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Alzheimer’s and Dementia in Seniors

Alzheimer’s and Dementia in Elderly

As people age, changes in the brain cause some decline in short-term memory and a slowing down in learning ability. This section deals with changes in the older person’s brain, which affect their cognitive powers including:

  • memory
  • thinking
  • reasoning
  • judgment and
  • behavior

By being knowledgeable about what is normal and what some of the more common neurological conditions, which inflict the elderly are, you will better understand the reasons for their thoughts and actions. You and caregivers will become familiar with confusion and dementia and recognize the impact these conditions have and they will understand that delirium, dementia and severe memory loss are not part of the normal aging process but are, instead, indicative of degenerative brain disorders, such as Alzheimer’s Disease. You will also learn that confusion can be attributed to other causes such as infections and fluctuations in glucose levels. This is important, as often people are too easily (and wrongly) categorized as being “senile”.

Nervous System Changes Due to Aging

The aging process causes a number of changes in the nervous system:

  • confusion
  • memory shortfalls
  • forgetfulness
  • dizziness
  • slower reflexes
  • loss of brain cells
  • decreased hearing and vision
  • decreased blood supply to brain
  • slower nerve conduction
  • slower response and reaction times and
  • reduced sensitivity to pain

Confusion

Confusion is a state of unstable awareness, which results in disrupted thoughts and affects decision making. Often orientation is affected in terms of person, place and time. Confusion is not a diagnosis in itself, but rather it is a symptom, which is the reason that assistance or intervention is sought in the first place.

Confusion can be divided into two categories:

  • Acute Confusion (Delirium)
  • Chronic Confusion (Dementia)

 

Acute Confusion (Delirium)

  • temporary;
  • has a fast onset; and,
  • may be recognizable by a combination of inappropriate behaviors.
CausesSymptomsTreatment
  • hospitalization
  • emotional & social disruptions
  • loss of hearing
  • loss of sight
  • diseases
  • infections
  • medication reactions
  • physical conditions such as:
    • nutrition
    • cardiovascular conditions
    • changes in urinary functions
    • changes is body temperature
  • disoriented regarding person, place or time
  • inaccurate perceptions
  • delusions
  • poor judgment
  • forgetfulness
  • difficulty communicating
  • angry
  • withdrawn
  • uncooperative
  • restless
  • hyperactive or lethargic
  • control or reverse the cause of the symptoms
  • make environment pleasant, comfortable & safe
  • stopping or changing medications
  • treat physical ailments which are contributing to confusion
  • provide glasses &/or hearing aid as required
  • advise of realities frequently

Chronic Confusion (Dementia)

Dementia is characterized as being:

  • long-term;
  • progressive; and,
  • possibly degenerative.

Dementia is a slow, progressive decline in mental function in which memory, thinking, judgment, and the ability to learn are impaired. Dementia is a much more serious decline in mental ability than confusion is. With time, it becomes worse. Seniors who are aging normally may become forgetful or misplace objects, but those with dementia, may forget entire events. Individuals with dementia have problems conducting regular tasks such as driving, cooking, and handling finances. Dementia progresses at different rates, depending on the cause. Generally it takes from two to ten years before death occurs, which is often attributed to an infection, such as pneumonia.

CausesSymptomsTreatment
  • Alzheimer’s Disease
  • Strokes
  • Parkinson’s Disease
  • Infections such as AIDS
  • Drug or alcohol abuse
  • Head injuries
  • Cardiac arrest
  • Huntington’s Disease
  • Multiple Sclerosis
  • Brain tumors
  • Syphilis
  • Conditions that worsen dementia are:
    • diabetes
    • emphysema
    • heart failure
  • forgetfulness
  • inability to recognize people places & objects perceptions
  • difficulty finding & using the right word
  • difficulty working with numbers
  • fast and severe range in emotions
  • changes in personality
  • worriers become more worried
  • failure to perform routine tasks
  • withdrawn
  • less control over behavior
  • unable to follow conversations
  • inability to speak
  • becoming bed ridden
  • difficulty swallowing food
  • No treatment can restore mental functions.
  • Sometimes treating a disorder that is worsening the dementia will slow the progression down.

