Tips for Caregivers: Caring for a Person with Alzheimer's Disease
Caring for a person with Alzheimer's disease at home is a difficult task and can become overwhelming at times. Each day brings new challenges as the caregiver copes with changing levels of ability and new patterns of behavior. Research has shown that caregivers themselves often are at increased risk for depression and illness, especially if they do not receive adequate support from family, friends, and the community.
One of the biggest struggles caregivers face is dealing with the difficult behaviors of the person they are caring for. Dressing, bathing, eating—basic activities of daily living—often become difficult to manage for both the person with Alzheimer's disease and the caregiver. Having a plan for getting through the day can help caregivers cope. Many caregivers have found it helpful to use strategies for dealing with difficult behaviors and stressful situations. Through trial and error you will find that some of the following tips work, while others do not. Each person with Alzheimer's disease is unique and will respond differently, and each person changes over the course of the disease. Do the best you can, and remind yourself to take breaks.
Please Be Patient Cards
As Alzheimer’s and other dementias progress, behaviors change and can sometimes be very challenging and traveling can add another layer of stress. One way to lessen stress and preserve your loved one’s dignity - carry a ‘please be patient’ business card to hand to a waitress, sales associate or flight attendant that simply states, your loved one has Alzheimer’s disease and may need extra time and consideration. Click to download (you will need Adobe reader)
For further information
Visit the National Institute on Aging, Alzheimer's Disease Education & Referral Center's Caregiving-Home/Family section (www.nia.nih.gov/Alzheimers/Caregiving/HomeAndFamily/) or the Alzheimer's Association (www.alz.org).
Dealing with the Diagnosis
Finding out that a loved one has Alzheimer's disease can be stressful, frightening, and overwhelming. As you begin to take stock of the situation, here are some tips that may help:
- Ask the doctor any questions you have about Alzheimer's disease. Find out what treatments might work best to alleviate symptoms or address behavior problems.
- Contact organizations such as the Alzheimer's Association and the Alzheimer's Disease Education and Referral (ADEAR) Center for more information about the disease, treatment options, and caregiving resources. Some community groups may offer classes to teach caregiving, problem-solving, and management skills. See "For More Information" below to contact the ADEAR Center and a variety of other helpful organizations.
- Find a support group where you can share your feelings and concerns. Members of support groups often have helpful ideas or know of useful resources based on their own experiences. Online support groups make it possible for caregivers to receive support without having to leave home.
- Study your day to see if you can develop a routine that makes things go more smoothly. If there are times of day when the person with Alzheimer's disease is less confused or more cooperative, plan your routine to make the most of those moments. Keep in mind that the way the person functions may change from day to day, so try to be flexible and adapt your routine as needed.
- Consider using adult day care or respite services to ease the day-to-day demands of caregiving. These services allow you to have a break while knowing that the person with Alzheimer's disease is being well cared for.
- Begin to plan for the future. This may include getting financial and legal documents in order, investigating long-term care options, and determining what services are covered by health insurance and Medicare.
Anna's mother was still going strong at 85. She kept busy with friends and church activities. But lately, Anna had noticed that things were changing. Her mother was becoming more forgetful and confused. Also, she was spending a lot of time alone in her house, which wasn't like her. One day, her mom got lost on her way home from shopping. Anna knew it was time to get help. She took her mom to the doctor. Anna was really upset to learn that her mom had early stage Alzheimer's disease. It's been tough, but learning about treatment choices and how to live with the disease has helped the whole family. They're taking one day at a time.
Talking with your family about Alzheimer's disease can help.
The story and photo above were featured in Understanding Memory Loss, Alzheimer's Disease Education and Referral Center (www.nia.nih.gov/Alzheimers/Publications/UnderstandingMemoryLoss/).
- Trying to communicate with a person who has Alzheimer's disease can be a challenge. Both understanding and being understood may be difficult.
- Choose simple words and short sentences and use a gentle, calm tone of voice.
- Avoid talking to the person with Alzheimer's disease like a baby or talking about the person as if he or she weren't there.
- Minimize distractions and noise—such as the television or radio—to help the person focus on what you are saying.
- Call the person by name, making sure you have his or her attention before speaking.
- Allow enough time for a response. Be careful not to interrupt.
- If the person with Alzheimer's disease is struggling to find a word or communicate a thought, gently try to provide the word he or she is looking for
- Try to frame questions and instructions in a positive way
- While some people with Alzheimer's disease don't mind bathing, for others it is a frightening, confusing experience. Advance planning can help make bath time better for both of you.
- Respect the fact that bathing is scary and uncomfortable for some people with Alzheimer's disease. Be gentle and respectful. Be patient and calm.
- Tell the person what you are going to do, step by step, and allow him or her to do as much as possible.
- Prepare in advance. Make sure you have everything you need ready and in the bathroom before beginning. Draw the bath ahead of time.
- Try a sponge bath. Bathing may not be necessary every day. A sponge bath can be effective between showers or baths.
