Safe Management of the Patient with Alzheimer's Disease
Guest Columnist: Janet Caputo, PT, OCS
November is National Alzheimer’s Disease Awareness Month and National Family Caregivers Month. This column is dedicated to the more than 5 million Americans afflicted with Alzheimer’s disease (AD) and the nearly 10 million dedicated, patient and loving family caregivers.
Alzheimer’s disease (AD) is the most common, progressive, irreversible loss of memory and intellect affecting 4.5 million American adults, typically 65 and older. AD changes an individual’s personality, mood and behavior interfering with routine personal, social and occupational activities. The precise progression rate and the exact changes that will occur cannot be predicted. Difficulty thinking, confusion and loss of judgment eventually produce unusual behaviors that are considered safety concerns. The caregiver must think prevention and adapt the environment to minimize danger to the individual with AD and to others.
Make Your Home Safe for Those With AD
- Throughout the home: Set answering machines to least number of rings possible. Ringers placed on low may avoid distraction and confusion. Place portable phones in a safe place. Hide a spare key outside in case the person locks you out. “Childproofing” the home may be necessary: safeguard all outlets, medications, tools, alcoholic beverages, firearms, poisonous items and fire starters. Protect valuable computer files with passwords. Restrict access to swimming pool. Post a “No Soliciting” outside the home.
- Kitchen: Remove knobs from stove or install an automatic shut off. Secure the “junk drawer” to prevent ingestion of small items. Remove from sight anything that appears but is not edible. Consider dismantling the garbage disposal.
- Bedroom: Anticipating the reasons (e.g. hunger, thirst, pain, restlessness, bowel/bladder activity) and satisfying these needs will minimize getting out of bed. A baby monitor will signal the need for help. Mats next to the bed may reduce the risks of falls out of bed. If bedrails are necessary, reduce gaps with a properly sized mattress or mattress with raised foam edges.
- Bathroom: A person with AD should not be unattended in the bathroom. Remove lock from the door. Using a single faucet that pre-mixes the water and setting the water heater at 120°reduces the possibility of burns.
- Living Room: A person with AD should not be unattended with a fire in the fireplace. Use decals at eye level to identify glass panes (doors, windows, furniture with glass panels). Controls for the TV, VCR and stereo should not be visible.
- Laundry Room: Keep door locked. Remove knobs and secure the doors to the washer and dryer.
- Garage/Shed/Basement: When possible, prevent access or supervise closely. All tools/equipment, motor vehicles, bicycles and toxic products/materials should be locked and/or out of sight.
Manage Agitation Behaviors
Agitation behaviors: The key to managing inappropriate verbal or motor activity (e.g. screaming, pacing, cursing, scratching, kicking) is to identify whether it is event related (e.g. when guests arrive, at mealtimes), sudden (unexpected and unrelated to circumstances) and/or escalates in intensity. Reduce known stressors with environment modification. Become cognizant of the pattern of behavior that precedes the episode. Consider the following recommendations to minimize agitation:
- Since fatigue may be a factor, allow short naps or rest periods twice daily.
- Following the same daily routine reduces stress.
- Safe activities can be substituted for ones previously enjoyed.
- Minimize excessive noise, commotion and people.
- Prevent infections, pain, constipation, traumas and drug interactions since they can cause dementia-like symptoms.
- Play calming or favorite music.
- Light exercise may decrease agitation.
- Human interaction is essential. Large groups are not appropriate but introduction to a “companion” can be helpful.
Specific agitation behaviors and remedial suggestions:
- Screaming: Continuously calling for someone, repeatedly shouting a word or incessant wailing may have other causes: illness, pain, hallucinations, loneliness, stress, anxiety, depression, boredom and hearing loss. A nightlight can reduce nighttime shouting. If the name being called is someone from their past, talk to them about that person.
- Pacing: May signal the need to use the toilet. Provide a safe pacing environment with comfortable shoes and clothes. Pacing can expend extra calories, cause “aches and pains” and may develop into wandering. Offer drinks and snacks, check their feet regularly and persuade them to relax in a comfortable area.
CONTRIBUTING AUTHOR: Janet Caputo, PT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and sports physical therapy. She is currently a Doctor of Physical Therapy student at the University of Scranton.