How Caregivers Can Care for Confused Seniors

Encourage the elderly perdon to lead a healthy lifestyle which includes:

  • Do one thing at a time i.e. Have the senior complete one task before starting another.
  • Keep instructions simple and try to ensure senior understands what is wanted.
  • Tell the senior everything that will happen before it happens, regardless of his/her state of alertness.
  • Avoid startling the senior.
  • Pay attention to complaints of hunger, thirst or pain.
  • If a senior seems agitated, distract him/her by asking a question.

Alzheimer’s Disease

Alzheimer’s Disease is the commonest form of dementia. It is a progressive and relentless loss of mental function revolving around memory, language and thought.

CausesSymptomsTreatment
The cause is not known but theories are:
  • chemical deficiencies
  • genetic factors
  • body attacks its own immunity system
  • virus
  • defective blood vessels in the brain
  • problems remembering conversations
  • forgetting where objects have been placed
  • routine tasks, which require thought, become more difficult
  • difficulty responding to simple problems
  • becoming lost in familiar surroundings
  • difficulty finding the appropriate words
  • problems paying attention
  • less responsive

There is no cure but it can be managed by:

  • medications to:
    • delay the onset
    • slow the rate of progression
    • improve memory, language, attention span & orientation
  • healthy diet
  • regular exercise
  • intellectual stimulation
  • social interactions
  • stimulating environment
  • support groups

Stages of Alzheimer’s Disease

Alzheimer’s Disease has three stages. Signs and symptoms become more severe with each stage and eventually death occurs.

Stage 1

Individuals in Stage 1 can generally manage their daily activities themselves, but they may require some assistance with organization. Traits common to Stage 1 are:

  • loss of memory
  • problems finding the right words
  • problems exercising good judgment;
  • problems making good decisions;
  • becoming lost in familiar places;
  • problems carrying out multi-task activities;
  • feeling sad, depressed, & anxious;
  • avoiding social interactions;
  • problems remembering appointments, names or recent events; and.
  • misplacing items

Stage 2

Individuals in Stage 2 may have more problems taking care of themselves, but they can still be involved in their daily care and follow a routine.
Traits common to Stage 2 are:

  • some assistance needed with their activities of daily living
  • becoming restless, especially during the evening hours
  • loss of memory increases – they may not know family or friends
  • failure to recognize dangers and differentiate between hot and cold
  • becoming angry or easily upset
  • need to be reminded to eat
  • having trouble expressing self and understanding others
  • some bowel and bladder incontinence; and,
  • loss of impulse control (e.g. uses foul language, poor table manners, sexually aggressive)

 

Stage 3

Individuals in Stage 3 usually require complete assistance with daily care.
Traits common to Stage 3 are:

  • unable to communicate – may grunt or scream
  • does not recognize self or family members
  • touching or patting things continuously
  • sleeping more often
  • disoriented to person, place and time
  • cannot sit or walk – becomes confined to bed
  • total bowel and urinary incontinence
  • unable to swallow
  • may have seizures
  • coma; and,
  • death.

 

Behavioral Patterns Found in Alzheimer’s Disease

 