- For someone who has Alzheimer's disease, getting dressed presents a series of challenges: choosing what to wear, getting some clothes off and other clothes on, and struggling with buttons and zippers. Minimizing the challenges may make a difference.
- Encourage the person to dress himself or herself to whatever degree possible. Plan to allow extra time so there is no pressure or rush.
- Allow the person to choose from a limited selection of outfits. If he or she has a favorite outfit, consider buying several identical sets.
- Arrange the clothes in the order they are to be put on to help the person move through the process.
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- Eating can be a challenge. Some people with Alzheimer's disease want to eat all the time, while others have to be encouraged to maintain a good diet.
- Aim for a quiet, calm, reassuring mealtime atmosphere by limiting noise and other distractions. Allow plenty of time.
- Give the person food choices, but limit the number of choices. Try to offer appealing foods that have familiar flavors, varied textures, and different colors.
- Choose dishes and eating tools that promote independence. If the person has trouble using utensils, use a bowl instead of a plate, or offer utensils with large or built-up handles. Use straws or cups with lids to make drinking easier. Try finger foods if utensils are not used.
- Encourage the person to drink plenty of fluids throughout the day to avoid dehydration.
- What to do all day? Finding activities that the person with Alzheimer's disease can do and is interested in can be
- a challenge. Building on current skills generally works better than trying to teach something new.
- Don't expect too much. Example: Did the person enjoy setting the table rather than was it set correctly.
- Help the person get started on an activity. Break the activity down into small steps and praise the person for each step he or she completes.
- Try to include the person with Alzheimer's disease in the entire activity process. For instance, at mealtimes, encourage the person to help prepare the food, set the table, pull out the chairs, or put away the dishes. This can help maintain functional skills, enhance feelings of personal control, and make good use of time.
- Incorporating exercise into the daily routine has benefits for both the person with Alzheimer's disease and the caregiver. Not only can it improve health, but it also can provide a meaningful activity for both of you to share.
- Think about what kind of physical activities you both enjoy, perhaps walking, swimming, tennis, dancing, or gardening.
- Be realistic in your expectations. Build slowly, perhaps just starting with a short walk around the yard, for example, before progressing to a walk around the block.
- See what kinds of exercise programs are available in your area. Senior centers may have group programs for people who enjoy exercising with others. Local malls often have walking clubs and provide a place to exercise when the weather is bad.
- As the disease progresses, many people with Alzheimer's disease begin to experience incontinence, or the inability to control their bladder and/or bowels. Incontinence can be upsetting to the person and difficult for the caregiver. Sometimes incontinence is due to physical illness, so be sure to discuss it with the person's doctor.
- Have a routine for taking the person to the bathroom and stick to it as closely as possible. For example, take the person to the bathroom every 3 hours or so during the day. Don't wait for the person to ask.
- Watch for signs that the person may have to go to the bathroom, such as restlessness or pulling at clothes. Respond quickly.
- Be understanding when accidents occur. Stay calm and reassure the person if he or she is upset. Try to keep track of when accidents happen to help plan ways to avoid them.
- If you are going to be out with the person, plan ahead. Know where restrooms are located, and have the person wear simple, easy-to-remove clothing. Take an extra set of clothing along in case of an accident.
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- For the exhausted caregiver, sleep can't come too soon. For many people with Alzheimer's disease, however, the approach of nighttime may be a difficult time. Many people with Alzheimer's disease become restless, agitated, and irritable around dinnertime, often referred to as "sundowning" syndrome. Getting the person to go to bed and stay there may require some advance planning.
- Encourage exercise during the day and limit daytime napping, but make sure that the person gets adequate rest during the day because fatigue can increase the likelihood of late afternoon restlessness.
- Try to schedule more physically demanding activities earlier in the day. For example, bathing could be earlier in the morning, or large family meals could be at midday.
- Try to keep bedtime at a similar time each evening.
Hallucinations and Delusions
- As the disease progresses, a person with Alzheimer's disease may experience hallucinations and/or delusions. Hallucinations are when the person sees, hears, smells, tastes, or feels something that is not there. Delusions are false beliefs from which the person cannot be reassured about.
- Sometimes hallucinations and delusions are signs of physical illness. Keep track of what the person is experiencing and discuss it with the doctor.
- Avoid arguing with the person about what he or she sees or hears. Try to respond to the feelings he or she is expressing, and provide reassurance and comfort.
- Try to distract the person to another topic or activity. Sometimes moving to another room or going outside for a walk may help.
- Make sure the person is safe and does not have access to anything he or she could use to harm anyone.
- Keeping the person safe is one of the most important aspects of caregiving. Some people with Alzheimer's disease have a tendency to wander away from their home or their caregiver. Knowing what to do to limit wandering can protect a person from getting lost.
- Make sure that the person carries some kind of identification or wears a medical bracelet. Consider enrolling the person in the Alzheimer's Association Safe Return program if the program is available in your area. If the person gets lost and is unable to communicate adequately, identification will alert others to the person's medical condition. Notify neighbors and local authorities in advance that the person has a tendency to wander.
