Try: Possible causes physiological or medical causes; illnesses such as angina congestive heart failure diabetes ulcers alcoholism; pain caused by illnesses such as arthritis; urinary tract infections which cause constant pressure to urinate; "restless legs" twitching or leg cramps often caused y metabolic problems; depression; side effect of medications such as diuretics; sleep apnea breathing difficulties; need for less sleep with increased age; disrupted sleep patterns due to progressive dementia the ability to sleep appears to deteriorate as cognitive abilities decline environmental causes ; too hot or too cold; lighting poor – darkness disorienting; can’t find bathroom; change in environment hospitalization often results in changes in sleep patterns other causes ; too much time spent in bed at night; too much daytime napping; too fatigued to calm down and sleep; not enough exercise; too much caffeine or alcohol; hunger; agitated from upsetting situation such as bath or an argument with caregiver; disturbing dreams coping strategies ; have a good medical work-up to identify and treat any medical problems; treat pain with an analgesic at bedtime if approved by physician; try vitamin e for ‘restless legs’ also discuss with doctor stopping or changing diuretic medications that may be contributing to this problem; for sleep apnea breathing difficulties characterized by heavy snoring help person lose weight if obese see doctor and discuss eliminating sedatives that may be contributing to this problem; have an evaluation for depression done if early morning awakening e g waking regularly at 4 00am is a problem antidepressants given at bedtime may help sleep; have all medications carefully evaluated for side-effects; check whether person appears to be too hot or cold on awakening internal thermostat may change with dementia; provide adequate lighting during evening hours shadows glares or poor lighting may contribute to agitation and hallucinations; provide nightlights or soft lighting while sleeping to cut down on confusion during night and to aid in finding bathroom; make sure there is a clear well lit pathway to the bathroom practice the route during the day; place a commode or hand held urinal next to bed if finding the bathroom is a problem; make sure older adult goes to bathroom before going to bed; try to change environment as little as possible; have the older adult spend less time in bed try getting the older adult out of bed at an earlier hour of keep him her up later until they are tired many people require only six to eight hours of sleep per night; make sure that the bed and bedroom are comfortable and familiar to the older adult a favorite blanket or pillow or bed clothes may be helpful; maintain a set bedtime and waking routine once a good routine is established continue bedtime rituals from the past e g a glass of milk before bed or music on radio at bedtime; try bedrails they may help to remind some people that they are in bed for others however bedrails may be confusing and may lead to falls if the older adult tries to climb out of bed; try to prevent daytime napping unless person seems very fatigued in evening hours then try a short rest or nap after lunch; make sure the person is getting adequate exercise try to take one or two vigorous walks a day; cut down on caffeine coffee tea or soft drinks during day and eliminate any after 5 00pm; cut down on alcohol intake discuss the effects of alcohol and medications being taken with physician; make sure the older adult is not hungry at bedtime try a light snack before bed some herbal teas may have a calming effect warm milk often helps promote sleep; avoid bathing or other upsetting activities in late afternoon or evening unless warm baths relax the older adult; avoid laying clothes out for the next day or talking about the next day’s activities this may be confusing and give a ‘wake up’ signal; allow the older adult to sleep on couch or in armchair if refusing to get into bed; make the house or an area of the house safe for the older adult to wander in alone at night safety proofing a house for a safe night of wandering may include ; gating off stairs; special locks or alarms on doors to outside; blocking off kitchen or locking up dangerous items; making sure windows are locked; give the older adult a backrub or massage legs at bedtime or during night wakefulness; try a softly playing radio beside the bed; hire a companion at night or work out shifts so that primary caregiver can get sleep; gently remind the older adult that it is dark out and time for sleeping; consider allowing the older adult to be up at night if this can be accomplished safely and without destroying the caregiver’s routine; for sundowning agitation and wandering in the late afternoon evening; try to distract put on music give the older adult something to hold feel or fiddle with; go for a walk; try a craft activity; turn on the television; try closing blinds or curtains to shut out darkness; turn lots of lights on to brighten atmosphere and combat shadows; try to be rested for better coping at the most agitated time of day; try to minimize noise confusion and the number of people around during the most agitated time of day; try a rocking chair in nursing homes or adult foster care homes; increase staffing volunteers or family visits at that time of day to permit more one-to-one attention; try a breathing chair – they are soft comfortable and easily cleaned however older people may need assistance getting up; be aware that shift changes are often noisy confusing times of day which can contribute to agitation; use psychotropic medications to take the edge off agitation use only under the supervision of a physician in some older adults with dementia these medications can have the opposite effect by making people more agitated; use otc sleeping medications only as a last resort be aware that their effectiveness is only short term but may be helpful in establishing a more regular sleep cycle however sleeping medications may add to confusion on waking other considerations ; be very cautious with the use of any kinds of medications for inducing sleep sometimes they may make symptoms of confusion and disorientation worse psychotropic or sleeping medications must be very carefully monitored by a physician familiar with dementia; problems with sleeping or late evening agitation are often a stage in dementia that eventually passes many older adults with alzheimer’s disease begin sleeping more during the later stages of disease; it is important to try to recognize elements in the environment the medical situation or problems of communication that might be contributing to sleep problems before deciding on particular strategies to try keep a log to help pinpoint possible cause of the sleeping problem; sleep problems are one of the symptoms that are least tolerated by family caregivers when the caregivers are unable to get adequate sleep themselves night after night they become high risk candidates for accidents or illness and their relatives become likely candidates for nursing homes; it may be helpful for the caregiver to try meditation or relaxation techniques to help him herself fall back asleep quickly references 1 alzheimer’s association 2 mace nancy & rabins peter 1999 the 36-hour day baltimore the john’s hopkins university press 3 robinson anne spencer beth & white laurie 1992 understanding difficult behaviors ypsilanti mi eastern michigan university

