By Holly Gainer
UAB News
Caring for someone with dementia is a top priority, but the sanity of the caregiver is equally important.
Nearly 6 million Americans are living with Alzheimer’s disease, and that number is expected to increase to nearly 14 million by 2050. Aside from the disease’s burden to the patient, it also impacts family caregivers. According to the Alzheimer’s Association, 16.1 million Americans provide unpaid care for people with Alzheimer’s or other dementias, accounting for an estimated 18.4 billion hours of care.
As the number of adults with Alzheimer’s or other dementias continues to grow, geriatricians at the University of Alabama at Birmingham want to educate both patients and their loved ones about ways to maintain a safe and supportive living environment, while also providing solutions for caregivers to use when caring for the patient.
“When approaching dementia families, I follow the safe and sane rule,” said Andrew Duxbury, M.D., a geriatrician in the Division of Gerontology, Geriatrics and Palliative Care at UAB. “Everything we do needs to make the patient safe and the family sane. In terms of safety, it boils down into the big four: meals, wheels, bills and pills.”
Duxbury says ensuring a loved one is provided for under the four categories of meals, wheels, bills and pills is the most important way to make sure someone is cared for and safe.
Meals
“You need to consider whether the person is capable of preparing food, eating healthy and appropriate amounts of food, and has the awareness that they need to eat,” Duxbury said. “If any link in that chain breaks, the person may not eat.”
Every person’s experience with Alzheimer’s is different, but there are a few things caregivers can do to allow someone to maintain their independence in the kitchen while also making sure they are safe.
“The biggest issue is leaving things on the stove and forgetting to turn the oven off; but if cooking is part of someone’s routine, let them cook on their own while monitoring what they are doing from another room. Think about it this way: Would you let your 12-year-old make dinner? You may, but you would definitely be in the next room listening for anything that could go wrong.”
Another option is to provide choices. For example, if it is your mom, ask her if she wants to cook things that can be made in the microwave or require minimal prep. You may also think about removing scissors and knives from the countertop and drawers, put labels on the cabinets, and disguise the garbage disposal switches to prevent someone from turning it on accidently.
According to Duxbury, it is not safe for patients to prepare food on the stove or in the oven in late dementia. It is important for the caregivers to have a conversation with their loved one’s doctor about the stage of the disease to evaluate their safety in the kitchen.
Wheels
Losing the independence driving provides can be upsetting. It is important to acknowledge a person’s feelings and preserve his or her independence, while ensuring the person’s safety and the safety of others.
Giving up the keys is one of the biggest challenges a caregiver and their loved one face when it comes to dementia, especially if that person is a man, according to Duxbury.
“A lot of times, an older man may just want to have the car keys, feel them in his pocket and see the car in the driveway,” he said. “You can let him have the keys, just not the key to the actual car. Give him the keys to a different car or remove the car key from his set of keys. This way, he has the keys, hears them jingle in his pocket and sees his car, but can’t go anywhere.”
Another solution is to reduce the need to drive by having medications, groceries or meals delivered to the home.
Once one is unable to independently drive or get to places on his or her own, the caregivers need to ensure there is another source of transportation, especially for doctor’s appointments.
Bills
The most important thing is to evaluate the person’s financial health and make sure there is enough money to keep the bills paid. It is also necessary to take steps to protect a loved one’s money and make sure he or she is not being taken advantage of or scammed.
To prevent elder financial abuse, have the conversation with a loved one in the earlier stages of Alzheimer’s or dementia, and remember that the person does not live in the same reality as one without dementia.
“One of the top mistakes made by families is that they try to use adult rationality and logic with people with dementia, and these people’s brains don’t work that way. All it does is frustrate them because it doesn’t make any sense.”
When discussing finances, Duxbury suggests taking a less startling approach.
“If you are speaking to a parent, tell your mom or dad, ‘we know you are fine; but since you are older, it is always good to have someone doublecheck your finances to make sure someone is not taking advantage of you.’ Then that can move into adding the caregiver’s name as a second name on accounts and access to their finances,” he said.
Caregivers can also prevent upsetting their loved one once that person can no longer be trusted to manage their money. Instead of telling that person he or she can no longer be in charge of their finances, let them think they are still paying the bills by giving them expired checks to sign so they think they are still in financial control.