- Keep a recent photograph or videotape of the person with Alzheimer's disease to assist police if the person becomes lost.
- Keep doors locked. Consider a keyed deadbolt or an additional lock up high or down low on the door. If the person can open a lock because it is familiar, a new latch or lock may help.
- Be sure to secure or put away anything that could cause danger, both inside and outside the house.
- Caregivers of people with Alzheimer's disease often have to look at their homes through new eyes to identify and correct safety risks. Creating a safe environment can prevent many stressful and dangerous situations. The ADEAR Center offers the booklet, Home Safety for People with Alzheimer's Disease, which lists many helpful tips. See "For More Information" to contact the ADEAR Center.
- Install secure locks on all outside windows and doors, especially if the person is prone to wandering. Remove the locks on bathroom doors to prevent the person from accidentally locking himself or herself in.
- Use childproof latches on kitchen cabinets and anyplace where cleaning supplies or other chemicals are kept.
- Label medications and keep them locked up. Also make sure knives, lighters and matches, and guns are secured and out of reach.
- Keep the house free from clutter. Remove scatter rugs and anything else that might contribute to a fall. Make sure lighting is good both inside and out.
- Be alert to and address kitchen-safety issues, such as the person forgetting to turn off the stove after cooking. Consider installing an automatic shut-off switch on the stove to prevent burns or fire.
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- Making the decision that a person with Alzheimer's disease is no longer safe to drive is difficult, and it needs to be communicated carefully and sensitively. Even though the person may be upset by the loss of independence, safety must be the priority.
- Look for clues that safe driving is no longer possible, including getting lost in familiar places, driving too fast or too slow, disregarding traffic signs, or getting angry or confused.
- Be sensitive to the person's feelings about losing the ability to drive, but be firm in your request that he or she no longer do so. Be consistent—don't allow the person to drive on "good days" but forbid it on "bad days."
- Ask the doctor to help.
Visiting the Doctor
- It is important that the person with Alzheimer's disease receive regular medical care. Advance planning can help the trip to the doctor's office go more smoothly.
- Try to schedule the appointment for the person's best time of day. Also, ask the office staff what time of day the office is least crowded.
- Let the office staff know in advance that this person is confused..
- Don't tell the person about the appointment until the day of the visit or even shortly before it is time to go. Be positive and matter-of-fact.
- Bring along something for the person to eat and drink and any activity that he or she may enjoy.
- Have a friend or another family member go with you on the trip, so that one of you can be with the person while the other speaks with the doctor.
Coping with Holidays
- Holidays are bittersweet for many Alzheimer's disease caregivers. The happy memories of the past contrast with the difficulties of the present, and extra demands on time and energy can seem overwhelming. Finding a balance between rest and activity can help.
- Keep or adapt family traditions that are important to you. Include the person with Alzheimer's disease as much as possible.
- Recognize that things will be different, and have realistic expectations about what you can do.
- Avoid crowds, changes in routine, and strange surroundings that may cause confusion or agitation.
- At larger gatherings such as weddings or family reunions, try to have a space available where the person can rest, be alone, or spend some time with a smaller number of people, if needed.
Visiting a Person with Alzheimer's Disease
- Visitors are important to people with Alzheimer's disease. They may not always remember who the visitors are, but the human connection has value. Here are some ideas to share with someone who is planning to visit a person with Alzheimer's disease.
- Plan the visit for the time of day when the person with Alzheimer's disease is at his or her best. Consider bringing along an activity, such as something familiar to read or photo albums to look at, but be prepared to skip it if necessary.
- Remind the person who you are if he or she doesn't seem to recognize you.
- If the person is confused, don't argue. Respond to the feelings you hear being communicated, and distract the person to a different topic if necessary.
- If the person is unkind, or responds angrily, remember not to take it personally. He or she is reacting out of confusion
Choosing a Nursing Home
- For many caregivers, there comes a point when they are no longer able to take care of their loved one at home. Choosing a residential care facility—a nursing home or an assisted living facility—is a big decision, and it can be hard to know where to start.
- It's helpful to gather information about services and options before the need actually arises. This gives you time to explore fully all the possibilities before making a decision.
- Make a list of questions you would like to ask the staff.
- Observe the way the facility runs and how residents are treated. You may want to drop by again unannounced to see if your impressions are the same.
- Find out what kinds of programs and services are offered for people with Alzheimer's disease and their families. Ask about staff training in dementia care, and check to see what the policy is about family participation in planning patient care.
- Moving is a big change for both the person with Alzheimer's disease and the caregiver. It is important to have support of family and friends during this difficult transition.
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For further information, visit the National Institute on Aging, Alzheimer's Disease Education & Referral Center's Caregiving-Home/Family section (www.nia.nih.gov/Alzheimers/Caregiving/HomeAndFamily/) or the Alzheimer's Association (www.alz.org).
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