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Categories: Cognitive Intellectual, Emotional Psychological, Medical Physical

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*This information is listed as a Fact Sheet and is not explicitly medically licensed

Try: Possible causes physiological or medical causes a direct result of physical changes in brain b inability to identify or express hunger c reaction to sedatives tranquilizers or the interaction of medications d physical discomfort due to pain infection constipation bruises e seizures resulting in aimless confusing wandering f need to use bathroom g desire to exercise h dehydration contributing to confusion wandering i stress environmental causes j temperature uncomfortable too hot or too cold k can’t make sense of environment l sensory overload too many people or activities excessive noise m sensory deprivation too quiet boredom n poor lighting resulting in shadows which are misinterpreted or frightening o feels closed in trapped p friend or family member out of sight q desire to leave triggered by seeing outdoor clothing such as coat hats boots etc r acting out once regular routine such as leaving for workplace s lost sometimes people with dementia suddenly begin losing their way to familiar places and become lost t inability to recognize new unfamiliar surroundings perhaps attending new day care program u feels tension in the environment other causes v task too difficult w perceives activity as too childlike x feels useless helpless while watching others do task y inability to follow through on task z bored with activity or lack of activity aa clothing too tight or uncomfortable bb caregiver’s anger tension impatience sensed cc touching by caregiver frightening or misinterpreted dd caregiver speaking too quickly ee directions from caregiver not understood ff searching for home or people from the past nightime wandering gg inability to separate dreams from reality hh inactivity; too much sleep during the day ii adverse reactions to tranquilizers jj inability to differentiate day and night kk disorientation to time – upon awakening the older adult thinks it is time to get up coping strategies 1 have a thorough medical evaluation particularly if wandering begins suddenly 2 consider possible physical causes such as illness fever hunger pain swelling etc 3 allow person to wander if environment is safe and secure 4 place familiar objects furniture and pictures in surroundings 5 help direct person with clearly labeled rooms for example door decorations or name plaques may be useful for finding bedroom; a picture of a toilet or a brightly colored door may help person locate the bathroom 6 decrease noise levels and number of people interacting with wanderer at one time 7 go for a walk around neighborhood in a mall around home walking or other exercise often reduces agitation that leads to wandering and also helps person to sleep better 8 remove items that may trigger desire to go out shoes coat purse coat rack etc 9 take a drive in the car make sure the older adult is safely buckled in and doors are locked never leave a person with dementia unattended in an automobile the person may become frightened about being alone could wander away release emergency brake or fiddle with gear shifts 10 distract with conversation food drink or activity 11 try to involve the older adult in household activities such as folding laundry washing dishes which will help him her feel useful 12 limit activities to 20-30 minutes or less depending on level of impairment 13 consider past skills and interests when presenting activities is it possible to adapt activity to encourage participation is it possible for the wanderer to do one step of the activity 14 make sure the older adult isn’t wandering because he she needs to use the bathroom look for signals such as fidgeting with clothes at night be sure the bathroom or a commode is easily accessible 15 improve lighting throughout environment especially at night older adults need about three times as much light to see properly as younger people 16 try plastic a large digital clock by the bed to orient the older adult to time 17 try these communication techniques with wanders a reassure the older adult frequently about where he she is and why b speak in calm normal tone of voice c try written reassurance for mildly impaired person d try not to confront or argue with the older adult e limit number of people to redirect wanderer if more than one person is needed for safety second person can remain out of sight or in background behind other caregiver f increase the wanderer’s trust by humoring and cajoling g allow the person to verbalize feelings without arguing h alleviate fears "your family knows you are here " "your glasses are right here " i approach wanderer in a casual non-threatening manner it is best to approach wanderer from the front slowly and calmly fall into step beside person and walk a short distance with the person before gently guiding him her back to activity event or location j giver wanderer verbal identification or person place and time large numeral clocks may help orient to time keeping the wanderer safe 1 place night lights throughout the house 2 try locks on doors that are out of sight or reach install lslide bolts on either top or bottom of outside door 3 use dead bolt locks models are available that require a key for exit or entrance it is important to think about exiting in an emergency if key locks are being considered 4 try child proof door knob covers that prevent potential wanderer from turning door knob covers are available at toy stores or medical supply stores may be inadvisable for caregivers who have arthritic hands 5 place warning bells above door bells that jingle when door is opened will signal caregiver 6 try monitoring devices available in a wide price range which alert caregivers that exit door has been opened 7 order a ‘toddler monitor’ available through children’s stores and catalogs a small device attached to a person’s clothing will set off a beeper when person goes outside of a 25-50 foot range 8 make house accident proof keep medications toxic substances such as cleaning supplies sharp objects alcohol and matches locked in cupboards or closets 9 put locks on outside gates fenced in back yards allow people to wander safely 10 use a safety gate across doors and at top or bottom of stairs this may help keep the wanderer in a limited area where he she can explore safely 11 consider using a bean bag chair for sitting and resting this may be helpful because they are comfortable yet difficult to get out of by themselves