Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ____
ANGER, AGITATION, AND AGGRESSION As the disease progresses, the person will recognize changes but may not be able to express themselves. They may be embar- rassed and frustrated with toileting and bathing. Stress can impact communication. Make sure that the person does not have access to items that can be dangerous. • Do not take behavior or outbursts personally. • Find a meaningful method of distraction—soft music, taking a walk, or engaging in conversation or a favorite activity can minimize outbursts. • Make sure the patient is not hungry or thirsty, that they are clean and do not need toileting, and that there are not stressful distractions. • Do not engage in physical contact that may exacerbate the situation, as you don’t want the person to feel threatened or violated. • Give the patient time and space to work through their anger in a safe place. Ensure that they are not in danger and then let it run its course—again, this is not personal. REPETITIVE ACTIONS A patient may develop unusual compulsive, repetitive actions. These repetitive actions can be picking something up in their hand, putting it down, and repeating these steps, while mum- bling intelligibly (or unintelligibly). Other repetitive behav- iors include pacing, appearing to be looking for something, emptying tissues from a tissue box, and emptying drawers. If the patient is safe and not engaging in self-harm, perhaps the repetitive behavior can persist.
OTHER BEHAVIORS SPECIFIC TO AD AND OTHER DEMENTIAS SUNDOWNING Sundowning is a disruptive evening stage that can present with restlessness, confusion, agitation, and anxiety. It can disrupt sleep and present challenges to the daily routine and care. Minimize overstimulation at the end of the day and eliminate caffeine and sugar, especially late in the day. If a patient is sundowning, implement the following to struc- ture a more comfortable day. • Establish daily sleep schedule with bedtime routine. • Have proper lighting, minimize shadows, and recognize that complete darkness can upset the person. • Ensure the diet is nutritionally sound food and supplement as suggested by a healthcare professional. • Engage in daily physical activity and limit sedentary activities. • Have a portable toilet/commode near the bed to minimize confusion and limit nighttime bathroom visits.
MANAGEMENT OF ADL/IADL THROUGH THE STAGES OF AD
Disease Stage
Activity of Daily Living
Suggested Supportive Methods
Early
Dressing
• Encourage choice • Give autonomy to actively participate in dressing
Personal hygiene
• Provide comb and brush along with encouragement to groom themselves • Aid with shaving, if needed • Assist with bathing/shower as needed • Establish specific bath timev • Help with toileting when needed; respect modesty • Provide easy-to-remove clothing to assist with bladder control • Provide wet wipes for easy cleaning • Monitor for safety • Engage patient in food selection; encourage choice and participation • Engage in grocery shopping, meal preparation, and clean-up • Provide adaptive utensils, as needed • Encourage patient to serve and feed themselves • Cut food, if necessary • Monitor for safety Table 7 continues on next page
Bathing and toileting
Eating
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