Pills
Aging adults often take multiple medications, which can lead to someone with dementia forgetting to take their pills or taking pills together that cause adverse side effects. One of the most important roles of the caregiver is to ensure their loved one is not mismanaging medications, going to doctor’s appointments and keeping an eye on their other health issues.
According to Duxbury, most people with dementia think they are fine. That is why it is crucial for caregivers to stay on top of their loved one’s health.
“Families need to remember that a person with dementia does not live in the same reality that we live in,” Duxbury explained. “They live in a reality of their brain’s dementia. These individuals may have completely different perceptions of the world around them and what it means. We don’t have a good way of entering their reality. We have to accept their reality for what it is.”
To help a loved one manage their medications, set up a pill box where you put a week’s worth of pills, sorted by day. This way you can check to see whether the person took the medications. You can also set up a timer in your loved one’s home to remind him or her to take their pills. Some versions of pill boxes have timers and locks you can set to prevent your loved one from taking medications from the wrong day.
The caregiver should also have a master list of medications taken, lock up or store out of reach unnecessary medications, and understand what each drug is for and the proper dosing schedule and side effects.
Alternative solutions
Helping someone with Alzheimer’s or dementia stay content in their environment is an important role for the caregiver.
“Human beings like for things to stay the same,” Duxbury said. “We develop a pattern we like. The best thing you can do with someone with dementia is to understand that it is real and it is happening and be willing to make changes as that process goes along to try to keep the individual and life patterns in sync as much as possible.”
For example, if a caregiver’s mother was always responsible for caring for the house, but she is no longer able to do that and does not realize that she is not keeping up the housework, suggesting she hire a maid may upset her because, in her reality, she does not need one. Instead of telling her a maid has been hired, couch it in a different way.
“One of the things I tell families to use with older women in particular is to say, ‘isn’t it great you are now old enough that you can enjoy life and have a companion to help you make it so much better?’” Duxbury said. “Now the mother thinks that the maid, who in her mind is a companion, is her choice and is there to keep her company, not there to help her do something she thinks she is already doing.”
Another example is for a person who likes to do laundry, but continues to ruin the clothes by putting bleach in the washer. Duxbury says to instead lock away the good clothes and linens and buy used colorful sheets and clothes that the person will easily see to wash instead. Replace the bleach with water and the detergent with cheap powdered milk. This way the launderer will still be able to do the usual tasks and feel helpful, but not ruin clothes.
“If you have a patient who loves to garden, you have to build limits around them so it is a safe activity, but also something that still meets their needs,” Duxbury said. “If it is someone who is a fall risk, maybe think about building some garden benches so we can sit on a stool while we do it.”
Frustration and irritation are common symptoms of dementia. When a person cannot remember or is constantly confused, they may become frustrated, fearful and even try to fight the changes they are experiencing. Instead of trying to rationalize with them and also getting frustrated, try to give them an activity to distract them.
“When most people are getting frustrated, they are usually easily redirectable. They just need to be given some other task or something to work on. If your loved one used to work in an office, save your junk mail and give it to them when they become upset. Ask them to sort it and categorize it. This way they are redirected and engaging in a safe activity.”
Providing concrete choices is another way to help someone feel independent and valued.
“Give them choices they can make,” Duxbury said. “As people become more demented, their ability to make abstract choices becomes damaged; but they can make concrete choices.”
Instead of asking your mother what she wants to wear today, ask her if she wants to wear the blue dress, green dress or red dress. If you are at dinner with your father, do not ask him what he wants to eat off the menu.
“If you put the menu in front of someone with dementia, it might as well be another language,” Duxbury said. “Instead, say ‘you like chicken, fish and pasta. Which one would you like to eat?’ Then let him choose from those options.”
Stay sane
Caring for someone with dementia is a top priority, but the sanity of the caregiver is equally important.
“The caregivers need to get away from their patients,” Duxbury suggested. “There has to be some sort of respite built into how the system works. They have to have a break from the patient and time to take care of themselves.”
Duxbury suggests adult day care centers or home health care. This way, the caregiver is able to take time to do something on his or her own.
“It’s important the caregiver does something he enjoys, not something for the patient — like going to the grocery store or picking up prescriptions,” he said. “Do something that makes you feel good and gives you a break from caring for your loved one.”