the wanderer may need assistance in sitting down and getting out of the chair 12 provide the wanderer with some type of identification medic-alert bracelet available at many pharmacies identification labels sewn in clothing emergency identification card in wallet purse or pocket the alzheimer’s association offers the ‘safe return’ a nationwide identification support program at 13 have a current picture of person available in case he she becomes lost a videotape of person may also helpful 14 alert neighbors and police that a memory impaired person lives at residence keep a list of important phone numbers e g neighbors police physician and family members 15 notify police about circumstances in caring for someone with dementia they might want to keep a picture of person on file and perhaps fingerprints 16 use brightly colored outdoor clothing such as jacket coat pants reflectors sewn onto sleeves or pant legs may be helpful to police involved in searching for the person 17 have an unwashed piece of clothing available for tracking dogs if person has been missing a long time this clothing may be helpful to police involved in the search 18 for caregivers at home there are some physical restraints that can be used to keep the person in a bed or chair as a last resort while it may be distressing for caregivers to restrain the person there may be no other way to prevent injury restraints may also be helpful for the caregiver to use while in the bathroom cooking etc a posey or vest restraints may be useful geriatric chairs keep the person in one place and have a tray for eating or doing activities it is important that the person does get exercise regularly 19 keep walker or cane if used in the same place at all times keeping the wanderer comfortable and healthy 1 weight weekly to make sure the person is not losing too much weight loss of five pounds in six weeks for example is of concern 2 provide comfortable clothing such as jogging suits and tennis shoes 3 it the person wanders a great deal try to get him her to rest for a half hour every few hours with feet raised to prevent swelling 4 give frequent drinks of water or juice to prevent dehydration the person with dementia will often forget to drink or not recognize thirst dehydration can be dangerous and may increase confusion 5 check feet often for swelling or blisters elevate feet when swelling occurs in long-term care setting 1 provide opportunities for exercise particularly when person are waiting for a meal or activity exercise might also include signing rhythmic movements dancing etc 2 with help from families develop a social medical history that includes information on the person’s style or coping with change and stress patterns of physical exercise and lifetime habits both at work and at home this information may be helpful in determining whether the wandering is related to previous lifestyles 3 develop areas indoors and outdoors where people can explore and wander independently 4 reduce amount of noise and confusion in the environment for example change of shifts loud speakers noises from housekeeping activity delivery of food or supplies are all potentially stressful situations 5 use physical restraints such as belts geriatric wheelchairs half doors for only brief periods of time and only as a last resort often times restraints add to the amount of stress and tension the person may be experiencing 6 reinforce where bathrooms and other public areas are by having rooms clearly labeled painted bright colors or marked with lights or awnings 7 try a yellow strip of tape across doors to prevent wanderers from entering the strip is easy to get through in case of an emergency allows patients to keep their doors open to see and hear what is happening inside or outside their room 8 have a plan of action in place in case someone wanders away from facility 9 camouflage doors by painting exit doors same colors as walls 10 cover doors with curtains or movable screens 11 a large ‘no ‘ sign on doors may discourage wanderer from entering exiting 12 place full length mirrors on exit doors some people will turn around when they see the image not recognizing themselves 13 be aware than after a move into an institutional setting it is not uncommon for a person to become disoriented when awakening in the middle of the night often patients are searching for a familiar person place or possession reassure with a calm voice listen to what feeling is being expressed distracting with food drink or activity may be helpful walking with person to the bathroom may serve as a distraction as well as promote sleep other considerations 1 a written diary or log may be helpful to understand what leads to wandering write down your observations about wandering for several days is the person trying to find a room what was going on before wandering started what time of day is it consider how medications mealtime weather bath time other people relate to wandering 2 wandering may be due to the person searching for a part of life lost to the disease or for a person place or object from the past reminiscing about things from the past may be comforting photo albums travel books etc may be helpful ways to reminisce 3 for some people with dementia wandering is a coping mechanism to relieve stress and tension try to stop the wandering may increase agitation and cause anger and frustration 4 anticipating an event such as a visit to or from relatives may contribute to wandering consider if person should be advised of plans ahead of time and if so what amount of time is necessary without causing anxiety or restlessness 5 wandering may occur when a change of location is anticipated in event of relocation slowing introduce person to idea visit new location several times prior to move to help orient person to new surroundings involve person in actual move if possible when in new environment such as day care hospital or long term care setting stay with person to reassure him her about new surroundings 6 medications may be helpful in controlling agitation that leads to wandering again chemical restraint should be used only as a last resort as these medications do have side effects also it is important to know that for some people these medications may increase restlessness 7 a person who wanders at the same time every day may be returning to a former schedule or routine for example a person may be trying to get back to work after lunch references mace n & rabins p 1999 the 36-hour day baltimore the johns hopkins university press robinson a spencer b & white l 1992 understanding difficult behaviors ypsilanti mi eastern michigan university

