neurodegenerative diseases, including Alzheimer’s disease, vascular dementia, cognitive impairment, and stroke.

Eating foods high in folate (folic acid) and other B vitamins (such as B6 and B12) have been shown to successfully lower homocysteine levels in the blood. Whether or not increasing these B vitamins in one’s diet might offer a protective effect is yet unknown. That said, some good sources of natural folate include romaine lettuce, spinach, asparagus, broccoli, collard greens, parsley, cauliflower, beets, and lentils.

Lowering Blood Pressure
Several studies have shown that antihypertensive medicine reduces the odds of cognitive impairment in elderly people with high blood pressure. One large European study found a 55 percent lower risk of dementia in people over 60 who received drug treatment for hypertension. These people had a reduced risk of both AD and vascular dementia.

Controlling Inflammation
Many studies have suggested that inflammation may contribute to AD. Moreover, autopsies of people who died with AD have shown widespread inflammation in the brain that appeared to be caused by the accumulation of beta amyloid. Another study found that men with high levels of C-reactive protein, a general marker of inflammation, had a significantly increased risk of AD and other kinds of dementia.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Research indicates that long-term use of NSAIDs (such as ibuprofen, naproxen, and other similar drugs) may prevent or delay the onset of AD. Researchers are not sure how these drugs may protect against the disease, but some or all of the effect may be due to reduced inflammation. A 2003 study showed that these drugs also bind to amyloid plaques and may help to dissolve them and prevent formation of new plaques.

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