Alzheimer's Disease

Etiology

Diagnosis

Signs and Symptoms

Care Management Strategies

Caregiver Support

References

Post-Test

Sometimes changing the subject or engaging in a pleasurable activity can stop the repeated questions for the time being. Some experts suggest ignoring the question.  Note how your patient responds, positively or negatively to any intervention and share what works with others. Remember what works today might change as the disease progresses.

You may remember a technique called Reality Orientation (RO), which was frequently used in long-term care with disoriented residents. Classes were taught and the resident was frequently reoriented to place, time and person in an attempt to get the person back to the here and now. While RO can be useful for people with delirium, it is not appropriate for patients with AD. AD patients do not have the ability to retain the information and being told that it is not 1944 serves no useful purpose. Validation Therapy (VT) is a communication strategy used to get the patient talking about what they are remembering right now and what is their reality (e.g. 1944). Reminiscence unearths long-term memory, which may decrease anxiety. Successful techniques rely on great listening abilities of the caregiver as well as a keen sense of how to distract and redirect the conversation to focus on feelings, not the inaccuracies, within the conversation.

Often times the AD patient will misplace lose or even hide items, forgetting where they are. A clutter-free living environment is important from a safety standpoint as well as making it a little easier to locate missing items. Never ask the patient where they put it-they won’t remember. Installing locks on closet and room doors can sometimes be helpful in decreasing the number of places for misplaced items. Teach family members to check the garbage before they throw it out for hidden treasures. Valuables should be placed in a safety deposit box early to avoid the trauma of a misplaced item. Don’t leave important items just lying out or they will show up in the most unusual places. My Dad’s wife, who was diagnosed with “probable Alzheimer’s Disease” three years ago, put the checkbook in the waffle iron. He spent days searching for it and only found it several days later when he was talking on the phone and noticed the waffle iron looked “uneven.”

Twenty-six percent of AD patients wander. A few years ago a 70-year-old woman with AD disappeared after her plane landed at a Texas airport. She hasn’t been seen since. Mace and Rabins (2002) state three main reasons why people wander.

1. Wandering may be a result of getting lost.
2. Wandering increases when there has been a change in the environment.
3. Wandering for no apparent reason. Sometimes these problems become worse at night. There are some interventions, which may be helpful in decreasing the frequency of wander behavior. Establish a regular daily routine for meals, activities and rest. Do fewer activities in the evening if sundowning or sleep difficulties are present. Make sure that at bedtime the patient is toileted and that a night-light is on. If a new environment is anticipated, try to introduce the change gradually, when the person is in the early stages of the disease. It is important to have a recent photo available and have some type of identification on the person, which says they are memory impaired (e.g. bracelet, label on clothing). Write down each day what the person is wearing. Neighbors should be aware that the person has AD and that they should call if they see him leaving the house alone. An environmental assessment of the indoors and outdoors should be performed to identify possible dangers (e.g. busy highway, lake, tool bench). Manipulate the environment indoors by putting locks out of sight and bells on doors to warn the caregiver that the patient has opened a door. Sometimes something as simple as a piece of tape across the doorframe or a stop sign will deter the patient from leaving. If your patient does wander, begin by immediately searching the surrounding environment, calling out their name. Inform your neighbors, the police and local stores. Enlist help of family and friends in the search and make sure that at least one person has continuous phone availability.