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Categories: Cognitive Intellectual, Emotional Psychological, Medical Physical

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*This information is listed as a Fact Sheet and is not explicitly medically licensed

Try: Definitions italic text 1 paranoia unrealistic blaming belief paranoia results from damage to the part of the brain that makes judgments and separates facts from fiction people with dementia and paranoia will not connect the unrealistic blaming belief to a realistic belief no matter how many explanations or clarifications are given by the caregivers example mrs simons can’t find the fifty dollars that she hid in the bible she has forgotten that she took the money out of the bible yesterday and hid it underneath a stock of magazines in her bedroom closet mrs simons accuses her daughter of taking the money despite her daughter having been vacationing out of state for the past two weeks 2 delusions beliefs that are contrary to fact delusions remain fixed or persistent despite all evidence to the contrary example mrs jewell firmly states to her husband of 47 years "you are not my real husband " 3 hallucinations sensory experiences that can’t be verified by anyone other than the person experiencing them any sense may be involved but seeing or hearing things is most common occasionally more than one sense may be involved example while assisting her mother with her bath mrs zimmer sees many scratches on her mother’s arms and legs when questioned about these her mother reports that despite her best efforts at cleaning numerous bugs reside in her bedding and attack her at night she brings her daughter into her bedroom turns back her bed covers and says "see them crawling " mrs zimmer cannot see any bugs possible causes italic text 1 physiological or medical cause sensory deficits especially diminished hearing and low vision also diminished taste medications particularly hormones in combination with antidepressants also any overdosage of medications brain damage due to alzheimer’s disease progression physical trauma from a blow to the head during a fall or other accident malnutrition including low fluid intake resulting in undernourishment of the brain psychiatric illness concurrent with alzheimer’s disease remember that alzheimer’s disease is not a psychiatric illness – it’s a physical illness memory loss due to brain changes and damage physical illness such as infection fever pain or fecal impaction physical illness such as anemia or respiratory disease which reduces the amount of oxygen delivered to the brain 2 environmental causes unfamiliar environment due to a move away from home unrecognized environment unrecognized caregivers unfamiliar caregivers disruption in routines removal of items from the person such as money or jewelry inadequate lighting particularly in evening misinterpretation of things in the environment due to too much going on diminished hearing or sight or non-use of sensory aids glasses hearing aids this misinterpretation seems very normal when we put ourselves in the older adult’s place if you wear glasses taken them off lie in bed while in a darkened room and have someone walk towards the bed while whispering to you you may well misinterpret their intentions now consider the above situation in an unfamiliar setting with an unfamiliar caregiver at the end of a strange stimulating day this scenario if often a true one for the individual with dementia 3 social isolation social isolation with the resulting lack of feedback from familiar others individuals talking animatedly to the air generally repel others family and friends falsely accused of persecuting or abusing an individual with dementia understandably have great difficulty accepting this behavior and often choose to avoid the individual yet the individual desperately needs the reassurance and reality orientation these familiar people can provide coping strategies italic text 1 have vision or glasses examined rapid visual deterioration is unusual but so are regular eye exams visual impairment easily leads to misinterpretation of the environment 2 have hearing tested or hearing aid regularly serviced diminished hearing also leads to ‘hearing noises’ that are unintelligible which in turn lead to ‘auditory hallucinations ‘ 3 seek a medical evaluation to assess for illness infection chronic pain or bowel impaction 4 seek a psychiatrist’s evaluation of paranoia delusions and hallucinations