BehaviorDescriptionTreatment
Recurring BehaviorsRecurring behavior is doing the same act over and over (e.g. folding a towel).
  • allow the individual to continue the repetitive behavior
  • hormonal therapy radiation surgery pain management combination
Abnormal Sexual BehaviorSexual behavior may involve the wrong person, at the wrong time, in the wrong place. Or, it may involve an inappropriate action (e.g. exposing themselves or masturbating in front of others).
  • encourage affection with individual’s sexual partner
  • when masturbating, lead individual to a private area
ScreamingScreaming occurs in an attempt to communicate. It can involve screaming a name, a word or simply making yelling sounds.
  • provide a calm & quiet environment
  • determine if there are vision or hearing problems
AggressionAggression & combativeness often occur because of restlessness or agitation (e.g. hitting, punching, biting).
  • do not argue with the individual
  • remain calm & collected
  • protect yourself
AgitationAn agitated individual may walk back & forth, hit or yell.
  • determine why the individual is agitated (e.g. Hungry? In pain? Insufficient sleep?)
  • maintain a calm & quiet environment
Disastrous ResponsesDisastrous responses are extreme responses, with the individual reacting as if a major disaster has occurred.
  • avoid having too many stimuli present at one time (e.g. asking questions when the TV is on)
  • maintain a calm & quiet environment
DelusionsDelusions area false beliefs, even when facts say differently. (e.g. An individual may think he/she is going to be murdered.)
  • reassure individuals that you will protect them & they are safe
  • use touch to cam them
  • distract the individual with some type of activity
HallucinationsA hallucination is hearing, seeing, smelling or feeling things that are not there. (e.g. Individuals may think snakes are in bed with them.)
  • reassure individuals that you will protect them from harm
  • Don’t argue with them, as they do not understand what you are saying
SundowningSundowning is the appearance of confusion, and other severely disruptive behavior coupled with inability to remain asleep. It occurs in the late afternoon & evening hours.
  • make sure their basic needs are looked after (e.g. hunger, toileting, warmth)
  • provide a calm setting at the end of the day
  • keep a light on, as many individuals with Alzheimer’s Disease may be afraid of the dark.
WanderingSince Alzheimer’s Disease causes the individual to be disoriented in respect to person, place or time, they may become lost or use poor judgment, which compromises their safety/
  • ensure individuals are not able to wander off by securing safety locks at tops or bottoms of doors & windows
  • keep their environment free from hazards

Caring for Seniors With Alzheimer’s Disease and Other Dementias

  • create a supportive environment by:
    • providing extra security measures such as posting notes to serve as reminders (e.g. turn stove off);
    • keeping the environment familiar e.g. don’t move furniture around;
    • establish and maintain a regular daily routine; and,
    • keeping the client oriented. (e.g clock, calendar, radio, night light);
  • evaluate home for safety and take corrective actions by:
    • removing scatter rugs;
    • storing household cleaners and harmful substances in a safe place;
    • removing sharp & breakable objects from the environment; and,
    • using plastic eating and drinking utensils;
  • provide structure and routine;
  • schedule low stress activities;
  • speak slowly and clearly to facilitate their understanding of what is being said;
  • provide simple explanations on everything said;
  • research community resources which will benefit the client;
  • encourage them to share their memories, as long as they can recall them;
  • plan physical activities, as they will offset disruptive behavior;
  • encourage mental activities (e.g. reading, crafts, keeping abreast with

Summary

As people grow older, changes in the brain cause some decline in short-term memory and a slowing down in learning ability. There is a general decrease in cognitive powers, which affect the individual’s memory, thinking, reasoning, judgment and behaviour. These changes, which occur throughout the nervous system, often cause an individual to become confused.

There are two main types of confusion — acute confusion, also known as “delirium”, and chronic confusion, also known as “dementia”. They each have distinct characteristics which affect cognitive abilities and behavorial patterns.

The most common form of dementia is “Alzheimer’s Disease”, for which there is no cure. It is a progressive disease and has three main stages. While it can’t be cured, it can be managed.

There are various ways a Home Care Assistant can support seniors with Alzheimer’s Disease or other dementias. This would include such measures as maintaining a safe and calm environment, making the senior feel secure and providing ongoing and increasing support with their activities of daily living

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Alzheimer in the movies

Still Alice

Alice Howland (Julianne Moore), happily married with three grown children, is a renowned linguistics professor who starts to forget words. When she receives a diagnosis of Early-Onset Alzheimer's Disease, Alice and her family find their bonds thoroughly tested. Her struggle to stay connected to who she once was is frightening, heartbreaking, and inspiring.

 

Video Link

 

The Notebook

released in 2004, stars James Garner as a man whose wife, played by Gena Rowlands, is in a nursing home with Alzheimer's disease. Garner's character attempts to rekindle his wife's memories of their long history by reading to her from his notebook. With Ryan Gosling and Rachel McAdams playing the couple in their younger years.

 

Video Link

 

The Savages

Laura Linney and Philip Seymour Hoffman play siblings in this tragic comedy about adult children caring for a parent with Dementia.

 

Video Link

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