Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ____
• Patients lose their sense of time and may wander to work or the grocery store. They can inadvertently attempt to engage in old activities. • Address issues that can cause pain or discomfort. The patient may walk and move for comfort. Recognize signs of pain. • Provide meaningful mental stimulation and exercise, and keep the person engaged. • Maintain minimal noise levels in the home, as loud noises and disruptive sounds can cause anxiety, stress, and the need to move. • Put personal items (keys, wallet, umbrella) in a closet or other storage place. • Lock the doors to the outside and install notification Ring on all doors. HOARDING, HIDING, AND RUMMAGING A person with AD may hoard, hide, or rummage for a sense of control. They may like an item, forget they have it, and hoard more in their personal space. These activities are rooted in confusion and familiar items may provide comfort, control, and security. • As critical thinking skills diminish, the person may not be able to discern items that should be disposed of, thinking throw-away items are important. • A lack of security and/or stimulation may cause the person to find items and hoard them. • The person may forget they’ve stored items in a specific spot, may no longer remember where they’ve placed things, and be unable to recall and communicate. • Rational explanations may only increase stress. To keep the person safe and comfortable, remove only those items that can be harmful. • Recognize there may be an attachment to hoarded or hidden items, and there can be options to “trade” items so that removal is easier. Negotiate with the person; don’t rationalize. • See if the person would donate surplus items to charity, giving them the opportunity to help others. HALLUCINATIONS As sensory processing becomes impaired, the person with AD can experience paranoia and hallucinations, and this should be shared with their physician. Altered senses can cause distorted perceptions. It is important to understand what is causing the hallucination or perception and ensure that the patient is safe.
• Collaborate with the physician to identify the cause of the hallucinations and paranoia. Identify any visual cues or shadows in the space. • The provider can discern if the hallucinations are physiological or environmental. ‒ Address lighting in personal space. ‒ Minimize noise. ‒ Maintain comfortable temperature. ‒ Clear room of dangerous items. • Avoid stress and increased anxiety. • Address the person in a calm, soothing, reassuring voice. Redirect, distract, and provide a change of scenery. • Track hallucinations and assess potential correlated trends to relieve the situation.
ENVIRONMENT
PHYSICAL SPACE Doorframes can be painted different colors to differentiate and delineate the space. This can occur in the community and at home. Walkways should be cleared, and nightlines situated along baseboards can provide dim lighting that can guide the person through the hallways. Use basic furniture arranged for easy access—don’t overwhelm spaces. If possible, include outdoor green space. People with AD who are exposed to green spaces experience improved mood and focus (Sturge et al., 2021). Other interventions for safe and inviting space for the person with AD include the following. • Remove area rugs for fall prevention. • Hang meaningful photos on the walls for reminiscence.
• Limit wall mirrors to avoid confusion. • Provide storage space, such as baskets, for
placement of preferred blankets, pillows, and other comforting items that the patient will use on a regular basis.
Self-Assessment Quiz Question
15. What are some things to remember about the physical space for a patient with AD? A) Doorframes can be painted a separate color.
B) Area rugs should be removed. C) Wall mirrors should be limited. D) All of the above.
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