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Categories: Cognitive Intellectual

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*This information is listed as a Fact Sheet and is not explicitly medically licensed

Try: Possible causes physiological or medical problems o depression or other physical illness can cause a loss of interest in physical hygiene o damage in the region of the hypothalamus can change the sense of perception of hot and cold water temperature o low vision may make it difficult for the older adult to see the bathtub or shower environmental causes o poor lighting o lack of privacy o room temperature is too cold o water is too deep o water is too hot or cold; other causes o fear of falling o fear of water or of being hurt by it o disruption in daily routine or schedule o unfamiliar caregivers o the task involved in taking a bath is too overwhelming o the purpose of taking a bath forgotten o the humiliation of being reminded to take a bath o agitated from an upsetting situation such as an argument with caregiver o feeling of being rushed by caregiver o feeling embarrassed and vulnerable about being naked or having another person in the bathroom o fatigue o fear of hair washing which is no longer understood o person kept waiting too long while caregiver prepares bath o fear of soap washcloth south of running water etc coping strategies ; evaluate the best time of day to bathing be consistent and routine try asking the older adult when he she would like to take a bath e g ‘would you like to take a bath or shower " or "would you like to take a bath now or before going to bed " of course the option depends on the mobility of the individual a sponge bath might actually be the best option try using a bath chart or calendar to indicate when baths were last taken you might point to the chart to show the older adult that it is time to take a bath try a reward system such as favorite food or activity to encourage the older adult to bathe; make sure the bathroom is warm enough and inviting let the older adult touch the water before getting into the tub try pulling down the blinds or close curtains and doors to create a feeling of privacy; provide adequate lighting in bathroom especially during evening hours; try bathing instructions written by a doctor on a prescription pad e g bath 2 to 3 times daily; prepare bath ahead of time check the water level and temperature some older adults will tolerate only one inch of water in the tub; lay out soap washcloth towel and clean clothes in sequence so that the person with dementia won’t have to wait; use a quiet calm matter-of-fact approach e g ‘mother your bathwater is ready; avoid getting into lengthy discussions about whether a bath is needed simplify the task of bathing by instructing the older adult one step at a time what to do to get ready for the bath; if the older adult becomes agitated or frustrated or you become agitated or frustrated it may be helpful to try again later; try separating hair washing from bathing some people with dementia associate bathing with having their hair washed and become terribly upset because water being poured over their head frightens them try taking the older adult to a salon to have their hair washed while in a chair or was hair in the kitchen sink try dry shampoo if necessary web address; to avoid rashes or infection be sure that all parts of the body are cleansed including genitals this is a good time too to check for decubitus ulcers or pressure sores as well as red areas or other sores if any are found call the physician also check fingernails and toenails and trim them if necessary after the bath shower; try giving the older adult a washcloth to hold onto for distraction while bathing; try placing a towel around the shoulders of the older adult held securely with a clothespin if he she is embarrassed about being undressed; try playing soft music in the background to create a calming and relaxing atmosphere persistent body odor might want to include this another fact sheet since it deals with internal bacterias or infection making the bathroom and older adult safe ; try adjusting the temperature on the water heater so that the water is not scalding between 120 and 130 degrees f the older adult may have an altered sense of hot and cold adjust the water to his her comfort; do not every leave the older adult alone in the tub or shower; remove the locks from the bathroom door; use plastic instead of glass containers in the bathtub; make sure hairdryers electric razors and other electrical appliances are out of reach; use non-slip bathmats on the floor on the outside of the bathtub so the floors remain dry; try using a rubber mat or non-skid decals on the bottom of the tub or shower; try draining the bathtub if the older adult has a fear of falling; try using a hand-held spray attachment on a flexible hose can convert the tub into a shower; adjustable safety benches or bath chairs which have holes in the seat so water can drain can be used in both the tub and shower see assistive devices websites other considerations ; if a person is absolutely refusing a bath or any kind and lack of hygiene is intolerable consult a physician; in the later stages of dementia when total assistance with personal care may be necessary meticulous and careful attention to hygiene is important in preventing skin breakdown this becomes a major challenge for caregivers coping with urinary and bowel incontinence; bathing is a very personal and private activity many people have never completely undressed in front of anyone else and this can be an uncomfortable and vulnerable experience also when a caregiver offers to help someone who is confused it is a strong statement that the person is no longer able to do for him herself this loss of independence can be terribly difficult for people with dementing illnesses it is important to recognize that these feelings may be contributing to some of the resistance to bathing

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Categories: Cognitive Intellectual, Emotional Psychological, Maintenance, Medical Physical, Mobility, Needs Much Assistance

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*This information is listed as a Fact Sheet and is not explicitly medically licensed

Try: Possible causes physiological or medical causes ; dry mouth; parkinson’s disease; mouth discomfort from gum disease or ill fitting dentures; vision changes – cannot see food or utensils properly; chronic illness causing loss of appetite e g diabetes heart disease etc; acute illness causing loss of appetite e g urinary infection pneumonia etc; constipation causing loss of appetite; depression causing loss of appetite; changed sense of taste from age or medications; muscles of jaw or throat no longer working properly due to motor abilities declining in advanced dementia; hunger sensation from stomach no longer understood or received by brain due to brain changes in dementia; side effect of medications such as antidepressants; day and night sleep patterns reversed; doesn’t remember to eat; agitation environmental causes ; relocation to new environment; poor lighting – unable to see food and utensils; too many distractions such as noise people too much on the plate or table; boredom may cause desire to eat all the time; food looks or smells unappetizing; odors in dining room such as urine or cleaning fluids depress appetite other causes ; no longer understand how to eat; can no longer coordinate use of silverware; caregiver not giving simple or clear enough instructions; task too complicated; feeling of being rushed by caregiver; caregiver’s tension or impatience sensed by person; fear or anxiety coping strategies ; have a good dental check-up of gums teeth and dentures sometimes children’s dentists especially those who specialize in working with children with disabilities are good at working with agitated individuals ask whether your dentist or hygienist will make housecalls; have vision or glasses checked; have a good medical work-up to discover any possible physical causes or medication problems contributing to appetite change; have an evaluation for depression done if appetite loss becomes a problem; stroke shoulders and neck to relax person; try soft relaxing music during meal; provide appetizing odors of fresh food cooking in nursing homes reduce other odors such as cleaning fluids or urine in dining area; improve lighting in eating area but avoid glares; reduce noise and distractions in dining area during meals; in a large family consider serving the older adult earlier than other family members then allowing him her to join the family during their supper so the older adult has a chance to socialize; in a nursing home consider; small group dining; grouping according to eating abilities; allowing particularly agitated individuals to eat alone; reducing excessive noise for example by lowering ceiling or using textured wall hangings; reduce distractions at the table; avoid patterned placemats plates tablecloths; serve only one food at a time if necessary; remove other distracting items from table make eating simple ; use bowls and cups that are larger than the portion of food; use bowls rather than plates; set place with only utensils that are needed; use bowls or plates that are different in color from the placemat to help the person easily locate the place; use brightly colored placemats; place a damp washcloth under the plate to keep it from sliding; don’t use plastic utensils they are too light to manipulate easily and may break in the person’s mouth; try bendable straws or cups with lids and spouts for liquids; use mugs for soups or stews be sure to get mugs with big enough handles for easy holding; use assistive devices such as large handled silverware plates with suction cups on bottom plates with rims or buy white plastic tubing which may be cut and fit on utensils found through medical supply stores; serve ‘finger foods’ such as french fries cheese small sandwiches chicken or pork kebobs fried chicken fresh fruits or vegetables even very impaired people often manage finger foods well; try yawning or asking the person to say ‘ah’ if he she won’t open mouth; put a bite of food to lips as stimulus to open mouth for chewing problems ; try light pressure on lips or under chin to get started; give verbal instructions i e ‘chew now and now swallow ‘; demonstrate chewing; make sure person is in a comfortable position; avoid sticky foods such as bananas peanut butter white bread; avoid foods that fall apart or have tough skins such as nuts; moisten foods with sauces gravy water some medications cause dry mouth; served chopped soft foods; offer small bites one at a time for swallowing problems; remind to swallow with each bite; stroke the throat gently; check mouth periodically for food stored in cheek; omit foods that are hard to chew and swallow such as popcorn nuts raw vegetables; offer small bites one at a time; allow plenty of time between each bite; keep liquids at room temperature; moisten foods for choking problems with liquids; try thicker liquids such as apricot juice or milk shakes; make cooked cereal with milk or water to help hydration; keep liquids at room temperature; notify your doctor of this problem for choking problems with solid foods ; try soft cooked foods such as scrambled eggs canned fruit cottage cheese frozen yogurt jello made with orange juice and fruits chopped chicken mashed potatoes applesauce; notify your doctor of this problem for sweet cravings; have medications checked some antidepressant medications cause a craving for sweets; try nutritious milk shakes or egg nogs for overeating or insatiable hunger ; try 5 to 6 small meals per day; have a tray of low-calorie snacks available such as apples or carrots; consider whether activities such as walks or other exercise might distract the older adult; put food up away from the older adult if necessary particularly if the person is overweight or on a special diet for undereating; try a glass of juice wine or sherry if medications permit alcohol use before the meal to whet appetite; offer ice cream milk shakes or egg nogs; make sure the person is getting enough exercise to stimulate appetite; try to prepare familiar foods in familiar ways especially foods that were favorites; consult doctor about the possibility of physical illness or depression; check with doctor about using supplemental drinks such as carnation instant breakfast or ensure if the older adult is in a nursing home supervise to be sure the older adult receives the supplement; try feeding all or more of one food before moving on to the next some people become confused when the tastes and textures change rapidly; sit directly in front of the person if peripheral vision isn’t good show each spoonful to help orient older adult; mix puddings or ice cream with other courses to sweeten if this encourages person to eat; allow the older adult to eat whenever he her is hungry; make sure meals are offered at regular consistent times everyday; try to make mealtimes simple relaxed and calm be sure to allow enough time for the meal feeding a very impaired person can take 45 minutes to an hour; remind the person of the approaching meal and if necessary help him her smell or taste a drop of the food before eating; be sure the person is in a comfortable upright position for eating in later stages it may be necessary to use a wheelchair geriatric chair or cardiac chair with special supports and or restraints; if necessary coordinate tranquilizing medications with mealtimes to reduce agitation; verbally guide the person through the meal if necessary using simple gentle respectful language when dining at a restaurant; choose quiet well lit restaurants where service is fairly fast; consider carrying printed cards to hand waiters that read ‘my companion has alzheimer’s disease and cannot understand you please direct your questions to me ‘ in long-term care settings; consider use of aprons instead of towels or hospital gowns; consider use of small square tables to aid in socializing and to help establish boundaries; try making milk coffee or juice available first thing in the morning to take the edge off the morning hunger; train staff volunteers or family members who assist with feeding to; bring favorite foods such as fruits or cookies to make eating a more pleasurable experience; encourage staff who has been successful in feeding the older adult to consistently feed the older adult whenever possible other considerations ; observe carefully to begin to assess what might be causing eating or feeding problems is the problem with the use of silverware chewing swallowing distraction noise too much food on plate caregiver impatience; keep in mind the older adult’s past history with food he she may have always had a small appetite been a voracious eater or had a craving for sweets it is perfectly all right to miss an occasional meal; watch food temperatures while warm food is more appetizing some dementia patients have lost the ability to judge when food or drink is too hot avoid styrofoam cups because while they maintain heat they are also easily spill over and some older adult’s may try to eat the styrofoam; mouth care is extremely important with dementia patients if it is possible to get teeth brushed try using toothettes they are inexpensive and found at medical supply stores; there are cookbooks available that contain ‘non-chew’ recipes available at bookstores and medical supply stores; spoiled food in the refrigerator hiding food or not eating regularly may all be signs that someone living alone is in need or more supervision; many older adult’s with dementia do not enough fluid because they forget to drink or may not longer recognize the sensation of thirst be sure to offer regular drinks of water juice or other fluids to avoid dehydration symptoms of dehydration many include thirst refusal to drink flushing and fever rapid pulse dizziness and confusion; many eating problems for older adults with dementia are temporary and will eventually pass as the older adult’s abilities change; choking and swallowing problems can be extremely upsetting to family caregivers it may be reassuring to discuss this with a physician or other health care professional caregiver might consider first aid training that includes the u8e2809cheimlich maneuveru8e2809d the red cross and some health care facilities offer training; family may wish to discuss nursing home policies regarding the use of feeding syringes for people who eat slowly or refuse to eat; some people with dementia reach a point where they are unable to swallow or simply refuse to eat it is important for families to discuss feelings ahead of time about the use of feeding tubes to use or not use a feeding tube is a very personal individual decision but one that needs to be made in advance and discussed with medical and nursing home personnel references 1 alzheimer’s association chapter newsletter 2 mace nancy & rabins peter 1999 the 36-hour day baltimore the john’s hopkins university press 3 robinson anne spencer beth & white laurie 1992 understanding difficult behaviors ypsilanti mi eastern michigan university

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Categories: Cognitive Intellectual, Emotional Psychological, Medical Physical

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References: n/a

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*This information is listed as a Fact Sheet and is not explicitly medically licensed

Try: Talk to cr and discuss topics that will reveal his or her attitudes and beliefs on various subjects evaluate the discussions that you have with cr and determine if this is new behavior or if cr has been negative his or her whole life if this is a long standing problem it may be very difficult or impossible to change what is embedded in the cr cr’s personality determine if cr wants to change the negative attitude and thinking if cr wants to change encourage him or her to implement the following recommendations do an intentional positive reframe of any negative thoughts that come automatically for you establish several daily check in times for example what can i be thankful for at lunch or dinner time consider joining groups that have positive discussions rather than negative ones this may encourage cr to decrease the amount of negative self-talk separate yourself from individuals who are negative in their talk toxic people may just drag you down to the same mindset of negativity establish relationships with individuals who are positive and optimistic

Materials: Journal and pen

Categories: Cognitive Intellectual, Communication, Emotional Psychological, Social, Spiritual

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References: n/a

Keywords: Negative negativity poor outlook on life negative perspective pessamist pessamistic

*This information is listed as a Tip and is not explicitly medically licensed

Try: Set aside regular time daily for the cr to work on his or her favorite brain games this should be done for 15 to 20 minutes set aside regular time daily for the cr to read favorite materials this should be done for a minimum of 15 to 20 minutes set aside regular time daily for the cr to meditate in a quiet and undisturbed place this should be done for 10 to 15 minutes encourage the cr to sit in a comfortable chair with feet firmly planted on the floor encourage the cr to let hands rest open and relaxed on his or her legs encourage the cr to close eyes and focus on something three feet in front of him or her encourage the cr to breathe deeply and with every exhale relax deeply as if he or she is melting into the floor as other thoughts come to mind encourage the cr to acknowledge them let them go and then refocus on the object three feet in front of him or her

Materials: Brain games crossword puzzles word finding games sudoku the cr’s favorite reading material books magazines newspapers sturdy chair for the cr to sit in

Categories: Cognitive Intellectual, Somewhat Aware

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References: n/a

Keywords: Difficulty thinking focusing not on task distracted

*This information is listed as a Tip and is not explicitly medically licensed

Try: When cr loses train of thought during conversations provide reminders and help with phrases or ideas regarding what he or she may have been trying to say do not push the cr to remember this will cause more stress for cr and he or she will still not be able to remember allow cr some time without stress to try to remember what he or she wanted to say make yourself available to help during this time give cr a pen and note pad to write down the train of thought if he or she remembers it and you are not there use slow and deliberate wording and actions to help cr remember his or her train of thought

Materials: Pen and note pad

Categories: Cognitive Intellectual, Fully Aware, Somewhat Aware, So-So L T Memory, Poor L T Memory, So-So S T Memory, Poor S T Memory

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References: n/a

Keywords: Forgetful cognitive impairment

*This information is listed as a Tip and is not explicitly medically licensed

Try: Ask cr if music is too loud too soft or sounds good make adjustments accordingly find out if cr is familiar with the music ask cr what the music sounds like ask cr if he or she recognizes what the tune is if cr is familiar with the music find out if he or she can hum or sing along with it if so hum or sing along with cr if cr is not familiar with the music ask what his or her favorite hymns and songs are or talk about your favorites make up a list and sing or hum with cr hold the cr’s hand and let him or her know that you are there to provide support this may assure cr that you understand and are not passing judgment

Materials: Chair to sit next to the cr

Categories: Cognitive Intellectual, Emotional Psychological, Social, Fully Aware, Somewhat Aware, So-So L T Memory, Poor L T Memory, So-So S T Memory, Poor S T Memory

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References: n/a

Keywords: Songs singing imagination

*This information is listed as a Tip and is not explicitly medically licensed

Try: Check the labels on prescription medications to insure that they are being administered in the appropriate dose at the appropriate times of day make corrections to the doses and timing if the directions are not being followed provide extra time in the morning for the cr to wake up use gentle sounds for any alarm clock or any approach used to wake up the cr allow the cr to move slowly and wake up on his or her own time schedule leave some juice or milk in a spill proof bottle on the cr’s bedside table provide small food items like a granola bar or yogurt that the cr can eat before getting up from bed assist the cr in dressing and toileting as needed provide transportation to and from the dining room as needed

Materials: Insulated spill-proof water bottles and drinking containers juice or milk granola bar fruit yogurt and so on

Categories: Cognitive Intellectual, Fully Aware, Somewhat Aware

Information: n/a

References: n/a

Keywords: Crabby in the mornings slow riser not a morning person disoriented out of sorts getting up on the wrong side of the bed

*This information is listed as a Tip and is not explicitly medically licensed